episode 82

In this episode I talk with Jerry Ross about his experiences with post-bariatric surgery reactive hypoglycemia. Jerry had Roux-en-Y gastric bypass in 2002 when he was in his early thirties. Although the fact that Jerry had RYGB is central to this story, gastric bypass alone is not the reason Jerry and I recorded this conversation. We talked because Jerry wanted to share his experiences regarding Late Dumping syndrome, aka Reactive Hypoglycemia.


There is a lot of information in this episode so I wanted to give you a chronology of what we talked about and when, just in case you wanted to re-listen to a section and wanted to be able to find it faster than starting over. Happy listening.

Chronology of Topics Discussed
0:22 Reeger Thanks for Patreon supporters.
2:30 Jerry’s history of obesity and decision to have bariatric surgery.
6:35 Thoughts on food addiction.
8:00 Early days after bariatric surgery. The honeymoon period.
9:30 Jerry and exercise right after surgery and his advice to you.
12:30 Jerry’s early weight loss progress, weight regain, and feelings of frustration.
13:30 The tricky thing about hunger- physical hunger vs head hunger.
15:30 Jerry’s journey of testing and evaluation in the first 5-7 years after surgery.
16:50 The surgeons advice to Jerry and Jerry’s thoughts on “getting his head on straight.”
18:00 Jerry’s pre-op and post-op education.
19:20 The beginning of his symptoms of reactive hypoglycemia with a description of what his symptoms were, trying to figure out what was going on, and how he began to manage his symptoms.
27:47 Reeger goes over blood sugar values and symptoms of low blood sugar.
29:12 The Oral Glucose Tolerance Test (OGTT).
32:00 Jerry’s “wake-up call” that his bariatric surgery was not as benign as he once thought and that he could not live like a “normal” person and eat whatever he wanted to eat.
32:30: Reeger describes normal digestion of carbohydrates, blood glucose, gut hormones, insulin, GLP-1.
35:40 Reeger’s disclaimer of gut-endocrine over-simplification and violin metaphor.
36:30 Jerry and Hyperinsulinemic Hypoglycemia and why we call it “Reactive Hypoglycemia.”
38:22 Why might Reactive Hypoglycemia occur after RYGB, the role of GLP-1, and why it tends to get worse over time.
41:20 Nesidioblastosis: What it is and why it might happen after RYGB.
43:00 Acknowledging the frustration of limited understanding why reactive hypoglycemia might occur.
44:16 Incidents of Reactive Hypoglycemia from other bariatric surgeries.
44:50 How to Diagnosis Reactive Hypoglycemia: Blood glucose levels, Whipples triad, Mixed Meal Tolerance Test.
46:20 Excellent paper by Shantavasinkul titled “Post-gastric bypass hypoglycemia: a review”.
47:00 Jerry’s further evaluation and treatment: Food diary, possibility of surgical revisio (Rose procedure, reverse RYGB, partial pancreatectomy).
50:00 Behaviors Jerry changed to help manage his symptoms.
51:00 The foods Jerry now avoids.
53:30 The tricky thing about Jerry’s hunger.
57:00 Struggles with constipation and further weight loss.
58:00 With more weight loss his Reactive Hypoglycemia got even worse and his theory as to why.
1:01 Jerry’s use of a continuous glucose monitor (CGM).
1:04 What Jerry has learned from wearing his CGM.
1:08 Hypoglycemia Unawareness Syndrome.
1:09 A deep dive into treatment: One reference I looked at said that meals and snacks should not exceed 30 grams of carbs, excluding fiber, and some meals can have no carbs at all. Often meals sizes need to be reduced to smaller sizes, eaten more often, 5-6 times per day.
1:10 Understanding Glycemic Index and Glycemic Load.
1:12 Medication Used to treat Reactive Hypoglycemia: Acarbose, Calcium Channel Blockers, Diazoxide, Somatostatin Analogues.
1:14 Surgical Options: Partial pancreatectomy, Reversal of the RYGB, or placement of a gastric feedling tube.
1:15 An additional thought on the work-up of Reactive Hypoglycemia: Insulinoma.
1:16 The medication that did work for Jerry: GLP-1 receptor agonist.
1:18 Reeger’s pondering why a GLP-1 receptor agonist might given and Jerry helping explain how the medication has helped him.
1:22 Reeger goes back to the violin metaphor.
1:23 The GLP-1 agonist medications available: Exenatide (Byetta or Bydureon), Albiglutide (Tanzeum), Dula-glutide (Trulicity), Lixisenatide (Lyxumia), and Liraglutide (Victoza, and as an obesity medication it is sold under the name Saxenda). It should be noted, that using any of these GLP-1 agonist medications to treat Post-bariatric surgery reactive hypoglycemia would be considered an off-label use, so prescriber beware.
1:24 Jerry’s new normal of health.
1:25 Does Jerry regret having had RYGB?
1:26 Reeger talks about caring for patients who have presented in the office with symptoms of reactive hypoglycemia.
1:29 Reeger’s concluding thoughts.
1:32 Bonus Content.

Connecting with Jerry
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Connecting with Reeger
WLSP Facebook

In Kindness,



081 Moving Forward with Laura Van Tuyl

by reeger on March 19, 2017


Follow your dreams

In this episode I have a conversation with Laura Van Tuyl. April, 2017 is Laura’s 14th Barisurgaversary for having Roux-en-Y Gastric Bypass. We talk about many aspects of her journey but some of the highlights include her thoughts of how being a very picky eater as a child contributed in part to her eating habits as an adult who developed obesity. She offers advice for anyone who is currently parenting or grand-parenting a picky eater. We explore her adult years leading up to her decision to have bariatric surgery. Then we talk about how bariatric surgery affected her marriage and how she and her husband worked out a plan that empowered him to help her without fostering a power-struggle between the two of them. About ¾ of way through our talk we switch gears and talk about the Weight Loss Surgery Foundation of America which is a non-profit organization that Laura is very involved with as a volunteer and we discuss the WLSFAs annual convention which will be in Portland, Oregon this year on May 19th-21, 2017. I’ll be there and I hope to see you as well.

Before I cut to the interview I want to give out shout-out to my new supporting patrons of the podcast. These are listeners who in the past month have taken their love and appreciation of the podcast to the next level by offering financial support of the podcast at Patreon. A big shout-out to Christina K, Ethel N, Alison B, Mary Ann, and Marie M!

If you feel this podcast gives you value and you want to support it for as little as $1.00 per month, head on over to and sign on up. If you can’t write down that web address right now then you can find a link at my website Weight Loss Surgery Podcast.

Discussed in this episode

  • Early years as a picky eater
  • Her family dynamics that did and did not contribute to her developing obesity
  • Her advice to parents and grand parents of picky eaters
  • Her role as a grandmother mentoring her grand children
  • Weight gain during two pregnancies that was never lost
  • Early adult years of working swing shift while her husband was in college
  • Yo-yo dieting that only resulted in more weight gain
  • The 10 years she and her husband lived in Russia and thoughts on that experience as it relates to her weight and dieting attempts
  • Returning to USA led to more weight gain
  • A new diagnosis of severe asthma
  • A decision to have Roux-en-Y Gastric bypass
  • Why never being physically hungry after bariatric surgery is good and not so good
  • Her recognition of her food addiction struggles
  • How bariatric surgery created opportunities for growth in her marriage
  • “Code” words between Laura and her husband which help him help her
  • The critical importance of support for the supporter
  • If you’re not working on something moving forward, you’re going backwards
  • Weight Loss Surgery Foundation of America (WLSFA) raises funds for people to have bariatric surgery or reconstructive surgery
  • Who might qualify and where to apply for a grant with the WLSFA
  • WLSFA annual convention on May 19th-21st, 2017 in Portland, Oregon
  • Reeger’s concluding thoughts on how to move forward

Connecting with Laura

Connecting with Reeger
WLSP Facebook Page

I believe in you,




epi. 080

In this episode I have a conversation with Dr Janine Kyrillos. Dr Kyrillos is Clinical Assistant Professor of Medicine at Jefferson Medical College in Philadelphia, Pennsylvania and she is Director of Jefferson Comprehensive Weight Management Program at Bala Cynwyd, Pennsylvania. She is also someone who herself is affected by obesity and has undergone Roux-en-Y Gastric Bypass in 2005. This conversation ranges from her personal story of obesity and bariatric surgery to her professional role as an obesity medicine specialist who helps people along their journey of treatment for their obesity.

Discussed in this Episode

  • Dr Kyrillos’ early and personal history with obesity, weight loss, weight regain
  • Early adulthood- not letting her weight define her, living her life, traveling, learning new things
  • Feelings of conflict on her role as a medical doctor counseling patients on obesity when she herself was obese
  • How the result of the Swedish Obesity Study helped her understand more of the complexity of obesity and the potential role bariatric surgery could play in its treatment
  • The limited education that medical students get on obesity and nutrition and how to help people
  • Deciding to have bariatric surgery and moving forward
  • Before surgery “The last supper” phenomena and “saying goodbye” to food
  • How well can we pre-surgically predict a persons post-surgical success?
  • Her early post-operative expectations and experiences
  • How, if, when to tell her patients about her own bariatric surgery
  • Struggles with food
  • The New York Times article How the Sugar Industry Shifted Blame to Fat
  • Letting go of expectation of a cure allowed her to be open to the process of self-discovery
  • Becoming specialty trained in Obesity Medicine
  • When should bariatric surgery be considered?
  • Medical weight management
  • A hard and fast rule for Dr Kyrillos is no alcohol
  • Dumping syndrome
  • Considerations regarding pregnancy and bariatric surgery
  • Reeger’s concluding thoughts regarding this episode
  • Kids jokes. No really, I’m not kidding. Don’t believe me? Listen to the very, very end

Connecting with Dr Janine Kyrillos

Connecting with Reeger

  • email:
  • WLSP Facebook
  • Support the podcast at Patreon


079 Bariatric Surgery Seminar as a Podcast

January 9, 2017

Happy New Year everyone! In this episode I bring you a podcast version of the bariatric surgery seminar I give twice monthly at Southern Oregon Bariatric Center. This version is more generic to bariatric surgery in general because my intent is not to tell you specifics about SOBC, but rather introduce you to important concepts […]

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078 Gathering Knowledge with Amy Swayzee

December 11, 2016

In this episode I talk with Amy Swayzee who had gastric sleeve in May of 2015. We talk about her life before bariatric surgery, how she came to the realization that bariatric surgery was not cheating or the easy way, and that if she was finally going to bring her weight under control perhaps she […]

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076 What to Eat with Sarah Muntel, RD

October 16, 2016

In this episode I bring you my conversation with registered dietician, Sarah Muntel. Sarah has been a registered dietician in bariatric surgery for over 17 years. She brings a wealth of information and education to you in this episode. Covered in this episode: Sarah’s role as a registered dietician and program coordinator Pre-surgery nutrition plans […]

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075 Bariatric Surgery Rules? A talk with Dr Walter Medlin

September 11, 2016

In this episode I have a conversation with Dr. Walter Medlin about bariatric surgery rules. You may remember Dr. Medlin from episode 53. He is a bariatric surgeon at the Bariatric Medicine Institute in Salt Lake City, Utah. He is also a bariatric surgery patient having had sleeve gastrectomy. During this conversation Dr Medlin and I […]

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074 (Unedited) Set Point, Biology, Environment & Obesity: An Interview with Dr Randy Seeley

August 8, 2016

What you are about to hear is the unedited version of my most popular episode to date: Episode 34, titled “Set Point, Biology, Environment & Obesity: An Interview with Dr Randy Seeley.” I first published the edited version of this conversation on August 17th 2014. Over the past two years that episode has had the […]

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073 How to Choose a Bariatric Surgery Program with John Bukenas

July 12, 2016

In this episode I welcome back John Bukenas. We explore how to choose a bariatric surgery program. If you are new to the podcast, John and I have talked about his obesity and the possibility of bariatric surgery in episodes 26 and 45. Topics discussed in the episode John’s struggles and declining health First Step: […]

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072 “Hey Reeger..,” A Letter from a Listener

June 17, 2016

Welcome to the weight loss surgery podcast where we talk about obesity and bariatric surgery one episode at a time. I’m your host, family nurse practitioner, Reeger Cortell. This episode is brought to you by you, my listeners. I am so touched by the love you show me, whether that is iTunes rates, sharing the […]

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071 Jeff Newell: On Gaining a New Life

May 31, 2016

In this episode Jeff Newell returns to the podcast to catch us up on his life since having Roux-en-Y Gastric Bypass on 12/1/2014. Jeff has been on the podcast before on episodes 055, 049, 043, and 042. He is now 18 month out from his surgery and 300 pounds down from his pre-surgery weight of […]

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070 Reeger Cortell FNP: An Interview by Rob Portinga

May 9, 2016

Presenting Your Host, Reeger Cortell, FNP Over the last 18 months or so, I, Rob Portinga, have had the pleasure of going from being a guest, to being a contributing host on the Weight Loss Surgery Podcast (WLSP). It was started by Reeger Cortel, FNP nearly three years ago now. One of the driving themes, and […]

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069 Talking about the Fear Factors of Bariatric Surgery with Dr Raul Rosenthal

April 17, 2016

My guest today is Dr Raul Rosenthal. Dr Rosenthal works at the Cleveland Clinic Florida in Weston Florida, where he is a bariatric surgeon, chief of surgery, chief of staff, and the director of the Cleveland Clinic Florida Metabolic and Bariatric Institute. In addition to all those good works, he is also the current president of […]

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068 Understanding Lipedema with Sarah Bramblette and Karen Herbst, MD, PhD

March 15, 2016

In this episode I bring you my conversation with Sarah Bramblette. As you are about to hear, Sarah is many things but above all she is an inspirational mix of hardwork, intelligence, grit, compassion, and determination. She is everything you would want in a loved one, a friend, a daughter, and an obesity advocate. Sarah’s […]

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067 The Bariatric Surgeon Episode

February 20, 2016

In this episode I bring you my interviews with six different bariatric surgeons. I conducted these interviews while I was at ObesityWeek in Los Angeles, CA in November 2015. I asked each surgeon one or two of the following questions: How do you help people decide which surgery to choose? And, If you could wave […]

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066 Connie Stapleton, PhD- Healing Your Relationship with Yourself

January 25, 2016

In this episode I bring you my conversation with clinical psychologist, Connie Stapleton, PhD. Dr Stapleton has been working in the field of bariatric surgery for 11 years and as you would image, and are about to hear, she has a wealth of information and insight and information to share with you. Discussed in this […]

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065 After the After with Nikki Massie

January 2, 2016

In this episode, I bring you my conversation with Nikki Massie. Nikki is many things within the bariatric surgery community including a bariatric surgery patient who had Roux-enY Gastric Bypass in 2008, the creator of the ever popular website Bariatric Foodie where she encourages you to “play with your food,” a prolific blogger, a storyteller, a […]

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064 Scott Monte, PharmD on Medications Just Before and Just After Bariatric Surgery

December 6, 2015

  In this episode I bring you my conversation with pharmacist, Scott Monte, PharmD. I met Scott at the 2015 Obesity Week conference in Los Angeles. Since 2009 Scott has worked as a pharmacist with the bariatric surgery program known Synergy Bariatrics in Buffalo, NY. After talking with him at the conference I knew I […]

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063 Pandora Williams on Feelings and Fitness

November 15, 2015

  After a lifetime of struggling with obesity, Pandora Williams underwent Roux-en-Y Gastric Bypass on October 19th, 2010. Now, five years later and through a lot of hard work and dedication, she is a fitness and wellness coach, blogger, avid runner, and motivational speaker. In this episode with interviewer Rob Portinga, Pandora tells her story […]

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062 “I Have a Disease; It’s Called Obesity” Video Contest Winner!

November 1, 2015

  This episode is a quick update telling you about a video I produced called “I Have a Disease; It’s Called Obesity.” The video won the American Society for Metabolic and Bariatric Surgery “It Starts Now” video contest! In this episode I tell you a little bit about how I came to write the script, […]

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