[39F] Experiencing postprandial headaches and fatigue post-gastric sleeve surgery

Patient Description

A 39-year-old female presents with symptoms of fatigue, confusion, irritability, muscle pain, severe throbbing headaches, and upper abdominal pain near the sternum occurring approximately 20 minutes after eating. The headaches are described as a pulling sensation from the back of the neck to the eyes, rated 9 out of 10 in severity, and have gradually worsened over time. The patient reports feeling cold constantly and having dark circles under the eyes. Fatigue and headaches are exacerbated by eating and stress, significantly impacting daily life. The patient underwent gastric sleeve surgery 10 years ago and has since been unable to consume more than a few bites of food at a time without discomfort. Difficulty swallowing is noted, particularly with meat. The patient experiences dizziness and lightheadedness after meals, as well as severe irritability and disorientation. Bowel movements occur approximately once a week and are difficult, with recent weight loss reported. The patient is currently taking Adderall 30mg twice daily and Ibuprofen 800mg twice a day, with no other medications or supplements. No recent blood tests for nutritional deficiencies have been conducted, and the patient has not been evaluated for dumping syndrome or reactive hypoglycemia since the surgery. No known allergies or pre-existing chronic illnesses are reported.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for what you might be experiencing:

  1. Dumping Syndrome: Given your history of gastric sleeve surgery, dumping syndrome is a possibility. This condition occurs when food moves too quickly from your stomach to your small intestine, leading to symptoms like fatigue, confusion, irritability, abdominal pain, and dizziness after eating. It can also cause changes in blood sugar levels, which might explain your symptoms of confusion and irritability.

  2. Reactive Hypoglycemia: This condition can occur after eating, especially if you consume foods high in carbohydrates. It involves a drop in blood sugar levels, leading to symptoms such as fatigue, confusion, irritability, and dizziness. This could be related to your gastric sleeve surgery, as changes in digestion can affect blood sugar regulation.

  3. Nutritional Deficiencies: After gastric sleeve surgery, it's common to experience deficiencies in vitamins and minerals like vitamin B12, iron, and calcium. These deficiencies can lead to fatigue, headaches, and other symptoms. Your difficulty swallowing meat and infrequent bowel movements may also contribute to these deficiencies.

  4. Gastroesophageal Reflux Disease (GERD): The severe stomach pain near your sternum after eating could be related to GERD, a condition where stomach acid flows back into the esophagus, causing discomfort and pain.

What you can do

Dumping Syndrome and Reactive Hypoglycemia:

  • Consider eating smaller, more frequent meals throughout the day to help manage symptoms.
  • Focus on a balanced diet with adequate protein and fiber, and limit high-sugar and high-carbohydrate foods.
  • Keep a food diary using MDandMe to track what you eat and how it affects your symptoms. This can help identify trigger foods and patterns.

Nutritional Deficiencies:

  • Consult with a healthcare provider about getting blood tests to check for vitamin and mineral deficiencies.
  • Consider taking vitamin and mineral supplements as recommended by your healthcare provider to address any deficiencies.

Gastroesophageal Reflux Disease (GERD):

  • Avoid foods and drinks that can trigger reflux, such as spicy foods, caffeine, and alcohol.
  • Try eating smaller meals and avoid lying down immediately after eating.
  • Over-the-counter antacids may provide temporary relief, but consult with a healthcare provider for a long-term management plan.

What you should look out for

  • If you experience severe abdominal pain, persistent vomiting, or signs of dehydration, seek medical attention promptly.
  • Monitor for any new or worsening symptoms, such as significant weight loss, persistent confusion, or changes in bowel habits.
  • Keep track of your symptoms using MDandMe to provide detailed information to your healthcare provider, which can aid in diagnosis and treatment planning.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and personalized treatment plan.

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2 mo ago

People Also Ask


What is dumping syndrome and how is it related to gastric sleeve surgery?

Dumping syndrome is a condition that can occur after gastric sleeve surgery, where food moves too quickly from the stomach to the small intestine. This can lead to symptoms like fatigue, confusion, irritability, abdominal pain, and dizziness after eating.


How can reactive hypoglycemia affect someone after eating?

Reactive hypoglycemia is a condition where blood sugar levels drop after eating, especially if the meal is high in carbohydrates. This can cause symptoms such as fatigue, confusion, irritability, and dizziness, and may be more common after gastric sleeve surgery due to changes in digestion.


What are common nutritional deficiencies after gastric sleeve surgery?

Common nutritional deficiencies after gastric sleeve surgery include vitamin B12, iron, and calcium. These deficiencies can lead to symptoms like fatigue, headaches, and muscle pain, and may be exacerbated by difficulty swallowing certain foods.


What lifestyle changes can help manage symptoms of GERD?

To manage GERD symptoms, it is recommended to avoid trigger foods and drinks like spicy foods, caffeine, and alcohol, eat smaller meals, and avoid lying down immediately after eating. Over-the-counter antacids may provide temporary relief, but a healthcare provider should be consulted for a long-term management plan.


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