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I ended up in the emergency room today after my lightheadedness and vision loss (vision going black) rapidly progressed after the past 3 weeks. It's a little fuzzy when I sit, but when I stand, I get very, very dizzy and my vision goes dark and I get some confusion. After a ton of tests (labs, ekg, chest xray, urine, orthostatic BP tilt test) ,and a consult with my bariatric surgeon, I was told I had orthostatic hypotension. The surgeon's office said that some people develop this after rapid weight loss and I can try adding salt to my food to raise my BP.

Does this get better? Has anyone experienced this? No one told me this was a possible effect of the surgery. I've already had an ulcer, hernia, and gallbladder removal and now this. It's pretty scary because I have to hold onto the wall and stuff sometimes when I walk, and I am afraid I may get dizzy while driving. I just had some heavily salted mashed cauliflower but still feel off.

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I would think it may get better when your weight loss stabilizes. Maybe try adding a sugar free Gatorade daily.

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I would think it may get better when your weight loss stabilizes. Maybe try adding a sugar free Gatorade daily.
I drink one daily. My electrolytes are fine. Even my sodium was in the normal range, although on the low end.

I am scared this is permanent. I had NO health problems before surgery and now I've had so many. I think I officially regret this choice. I start with my trainer next week and I am nervous I will be very dizzy doing intense exercise. I also haven't lost any weight in 7 weeks now, despite the high ketone levels and the surgeon can't figure out why. I hate this.

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Unfortunately some people do have issues have surgery, it is why they make us sign the informed consent form.

Hopefully yours resolve with time so you do not regret your decision, but it seems too early to tell.

Maybe some of these problems will resolve and then you’ll feel better.

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One of the possible side effects of rapid weight loss after undergoing weight loss surgery is orthostatic hypotension or orthostatic intolerance. These terms describe a significant drop in blood pressure upon standing from a seated or reclined position. Drip in blood pressure causes a decrease in blood flow to the brain. There are several studies discussing this after RNY gastric bypass and sleeve gastrectomy. However, this can also be an issue post Duodenal Switch. The process is still not completely understood but can be due to several factors. Rapid weight loss, sympathetic nervous system dysfunction, dehydration, electrolyte imbalance, malnutrition, thyroid issues, cardiac issues, post prandial hypotension (blood pressure lowering after meals due to blood flow shifting to the gut) or medications are all suspected as possible cause for orthostatic hypotension.

Source: https://www.dssurgery.com/orthostatic-hypotensionintolerance/

Prior to weight loss surgery I had high blood pressure and I was taking 2 types of prescription meds for that condition. A few weeks after surgery, this condition went into remission and I stopped the medication. If you are in a similar situation, perhaps a readjustment or elimination of your prescription may be in order.

Also meeting your daily Fluid requirement is very important and if your body gets dehydrated, it can cause this problem.

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Yep, I had this. Adding salt to my food helped.

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One of the possible side effects of rapid weight loss after undergoing weight loss surgery is orthostatic hypotension or orthostatic intolerance. These terms describe a significant drop in blood pressure upon standing from a seated or reclined position. Drip in blood pressure causes a decrease in blood flow to the brain. There are several studies discussing this after RNY gastric bypass and sleeve gastrectomy. However, this can also be an issue post Duodenal Switch. The process is still not completely understood but can be due to several factors. Rapid weight loss, sympathetic nervous system dysfunction, dehydration, electrolyte imbalance, malnutrition, thyroid issues, cardiac issues, post prandial hypotension (blood pressure lowering after meals due to blood flow shifting to the gut) or medications are all suspected as possible cause for orthostatic hypotension.
Source: https://www.dssurgery.com/orthostatic-hypotensionintolerance/
Prior to weight loss surgery I had high blood pressure and I was taking 2 types of prescription meds for that condition. A few weeks after surgery, this condition went into remission and I stopped the medication. If you are in a similar situation, perhaps a readjustment or elimination of your prescription may be in order.
Also meeting your daily Fluid requirement is very important and if your body gets dehydrated, it can cause this problem.
I did not have hypertension and was on no medications for any comorbidities. I've always had great BP. I feel like I drink a ton during the day now. My electrolytes were normal, which is weird. I'm going to add salt to food now and see what happens... I REALLY hope this goes away because I just started yoga again, which I've been waiting to do for so long, and I feel very dizzy.

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Unfortunately some people do have issues have surgery, it is why they make us sign the informed consent form.
Hopefully yours resolve with time so you do not regret your decision, but it seems too early to tell.
Maybe some of these problems will resolve and then you’ll feel better.
I am trying to stay positive... I just feel very beat down over the last 4 months for little "reward". I feel much less healthy than I did before. Sure, I'm a pants size down but whatever. I've missed over a month from work due to complications, and as soon as one resolves something new happens. It's just so discouraging. You never hear about the bad things that happen to people, only the positive things.

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This is a thing for me at the moment too. I measured my BP (sitting) and it was 108/61. Pre-surgery my readings were in between 120-130/80-90.

I just think my body needs to get used to being at a lower pressure, but in the meantime imma get up from chairs a little more slowly.

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The orthostatic hypotension is not unusual with rapid weight loss, and is one of several ramifications of your body still trying to function at your old weight when there is substantially less of you at hand - we often feel cold for the same reason, that the body is still trying to cool what is no longer there. These things do improve over time, though it may be a year or two. In the meantime, as the docs and others suggest, more salt, lots of fluids (non-alcoholic), and also exercise is also a common prescription to "keep things pumping"

On the exercise front - this should improve things, but let your trainer know that you have this problem so they can watch for it. Also, another side effect of the rapid loss is that your heartrate will likely be lower, at rest and in activity, so if the trainer is pushing to achieve some specific heartrate to indicate some level of exertion, (often it is 80+% of a theoretical maximum rate) their measurement scale may be skewed and they may push you harder than they should. When I was 2-3 months out, I noticed that exercise (brisk walking short of a jog) that used to get my heart into that 80% zone (140-150 for me at the time) would barely get me over 100; even today, years later, my resting pulse is low, often 50 or below, and doctors/nurses unfamiliar with me will question it (yes, it's normal) though my BP is normal to a touch high.

So, the exercise should be OK, but let them know and don't let them push you too hard - your cardiac system may have excess capacity, but you may be evertaxed elsewhere.

Your ketone levels have little to do with whether or not you are losing weight. They are in indication that you are burning fat. but that can be ingested fat as well as stored fat. If you want to burn your stored fat, you need a good caloric deficit, and it matters little what style of diet is used to accomplish that - low fat, low carb, Keto, paleo, Atkins, whole 30 or whatever it may be. I used a relatively high carbohydrate diet (by Atkins/keto standards - 100ish g/day) and lost quite rapidly - because of the fairly high caloric deficit; ketones were there in the blood tests because I was burning my fat stores, but those readings weren't a goal.

The high fat/low carb type diets a la keto and paleo are popular these days, but the high calorie levels that often accompany them can sometimes make weightloss difficult. Clinically, high fat/low carbohydrate diets are often prescribed to avoid or minimize weight loss after a non-WLS gastrectomy, so if you are trying to use such a diet for weight loss, you have to keep a close eye on calorie levels.

Being four months out, you should still be fairly restricted in you eating volume so that you should still be losing at a reasonable pace, but if you are ingesting too many calories by "eating around" your wLS - drinking calories or very high calorie foods - then you can see low or no loss at this point.

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The orthostatic hypotension is not unusual with rapid weight loss,... .


Such an informative and helpful post!

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I have had issues with this myself. I had pretty low blood pressure even before surgery, but it is really low now. Adding a bit of salt has helped, but I just have to be aware of when I stand up. Sometimes if I feel the dizziness come on, I will bend over for a second and that seems to resolve it. I have had it so badly a few times that all I saw was black and my legs began to give out. That hasn’t happened in a while, but it was still scary.

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Had this after Baby#2, went to answer front door because my pastor had come for a visit, nearly swooned into his arms.

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This is a thing for me at the moment too. I measured my BP (sitting) and it was 108/61. Pre-surgery my readings were in between 120-130/80-90.

I just think my body needs to get used to being at a lower pressure, but in the meantime imma get up from chairs a little more slowly.

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Yeah my normal BP has always been in the low 100s over the low 70s. Now it's in the 80s over the 40s. My braaaiiinn.

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