{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:08:49Z","timestamp":1792098529883,"version":"4.4.0"},"reference-count":28,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2018,5,25]],"date-time":"2018-05-25T00:00:00Z","timestamp":1527206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Post-bariatric hypoglycemia (PBH) is an increasingly recognized long-term complication of bariatric surgery. The nutritional treatment of PBH includes a high-fiber diet and the restriction of soluble and high-glycemic index carbohydrates; however, these measures are not always enough to prevent hypoglycemia. We evaluated the efficacy of uncooked cornstarch, a low-glycemic index carbohydrate characterized by slow intestinal degradation and absorption, in addition to a high-fiber diet, for the treatment of PBH. We report the cases of two young women suffering from severe postprandial and fasting hypoglycemia following Roux-en-Y gastric bypass (RYGB). The patients underwent Continuous Glucose Monitoring (CGM) before and 12\u201316 weeks after the administration of uncooked cornstarch (respectively 1.25 g\/kg b.w. and 1.8 g\/kg b.w.) in addition to a high-fiber diet. In both patients, CGM showed more stable glucose levels throughout monitoring, a remarkable reduction of the time spent in hypoglycemia (&lt;55 mg\/dL) both during the day (\u221211% for both patients) and the night (\u221222% and \u221232%), and the improvement of all glycemic variability indexes. Our report, within the limit of only two cases, suggests that the implementation of a dietary intervention through the addition of uncooked cornstarch reduces daily glycemic fluctuations and hypoglycemic episodes in patients with PBH.<\/jats:p>","DOI":"10.3390\/nu10060670","type":"journal-article","created":{"date-parts":[[2018,5,28]],"date-time":"2018-05-28T03:54:21Z","timestamp":1527479661000},"page":"670","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Implementation of Low Glycemic Index Diet Together with Cornstarch in Post-Gastric Bypass Hypoglycemia: Two Case Reports"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9489-9007","authenticated-orcid":false,"given":"Erminia","family":"Lembo","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Lupoli","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Ciciola","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Creanza","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eufemia","family":"Silvestri","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Saldalamacchia","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5222-1524","authenticated-orcid":false,"given":"Brunella","family":"Capaldo","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.soard.2016.12.005","article-title":"ASMBS position statement on postprandial hyperinsulinemic hypoglycemia after bariatric surgery","volume":"13","author":"Eisenberg","year":"2017","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1007\/s00125-010-1798-5","article-title":"Nationwide cohort study of post-gastric bypass hypoglycaemia including 5040 patients undergoing surgery for obesity in 1986\u20132006 in Sweden","volume":"53","author":"Marsk","year":"2010","journal-title":"Diabetologia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1007\/s11695-014-1260-8","article-title":"Hypoglycemia after Roux-en-Y gastric bypass: The BOLD experience","volume":"24","author":"Sarwar","year":"2014","journal-title":"Obes. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1002\/oby.21042","article-title":"Prevalence of and risk factors for hypoglycemic symptoms after gastric bypass and sleeve gastrectomy","volume":"23","author":"Lee","year":"2015","journal-title":"Obesity"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1111\/obr.12307","article-title":"Diagnostic tools for post-gastric bypass hypoglycaemia","volume":"16","author":"Emous","year":"2015","journal-title":"Obes. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/j.soard.2014.11.003","article-title":"Hypoglycemia after Roux-En-Y gastric bypass: Detection rates of continuous glucose monitoring (CGM) versus mixed meal test","volume":"11","author":"Kefurt","year":"2015","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.numecd.2017.07.004","article-title":"Diabetes remission after bariatric surgery is characterized by high glycemic variability and high oxidative stress","volume":"27","author":"Nosso","year":"2017","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1177\/1932296814537039","article-title":"Glycemic variability in nondiabetic morbidly obese persons: Results of an observational study and review of the literature","volume":"8","author":"Salkind","year":"2014","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1381\/096089204772787419","article-title":"Insulinoma misdiagnosed as dumping syndrome after bariatric surgery","volume":"14","author":"Zagury","year":"2004","journal-title":"Obes. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1007\/s11695-016-2092-5","article-title":"Insulinoma after bariatric surgery: Diagnostic dilemma and therapeutic approaches","volume":"26","author":"Mulla","year":"2016","journal-title":"Obes. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.soard.2017.01.025","article-title":"Medical nutrition therapy for post-bariatric hypoglycemia: Practical insights","volume":"13","author":"Suhl","year":"2017","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1007\/s11695-008-9569-9","article-title":"Postprandial hypoglycemia after bariatic surgery: Pharmacological treatment with verapamil and acarbose","volume":"18","author":"Moreira","year":"2008","journal-title":"Obes. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1097\/MPG.0b013e3181818ea5","article-title":"Nutritional therapy for glycogen storage diseases","volume":"47","author":"Heller","year":"2008","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_14","first-page":"228","article-title":"Use of slow release starch (SRS) to treat hypoglycaemia in type 1 diabetics","volume":"40","author":"Qi","year":"2010","journal-title":"J. Nutr. Food Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1038\/ejcn.2015.151","article-title":"Hydrothermally modified slow release corn starch: A potential new therapeutic option for treating hypoglycemia in autoimmune hypoglycemia (Hirata\u2019s disease)","volume":"69","author":"Lechner","year":"2015","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1161\/CIRCRESAHA.116.307591","article-title":"Treatment of obesity: Weight loss and bariatric surgery","volume":"118","author":"Wolfe","year":"2016","journal-title":"Circ. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1038\/ijo.2015.187","article-title":"Effects of bariatric surgery on markers of subclinical atherosclerosis and endothelial function: A meta-analysis of literature studies","volume":"40","author":"Lupoli","year":"2016","journal-title":"Int. J. Obes."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s11695-013-1148-z","article-title":"Early improvement of postprandial lipemia after bariatric surgery in obese type 2 diabetic patients","volume":"24","author":"Griffo","year":"2014","journal-title":"Obes. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"869536","DOI":"10.1155\/2011\/869536","article-title":"Continuous glucose monitoring for evaluation of glycemic excursions after gastric bypass","volume":"2011","author":"Halperin","year":"2011","journal-title":"J. Obes."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/cen.13033","article-title":"Post-gastric bypass hypoglycaemia: A review","volume":"85","author":"Shantavasinkul","year":"2016","journal-title":"Clin. Endocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jss.2010.09.047","article-title":"Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass: Unraveling the role of gut hormonal and pancreatic endocrine dysfunction","volume":"167","author":"Rabiee","year":"2011","journal-title":"J. Surg. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.2337\/db11-0203","article-title":"Gastric Bypass Surgery Enhances Glucagon-Like Peptide 1-Stimulated Postprandial Insulin Secretion in Humans","volume":"60","author":"Salehi","year":"2011","journal-title":"Diabetes"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1002\/oby.21043","article-title":"Insulin response to oral stimuli and glucose effectiveness increased in neuroglycopenia following gastric bypass","volume":"23","author":"Patti","year":"2015","journal-title":"Obesity"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.2337\/dc06-0392","article-title":"Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover","volume":"29","author":"Meier","year":"2006","journal-title":"Diabetes Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1055\/s-0041-111505","article-title":"Comparative effects of Roux-en-Y gastric bypass and sleeve gastrectomy on glucose homeostasis and incretin hormones in obese type 2 diabetic patients: A one-year prospective study","volume":"48","author":"Nosso","year":"2016","journal-title":"Horm. Metab. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1210\/jc.2013-2686","article-title":"Altered islet function and insulin clearance cause hyperinsulinemia in gastric bypass patients with symptoms of postprandial hypoglycemia","volume":"99","author":"Salehi","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1053\/j.gastro.2014.01.038","article-title":"Hypoglycemia after gastric bypass: The dark side of GLP-1","volume":"146","author":"Patti","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_28","first-page":"80re2","article-title":"Differential metabolic impact of gastric bypass surgery versus dietary intervention in obese diabetic subjects despite identical weight loss","volume":"3","author":"Reilly","year":"2011","journal-title":"Sci. Transl. Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/6\/670\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:05:51Z","timestamp":1760195151000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/6\/670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,25]]},"references-count":28,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,6]]}},"alternative-id":["nu10060670"],"URL":"https:\/\/doi.org\/10.3390\/nu10060670","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,25]]}}}