This study will compare glucose and simple carbohydrate sensitivity. The hypothesis is that rapid emptying of high-glycemic index foods after Roux-En-Y gastric bypass (RYGB) causes reactive hypoglycemia. It is believed that the controlled release offered by an intact pylorus will be advantageous for long term results in bariatric surgery. This study can provide a scientific rationale, in a short duration of time, for why pylorus sparing surgery, such as the sleeve gastrectomy or duodenal switch, may offer therapeutic advantages, as compared to non-pyloric sparing surgery, namely the gastric bypass.

Clinical Trial Objective:

The objective of this clinical trial is to determine whether an intact pylorus prevents reactive hypoglycemia following challenge with liquid glucose preparation and/or solid load made of refined flour product that is a simple carbohydrate.

Clinical Trial Design:

This is a prospective, non-randomized, clinical trial.

Inclusion Criteria:

• The patient is greater than 18 years old;
• The patient has a BMI > 35;
• Patient meets standards for bariatric surgery;

Exclusion Criteria:

• The patient has an incurable malignant or debilitating disease;
• The patient has been diagnosed with a severe eating disorder;
• The patient is currently pregnant (pregnancy test required for confirmation for those of child bearing years);
• The patient is unable to comply with the study requirements, follow-up schedule, or to give valid informed consent

Patients >18 years of age BMI greater than or equal to 35

Day 0, 2 weeks, 4 weeks, 3 months, 6 months, 9 months, 12 months

During each visit study subjects were asked whether an adverse event had occurred, and their 'yes'/'no'responses were recorded on the corresponding visit CRFs.