Question: Hi. I have been sick since March 2014. I get extremely tired 20-30 minutes after I eat, so much so that I must lay down. When I get up from the nap, I still feel very worn down. This seems to be most affected by carbs and sugars. The carbs and sugars also cause me to immediately go into a "brain fog" (I feel intoxicated) and it causes an imbalance or light dizziness. I have even felt slurred speech with carbs. Strange enough peanuts do the same. The worse food is fried chicken battered in flour or potatoes: very bad diarrhea and abd pain. Once I eat in morning, I stay extremely fatigued all day long. If I try to do something physicial, ie. riding a bike for 1 minute or taking stairs, I feel like a can not breathe and this will last from a few minutes to a couple of hours. I have diarrhea with carbs and sugars (seems worse with carbs). Abd pain starts immediately after eating carbs and can last a few minutes to hours. If not diarrhea, stool can be oily, sticky, pale and stick to the toilet bowl. I am unable to gain weight. I have had a 10-15 weight loss since the beginning of the year. Currently I weigh only 107 lbs. I was diagnosed with a B12 def in Oct 2013. No matter how much red meat I eat my B12 stays low therefore I take shots every two weeks now. My Vit D was started lowing at the same time and was "officially" low in March 2014 at which time I took RX supplements but the level has continued to drop again. I have also keep acne with two facial abscesses over the last two months (which is not normal for me). Over the last two months, I have began to smell a very strange smell, now becoming daily. It comes and goes. I am unable to say what it smells like (not like feces). No taste in my mouth. Just recently I felt mild heartburn after eating (although I am not sure why they call it heartburn, seemed to be more pressure below the esophagus, not sure if this relates or just coincidence). I have had two GTT tests. One two months ago showed my sugar level at 220 at the two hours mark (high at 1-3 hours) An insulin level draw was take at the 2 hour and was 64 ulU/ml. . I was asked to increase the carb/sugar intake and repeat it since during at that time I kept a diet of mainly chicken and vegs to lower symptoms. I repeated the test last week and it showed the my sugar at 129 at the 1 hour and 71 at the two hour. No insulin draws were done. Current labs: A blood amylase was at 37 and lipase was 20. BUN 30 (BUN was 18 in May 2014). Normal creatinine. C peptide 2.6. Fasting Insulin 13.6. Fasting glucose 91. Celiac blood test came back negative. Stools negative Lactoferrin, Campylobacter, Shigatoxin, O&P Antigen, Giardia, Cryptosporidium, Entamoeba histolytica. Sudan fat stool "within normal limits". Allergy Food tests are negative (twice since March). Primary ordered Echo and EKG that were negative. Took Bentyl for one week and it seemed to make stools become more oily and stringy. Took oral Nystain for two weeks to rule out intestinal candiasis with no change in symptoms. I have went to Infectious disease, Respiratory, & Neurology. All of these specialist ruled out it was their area. Test performed: chest xray (negative) and PFTs (possible restrictive lung dz: resp doc said something else may be putting stress on the lungs but no lung disease). Endo: ruled out diabetes and felt I need to see GI. GI: feels the GTT was abnormal for a reason and the pancreatis needs to be worked up. . One sends me back to the other. What tests do you feel needs to be performed and what do you think this could be? It is becoming extremely difficult to live so sick everyday feeling so fatigued and the muscles and general feel of my body being so worn down. It is a consistent pattern of feeling extremely fatigued 20-30 minutes after eating. I find it difficult to want to eat knowing the extreme fatigue and possible abd pain (higher carb level seems to be worse) is coming. I think it would be worth noting that the abd pain and diarrhea started over the last couple of months. When this first stated it march 2014, the main symptom was extreme fatigue after eating. When I connected the carbs and sugars to the fatigue, I eliminated carbs/sugars totally for a couple of weeks. Still felt fatigued. When adding them back in, the fatigue was worse with the abd pain and diarrhea. Please help.

Thank you for your response. I have also had the following labs: TSH 1.3, T4 Total 6.5, ACTH 35.

Does that change your thought process? And how would that explain the extreme weakness 20-30minutes after eating?Also Cortisol 20.9

Can being on Depo Provera (for 12 yrs) affect any of those labs?

My last Depo Provera shot was April 2014. I am currently 3 months out, but I have not yet had a menstrual cycle which I assume could indicate that the Depo is not completely out of my system, although I am not convinced that all these symptoms are due to Depo but was curious to know if the thyroid labs could be not accurate due to the steroid.

I have considered Postprandial Hypotension. I have taken my blood pressure before and after eating. My lowest reading after eating is 98/76 and that is not a 20 point sys drop from the pressure before eating. My pressure stays around 108/80.

I do have orthostatic hypotension, but not daily. It does occur more with carb meals, but does also happen with no meal. This does not bother me because after a few seconds of dizziness, I am fine. I have experienced this for 2.5 years. It started after a 5K run when I felt off balance for several months with movement. At that time is when dizziness started after eating certain foods. I still can not eat pork or processed foods to this day. Bacon and pepporoni cause a dizziness and unbelievable brain fog immediately after very little has been ate. Menieres was ruled out at that time by ENT.

I take Metformin for one week after the first GTT showed high blood sugars. This did allow me to eat some simple sugars and complex carbs without the brain fog and dizziness (limited amounts).

I am not sure how the brain fog and dizziness relates. I can avoid certain foods. But strange enough when I ate only chicken and vegs, I had one of the worst brain fogs and feeling intoxicated feelings that lasted for 1-2 hours after eating. I had preceded this meal (and actually the meal before that) with a full glass of water, which I had read would help if it was postprandial hypotension.

The extreme fatigue started in March 2014 along with the exercise intolerance (a 1 minute bike ride will though me into my entire body feeling like I can not move). The GI doctor suggested the cause of dizziness/fatigue after eating being food not being processed appropriately though the body. He thought a pancreatic disorder.

No one has addressed my BUN increasing each time I have labs drawn.

With the amylase and lipase being in normal range, could it be an enzyme deficiency?
Would it be worth a pancreatic work-up and what would that work up consist of?
Could hemochromatosis be a possibility?

I will suggest the MRI which I assume could also rule out MS, parkinsons, etc. as well. Correct?

MY cortisol level done in August was 23.7 done at 7:30am