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post-gastric bypass surgery) Pregnancy Malabsorption diseases (Celiac Disease, Colitis, Crohns disease) Lack of or deficiency of stomach acid

Bird, Effect of sodium bicarbonate ingestion upon repeated sprints., Br J Sports Med 23 (1989) 4145

So your doctor can prescribe a drug however they think is best for your care

In the withdrawal trial, continuing preserved loss far better than switching to placebo, which regained about 14% over a year. The metabolic benefit fades in proportion to the weight regained, so a taper plus protein and resistance training beats a hard stop

Mass spectroscopy or direct gene analysis will provide a definitive diagnosis