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Archive for the ‘Hypoglycemia’ Category

Managing Hypoglycemia

In Hypoglycemia on September 9, 2011 at 10:18 AM

I have many clients coming to me with complaints of headache, fatigue, shakiness, irritability, ravenous appetite, and/or feeling downright awful at various points throughout the day, wanting to know what they can do to feel better.   Often times, people go years and years feeling like this before they realize there is a problem that may have a solution.  The good news is that these are often classic symptoms of hypoglycemia, also known as low blood sugar, and there are definitely various lifestyle changes one can make to solve the problem and get back to feeling healthy and energized.  Hypoglycemia can happen to anyone who has gone too long without eating, such as first thing in the morning or if you happened to skip a meal during the day.  This is referred to as “fasting hypoglycemia”, and is best managed by eating within one hour of waking and not going longer than 4-5 hours without eating. 

However, a chronic, more challenging case of hypoglycemia is known as “reactive hypoglycemia”, in which a person’s pancreas over-reacts to excessive carbohydrate (starch and sugar) intake by overproducing insulin (the hormone responsible for blood sugar regulation), which quickly transports the digested sugar out of his or her bloodstream, thereby resulting in a blood sugar “crash” 1-3 hours after eating a high carbohydrate meal.  When your blood sugar suddenly dips low, your nervous and endocrine systems respond with shakiness, headache, fatigue, hunger, irritability, and cravings for sugary foods to help raise the blood sugar back up and provide energy for the body.  The key to managing reactive hypoglycemia is to understand which types of carbohydrate-containing foods need to be consumed in moderation (or completely avoided) in order to prevent blood sugar crashes, and how to incorporate other foods into your meal plan to keep blood sugar levels more steady throughout the day.  Accomplish this, and you will be guaranteed to feel better.  The caveat here is that reactive hypoglycemia is a chronic condition, as your pancreas is always going to be over-reactive in response to food intake, so you will need to maintain the recommended diet changes for a lifetime in order to avoid feeling lousy.  Contrary to popular belief, having frequent episodes of hypoglycemia does not mean you are harming your body or that you are more likely to get diabetes.  Yes, people with diabetes who take outside sources of insulin or pancreas-stimulating pills for regulating blood sugar  (such as glynase, glucotrol, or glimipiride) are also prone to low blood sugar, but it is because they have too much insulin in their system due to the medication they are taking, not because their pancreas is inherently producting too much insulin.

First and foremost, you want to follow a diet designed to regulate your blood sugar level.  This generally includes eating small, frequent meals spaced evenly throughout the day, such as every 2-3 hours.  Meals should consist of moderate portions of high-fiber whole grains (such as 100% whole grain cereal or bread, brown rice, whole wheat pasta, quinoa, sweet potato), some lean protein (such as turkey, ham, fish, egg, beans, lowfat yogurt or cheese), and healthy fat (such as nuts, nut butters, olive oil, avocado).  Sugars, especially in the form of beverages (juice, soda, etc.) and sweets (candy, jelly, table sugar, syrup, honey, cookies, cakes), should be avoided as much as possible, as they stimulate the pancreas the most because the sugar rushes into your bloodstream rapidly.  Starchy carbohydrates digest down into sugar as well, so it is important to eat these in moderate amounts (such as 1/2-1 cup), and choose whole grains over refined flours.  White pasta, rices, breads, and cereals are more or less guaranteed to make you feel lousy after eating them as they are digested quickly and raise insulin levels.  Fruits also need to be consumed in small amounts, as they contain the natural sugar, fructose, and are best consumed with a source of protein, such as cottage cheese or nuts.  Even though fruits are an excellent source of fiber, the sugar content is enough to cause your pancreas to over-react if eaten on an empty stomach.  The goal is essentially to not eat carbohydrate foods without including a source of protein or fat at the same time.  Proteins and fat help stabilize blood sugars by making the carbohydrate digest more slowly, as proteins and fats take longer to digest and do not convert into significant amounts of sugar.

Examples of meals and snacks that work well for stabilizing blood sugar include:

  • lowfat cheese and whole grain crackers
  • slice of whole grain toast with peanut butter
  • sandwich made with whole grain bread
  • fat free plain Greek yogurt with a small piece of fruit or 1/2 cup berries
  • large salad with abundant veggies and a source of protein (chicken, tuna, beans, egg)

The classic “healthy” breakfast of cereal, fruit, and milk contains a large amount of carbohydrate with minimal protein and fat.  This is a breakfast that you will likely want to avoid if you often have symptoms of hypoglycemia mid-morning.  Changing your breakfast choices to include some whole grain, fruit, and protein/fat would be a better option, such as a couple slices of whole wheat bread with peanut butter, egg, or unsweetened yogurt along with a small piece of fruit if desired.  Absolutely no fruit juices and limit sugar if adding to coffee or tea.

Speaking of coffee, caffeine can also cause your blood sugar to drop low, so you may want to consider switching to decaffeinated coffee.  Other stimulants such as nicotine and alcohol may also aggravate reactive hypoglycemia.  Keeping a food and lifestyle diary may help you determine which foods and other factors lead up to a blood sugar crash.

Need more information on carbohydrate-containing foods and additional meal planning ideas?  Check out previous articles categorized under “Diabetes” in the blog archives, as diabetes is also best managed with a reduced-carbohydrate plan. 

On a final note, strenuous exercise burns sugar out of your muscles and bloodstream quickly, so you may be more prone to low blood sugar during extended periods of activity as well.  Eating a snack contain a small amount of carbohydrate and protein (such as yogurt or trail mix) within 1 hour of strenuous activity may be enough to keep you going strong.

Developing a habit of eating small, frequent meals and taking healthy foods with you for work, school, and when on-the-go, is your best weapon against suffering the symptoms of low blood sugar.  If you find incorporating the above suggestions is still not improving your symptoms, you may need to sit down with a dietitian to develop a personalized meal plan to meet your schedule, food preferences, and overall lifestyle needs.  Either contact me or visit to find an RD in your area.  There is no point in living day-in and day-out with symptoms of hypoglycemia when there is a common sense way to tackle the issue and regain your quality of life!

Any questions?  Feel free to ask!

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