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Reactive Hypoglycemia

Background

Anytime we eat grains, vegetables and fruit or dairy, the carbohydrates within these foods are broken down into sugar (e.g. glucose, fructose, etc.) in order for our body to be able to absorb them into our blood stream. Once in our blood, the pancreas produces a hormone called insulin that allows the sugar to be taken up by our cells, giving our body energy. Normally this process happens meal after meal without us even having to think about it! However, if our body doesn't produce enough insulin or our body doesn't respond to it very well (as is the case with diabetes) or when our body produces too much insulin in response to what we eat (as is the case with reactive hypoglycemia) we run into trouble.

Hypoglycemia in a nutshell

Hypoglycemia (or low blood sugar) occurs wherever there is too much insulin circulating in the blood for the amount of sugar ingested and absorbed. The body operates at it's best when blood sugar concentration stays in a specific range (4.0 - 6.0 mmol/L). Hypoglycemia results when too much sugar is driven into the cells causing the concentration of blood sugar to drop below 4.0 mmol/L. A person with low blood sugar may have any of the following symptoms: sweating, shakiness, elevated heart rate, hunger, nervousness, sweating, and possibly confusion and blurred vision.

What happens in reactive hypoglycemia?

In people with reactive hypoglycemia, low blood sugar happens within 2-5 hours after they eat. People with reactive hypoglycemia need to manage their diet similarly to those with diabetes to avoid symptoms.

Nutrition Recommendations

1. Timing is everything!

  • Timing of meals and snacks alone can be enough to control symptoms.
  • Eat small, frequent meals. Six small meals a day (i.e. every 2-3 hours) is the best way to avoid symptoms as it spreads out the amount of carbohydrate (sugar) in your bloodstream.
  • Skipping meals or not eating for long periods of time can make symptoms worse.

2. The combination for success - mixed meals

  • Eating mixed meals - that is, having carbohydrate, protein and fat is the combination for success. Follow recommendations outlined in Canada's Food Guide to Healthy Eating for a proven way to eat a balanced diet! Healthy Eating Made Simple: Canada's Food Guide to Healthy Eating.
  • For those who like math. this combination can be calculated in order to distribute the calories between carbohydrate, protein and fat appropriately. The best combination to control reactive hypoglycemia is to aim to have 50% of total calories coming from carbohydrates, 20% of total calories coming from protein, and 30% of total calories coming from fat. For example, if consuming a 2000-calorie diet, carbohydrates would account for 1000 calories (or 250 grams), protein would account for 400 calories (or 100 grams) and fat would account for 600 calories (or 100 grams). This percentage breakdown fits well into the most recent recommendations. See Achieving and Maintaining a Healthy Weight.

More about mixed meals, specifically:

Carbohydrate

  • Don't cut the carbs! Even though it seems like sugar is the culprit - not all carbohydrates are created equal.just choose wisely. In fact, carbohydrate is our body's best and most sustainable source of energy - read on!
  • Choose high fibre, complex carbohydrates (whole grains breads and cereals, pasta, brown rice, beans, lentils and split peas, fruits and vegetables). Complex carbohydrates take about 2 hours to digest and be absorbed into the bloodstream. High fibre, complex carbohydrates allow for a slow release of sugar into the bloodstream.
  • Limit simple and refined sugars - candy, honey, jams, jellies, sugar, syrup, sweetened drinks, fruit juice, and sweets (desserts). Simple carbohydrates, such as table sugar, fruit and lactose (milk sugar) can be absorbed into the blood within 15 minutes (fast release = increased risk of symptoms). In fact, simple sugars can make symptoms worse, especially if eaten on an empty stomach. If eating simple sugars, eat them in moderation and with other foods. (see the combination to success)

Protein

  • Eat protein at each meal and snack as it helps to stabilize blood sugar. Good choices include lean meats, fish, poultry, eggs, beans, lentils and split peas, tofu, soymilk, peanut butter, low fat milk and milk products.

Fat

  • Fat slows digestion, which in turns slows the release of sugar into the bloodstream.
  • Choose healthy fats such as canola, olive, flaxseed or soybean oils, and non-hydrogenated margarines made with these oils. Fish, nuts, seed and avocado are also good choices.

3. Other things to consider

  • Limit caffeine as it can make symptoms worse. link to caffeine
  • Alcohol can also cause low blood sugar. It's best to talk to your doctor about alcohol.
  • Exercise after a meal or after a high carbohydrate snack to avoid symptoms.
  • Consider carbohydrate counting as a way to regulate total carbohydrate intake. Carbohydrate counting is typically used in the management of diabetes - visit www.diabetes.ca, or talk to your doctor or dietitian for more information.

4. A caution about ketones

  • If too little carbohydrates are consumed and blood sugar is in short supply, the body breaks down fat and produces ketones as a by-product. When ketones build up in the blood they cause people to feel unwell - decreased alertness, fatigue, nausea, etc. Moreover, the kidneys have to work hard to remove these ketones from the body. To avoid ketones building up in the blood it is recommended that a minimum of 130 grams of carbohydrate be consumed each day. This allows for proper brain and nervous system function, where sugar is the preferred fuel.

A Sample Menu - Canada's Food Guide to Healthy Eating in Action

Remember that small, frequent meals are the best way to control symptoms.

Breakfast*

Whole grain cereal
Low fat milk
Fruit
Decaffeinated coffee or tea

Snack

Cottage cheese and fruit

Lunch

1/2 sandwich with lean meat, fish or poultry
Lettuce and tomato
Margarine, mayonnaise
Fruit
Vegetable and bean soup

Snack

1/2 sandwich from lunch
Low fat milk or yogurt

Dinner

Meat, fish, or poultry
Brown rice, whole-wheat pasta or baked potato
Cooked vegetables or salad with low fat dressing
Low fat yogurt
Fresh fruit cup
Decaffeinated herb tea

Snack

Cereal with milk

Other snack ideas:

  • Whole grain toast, bagel or muffin with peanut butter, egg or low fat cheese
  • Veggie sticks
  • Smoothie made with soft tofu
  • Low fat milk with plain cookies
  • Whole grain crackers with cheese and fruit
  • Nut and seed mix (add small amount of dried fruit)
  • Bran muffin and cheese
  • Bean spread with whole wheat crackers

*Drink water throughout the day

The bottom line

Following the above tips may be helpful in avoiding symptoms of hypoglycemia. However, it is important to remember that everyone is different in regards to their tolerance of carbohydrates and their body's blood sugar/insulin response. Ask your Doctor or Registered Dietitian for more information.