Friday, October 24, 2008

I'm back!

Sorry I haven't posted much for the past month or so.

For those of you who don't know me personally, I've suffered from reactive hypoglycemia for a long time. I'll give you a little background on it and some information about it and get on to how I've dealt with it.

Clinically speaking, reactive hypoglycemia, also known as post-prandial hypoglycemia, is when blood sugar drops "too low" (sorry I don't know the numbers) within 2 to 5 hours after a meal. The symptoms can include anxiety, shakiness, light-headedness, sweating, nausea, difficulty concentrating, depression, heart palpitations, flushing, epileptic-type response to flashing lights, headaches, craving sweets, and increased appetite.

I personally experienced almost all of the above and the symptoms I didn't develop my wife did. In retrospect, my and my wife's symptoms have been evident for a long time, but people know so little about this problem that many people don't get the treatment they need because the symptoms can be attributed to all sorts of problems.

The general advice that many receive is to drink some juice or eat some crackers. People are told to eat every two hours or so. I took this advice and it worked to temporarily relieve symptoms, but never offered permanent relief.

It took a long time to start to make the connection between what I ate and the severity and frequency of my symptoms, but when I was around 19 I started to make the connection. At first I thought sugar was my whole problem, but I later learned that all carbohydrates contributed to the problem, not just sugar.

After years of suffering and reacting to symptoms of low-blood sugar by eating, my weight had skyrocketed until I was nearly 100 pounds overweight and my wife was about 60 pounds overweight. We were hooked on a high-carb diet. We tried losing weight by reducing fat, cutting calories, exercising and failed at every turn.

About 6 years ago I started reading books about low-carb eating. I read "The Zone" by Barry Sears, "How I Gave Up My Low-Fat Diet and Lost Forty Pounds" by Dana Carpender, and "Dr. Atkins New Diet Revolution" by Robert C. Atkins. I found a little bit of information about normalizing blood sugar levels in these and I thought this way of eating might work for me. I experimented with reducing some of the carbohydrates in my diet and immediately my weight started to drop and my symptoms improved. I had the evidence I needed to move forward with trying the Atkin's Diet. I talked to my wife and persuaded her to try it with me.

Within a couple weeks, most of our maladies disappeared. My wife's migraine headaches got better, we both had energy again, shakiness, anxiety, and depression appeared to be a thing of the past.

We later found that these weren't all gone completely. Artificial sweeteners and caffeine also turned out to be culprits as well. These affected me more substantially than they did my wife.

I have intermittently removed these from my diet with positive results. One of the things that plagued me for years is that even when I avoided all the "culprit" foods in my diet, I still developed many of the same symptoms I had experienced in the past. I tried going "no-carb" and very low-carb without any positive results. I went to my doctor and she said "eat 6 or 7 small meals a day" and "eat a little bit of everything". She didn't listen when I told her I was eating low-carb, she was too busy giving advice that sounded right to her.

I kept careful food logs for a month that detailed when I ate, what I ate, how I felt, and what I did. I saw my doc again in a month and brought my food log. She wasn't interested. I told her I noticed that when I ate, I experienced symptoms, but when I fasted for long periods I had no symptoms. She remarked "that's odd, you would expect it to be opposite". Her final advice, "just keep eating small frequent meals". I knew she was insane and that she just wasn't listening. I had spent $300 on blood tests that told me nothing. I had to figure things out for myself.

I was desperate for some help because the anxiety, depression, and inability to concentrate were really taking a negative toll on my life, so I wrote to Dr. Jay Wortman at He suggested that too much protein could be part of the problem. He advised me to try to eat about 1 - 1.5 g of protein per kg of body weight. I started experimenting with that advice with some positive results, but I still was developing symptoms intermittently.

Next I stumbled upon the "Optimal Diet" by Dr. Kwasniewski read more here and here. It is a low-carb diet, in which you avoid eating too much protein and get the majority of your calories from fat. I did that for a month and saw, in general, a tremendous improvement in my symptoms.

Finally, I ready a post on Stargazey's site about reactive hypoglycemia with advice to wait 5 - 6 hours between meals. The advice is based on allowing insulin levels to drop between meals. For me that advice has turned out to be spot on.

I have since combined that advice with eating the prescribed amount of protein by Drs. Mike and Mary Eades in "Protein Power Lifeplan".

Since I have made these most recent changes, I have finally been relieved of my symptoms. Now I eat about 34g of protein at each of three meals a day, I get most of my calories from fat, and I get a few calories from carbohydrate. I am able to take some amount of artificial sweeteners, but I don't eat them during the day when my symptoms are more likely to occur.

If you have symptoms of reactive hypoglycemia, I encourage you to seek out information as I have and don't be afraid to ignore your doctor's advice if they're not really helping. Try keeping a food log with details about when, what, and how much you eat and any thing you notice about how you feel. Talk to people and don't stop searching until you get the answers you need. I don't know if I've solved the problem, but I think I have just made a major breakthrough.

I couldn't have done it without the help of so many of the websites, blogs, and books out there. Each shed a little more light on a poorly understood subject.

The positive changes in my health, my weight, and my mental health have all come from the low-carb community. That's why I'm proud to be a part of it. I hope that someday someone's life will be improved by something they found on my site.

So, there's your glimpse into some of the craziness of my life. If you have any questions, feel free to post them in comments or of course email me at


PS. Don't fear the fat! Without it, I wouldn't have anything to eat!


Stargazey said...

Hi, Alex!

I don't have reactive hypoglycemia myself, but I'm interested in it because so many people suffer from it, and because it's frequently one of the stages people go through on their way to type II diabetes. Both conditions involve insulin resistance, so I guess that's not too surprising.

I appreciate your thorough account of what did and did not work for you. A few years ago I would have guessed that low carb or zero carb would have been the answer, since carbs can cause insulin resistance and the body can make all the carbs it needs from protein.

But now that I've been reviewing some of my biochemistry and physiology, I've realized that eating protein also causes insulin release, and (unlike cutting out carbs) cutting out protein isn't compatible with life.

What to do? As your personal experiments showed you, you have to eat enough protein to meet your body's daily needs, but not much more than that, in order to minimize the amount of necessary insulin secretion. Even at that, if you eat freqently (as your doctor instructed), there will always be some insulin present in the blood, and that will allow some degree of insulin resistance to persist. From your experience, it appears that it's also important to allow 5-6 hours to pass between meals, permitting insulin levels to return to baseline and enabling insulin-exhausted tissues to regain at least some of their insulin sensitivity.

Thanks for sharing your saga. I hope other people who have reactive hypoglycemia will consider this approach and see if it works for them. If it does, it might be possible for us to present our anecdotal experiences to a low-carb physician and see if it would be possible to set up a research protocol to test them in a formal way. What do you think?

Anonymous said...

Alex, congratulations on your success! If you don't mind a couple of questions, are you still on the same eating schedule? And, what level of carb intake did you find works the best for you?

I am finding that eating very small amounts is helping. VLC, HF and reduced food intake, per Dr. Richard Bernstein's law of small numbers, and Dr. Kwasniewski's food recommendations.

Hope you are doing really well. :)

Rachel said...

Hi Alex,

I'm not sure you'll read this, as you posted this about 4 years ago (and I haven't yet checked to see if you're still blogging because I'm searching the web on my phone)!

My is Rachel, I'm 24 years old, and I have reactive hypoglycemia. Like you, I've had to discover it myself and I'm now attempting to treat it myself. I'm only 105lbs, 5'2" and have been fairly active my whole life. I had a few bouts of pancreatitis 3 years ago that doctors can't explain, and since then I've had tons of digestive issues, again unexplained. These symptoms of hypoglycemia have been occurring even before the pancreatitis, I just didn't know what it was yet, and it wasn't yet so severe.

My doc found I had PCOS and suggested my symptoms sounded like low blood sugar. I started eliminating most sugars and glutens, and this seemed to help somewhat. I then ate mac & cheese and some toast one day when I was feeling blah, and realized my symptoms were quite bad afterwards.

I became more strict cutting out all carbs, but my only weakness was fruit. I ate too many cherries one night and had anxiety, surges of adrenaline as my body was stimulating my liver to up my blood sugar- I was in really bad shape. I found all these articles telling me to eat sugar, drink juice - This wasn't logical to me but I was starting to panic. I drank a few sips of pedialyte (has sugar) and started to relax... Until an hour later my symptoms were even worse, and I was trembling.

I got really strict after that, not eating fruits or veggies without protein, and my diet became 60% fat 35% protein and 5% carbs, sometimes 0 carbs.

Oh boy... I started to feel more and more insulin resistant the more carbs I cut out! I eat so much meat in an attempt to maintain my weight, I can't eat any more fat than I am because of digestive issues, and I'm starting to feel nauseated at the thought of food.

My food allergies seem to be ever-increasing (whereas before all this I had no allergies to anything).

I've been taking supplements (Metabolic Synergy - with chromium, magnesium, zinc and lipoic acid among others known to help with insulin resistance) and Omega 3 and a few others. It's gotten so bad my doctor has put me on Metformin in the hopes that I can put some weight back on and feel some relief.

The eating every 2 hours thing has not been very helpful, particularly because I (who used to eat at least twice as much as my 200lb brother) can hardly stomach the foods I can eat. And even then, I still experience symptoms.

I somehow came across Stargazey's blog and found your story. I'm going to try the 5-6 hour meal idea since it worked for you.

I'd like to know - how many grams of carbs do you eat a day (roughly)? Or, more specifically, what percentage of your daily intake is carbs? I have been eating about 120g fat, 90g protein and 40-50g carbs (on days that I work up the courage to eat some veggies/berries).

I've only been on the Metformin for 2-3 days so it's not taken effect on my system yet. I'm hoping it helps, but there's a possibility that it may not, depending on the underlying cause of my insulin resistance. Any advice, especially about diet, would be greatly appreciated.

Thanks for posting your story.