Monday, October 27, 2008

Reactive Hypoglycemia--An Experiment?



Reactive hypoglycemia is a condition which is characterized by unusually low blood sugar that occurs one to four hours following a meal. The symptoms are the typical ones for low blood sugar--shakiness, light-headedness, weakness, confusion, anxiety, depression, hunger, pounding heartbeat and sweating.

Progressive development of insulin resistance is often the cause of reactive hypoglycemia. When the pancreas becomes insulin resistant, it is unable to release the proper amount of insulin in response to the stimulus of carbohydrates and proteins. Sometimes the pancreas will overshoot its estimate of the amount of insulin needed to store ingested carbs and proteins. The excess insulin produces hypoglycemia and its associated symptoms. A more detailed explanation of the process can be found in my original post called Reactive Hypoglycemia. (Be sure to read the comments section.)

Reactive hypoglycemia can be diagnosed with a glucose tolerance test. If the test is positive, the patient will typically be advised to eat every 2-3 hours to relieve the symptoms. Although freqent ingestion of food does keep blood sugar from falling too low, it will not provide a long-term resolution of the underlying problem.

One of my readers, Alex, who blogs at Low Carb New England, entered the discussion on the original post with the story of how he has been dealing with reactive hypoglycemia since he was a teenager. Over the years he has systematically tried many different approaches and has taken careful note of what result each personal experiment has produced. To summarize briefly, Alex initially tried eating less sugar and eating frequent meals, but eventually he gained nearly 100 pounds. Next he investigated low-carb eating. By using the Atkins diet, he lost weight and many of his symptoms improved considerably. In an effort to reduce the remaining symptoms, Alex tried eliminating artificial sweeteners and caffeine, and this helped somewhat. He also tried extremely low-carb and even no-carb eating, which didn't help.

Eventually Alex realized that he needed to limit his protein intake to the amount recommended by Drs. Mike and Mary Dan Eades in The Protein Power Lifeplan. (Remember, eating protein also causes insulin release, and thus can contribute to insulin resistance.) Again, his symptoms improved, but were not entirely gone. The final piece of the puzzle seemed to arrive when he read my first comment under the Reactive Hypoglycemia post and decided to try waiting 5-6 hours between meals to allow his insulin levels to come back to baseline and give his body a chance to re-establish a normal level of insulin sensitivity.

After a month of using this three-legged stool approach (low-carb/moderate-protein/5-6 hours between meals) to dealing with reactive hypoglycemia, Alex has finally experienced relief from the symptoms of reactive hypoglycemia. He gives a much more complete version of the story on his blog in a post called "I'm back!" (For those who don't have access to The Protein Power Lifeplan, another method of calculating one's daily protein need can be found here.)

And now I've reached the main point of this post. If the three-legged stool approach (illustrated in the picture above) has worked for Alex, would it work for anybody else out there who has reactive hypoglycemia? Each leg of the stool is designed to reduce insulin resistance and, one hopes, to restore some degree of insulin sensitivity in muscle, liver, brain and pancreas. If any of my readers is interested in trying to follow this plan for a few weeks or a month, I would be very interested in getting your feedback. If this method actually works, it's possible that a series of anecdotal experiences could convince a low-carb researcher to design a study to see if using the three legs of the stool is an improvement over frequent feeding as a way to treat reactive hypoglycemia. If these informal personal experiments don't work, that's also important information. It's possible that there are other pieces of the puzzle that aren't obvious, or perhaps that the mechanisms of reactive hypoglycemia are different from one individual to the next. If you decide to try this, please be very careful, and please don't do anything that would put your health in danger. That said, if you try it and you have observations you would like to share, please put them into the comments and we shall see where this might lead.

25 comments:

Alex said...

Stargazey,

Great synopsis of my experience and my experiments.

I look forward to hearing others' experiences with this and other approaches.

I'd also to be interested to hear if anyone else has experienced the same problems I did with frequent meals. I found that more frequent meals ALWAYS produced problems for me. It took a long time to piece that part of the puzzle together.

Thanks for putting this out there to talk about Stargazey. I look forward to the ensuing discussion.

Cheers,
Alex
Low Carb New England

Danny Jimmy said...

I have been diagnosed with reactive hypoglycemia with a glucose tolerance test, in the middle of which I fainted when my blood sugar reached 38

As a teenager it reached a point where I was having symptoms all the time. The symptoms include fatigue, exhaustation, forgetfullness, poor concentration, vertigo, fainting, cold spells, sweating, short breath, irritability, anxiety, panick, anger, irrational negative thinking, mood swings.

This condition has turned my life into an unbereable hell. I was so tired and fainting so often that I had to drop from school and study at home. I have never been at a party, never had a date, never became able to take a driving licence, never completed a school year (to exhausted to remember, study and I progressed very slowly)

I have tried EVERYTHING without success. Many meals a day, no carb diets, low carb diet, high carb diet, vegetarian diets, zone diet, bodybuilding diets, body for life, diabetes diets, no sugar, clean foods diet, fasting and nothing has worked.

I'm desperate for a solution as the symptoms progress and get worse. The interesting fact is that I'm not overweight. I'm fact since I developed Reactive Hypoglycemia I have been skinny with wasted aching muscles and fat in my bloated abdomen.

What I have discovered so far from my experimentation is that:

1) Eating many times a day just makes the whole Reactive Hypoglycemia worse even when it seems to relieve the symptoms on the short term. Eating often is a no no for me

2) The worst moment for me is the morning, when I wake up I'm hypo and if I eat simple carbs I ruin the whole day. Usually I tolerate more carbs at evening and less in the morning. Morning must be carb free for me

3) Ketogenic and no-carb diets don't work for me, hypoglycemia symptoms gets worse and raising sugar to normal levels becomes even harder.

Stargazey said...

Thanks for your comment Danny Jimmy. If you decide to try waiting 5-6 hours between feedings and if it works for you (or even if it doesn't), please do report back and let us know!

Danny Jimmy said...

Can I have suggestions on what to eat. Foods that I can eat and a typical daily menu for someone trying to minime carbs and get moderate proteins and more fats?
Also how many grams of carbs a day should I eat?

I'm having symptoms right now and it's so hard to even concentrate enough on the issue to figure out a diet on my own.

Thanks

Stargazey said...

The best place to start is with one of the standard books on low-carbing. I would recommend "Dr. Atkins' Diet Revolution" or "Dr. Atkins' New Diet Revolution." Both are available on Amazon or at used book stores. Another good choice would be "Protein Power" by Mike and Mary Dan Eades. (DO NOT, however, wander over to the Atkins website. They have made all sorts of income-generating modifications since Dr. Atkins died in 2003, and the bottom line is that for most people, their version of low-carbing doesn't work in the long term.)

The reason you need to read one of the three books I listed, is that there is lots more to low-carbing than you might expect. It's not just a simple list of recommended meals. Low-carbing involves major changes in the way your body processes foods and in the way it responds to those foods.

Everybody is different, and everybody has a somewhat different experience when they low-carb. Dr. Atkins was an excellent clinician and was able to explain the whys and the hows of low-carbing in language that most people can understand. The Drs. Eades are also practical people and their book is a good resource as well.

Yes, it will take a significant amount of commitment and effort to read, understand and follow one of those books. But you have the rest of your life ahead of you. Low-carbing is a lifelong process of self education, and the best place to start is with one of the books written by one of the experts in the field.

Danny Jimmy said...

How the diets proposed by Atkins or Eades differ from the kind of diet I have to follow to reverse my reactive hypoglycemia and the horrible symptoms?

Can I just follow the diets to a tee or I have to make adjustment? Is the amount of carbs the propose enough for me? I tried to do no-carb and I felt very sick.

Thanks!

Stargazey said...

Danny Jimmy--Because I'm a biochemist and not a physician, I can't presume to give you any specific medical advice.

I probably should have made that clear from the beginning of our discussion. For people who have only minor health issues, reading and following the Atkins and/or Eades books can often give them significant relief. However, from the duration and severity of your symptoms, it sounds as if you need to see a medical professional such as a diabetologist or an endocrinologist. Once they get you stabilized you can consider experimenting with things like low-carb, but this is probably not the time to do self treatment. I do wish you the best.

Danny Jimmy said...

I have the same problem everyone with this condition have. Doctor don't have a clue and they suggest diets that don't work.

When I said I have tried everything it included dozen of professional medical consultations. I needed to consult five endocrinologist before I found someone who didn't underestimate my glucose tolerance test results. And this person suggested me a low-fat 12 snacks a day diet that never worked. He ignored what I had to say about how I felt on that diet.

No doctor of the dozen I have consulted believed my symptoms can be helped with drugs or therapies, it's just a matter of following an high carb many snacks diet.

It's definitely time for self experimenting because there's nothing doctor know that I don't know and nothing they can do at this point to help me. In fact doctors are the ones who don't believe I can or should get stabilized, for them it's not even a medical condition just my fault for not eating every 2 or 3 hours.

Thanks for your help

Stargazey said...

You're welcome, Danny Jimmy.

If you'd like to risk one more encounter with the medical community, Jimmy Moore has a blog that lists doctors who are willing to manage patients in the context of a low-carb diet. Here is the URL:
http://lowcarbdoctors.blogspot.com/

cindyo said...

Following your advice and delaying my meals by 6 hrs in between has done away with my reactive hypoglycemia, as long as I keep following it. It began to help immediately and now that I have been using it for a week I can eat anything and still not react, and also am sleeping well for the first time since 6 years with the exception of when I was on an all meat and fat diet for 3 weeks before trying your waiting between meals technique. I wrote more just as I was beginning your technique and when writing it did not know how well it would turn out, but it really has. Here is a link to my initial comments, made at another site under the name Cindyo. http://ehealthforum.com/health/permanent-ketosis-unable-to-eat-carbs-t134292.html

Cindy O.

Stargazey said...

Thanks for your comment, Cindy. That is great news!

Gladina said...

@ Danny Jimmy:

I know this is two years later, and you might have already discovered or tried this, but I recommend going over to Dr. Bernstien Diabetes forum. There may be people over there to help you out, after all, type I's have to consider hypo symptoms too.

Good luck and hope you have found something that has helped you in the two years since.

Johnny Mcneely said...

This is amazing stuff!! totally changed my life.

I've always thought I needed carbs for my blood sugar levels. I can remember growing up as a kid and on the holidays I would have breakfast in the morning (big bowl of oatmeal) and spending all day on the computer with out any food and forgetting to eat food.. and almost fainting towards 2pm (if I didn't have food). But to be honest.. its always been not to bad (as long as I had food eg. carbs).

That is until the 4 year. I drank alot of beer and big pizzas during the weekend (coupled with a big carb breakfast and bread for lunch - normal for me) which (which made me fat). Its only been the last year that my reactive hypoglycemia went out of control. After a night of drinking (beer and pizza) it when it is at its worse.

I've been searching on the internet for ages for a help. Search terms like reactive hypoglycemia, insulin resistance, hyperinsulinism or hyperinsulinemia and I couldn't find anything for ages! Anyways.. long story sort - low carbs, moderate protein, high fat, eating after 5 hours apart really works! my symptoms have just about gone. I've got to the stage in where I might eat a normal meal eg. subway and be totally unaffected by reactive hypoglycemia!! (or though I don't like eating that crap.. I like to eat real food eg. paleo / primal blueprint diet sort of stuff.

Anyways.. one thing I have to add to this blog is electrolyte imbalances!!

For awhile after eating this diet.. I misunderstood the symptoms of reactive hypoglycemia and the symptoms of electrolyte imbalances! I would feel extremely thirsty and lose energy.. and I would feel wasted and just about faint.. eating carbs seemed to fix this (temporary). just like reactive hypoglycemia! (apart from the thirst) it would last for days! (I think the atkins people call it the atkins flu).

I also would get this weird pain above my right ear on the side of my head -It only hurts when I graze it it softly or rub moderately. Increased pressure from my fingers does not necessarily mean an increase in pain or sensitivity. On gross observation it looks as normal as the other temple on the left side. No lumps or anything. I do not get headaches. This feels different though. When I'm not touching it I don't feel it, when I fun my fingers over my right temple I feel it. It would especially happen and be at its worse after a night of drinking and then slowly go after about 3 days (drinking.. anything.. even half a glass of wine would bring it back.

Anyways.. having a electrolyte drink cures this all! I simply put about a half a tea spoon of salt into half a cup of lemon or lime juice and then the rest water and mix it! and after taking this its gone!

For me these sort of symptoms happen (not normally the right side of head pain one happens when I eat too much carbs.

My theory on why I get affected by this all is that because I have higher than normal insulin levels circulating in my blood, it drives the kidneys to retain alot of fluid. So when you go back to low carb again.. you lose all that fluid! and all those electrolyte minerals!

Check this page I found on the topic:
http://www.proteinpower.com/drmike/saturated-fat/tips-tricks-for-starting-or-restarting-low-carb-pt-ii/

Anyways.. I hope this info helps someone out there!!!

THANK YOU!

Sigrid Macdonald said...

Hello, thanks so much for your main post and for the comments. Like other people here, I have had reactive hypoglycemia for a long time and have tried just about everything. Unfortunately for me, cheese and yogurt trigger migraine headaches and so do many nuts, so I am in a real box when it comes to adding in fat. Right now I am down to eating about 10 foods, and I have about 50 g of carb a day. But it had never occurred to me to eat less often although I've had similar experiences where I've been in the hospital, or other places where I can't get to food, and I've had to fast for hours and I didn't get considerably worse.

Plus every day at 4 PM I used to have a snack of almond butter and rye cracker and when I measured my blood sugar before and after, it was always lower at 5 PM than it was before I ate at 4 PM. So that made no sense and I would always feel shaky and really crummy after that snack.

I'm going to try waiting four to five hours in between meals. I'm afraid to go longer, but this is a great new concept that I had never considered. Ditto for protein. I know I need to reduce the protein and add in some fats but because of the migraine trigger food problem, I'm stuck on that one at the moment.

Anyway, thanks so much for all this info. If it works for me, I will report back. SM

jlb said...

Try a small ammount (1 tsp) of coconut oil daily until you can gradually reach a greater ammount. Coconut oil metabolizes well, giving you energy, so eat it earlier in the day. Start slowly, as it can cause loostening of the stool if you start suddenly with a greater ammount, say a Tablespoon... this helped me be able to go several hours between meals, and also helped me kick the sugar and carb adiction and the hypoglycemia. I doo still eat cabs / starches, though.

Lydia Mills said...

i want to take part in this can i follow you on facebook?

Stargazey said...

Sorry, I don't do Facebook, but you can do the experiment and report in on your progress here.

Lance So said...

Stargazey,

Can hypoglycemia be cured? or you have to have those diet with you forever ?

Cheers,
Lance

Stargazey said...

I don't think hypoglycemia can be cured, Lance, but it certainly can be controlled. You'll have to make personal observations as to what foods and eating practices affect your symptoms and make adjustments accordingly. If it's like most dietary things, you will find that you have a bit more leeway after you have spent several months using a system that works for you.

work related said...

IS this experiment still working for people with Reactive Hypoglycemia? I tried this and had some VERY good days, and then some not so good one. I wonder if my body is adaptig? But the bad days feel awful and wan to make sure I am not damaging the system further. Thanks! Lee

Stargazey said...

I'm not a physician, Lee, so I can't say for sure. It may have something to do with your specific food choices from day to day. You might try tracking your blood sugar to see how it is affected by what you eat and when you eat it.

Also, have you read the earlier comments here? Some of the insights offered may be helpful. If all of that doesn't work, it's possible that this system isn't for you. You may need to contact a doctor to give you suggestions that will work for your particular situation.

Ahu said...

Hello, I have RH as well & in addition, my insulin sensitivity is very very high. I started trying 6 hours rule between meals and most of the time it works. I just wanted to check that if there is anyone who has information on insulin sensitivity. It is very easy to find articles on insulin resistance on the other there is no sufficient data re. insulin sensitivity. I am wondering cause I have a belief that when I can not control my RH, it is most of the time related to my high insuln sensitivity.

Joan said...

Hi, i am wondering if this blog is still active? I am suffering from RH and epilepsy. Currently i am doing a lot of meal experiments and monitor my blood sugar levels continuosly with a little device in my arm. I would like to hear your thoughts on my results and have a lot of data thanks to the CGM device.

Stargazey said...

Hi, Joan! The blog is currently inactive because I simply had too much work to do at work. I couldn't keep up with the blog and do a good job.

If you would like to put your results into a comment, go ahead. As long as it doesn't have an advertising link in it, and it isn't too long, I will go ahead and post the comment when I get it. Okay?

Stargazey said...

Hi again. I received your comment but won't publish it to preserve privacy. It's flattering to be called an expert on insulin response and reactive hypoglycemia, but I have to admit that I'm not. I did my insulin signalling research on dishes of fat cells in culture and came nowhere near an actual human being as a test subject. That's why this blog is mostly a review of the literature with some anecdotal information and speculation thrown in for interest. I try to label the non-peer-reviewed information clearly so that people don't mistake it for actual science.

Unfortunately I don't have any ideas about who might be able to interpret your data from a clinical standpoint, unless it might be Dr. Richard Bernstein of Dr. Bernstein's Diabetes Solution. He has an internet teleseminar on the last Wednesday of each month. Here is the link: http://www.diabetes-book.com/free-teleseminar-registration/ You can submit questions, and if they are something of general interest, he will answer them on the air. I wish you the best. Keep on with your efforts to control your RH and epilepsy, and I know you will be rewarded.