In my experience, hypoglycemia happens to most people when first beginning a low carb, ketogenic diet. It may be especially strong in people who have already developed insulin resistance or pre-diabetes from a chronic excess of carbohydrate intake.
Dr. Mary Vernon, a physician who treats metabolic syndrome and diabetes patients with a low carb diet, says there are actually two types of hypoglycemia that patients can experience.
Hypoglycemia, the first type, normally happens when most people who have been eating a high carb diet drastically reduce carbohydrate intake for the first time. This type happens during the first several weeks of carb reduction because the body has not had time to create the enzymes or metabolic state to burn internal fat stores for fuel. Basically there is a gap in the amount of carbohydrate available for fuel, and the process of accessing fat stores for fuel. The lack of fuel sources results in transient low blood sugar.
Reactive hypoglycemia, the second type, is more of an acute reaction to a very high carb meal. For instance, when a person eats 2 or 3 glazed donuts, there is a huge spike in blood sugar and insulin after such a meal. The insulin spike drives blood sugar very low afterwards.
How Reactive Hypoglycemia (or just plain Hypoglycemia) Happens
Insulin, a hormone, is secreted from the pancreas in response to eating food, especially foods high in carbohydrates. Its main job is to move the sugar your body makes from the food you eat into your cells so that this excess sugar can be broken down for energy or stored. Insulin is a very powerful hormone, and it acts very quickly. The amount of insulin your body secretes is closely tied to how much blood sugar is being created from food.
Eating a high carbohydrate diet over a long period of time will cause a chronic elevation of your blood sugar, which results in a chronic elevation of your insulin levels. High levels of insulin are associated with inflammation and obesity, mainly because when insulin levels are elevated, fat storage is increased, and burning stored fat for fuel is inhibited. It’s a sort of vicious circle - the more carbohydrate eaten, the higher the insulin, the less stored fat can be accessed to fuel the body, so more carbohydrate has to be eaten to provide fuel instead.
One of the benefits of eating a ketogenic diet is its ability to lower your average blood sugar and insulin levels, and allow the body to burn stored fat. However, when first starting the diet, your body might still be in high carbohydrate, high insulin mode.
As you lower your carbohydrate intake, you begin a process of retraining your body to burn stored fat instead of carbohydrates for fuel. Normally, it takes from 1-3 weeks for the body to adjust the new lower level of carbohydrate intake, and build the enzymes needed to burn stored fat.
Meanwhile, during this adjustment phase, your pancreas is still secreting enough insulin for the older, higher level of carbohydrate consumption. And remember, because insulin levels are high, the body is dependent on carbohydrate for fuel, since stored fat can't be accessed.
Your body hums along with less carb intake for a couple of days because it can tap into the stored carb (glycogen) in your liver and muscles. But eventually, the glycogen stores get low, more insulin is secreted than actually needed, and a couple of hours later, you have a severe episode of reactive hypoglycemia.
Your body perceives that your blood glucose is too low, and starts evasive tactics to get that sugar from somewhere. It pumps out adrenalin to tell the liver to break down some protein into glucose FAST and dump it in the blood stream.
The adrenalin causes the symptoms that are associated with reactive hypoglycemia:
- heart palpitations or fibrillation
- dizziness
- light-headedness
- sweating
- headaches
- nervousness
- irritability
- shaking and tremors
- flushing
- craving for sweets
- intense hunger
- nausea, vomiting
- panic attack
- numbness/coldness in the extremities
- fatigue and shakiness for hours afterwards
Generally, drinking or eating something that is high in carbohydrate, like orange juice or candy, relieves the majority of the symptoms after about 15 minutes. There may be some residual fatigue and shakiness for a time afterwards. (I've have episodes of reactive hypoglycemia so bad I was still shaky 6 hours later.)
In my experience, eating 1-2 glucose tablets are an easier and faster way to relieve the symptoms. When beginning a ketogenic diet, I highly recommend buying some glucose tablets or glucose drinks like the ones below and carrying them around with you. They are available at most discount stores in the diabetic supplies section.
In addition, my friend Luke, who loves rock climbing, swears by a product called SuperStarch by UCAN. He says it has helped him get past some hypoglycemic episodes when he started a keto diet. He says the product is marketed as a gluten free sports drink, and supplies sodium and potassium as well as carbohydrate to help with low blood sugar. He writes "It has really saved my bacon more than once and allows me to stay on my ketogenic diet with confidence."
I have never used Superstarch, but Dr. Peter Attia at the Eating Academy blog uses this product and he's pretty savvy about ketogenic diets and exercise.
How to Avoid Reactive Hypoglycemia
In the short term, when first starting a low carb diet, eating more frequently may help.
Long term, the best way to avoid reactive hypoglycemia is to permanently reduce the amount of carbohydrate that you eat on a daily basis.
This will eventually lower your daily blood sugar and circulating insulin. Once insulin returns to normal levels, your body can then access its fat stores, and quickly switch over to burning fat for fuel when you go without a meal or two.
During the first phases of eating a lower carb, ketogenic diet, it’s a good idea to make sure you eat every 3-4 hours. Until you can retrain your body to burn fat, don’t try to go for more than 4 hours without food.
Paradoxically, some people who experience chronic hypoglycemic reactions report that waiting 5-6 hours before the next meal actually helps reduce the reactions.
Be aware that mainstream physicians aren’t generally knowledgeable about this condition because it is rooted in nutritional causes. Doctors aren’t taught about the power of nutrition, and so he or she may minimize your concerns about it.
But if you having these reactions, it indicates you are becoming insulin resistant, and that can mean you are on a path to diabetes, even if your fasting blood sugar is normal.
You may have to reduce your carbohydrate consumption slowly over a longer period of time to minimize these reactions, but eventually, by continuing to consume a diet lower in high carb foods, you should be able to avoid reactive hypoglycemia completely.
Source
Comments:
Reactive Hypoglycemia seems to be a short term state where the body is not able to access its fat stores as efficiently as it should. Ideally, a shortfall in glucose as fuel should be very quickly matched by fat burning. But due to chronic high intakes of carbs the body has become very dependent on carb metabolism.
It may be possible to consume a lower amount of carbs a little at a time for instance reduce carb calories by 10% each week and replace these with fat calories to slowly build up the fat metabolising enzymes. I have found that when my glycogen stores are full I should not go over a certain range of carb consumption each meal as to not trigger a massive high in insulin production. Also, slowing that carb from entering the bloodstream helps a great deal with controlling the nasty symptoms associated with reactive hypoglycemia.
The steps I have taken include limiting carb consumption, picking lower GI carbs with more fibre, limiting dairy (some proteins in dairy seem to provoke a really strong insulin release), doing some strength training before a heavy meal (to make the muscles more able to absorb glucose) and drinking a couple of glasses of water with my meal to dilute the digestive enzymes (slow down the break down of the carbs) to be helpful. (Intermittent fasting seems to help to break the cycle faster - near bed time when hopefully if I do experience short term hypoglycemia I don't feel it).
The symptoms are strongly associated with excess adrenaline secretion which brings about a panicked state. Remaining calm helps as does gentle exercise and anything to calm the mind as your body gets used to burning fat and decreasing adrenaline secretion. This will take a number of weeks and more for very severe cases (people that have been very insulin resistant) or have type 2 diabetes).
It makes very good sense the brain would be affected because it is one of the organs that requires some carb to operate as it can not burn fat alone. (With a carb rich diet the brain has a strong reliance on carb but on a low carb diet the brain can slowly adapt to burn a much higher ratio of fat.) With the brain affected it can seem like real panic and have certain neurological symptoms that are more severe than they really are.
Many people that have been on a keto diet for months where the main fuel consumed is fat (carbs and protein are low and controlled) report they have very clear thinking as opposed to when they had a carb rich diet where they recall they had trouble concentrating when they missed meals. (Missing some meals should not have had such a dramatic affect unless we are very short of essential nutrients because even thin people can carry 100,000 C worth of stored fat on their bodies. Current government guidelines do not explain why this huge storage is there. Speculatively, it is likely humans have in history have had to rely on this huge tank of calories for perhaps days or weeks without eating much because food was not as plentiful or available as it is today.)
Everyone, is a little different so do what works well for you. But one thing is absolutely clear is the need to break out of the cycle.
Comments:
Reactive Hypoglycemia seems to be a short term state where the body is not able to access its fat stores as efficiently as it should. Ideally, a shortfall in glucose as fuel should be very quickly matched by fat burning. But due to chronic high intakes of carbs the body has become very dependent on carb metabolism.
It may be possible to consume a lower amount of carbs a little at a time for instance reduce carb calories by 10% each week and replace these with fat calories to slowly build up the fat metabolising enzymes. I have found that when my glycogen stores are full I should not go over a certain range of carb consumption each meal as to not trigger a massive high in insulin production. Also, slowing that carb from entering the bloodstream helps a great deal with controlling the nasty symptoms associated with reactive hypoglycemia.
The steps I have taken include limiting carb consumption, picking lower GI carbs with more fibre, limiting dairy (some proteins in dairy seem to provoke a really strong insulin release), doing some strength training before a heavy meal (to make the muscles more able to absorb glucose) and drinking a couple of glasses of water with my meal to dilute the digestive enzymes (slow down the break down of the carbs) to be helpful. (Intermittent fasting seems to help to break the cycle faster - near bed time when hopefully if I do experience short term hypoglycemia I don't feel it).
The symptoms are strongly associated with excess adrenaline secretion which brings about a panicked state. Remaining calm helps as does gentle exercise and anything to calm the mind as your body gets used to burning fat and decreasing adrenaline secretion. This will take a number of weeks and more for very severe cases (people that have been very insulin resistant) or have type 2 diabetes).
It makes very good sense the brain would be affected because it is one of the organs that requires some carb to operate as it can not burn fat alone. (With a carb rich diet the brain has a strong reliance on carb but on a low carb diet the brain can slowly adapt to burn a much higher ratio of fat.) With the brain affected it can seem like real panic and have certain neurological symptoms that are more severe than they really are.
Many people that have been on a keto diet for months where the main fuel consumed is fat (carbs and protein are low and controlled) report they have very clear thinking as opposed to when they had a carb rich diet where they recall they had trouble concentrating when they missed meals. (Missing some meals should not have had such a dramatic affect unless we are very short of essential nutrients because even thin people can carry 100,000 C worth of stored fat on their bodies. Current government guidelines do not explain why this huge storage is there. Speculatively, it is likely humans have in history have had to rely on this huge tank of calories for perhaps days or weeks without eating much because food was not as plentiful or available as it is today.)
Everyone, is a little different so do what works well for you. But one thing is absolutely clear is the need to break out of the cycle.
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