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Hypoglycemia - and Dietary Guidelines for Hypoglycemics

  [ 205 votes ]   [ 7 Comments ]
By R. Paul St. Amand, MD, and Claudia Craig Marek, MA* • • November 27, 2007

The word hypoglycemia simply means low blood sugar. It’s often used to suggest a disease, but it is actually only one symptom of a syndrome with many complaints.

This complex would be better defined by the term carbohydrate intolerance. It is expressed by the body’s inability to use certain carbohydrate loads effectively without adverse consequences.

When consumed, sugar and complex carbohydrates evoke a rise in blood sugar that triggers insulin release from the pancreas. This hormone facilitates immediate carbohydrate utilization or storage in various parts of the body. The liver converts excesses to fatty acids that are packaged into triglycerides and transported into fat cells for storage. In hypoglycemics, insulin release is either excessive, or the cutoff is inadequate, or insufficiently terminated by counter regulatory hormones.

A system-wide disturbance is created that results in one of the endocrine fatigue syndromes we call hypoglycemia.

The standard for diagnosis has been the five-hour glucose tolerance test (GTT).

This was designed to document the rise and gradual fall of blood sugar after carbohydrate consumption. A sugar solution is administered and blood samples are drawn at various intervals.

The GTT has not been very efficient in detecting the sudden fall of blood sugar levels that characterize hypoglycemia. Timing is crucial, and with a predetermined schedule for blood draws, the lowest level may be missed.

Another problem was seen in a study done in 1994 by Genter and Ipp on a group of young, healthy people who had no symptoms of hypoglycemia.1 Blood samples were drawn every ten minutes to measure the amount and time-release of various hormones that counteract insulin to prevent an excessive drop in blood sugar. One-half of the subjects developed acute symptoms of hypoglycemia near the peak adrenaline release coinciding with their lowest glucose levels. However, the symptoms occurred at glucose levels that are considered “normal.”

Obviously each person has a personal alarm system, an individual blood sugar level at which the brain perceives danger and releases adrenaline (epinephrine). For these reasons, listening to a patient’s symptoms has been more accurate in making the diagnosis than blood testing.

The symptoms of hypoglycemia (a term we continue to use) are many.

First are the chronic symptoms that are experienced even when the blood sugar is normal.

  • They consist of fatigue, irritability, nervousness, depression, insomnia, flushing, impaired memory and concentration.
  • Anxieties are common as are frontal or bitemporal headaches, dizziness and faintness.
  • There is often blurring of vision, nasal congestion, ringing in the ears, numbness and tingling of the hands, feet or face, and sometimes leg or foot cramps.
  • Excessive gas, abdominal cramps, loose stools or diarrhea are frequent.
  • The acute symptoms are frightening and occur at highly variable glucose levels, but usually three or four hours after eating. The release of adrenaline, more than sufficient for correcting the fallen blood or brain sugar, induces these distressing twenty- to thirty-minute events.

  • They include hand or internal shaking accompanied by sweating, especially with hunger.
  • Heart irregularities or pounding and severe anxiety completes the picture. The more intense bouts are labeled panic attacks.
  • Feeling faint is common and actual syncope [fainting] may occur.
  • Nocturnal attacks are often preceded by nightmares and cause severe sleep disturbance resulting in daytime somnolence.
  • Only a perfect diet will control hypoglycemia.

    It is not the food one adds, but what one removes that assures recovery.

  • Patients must totally avoid sugar, corn syrup, honey, sucrose, glucose, dextrose or maltose.
  • Heavy starches such as potatoes, rice and pasta are also forbidden.
  • We allow one piece of fruit in a four-hour period but no juice, since they contain excess fructose.
  • Certain carbohydrates such as sugar free bread are allowed but intake is limited to one slice three times per day.
  • All carbohydrates are not created equal, as can be seen by our list. You must follow the diet as written with no substitutions: for example puffed rice is allowed but not rice. Caffeine is not allowed since it prolongs the action of insulin.

    Improvement begins in about seven to ten days of beginning a perfect diet.

    Considerable relief is afforded within one month. Symptoms totally clear within two months but only if the diet has been carefully followed. During the first ten days of treatment, headaches from caffeine withdrawal and the fatigue induced by changing the body's basic sources of fuel are common and in some patients can be fairly intense.

    Consider the entire dietary process as if one were building a checking account.

    First, deposits must be made to obtain sufficient funds. Only at this point should one begin writing checks, but with the understanding that balances are lowered with each one written. Similarly, the hypoglycemia diet builds energy reserves to the highest amount attainable for a given individual. Only then can carbohydrate experimentation begin. Each "cheat" draws on the credit line.

    Since no physician or dietician can predict the final baseline diet, this hunt and peck system is necessary for each patient. The first warning of an excess may be spotted with the reoccurrence of any of the above hypoglycemia symptoms. A stricter diet may again be required to rebuild credit, or to meet demands for added energy at times of emotional or physical stress such as during the week premenstrually.

    Some hypoglycemics also suffer from Fibromyalgia

    Symptoms overlap greatly but not the acute ones listed above. Fibromyalgia is a generalized metabolic disturbance that includes contracted, working muscles, ligaments and tendons, which constantly burn fuel. This is the subject of another paper we have written. Predisposed individuals with Fibromyalgia may attempt to create energy by yielding to their carbohydrate cravings. The resulting repetitive insulin bursts can tip them into hypoglycemia. Patients with both conditions [which Dr. St. Amand has estimated at 30% of women and 15% of men with FM] are among our sickest.

    Dietary Restrictions the Hypoglycemic Must Follow


  • Alcohol (for one month)
  • Sugar in any form, including soft drinks
  • Fruit juices and dried fruits
  • Baked beans
  • Black eyed peas (cowpeas)
  • Garbanzo beans (chickpeas)
  • Refried beans
  • Lentils
  • Lima beans
  • Starch
  • Potatoes
  • Corn (limit popcorn to one cup)
  • Bananas
  • Barley
  • Rice
  • Pasta
  • Burritos (flour tortilla)
  • Tamales
  • Caffeine, Dextrose, Maltose, Sucrose, Glucose, Honey, Corn Syrup, Rice Syrup, Cane Syrup, Fructose
  • No compromise is allowed with the diet for the carbohydrate intolerance syndrome.

    One must eat correctly or symptoms continue. The reward of well-being is exhilarating when contrasted with the disabling symptoms of hypoglycemia. It is yours to control. n

    * * * * *
    For detail on foods that can be eaten, see: “Diets for Hypoglycemia” by Dr. St. Amand.

    The compact, printable diet charts that Dr. St. Amand has created list foods from which to choose in nine food categories, subject to individual differences in food tolerance. There is:

  • A “Strict Diet” - for those who wish to lose weight, and
  • A “Liberal Diet” - for those who wish to maintain weight. The liberal diet chart lists foods that may be added to the strict diet.
  • ___
    * This material is excerpted with generous permission of the authors from their book What Your Doctor May Not Tell You About Fibromyalgia (Hachette Books, 2006) CR. Paul St. Amand, MD, and Claudia Craig Marek, MA.

    1. ”Plasma glucose thresholds for counterregulation after an oral glucose load,” Metabolism. 1994 Jan;43(1):98-103. PMID: 8289681, by Genter P, Ipp E. Department of Medicine, Harbor UCLA Medical Center, Torrance, California, USA.

    Note: This information has not been evaluated by the FDA. It is not meant to prevent, diagnose, treat or cure any illness or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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    Article Comments Post a Comment

    Hypoglycemia - and Dietary Guidelines for Hypoglycemics
    Posted by: squirt
    Dec 5, 2007
    Excuse me, but I have to disagree with these guidelines for hypoglycemics. I have been borderline hypoglycemic since I was a teenager and am now 62. This drastic deprivation of carbohydrates is just simply uncalled for. In looking back at my life, it has been the times of low carbohydrate dieting that have been worst in giving me the feeling of well-being. And I was a faithful, determined patient in following the protocols. What HAS worked for me has been a program that emphasizes free use of all fresh fruits and vegetables (the 1's, 2's and 3's of the food scale) moderate use of whole grains, breads, flour, cereals, rice, pasta, fish and lean meats(4's, 5's and 6's), limited use of high-fat meats, refined sugars, packaged and processed foods (7's, 8's, and 9's), and occasional use of fats, nuts and avocados (10's). I am now eating anywhere from 35 to 100 one-cup servings of fruits and vegetables per week, using protein shakes to replace 3 to 5 meals per week, exercising on a regular basis (swimming laps), and staying as close as possible to whole and organic foods while avoiding frozen meals/entrees, high sodium, packaged foods, and especially products with high fructose corn syrup. Following a balanced NUTRITIOUS food plan like this has given me energy, a sense of control, and a life of purpose. That does not mean I am pain-free and never feel fatigued. I still have cycles of pain; on occasion I still find myself falling asleep while reading a book in the afternoon; I sometimes feel sorry enough for myself that I spend the day, or even 2 to 3 days, grazing my way through the day in the pantry and the fridge. But the food I make available for myself is unadulterated, fresh or freshly made, using recipes converted to low-fat, sugar free or substituted with organic sugars. To me, that is the key to good health: eating unadulterated fresh and freshly made foods that are full of natural nutrients in amounts that make our bodies work at optimum levels. Let's strive to make eating a joyously natural and healthful exercise, not a loathsome burden. Winning With Nutrition, Donna Busto Molalla, OR
    Reply Reply

    Posted by: jaegersmom
    Dec 28, 2007
    I agree with you. I do have a weight problem that I would like to address as well as fibromyalgia. Do you have any of these symptoms and has the diet that you suggest helped you? And, I'm new to organic and whole food concept...where does one find places to shop for these things?

    Joan, Bloomington MN


    Posted by: goddesslunacy
    Dec 6, 2007
    What a terrible existance to live on a diet like this...sugar makes me feel good not bad. I'd rather live life to the fullest than suffer by depriving myself. I love food, fresh food, fruit, juice, chocolate, etc. I thought I ate healthy compared to nearly everyone around me, but apparently I have to starve myself and exclude any joy of eating or taste. There has got to be another way. I refuse the accept this as the only solution.
    Reply Reply

    Posted by: musiclvr
    Dec 7, 2007
    I am dismayed that the hypoglycemia food list posted here by these experts includes aspartame (Nutrasweet). Believe me I know, oh-so-well, how pleasant sugar can be, and how deprived one can feel - and how difficult it can be - if sugar is not allowed. However I thought it was well-known and generally accepted that aspartame is toxic and should be avoided. I personally will not consume it. There are better alternatives.


    Posted by: kjschlotte
    Mar 27, 2008
    I disagree with the above, Since changes my diet, i feel great, i no longer have the hot flushing in my face, the frontal lobe migranes, the ringing in my ears the bloating and since december i have lost 30lbs and i am not trying just following this.
    Reply Reply

    The Food List
    Posted by: fjaril
    Feb 2, 2012
    I'm hypoglycemic and reading this is NOT the end of the world. So what if you like sugar, obviously you also like being fat or crashing mentally after the sugar wears off.

    Bottom line, you need a balance of carbs (about 14 grams to protein (about 7-9 grams), and you feel fantastic. Fruit and veggies are great, but we need protein with those. I have no issue cutting out starches and white sugars, nor do I alcohol or sweeteners. Fake sweeteners will spike insulin levels as much as real ones, you are safer eating real sugar, even then if you are hypoglycemic, why would you want to??? Caffeine never made me feel great, neither did pop.

    I'm okay with this list, sans beans, I think beans in very small amounts are fine, same with fruits. Bottom line is portion control, how often you eat, and keeping the foods natural - being educated on what foods have what in them, and what a normal portion size is. Too many people freak out when they read things like this, I find it a good thing, and just another piece of research to add to my knowledge of this condition.
    Reply Reply

    Post a Comment

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