Managing Hypoglycemia – Basic Guidelines (Part I)

As must be abundantly clear so far, hypoglycemia is a very complex syndrome that most doctors don’t understand, don’t treat and which many believe to be the product of a troubled mind.

This is the bad news.

The good news is that treatment is easy and you can manage it yourself if you are unable to find medical help. Best of all, the treatment is without risk, whether or not you actually have hypoglycemia because the treatment is a change in diet.

The diet of the western world is a nasty combination of sugar, refined flour (mostly wheat) and more sugar. One study suggests that Americans eat on the order of 1/4 pound of sugar every day while another source quotes the amount as 100-120 pounds each year! The Canadian diet is very similar, so I wouldn’t be surprised to find similar numbers for all of North America.

Hypoglycemia can be the precursor to Type II diabetes and other insulin resistance related ailments, but in less than a year you can turn around the course of your hypoglycemia, and perhaps avert many of the other serious conditions that may be lying in wait. The best news of all is that this diet can improve the health of everyone in your family, and possibly help you live longer.

Don’t be fooled. This is not a weight loss diet – you won’t be counting calories or weighing your food. You will, however, increase the variety of what you eat, and learn some new recipes! And, as a side benefit, if you are overweight, you will probably lose weight because your metabolism will begin to work much more efficiently.

Is there a cure for hypoglycemia?

Hypoglycemia is a combination of symptoms, and may itself be a symptom. If this were the case, a “cure” would have to remove the underlying condition causing the hypoglycemia. With drug-induced hypoglycemia, this is easy, assuming that you are willing and able to stop using the medication causing the problem. If tumours of the pancreas are causing your hypoglycemia, removal of the tumours will effect a cure, since the amount of insulin produced would no longer overshoot your food intake and you would no longer have incidents of low blood sugar.

Alcohol induced hypoglycemia can be a short term problem, caused by drinking a mixed drink while eating straight carbohydrate, like a cookie, perhaps, and this episode of low blood sugar will end after the alcohol is out of your system. If, on the other hand, your drinking is chronic, the hypoglycemia is often chronic as well, and following the hypoglycemia diet while reducing your alcohol intake could control, and eventually “cure” your hypoglycemia. Studies suggest that following the hypoglycemia diet may actually reduce the craving for alcohol, so controlling your diet will be helpful and can improve your chances of success in a stop-drinking program.

If you have alimentary hypoglycemia, caused by stomach surgery, there would be no cure unless the surgery was reversible. If you have had stomach surgery in which the size of your stomach has been reduced, your diet has already changed drastically, and it will be very important to make sure that the small amounts of food you are able to consume are as nutritious as possible. In this case, supplementing with fiber may help normalize your blood sugar, but more study is required. [All about vitamins, minerals and herbal supplements in the next article.]

In most cases, the cause of the hypoglycemia is never found. For those unexplained cases, some doctors believe that there is no cure and that the best you can hope for is to reduce your symptoms. Other doctors, often those who have made a study of hypoglycemia, believe that the proper diet, used consistently, can actually improve your metabolism and “cure” your hypoglycemia. It might be argued that you are not cured if you must continue the treatment for the rest of your life, but consider this: would you say your Ferrari was a lemon just because it only runs properly on the best possible fuel?

What can I do to feel better?

The most important change to your lifestyle will be your diet. Since hypoglycemia is an indication that your body doesn’t deal well with sugar, the first thing to do is eliminate sugar from your diet. Sounds strange, doesn’t it? If I have low blood sugar, shouldn’t I eat more sugar to feel better?

The body runs on sugars, and it gets them by breaking down all of the carbohydrates you eat. When you eat simple carbohydrates, (sugar, white breads, fruit juice), your body has to do very little to gain access to the sugar, and you will have a sudden “sugar boost”. In hypoglycemia, your body has a tough time keeping the blood sugar level stable, so when the sugar is “used up”, there is nothing left and you may experience a sugar crash.

By choosing to eat complex carbohydrates instead (whole grains and protein, for example), you will find that your body breaks down the food much more slowly, and the sugars are released into your blood stream more slowly, too. This will help you to keep your blood sugar stable for longer periods, reducing, or even eliminating your symptoms.

Changing your Diet

There are many different recommendations for hypoglycemia diets. Some gurus advocate low carbohydrate diets with lots of protein, while others seem to be advocating the exact opposite – a high carbohydrate, low protein diet. In spite of these large differences, the basics of the hypoglycemia diet are all the same. And the first step is to eliminate sugar.

Avoid Sugar

Sounds difficult, but paradoxically, once you stop eating sugar, the sugar cravings begin to lessen and the sugary snacks and desserts just look less attractive. Taste is learned, and after a couple of weeks without sugar, you will probably find that sweet foods you once liked now taste too sweet, and you no longer enjoy them as much. This is a big bonus, because it makes sticking to the new regimen much easier.

It’s not enough, though, to forgo desserts. Most processed foods contain sugar. Mayonnaise, peanut butter, granola or snack bars, canned fruit and fruit drinks often contain sugar – in some cases a lot of sugar-and these should be avoided as well. When you start checking labels, you may be surprised to see how much sugar you have been eating every day.

What is a good indication of whether or not you should eat it? Ask yourself “Does this taste sweet?” If the answer is “Yes”, you should probably avoid eating it or eat it only sparingly. This includes sweet fruit like bananas and watermelon.

Dr. Ross, in Hypoglycemia, recommends avoiding everything sweet tasting. His logic is that, to remove all craving for sugar, we should avoid all things sweet. He even suggests avoiding sweet fruit such as apples and raisins for at least the first month or two of your new diet. It is best not to switch to sugar subsitutes like aspartame. It is much easier to maintain a sugar free diet if the taste for sugar is gone. In addition, some studies show that release of insulin can occur even with just a sweet taste.

Whether or not you are hypoglycemic, cutting sugar out of your diet will probably be a positive change. The point of removing sugar is to slow your body’s response to food, so that your blood sugar stays more constant. Most hypoglycemics report that they feel much better if they reduce their sugar intake to zero.

Avoid Caffeine

Caffeine often improves the symptoms of hypoglycemia, at least temporarily, so it can be tough to remove it from your diet. If you are a caffeine addict, and just can’t get through your day without it, it is likely that a sugar stabilization diet will help you reduce your caffeine cravings.

Caffeine stimulates release of stored sugar into your blood stream, so you will feel better for a while, but your blood sugar will drop abruptly again once the effect of the caffeine wears off. As my nutritionist, Dr. Todd Norton, once described it, “In asking the glucose-bearing cells to release sugar, insulin knocks at the door. Caffeine, on the other hand, simply kicks the door down!” Another reason that you get a boost from caffeine is that it stimulates the adrenal gland. This makes your heart beat faster and raises your blood sugar. Excess caffeine also puts stress on your kidneys, and flushes minerals like selenium, manganese, zinc, calcium and magnesium from your body.

My first response was, “So what-I really feel better. I neeeeed it!” Caffeine, like sugar, causes a roller coaster of sugar highs and lows. I know that after I drink caffeinated drinks, I find that I am constantly hungry the next day or two and it takes me a couple of days of proper eating to get back on track. As you learn to regulate your blood sugar by changing your diet, even your cravings for caffeine will subside.

Quit Smoking

I know, I know now I’ve really gone overboard! We have been hearing for years that nicotine will kill you and we have all lost people important to us. What you, as a hypoglycemic, need to know is that nicotine also has an effect on blood sugar. Nicotine, like caffeine, activates the adrenal gland. Your heart speeds up and your blood pressure rises and you get that much-needed boost. Although butting out may be much more difficult than eliminating caffeine, you will find that as you change your diet and begin to feel better, your cravings for nicotine may also slowly begin to subside. Quitting still may not be easy; after all, cigarettes become a habit based on more than the nicotine addiction. As your blood sugar begins to stabilize, you will find that it will be easier to taper down and smoke fewer cigarettes per day.

Avoid Alcohol

Alcohol, like sugar, contains nothing but calories. It has no nutritive value at all and moves very quickly into your blood stream. This affects your blood sugar very suddenly, and there is a corresponding drop in blood sugar as the alcohol leaves your system.

The problem of maintaining a constant blood sugar level is common to both hypoglycemics and diabetics. For diabetics, the insulin injected must compensate for the food and drink consumed. An old friend of mine, an insulin dependent diabetic, once told me why he avoids alcohol.

Roy said, “It’s a challenge to figure out how much insulin I will need to match my food intake and the amount of exercise I do. I have a routine that includes a standard, no sugar diet, and lots of exercise every day. I plan my food so that I eat the same amounts at the same times of day, and I get my bike out for an hour every evening. And I don’t drink – it’s just too difficult to get the insulin right to compensate for it.”

In diabetes, you can control your sugar level with injected insulin -in hypoglycemia this is not possible, and if you eat and drink foods that play havoc with your blood sugar level, you just have to live with the symptoms. It’s much better then, to avoid the booze and the feeling rotten that comes with it.

Keep in mind that many medicines also contain alcohol. One woman told me that she even had trouble with her allergy shots, and found out that they contain alcohol! She had to find an alternative way to deal with her allergies.

Switch to Complex Carbohydrates

All foods sit on a continuum that relate their sugar content to how fast they are used in your body. This is called the Glycemic Index. We’ll explore this more in another article, but a quick introduction here.

In order to keep your blood sugar constant with as few peaks and valleys as possible, you need to slow the rate at which your body converts your food to the various kinds of sugar used and stored in your body. The best way to do this is to eat foods that, in addition to supplying all the right components of nutrition, burn very slowly.

Since the goal is to slow the rate at which your food is broken down, it is important to avoid fast burning, high glycemic foods (starting with sugar), but also including refined foods. This includes white flour, white rice, and other refined and polished grains and seeds.

The breads category of your new diet will include only whole grain breads, brown rice, and other grains such as quinoa and millet-complex carbohydrates. Lots of vegetables will fill out the balance of your intake with the occasional piece of fruit added for variety.

And when you eat fruit and vegetables, eat them raw and with the skin as often as you can. Peeling removes much of the fibre and many of the vitamins and minerals, and cooking results in the loss of most of the vitamins into the water.

Even potatoes, a staple for most of us, should be used in moderation only. Try switching to sweet potatoes for variety-believe it or not, sweet potatoes actually break down more slowly than ordinary white potatoes. The “sweet” in sweet potato seems to be a misnomer!

Choose Balanced Snacks and Meals

When my daughter was diagnosed with low blood sugar many years ago (on the basis of one blood sample!) the advice of the doctor was simply this “Make sure she eats protein with every meal and snack!” I have followed this advice for myself and both of my children ever since and I have found that for myself and for my hypoglycemic daughter, in particular, this makes a huge difference. Where I used to snack on an apple, I began adding a small piece of cheddar cheese. Instead of a cookie, I would give my daughter yogurt. When she was diagnosed, she was in a “chicken noodle soup phase”, and that is all she would eat, so I added small amounts of diced, cooked chicken.

I have found that the most effective meals and snacks, effective being the measure of how I felt and how long before I was hungry again, contain moderate amounts of carbohydrate, protein and fat. Protein, like complex carbohydrates, takes time and effort to break down.

Here are some good snacks that contain all three:

Fruit and cheese or yogurt Nuts (no peanuts for the first few months of your diet)

Crackers with nut butter (almond butter or peanut butter)

Whole wheat pita bread or whole grain crackers with hummous (a mixture of chick peas, sesame seed paste and garlic)

Half of a whole grain bagel with cream cheese

Whole grain crackers with avocado and a dash of salt and lemon juice. Avocado is a wonderful food for hypoglycemics because it is a source of many essential fatty acids plus beneficial vitamins and minerals.

A tofu shake with fruit

A small salad with cheese and/or nuts and sunflower seeds and/or diced chicken

In all of these examples, there is a good balance of protein, carbohydrate and fat, and all will lengthen the time before you need to eat again. Before I started the hypoglycemia diet, I was hungry almost all the time and it really affected my ability to concentrate. After learning to snack properly, I now find that I can really get down to work and not think about food all the time. In another article, we’ll discuss more meal and snack ideas and I will include some recipes. The hypoglycemia diet doesn’t have to be colourless and restrictive.

Not all of these snack suggestions will work for you-experimentation will tell you which snacks are most satisfying and long lasting. Keep in mind, too, that some of these foods may also cause allergic reactions. Experts say that the top allergens are wheat, corn and dairy, and of course, peanuts, and you may not even know you are sensitive to these foods unless you stop eating them for a while. Allergies and food sensitivities are common in hypoglycemics, and we will explore the subject of hypoglycemia and allergies in a later chapter. If you are vegetarian, this will also affect your food choices, but the rules stay the same-protein, carbohydrate and fats every time you eat.

Eat Small Amounts Frequently

Many hypoglycemics feel hungry more often than other people they know do. Follow your appetite. If you find that you begin to be hungry, or you often feel unwell about 3 hours after a meal or snack, plan to eat every 2½ hours. If you have symptoms 2 hours after eating, plan your snacks and meals to occur at 1½-hour intervals.

Even when you feel very hungry, stick to small meals and snacks. You may find that the amount of food you eat really doesn’t affect how long you can go before you need to eat again, so eating more than just enough to satisfy you will lead to weight gain.

As your metabolism changes, you should find that you are able to increase the intervals between “feedings”-just make sure you continue to eat nutritious, complex carbohydrates with proteins and fats.

Keep in mind that the three-meal-a-day model will probably never work for you. Some people may be able to tolerate it, but everyone would probably function better with more small meals. What you will be able to do is wait for a meal or skip a snack occasionally, without the serious symptoms you experience now.

If you believe you or someone you care about has hypoglycemia and you’d like to learn more, read the next installment: Managing my Hypoglycemia – Helpful Supplements (Part II). Part II will discuss the dietary supplements we need to help get hypoglycemia under control.