Laura Schoenfeld: Reactive hypoglycemia tends to be an issue where the person is having either an over-response of insulin to the amount of carbs that they’ve eaten or they just didn’t eat enough carbs to get the blood sugar where it needed to be after the meal. Honestly, a lot of my clients that have reactive hypoglycemia, the reason that they’re having that is because they’re eating too much protein in their meal and not enough carbs. Carbs are one of the main macronutrients that cause insulin release when you’re eating. However, protein can also stimulate insulin release, so if you’re eating a very high protein, low-carb diet and you have all this insulin release after you eat because of the protein but you don’t have the carbs in there to actually provide glucose to the blood, then that can cause an overproduction of insulin for the amount of glucose that you actually get from that meal. That’s something that I see happening a lot in my clients that have more of a Paleo diet.
The other potential issue is if somebody who’s on a pretty Standard American Diet and eating a lot of carbs and not having fat or protein is that they’re going to have a much higher glycemic index response to their meal because you have a lot of carbs and not a lot of protein or fat actually to buffer that glucose absorption from the food that they’re eating. So they have a big spike in blood sugar, and then they have a high release of insulin, and sometimes the insulin can overshoot, and then what happens is you get too much of a drop of blood sugar, and that’s when you get that reactive hypoglycemia.
It depends on where the person is coming from. If they’re coming from a Western diet, which is potentially very low in fat and higher in refined carbs and maybe also they’re undereating, which I know sounds a little bit strange to say undereating could cause reactive hypoglycemia, but if the body is relying on carbs for its primary source of fuel and the person is not giving them enough carbs even on a higher carb percentage diet, then that can cause reactive hypoglycemia, as well, which is super common in women because, as we know, women tend to try to eat a lot less than men typically do. So if I’m looking at a patient’s diet, again, if they’re on more of a Western diet, I’d want to make sure that they’re eating enough food, in general. I’d want to make sure that they’re getting some protein and some fat with those carbs. It doesn’t have to be a ton of fat, and actually I would discourage copious, unrestricted fat being added to carbs because typically that’s going to make people gain weight, and it can actually also make someone’s blood sugar stay elevated for a longer period of time than if they had a lower fat intake with those carbs. However, you don’t want to have, like, a 100 percent fat-free, super-high-carb meal or these liquid sodas and that kind of stuff that are liquid carbs that get absorbed very quickly, and that can cause reactive hypoglycemia. That would be more of a Western diet patient.
If I have a patient that’s coming to me from more of a Paleo diet approach, which is my typical patient population, I’m going to, again, look at the calories that they’re eating because if they’re undereating that’s going to be a much more likely situation that they’re going to be having hypoglycemia than if they actually get enough calories. Then the other things I’m going to look at is the amount of carbs they’re eating compared to the amount of protein and fat they’re eating. Unfortunately, a lot of people, when they do low carb, they end up doing a super-high protein intake. They eat a lot of fat, but they’re not doing a very high-fat, more of a ketogenic diet when they’re doing low carb. And what can happen, like I said, the protein stimulates the insulin response, but they’re not getting enough carbs to actually get the proper insulin and carb balance, and then that’s when they’re going to have some reactive hypoglycemia.
Again, in a patient that’s on more of a Paleo diet, I’m going to have them probably add carbs. I’ve actually been experimenting with a lot of patients going on a more high-carb diet than would even be typical with Paleo, so looking at 40 to 50 percent of calories from carbs instead of that 20 to 30 percent range that is more typical with Paleo, and that’s actually been really helpful for a lot of my clients. It is something to consider if you’re having a client with reactive hypoglycemia to see, first of all, are they eating enough total? And then also consider adding more carbs to their diet if they’re on a low-carb diet and they’re having reactive hypoglycemia. It is something that people who are transitioning from low-carb to a higher-carb diet might experience, as well. It’s one of those things that you have to give it a couple of weeks before the person is fully transitioned back to a higher-carb diet, but you want to make sure that the total amount of carb intake is going to be enough that the body is not dipping too low on blood sugar because that can cause a lot of problem, as I’m sure you’ve experienced.