The truth about hypoglycemia

I’ve received this question a number of times over the years:

“I have episodes of hypoglycemia that make me really tired, foggy, and shaky. My doctor says to drink a glass of orange juice or eat some candy immediately and it works. But what should I do on the Wheat Belly lifestyle?”

First of all, let’s put aside hypoglycemia–low blood sugars, generally 70 mg/dl (3.8 mmol/L) or less–that occurs in people with diabetes. In diabetics, it is a matter of making adjustments in insulin or other medications, or avoiding blood sugar drops during exercise, sleep, or prolonged periods of not eating. I’m not talking about this kind of hypoglycemia. I’m also not talking about very rare causes of hypoglycemia, such as insulinoma (a form of pancreatic cancer), binge drinking, antibodies against insulin or the insulin receptor in people with lupus, people who have undergone gastric bypass surgery, or have rare inherited carbohydrate metabolism defects such as glycogen storage diseases. Put all of that aside.

I’m talking about the common, everyday form of hypoglycemia that plagues non-diabetic people and is responsible for symptoms such as fatigue, mental “fogginess,” confusion, slurred speech, trembling, rapid heart beat, irritability, and sweating. This form of hypoglycemia–“reactive hypoglycemia”–typically occurs about 90 minutes to 3 hours after eating (varying depending on the composition of the meal and the vigor of your insulin response).

The conventional “solution,” as in the question above, is to consume some source of sugar, usually 15 to 25 grams worth. Once you understand why hypoglycemia develops, however, you will understand how knuckleheaded that solution is.

Outside of diabetes, some diabetes drugs, and the rare causes of hypoglycemia mentioned above, hypoglycemia virtually always follows hyperglycemia. In other words, low blood sugar is nearly always preceded by high blood sugar. Hypoglycemia is most likely to occur in people who have insulin resistance and pre-diabetes who produce three-, four-, or five-fold greater quantities of insulin than normal. So the blood sugar roller coaster ride starts with a meal containing carbohydrates, resulting in a high blood sugar that triggers release of excessive insulin. Blood sugar is cleared from the bloodstream by insulin (and converted to fat) but the effects of insulin persist, dropping blood sugar to low levels, generally below 70 mg/dl. At this point, consuming sugar does indeed raise blood sugar back up and provide immediate relief of the symptoms–but the process can start over again, not to mention can also add to the insulin resistance/pre-diabetic situation and cause weight gain.

So consuming sugar is no more a solution to hypoglycemia than taking a swig of bourbon is a treatment for alcohol withdrawal. There are indeed times when sugar is necessary to recover from a hypoglycemic episode, but this is virtually never necessary in non-diabetics. Sugar does not treat the cause; it only sustains the problem.

The solution: Don’t consume foods that raise blood sugar. This keeps the process from ever being triggered. No hyperglycemia; ergo no hypoglycemia. It’s that simple for the majority of people. If your blood sugar by a fingerstick check was 100 mg/dl, the 30-60 minute later blood sugar peak should be no higher than 100 mg/dl. If checked at 1,2, or 3 hours afterwards, you should still see values of around 100 mg/dl–no hypoglycemia. A person following the awful advice to solve their hypoglycemia symptoms with sugar would see something like this: blood sugar before meal 100 mg/dl; 30-60 minute after-meal peak 140 mg/dl; 2 hour blood sugar 70 mg/dl–shakiness, anxiety, fatigue, etc. Drink 6 ounces of orange juice: blood sugar 135 mg/dl and the cycle repeats, insulin resistance/pre-diabetes is worsened, and you gain some weight.

When you do consume carbohydrates that raise blood sugar, do so in small quantities, as advised in the Wheat Belly books and in this Wheat Belly Blog post, Can I Eat Quinoa? Carb Counting Basics. If you adhere to the Wheat Belly carbohydrate management approach, coupled with the insulin-normalizing strategies of vitamin D, magnesium, fish oil supplementation and cultivation of healthy bowel flora, hyperglycemia does not develop, therefore hypoglycemia no longer follows.