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.
I find quinoa gets me to the bathroom quicker than when I was eating rice. I am thinking of trying sweet potatoes fried in coconut oil. Not fan of baked or boiled potatoes. Some frozen ones I see in stores actually contain wheat.
re: … thinking of trying sweet potatoes fried in coconut oil.
Cooked sweet potatoes are 18% net carb, 6% sugars. A whole small one, or half a medium can consume the majority of the meal’s 15 ram net carb budget.
re: Not fan of baked or boiled potatoes. Some frozen ones I see in stores actually contain wheat.
If a product has an ingredients list, you have to read it, the first time you buy the it, and from time to time thereafter.
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The pancreas releases insulin into the blood in response to elevated blood sugar. The insulin acts as a vehicle, causing fat cells and other cells to absorb the glucose. But the pancreas also releases insulin in response to endorphin, the body’s natural opiate pain killer. Muscle cells release endorphin during extreme exertion, like during fight-or-flight response. The insulin prevents muscle cells from destroying themselves.
Gluten A5 and B5 are opiates which mimic endorphin. In the presence of grassy grain peptides the pancreas releases excess insulin without any rise either in natural endorphin or in blood sugar. People have greater and lesser insulin responses to A5 and B5.
The excess insulin causes cells to over-absorb blood sugar. High blood sugar can be a problem for anyone. Low blood sugar is only a problem for carb-adapted people. Fat-adapted people can have low blood sugar with no ill effects. The biggest blood sugar problem comes not from low blood sugar, but from the fast drop in blood sugar.
Like you, Dr., Davis, I suggest, instead of medicating with sugar, that people stop ingesting grassy grains and sugar.
Are you hypoglycemic based on an accurate BG meter reading or do you just “feel” hypoglycemic? If it is the latter, note that the symptoms of dehydration and low electrolytes are similar to those of hypoglycemia – try a cup of salty broth to see if they clear up before you start carbing up.
And in the meantime, the dangerously useless ADA is re-arranging deck chairs on their sinking T2D cruise ship.
http://care.diabetesjournals.org/content/38/7/e98.full.pdf+html
“… this pilot study suggests that improvement in glycemia may be achieved by optimal timing of carbohydrate ingestion during a meal.”
Yes, you too can reduce your frankly diabetic 169 postprandial spike to a mere borderline diabetic 141 by re-ordering how you eat the standard lethal ADA-approved meal.
Hey, ADA, how about we skip the hi gly carbs altogether and keep the BG under 100 indefinitely?
I have a related issue. Before I started WB I could guzzle six pops without a problem. Now, as my weight has come down, so has my alcohol tolerance, to the point that one drink leaves me a little woozy. Is this normal?
re: Now, as my weight has come down, so has my alcohol tolerance, to the point that one drink leaves me a little woozy. Is this normal?
Although the WB books don’t mention it, a quick web search shows that it’s a well-known phenomenon of low-carb generally, and especially ketogenic diets, with search results going back over a decade.
You can find conflicting theories of action. One thing that is clearly the case is that alcohol tolerance in any individual scales with body weight. Make no other change in diet, lose weight, and tolerance declines.
Further theories conjecture faster absorption, and various liver effects, including possible BG depression (not sure I buy that last bit).
Look on the bright side – the bar budget is competing for a lot less of your income now.
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