Hypoglycemia

I have been diagnosed with hypoglycemia. My doctor put me on a diet that did not seem to work well (high carbohydrate). Recently, I have consulted a Registered Dietitian who has put me on a strict regimen to get some baseline results. She has put me on a no-sugar, hi-protein, low carbohydrate diet (no wheat products, pasta or rice; eating lots of seeds and nuts, vegetables, protein; eating fats-butter or oil with starches such as quinoa, amaranth, millet, potatoes, etc.). I'm wondering if this is a good way to start, because I am frustrated with the limited food choices I have. Also, she has told me that planning to get pregnant until the problem is brought under control may be a bad idea. Can you give me any insight into these issues?

Your doctor was incorrect and the dietitian is following the current medical nutrition therapy for hypoglycemia. She needs to find a baseline amount of carbohydrate that will produce no or infrequent symptoms while providing you with the nutrients you need to meet your Recommended Dietary Allowances. Since hypoglycemia symptoms are in response to food, you should be able to stabilize your blood sugar by regulating your carbohydrate intake.

It appears that your dietitian is concerned about the glycemic index of carbohydrates as well. The glycemic index is a list of how certain carbohydrates effect blood glucose. Those with a high glycemic index cause a greater rise in blood sugar. Those foods with a low glycemic index have a low rise in blood sugar. Ask your dietitian about a glycemic index for foods.

Low blood sugar reactions are hard on a fetus's brain, as that is the organ that uses the most amount of glucose. I don't have any current references regarding stabilizing hypoglycemia during pregnancy, but doesn't it make sense that you follow a healthy diet to develop a healthy baby? It is a good idea to get your hypoglycemia under control, but I would discuss getting pregnant with active hypoglycemia with your gynecologist. For some women, the hormones of pregnancy can increase blood sugar levels above normal to the point that some people with normal glucose metabolism become diabetic during pregnancy.

Because of limiting carbs, you may feel like you have few choices, but as your symptoms stabilize, your carbohydrate will be increased to the point where you start having more episodes of low blood sugar. At that point is the threshold of carbohydrate that your body can tolerate without having low blood sugar reactions.

I am really enjoying your web page.

I just recently graduated from Junior College as a Dietetic Technician. But I am not ending my education as a DT. I am starting at the University in the Fall to become a Registered Dietitian. Through my two years of training I had never seen so much information on hypoglycemia.

I am a hypoglycemic and for the last 6 to 9 months, have really had a problem with my blood sugar being so low. I told my doctor and he pretty much told me to do something about it. He said I knew best! I couldn't believe he said that, typical. So I read what you had to say about it and have followed a diet of 45% carbohydrate, 25% protein and 30% fat with 1500 calories. I need to lose weight also but, I feel great! My blood sugar has stabilized no more shakes! I know the protein is a little high. I didn't eat much meat before, mainly carbohydrates. What a mistake!

I have been walking 2 miles a day also. Anyway, I think you are doing a great job!!

Sound like you have learned how your body handles carbohydrates and have adjusted to a reasonable diet to achieve your health goals. You're consuming about 169 grams of carbohydrate a day, so you must have your hypoglycemia under control. How do you keep track of your food intake? How do you monitor your protein and carbohydrate content? Do you use the exchange list or computer software?

There is a lot of misinformation on the Internet about hypoglycemia, so beware of persons without nutrition credentials, testimonials (it worked for me, so you should try it too) or selling dietary supplements.

Good luck with the DT exam and your continuing dietetic education! Thanks for your kind words.

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I notice there is nothing in your topics about the failure of the adrenal glands because of Addison decease. I was assumed to have anorexia because of an inability to eat and it took ten years of suffering before I was finally diagnosed correctly and my life literally saved. Why isn't this disease looked at more often with the inability to eat?

Anorexia means the loss of appetite. To the public, anorexia more often refers to girls who restrict their food intake willingly. That disease is called anorexia nervosa. Loss of appetite and resulting weight loss should always be investigated until a cause is found.

Typically the nutritional symptoms of Addison's disease can be hypoglycemia due to the body's inability to create new glucose from amino acids and fat. Sodium levels in the blood may also be low which may have to be corrected immediately using intravenous solutions. Weakness, feeling faint when standing up quickly and pigmentation where tissue-overlying skin is thinner are early symptoms. Weight loss is one of the later developing symptoms. Because the disease can be slow to develop, a misdiagnosis of psychological cause may be made. The treatment is usually with cortisone or steroid compounds and no specific dietary recommendations unless the steroids cause secondary problems.

By the way, the information in my nutrition topics is the result of people asking questions. No one has asked about Addison's disease before. Thanks for asking.

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I would experience low sugar spells before the following control habits. I have been on a dietitian planned diet (6-7 small balanced meals) and exercise daily. Immediately after I eat, I feel extremely heavy in my head and very sluggish. It takes 30-45 minutes for the feeling to subside, before I feel fine again. Could this be glucose related ? What do I need to do ?

First, have you discussed your symptoms with your dietitian and what has she recommended?

Do you also feel weak and shaky like you are going to faint and break out in a sweat without expending any exercise? Or is the heavy head and sluggish feeling unrelated to low blood sugar?

Sounds like you may be eating too much food at one meal. Without changing how much or when you eat, I would suggest you keep a record of what you eat for the next three days. Show these food records to your dietitian who can evaluate your meals for calories and carbohydrates.

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Is there a proven hypoglycemic diet which does not result in weight gain with moderate exercising?

What hypoglycemic diet is recommended to achieve the most optimum insulin levels in the blood? If it's different from the one above? What exercise plan is recommended for a severely hypoglycemic patient?

I've been controlling my severe hypoglycemic condition (diagnosed with a 6 hr Glucose Tolerance Test) with a low carbohydrate, high protein diet and some exercising. Unfortunately, I've gained 12 pounds in a year. I've been exercising 2 times/week for 30-35 minutes each time. I've tried to increase my exercising several times and inevitably it results in the condition becoming significantly worse. I have to go on a very rigid hypoglycemic diet for several days to control it before returning to my routine diet. My doctor gave me the routine hypoglycemic diet. (She did mention at the time there might be better ones out there.) I've been following it for over a year with reasonably good results, except for the weight gain problem.

Thank you very much.

Weight gain on a hypoglycemic diet would result if you ate more calories that your body needed. Weight gain is not a usual occurrence. Your diet seems appropriate and not excessive except for the 1 cup of tuna at bedtime.

Exercise may increase your body weight due to muscle, which weighs more than fat. However, your exercise program doesn't seem to indicate this is the reason unless you are only doing weight training. The biggest caution to exercise is preventing low blood sugar due to prolonged exercise without eating. It would be wise to have some protein snacks like cheese or a low fat dairy product along.

The appropriate diet is a high protein (20% protein calories, low carbohydrate (at least 100 grams to prevent ketosis) moderate fat (30% fat calories) with 6 small meals per day.

I would suggest you see a Dietitian who could monitor your food intake and exercise program along with instances of low blood sugar. Maybe, a dietitian could see a pattern to your problem with low blood sugar.

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Thank you so much for answering my question about which diet is right for hypoglycemia! I worried a lot about it and was pretty confused by the different advice from my internist and dietitian, as well as from several sources on the Net. Thanks to you. I feel more weaponed in the confusing world of hypoglycemia diet theories now.

High protein again:

My dietitian told me that in the Netherlands the Carbohydrate Addict (CAD), Dr. Atkins and other low carbohydrate, high protein ways of life are not considered serious any more. Therefore, I was mixed up reading the bulletins of the Hypoglycemia Association, Inc., which I con consider 'professional', looking at the amount of their published material, wide coverage and use of sources. Their diet focuses on eating sufficient vitamins, minerals and essential fats and proposes proteins and almost no carbohydrates. This diet is not forever (though the term "the DIET" suggests otherwise), the HAI suggest you follow it for 6 months, after that period you may start to increase the carbohydrate fraction, up to the amount you can take. Is this what you meant in your answer when you talked about hypoglycemic symptoms subsiding? Though you did not mention the amount of months I got the impression that the diet would be 'adjusted' within say 2 to 3 months and not over a year's period of time, as with HAI's DIET.

My diet:

As for my own diet: eating regular meals and avoiding all sugars brought so much improvement I hardly couldn't believe I had gained back a lot of the energy I've always had in me. The first week was 110% full of energy (maybe a relative feeling), the second week was a total disaster (feeling worse than ever), but after then, I was and still am, building up energy day by day. I do have drawbacks, in most weeks 2 days have a part 'lost'. A lot of times this has to do with an overload of activities the day before (especially computer work is high energy consuming) or a skipped meal. Especially eating out and social activities cause a lot of problems, good food seems hard to get outside of your own kitchen!

In your answer you asked me if I did eat sugar and what my current diet consisted of. Well, the answer is yes, I did use sugar before I consulted my dietitian, with occasional cravings (chocolate, cookies) to compensate hypoglycemia. It works, only, the reaction comes hours later.

Candida and hypoglycemia:

Recently I have become involved in founding a hypoglycemia association in the Netherlands. We had no such thing yet and because of my diet I experience a lot of energy now. The association is in a very early state yet, defining goals and statutes, collecting information and raising funds. A lot of people suffering from hypoglycemia we contacted have (had) problems with Candida. The relationship between the two, hypoglycemia and Candida Albicans, is still very unclear to our group, on first sight is seems that two types of patients exist: hypoglycemia with Candida problems possible due to their hypoglycemia and Candida sufferers with induced hypoglycemic problems. Do you know anything about this subject? Are these two different types of problems or is it a mere matter of sensitivity? I know that both hypoglycemia and Candida have to do with the immune system. The immune system is, among others, greatly influenced by bacteria and viruses (yeast?), chemicals and other allergens, mental and physiological stress, type of diet. So some Candida patients suffering from hypoglycemia may experience that their hypoglycemia disappears at the moment they get their Candida under control. Other people, however, may get rid of their Candida, but keep their hypoglycemia because other immune factors are still present. This is only a simple model and we would appreciate any information about hypoglycemia and this topic in special. Can you help us?

PS Are you the one behind all the Ask the Dietitian (TM) topics (over 50)? It must be a full time job, as you took so much effort (ta!) to answer my question!

Most persons with hypoglycemia feel better within a week of following a lower carbohydrate diet. The amount of time before the carbohydrates can be increased is very individual, but 1 to 3 months seems reasonable before increasing carbohydrate. The amount of carbohydrate is dependent on the absence of hypoglycemic symptoms.

Your description of eating sweets for hypoglycemic reactions only to have it reoccur within hours is expected. Persons with hypoglycemia should eat foods with a higher protein component like cheese or unsweetened dairy products, nuts, etc. High sugar foods will continue to stimulate the problem, which is the over production of insulin. I would suggest you ask your dietitian for help in meal planning as you need more evenly balanced meals throughout the day.

Your comment about computer work "high energy consumption" is not surprising as the brain uses more blood glucose than any other organ in the body. Also, Dr. Paul Gold, at the American Dietetic Association meeting, presented research suggesting that a moderate intake of glucose (50 grams = approximately 12 ounces of soda) improves memory in rats. Higher or lower intakes of glucose do not improve memory. It seems that computer work would involve lots of memory work.

At this time, there is no research evidence regarding Candida in the gut as you describe and no relationship to hypoglycemia. As such, there is no diet for Candida either. Candida Albicans causes a fungal infection in the vagina or mouth. Also, hypoglycemia has nothing to do with the immune system, but the endocrine (hormones) system. I would suggest your association pass along information that is supported by research as there are a lot of quacks with only testimonials (It worked for me and I got better type mentality.) for support. You can also ask your dietitian for nutritional information as it becomes available through new research.

Yes I am the one and only that writes Ask the Dietitian (TM). Thanks for your comments.

PS Your diet is what you eat and as long as you are alive, you will continue to eat. Unfortunately diet has gathered a negative connotation.

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I was tested for hypoglycemia (fasting and then a blood test) and I was found to be negative. But after eating high sugar foods, such as pastries, donuts, etc. my stomach feels funny and I feel tired.

What's causing the tiredness? I do not have diabetes either, by the way.

Your symptoms are not uncommon and typical for how the human body responds to high levels of fats and concentrated sweets. Carbohydrates (especially foods high in simple sugars) are sleep inducing and protein (meats or cheese) will help keep you awake. (See Eating Habits topic for more information on this.)

In addition concentrated sweets will draw water into your gastrointestinal tract as well which may contribute to your "funny stomach". Foods high in fats can cause indigestion depending on your body's ability to produce bile by the liver. Simply put, maybe your body cannot use that many calories at one time. Next time try a smaller amount (less than one serving) of the same food to see if you get the same reaction.

How much do you eat at a time? If you only eat one pastry or one donut and feel discomfort, you may want to talk to your doctor about this.

While pastries and donuts are high fat, high sugar foods should be an exception to a healthy diet, I do not believe in eliminating whole groups of foods even in a healthy diet.

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Last month my internist finally diagnosed me to suffer from "reactive hypoglycemia" after 2 years of struggle with a series of doctors. He told me a diet is the cure for me. Frequent meals (6 times a day) improved my health substantially. My internist prescribed me a low carbohydrate - high protein diet and sent me to a dietitian to fill in the details. She, however, wrote down my regular eating pattern and decided that not any of the day - quantity of proteins, carbohydrates or fat had to be changed, so no low - carbohydrate at all. Just the "frequency" had to be adjusted. I had to take regular (every 1.5-2 hours) small meals. Now what's the right diet?

CAN YOU HELP ME?

ABOUT LOW CARBOHYDRATE DIETS

I read some things about low-carbohydrate diets on the Net, a lot of them were meant to lose weight. Some of the messages claimed good results with hypoglycemia patients.

With this kind of diet a very small amount of carbohydrates per day is allowed. You have to get the bulk of your energy from proteins and fat (vegetables can be freely eaten). After a week's introductory diet the body has been brought into ketosis, the state of fat burning. This can be checked by means of urine ketone indicator strips. As the digestion of both proteins and fat is far more complex than the digestion of single (like sugar) or complex (e.g. bread) carbohydrates, glucose is resorbed into the blood far more slowly. It is said that in this way hypoglycemic problems are taken care of quite effectively. Well known authors in this field are the Hellers and Dr. Atkins (he runs a nutritional center based on these ideas).

WELL-COMBINED MEALS

Combining food in a proper way seems to be not only the cure for hypoglycemia, but a good way of living for the healthy too. According to this "school" proteins and carbohydrates have different mechanisms of digestion. Proteins have to be broken down in an acid environment, while concentrated carbohydrates are digested more easily in a high pH environment. The stomach is said to be able to sense the kind of food and adapt the pH of stomach (or intestinal) fluids accordingly. As a result of this theory, any meal combining carbohydrates and proteins is considered bad, giving you problems like indigestion due to slow stomach passage, wind (gas), acidulous feeling, only partial digestion of food, etc. Typical bad combinations are ham or cheese sandwiches, hamburgers and fruit after dinner and meat with potatoes. Better is: meat with vegetables, fruit on an empty stomach or between meals, cheese with vegetables, bread with sweet products. Dr. Hay's diet is making full use of these principles, even distinguishing sweet (bananas, combine with carbohydrates), medium (apples, not to be combined too much) and acid (kiwi, combine with proteins) fruits. Harvey & Marilyn Diamond have written several books (among which are cookbooks) on the subject. They suggest eating fruit only until noon. (I've tried this one and felt quite well on it. It's only that I got hungry every 30-min., fruit is known to leave the stomach very quickly.)

HIGH CARBOHYDRATE DIET

Recently I read a study that was meant to advise dietetics and doctors about (additional) treatment of diabetics by means of a diet. They suggested a more-than-average intake of carbohydrates: proteins 12-15%, fat 30-35%, carbohydrates 50-60%. In addition, sufficient intake of fibers is recommended. As far as I know, these are standard recommendations by the American Diabetes Association and the Dutch Council of Nutrition. The fact that diabetics have a tripled statistical risk of heart or arterial diseases is an important reason for these recommendations, partly because of obesity that is common among insulin-dependent diabetics. A reduced protein and fat intake could bring down this risk substantially. The carbohydrate fraction that is considered normal depends on cultural habits, but is generally lower: e.g. in Belgium 40%. Though diabetes is not the same as hypoglycemia, both have problems with blood glucose level control. The prescribed diets sometimes look very much the same.

The dietary treatment of hypoglycemia is very similar to that for diabetes and has changed over the years as a result of current research. Both follow a sugar free, regular meal plan.

Current dietary practice for hypoglycemia is 6 small meals with 50% of calories from carbohydrate, 20% protein and 30% fat. (i.e. 50% carbohydrate calories in an 1800-calorie diet amounts to 225 grams of carbohydrate.) This is the best combination of foods that work best to control low blood sugar reactions.

Diabetic diet recommendations previously contained 55 - 60% of calories from carbohydrate, but that was lowered to 50% of calories from carbohydrate according to the American Diabetes Association and practicing Registered Dietitians. The long term complications (not statistically proven triple risk as you state) of diabetes can be reduced by regulating blood sugar levels, more frequent insulin shots that mimic pancreatic insulin levels, diet, weight control and exercise. These complications seem to be greatly reduced when a diabetic's blood sugar levels are close to that of non-diabetic's blood sugar norms and the diabetic maintains healthy body weight.

You did not indicate if you had been eating concentrated sugars or sweets prior to either your doctor's or dietitian's recommended dietary changes. The low carbohydrate (less than 100 grams per day)- high protein diet your doctor prescribed would eliminate the concentrated sugars and sweets that caused your blood sugar to drop rapidly and cause symptoms. After hypoglycemic symptoms subside, the dietary carbohydrate is gradually increased until the person starts to experience hypoglycemic symptoms again and the carbohydrates are again lowered slightly. Everyone is different as to their individual tolerance of carbohydrates and blood sugar / insulin response.

The dietitian's prescribed diet was based on what you told her you ate on a usual basis or within the last 24 hours. If you had already changed your diet to low carbohydrate or forgot to report your usual intake or your 24 hour recall of the previous day's food intake was not typical, then you may not see the difference in the two professional's recommendations. The dietitian's diet plan with 6 small meals and moderate carbohydrates will do fine and should eliminate hypoglycemic episodes as long as you follow it. The small, frequent meals will spread out the carbohydrate and be less likely to trigger low blood sugar reactions.

Which diet are you following and how do you feel? Or have you combined both your doctor's and dietitian's recommendations?

Carbohydrates take about 2 hours to digest and be absorbed into the blood. Protein or fat does not effect carbohydrate's absorption rate. Some simple carbohydrates like sugar, fruit and milk sugars can be absorbed into the blood within 15 minutes which is helpful for a diabetic experiencing an insulin (injected) reaction. Hypoglycemia however is an over production of insulin (by the pancreas) in response to concentrated sugars or sweets. So if you eat small meals every 2 hours or so, you will be slowly absorbing carbohydrates rather than dumping larger amounts of carbohydrates from larger meals into your blood, thereby causing hypoglycemic reactions.

The pH of stomach acid is about 1.2 and any food you put into your stomach will neutralize the acid. The body does not adjust the amount of acid based on the "kind of food". Acid does start the digestion of protein by denaturing it or unwinding the strands of protein so those enzymes can break down protein for absorption. Fat digestion starts with the action of bile, which is an emulsifier that pushes the fat molecules apart to allow enzymes to break down fat and allow absorption to occur.

Normal fat metabolism needs oxygen and glucose to break down completely. Ketones are produced by the incomplete breakdown of fat (either dietary or body fat) because glucose is in short supply. Ketones build up in the blood and are excreted by the kidneys. The urine can be checked for the presence of ketones with testing strips that diabetics have used. The minimum amount of carbohydrate needed to prevent ketosis is 100 gm per day. The brain does not run well on ketones and prefers glucose, but after a few weeks, the brain and nervous system may have no choice and have to use ketones for energy. So most persons in ketosis feel mentally dull or lethargic.

I would suggest you refer to a basic nutrition text by an author with a degree or two in nutrition and review how food is metabolized. You should stringently question the validity of other persons who may promote a particular nutritional idea based on their own experience (testimonial).

Other than sugar and fat, foods are neither pure sources of one macronutrient (protein, fat and carbohydrate) nor a single source of any nutrient. Therefore it is not bad to eat a mixed meal of carbohydrate and protein. Indigestion or an acidulous feeling can occur for a variety of reasons including inadequate digestive enzymes, hiatial hernia and just plain old individual differences and inherited. Some foods (broccoli, brussel sprouts, cauliflower, cabbage, dried beans, carbonated beverages including beer) are gas producing (you call wind) even if you ate them alone at a meal.

A healthy lifestyle combines a diet low in fat, enough calories to maintain your healthy body weight, sufficient fiber to maintain normal intestinal elimination and at least enough vitamins and minerals to meet the RDA with a regular aerobic and weight training exercise program. (There is new evidence that the body may need additional amounts of specific nutrients, i.e. antioxidants.)

Persons will often follow a low carbohydrate diet (like Dr. Atkins diet) because it produces quick weight loss results (see Overweight topic) through depleting the body stores of glycogen (stored glucose) which holds water. Basically the body becomes dehydrated on this type of diet. When you resume a normal food intake, your body will restore the glycogen reserves and water, which will result in weight regain.

The most successful weight loss diets over the long term (more than 2 years) include reduced calorie and fat intake with a regular exercise program according to current research findings.

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I have recently been diagnosed with hypoglycemia. I have been put on the proverbial high protein / low carbohydrate diet. In doing some research I have found many discrepancies on just what a hypoglycemic diet is. Example: the diet my doctor gave me lists pancakes and waffles as foods I can eat. Other lists I have found list these as foods I should not have. This is just one of many discrepancies I found.

Common sense tells me to eat by the way my body reacts and to experiment with different foods. What do you think?

I am still very confused. For one thing, I am now supposed to eat more times during the day. This is hard for me. I find myself forcing food down my throat when I am not hungry. (I have never eaten a lot and don't usually crave food.) I fight nausea when I eat and I am not hungry and nausea is usually how I know to stop eating. I feel sick for a little while after I eat. For as long as I can remember I have been this way. I don't have very large meals, maybe a piece of fruit or half a sandwich now. Why do I have to eat when my body says not to?

I also have never eaten sweets on a regular basis. Sweets were and still are too sweet for me. Maybe I'll eat a piece of cake or have some ice cream every now and then. Most of my sugar intake seems to come from soda. So I am having difficulty understanding where this hypoglycemia comes from.

Also, I don't seem to know, nor can I find a list of just what foods are simple and complex carbohydrates and high protein. I don't pay attention to food except when I am hungry so I never learned just what foods are what and their classifications. Do you know where I can attain a list describing what these foods are? All the diets I have found have meager lists of what I should eat and don't tell me just which food is a carbohydrate or protein.

Like I said before I am having a hard time with this. I still don't feel well and seem to be battling with the food I eat. I am hoping you have some information that may be of help.

The information you have received sounds confusing to me too. A low carbohydrate (less than 100 grams per day) is no longer used for hypoglycemia.

First off hypoglycemia results from an over production of insulin, poor glycogen reserves in lean muscle tissue (liver and muscles) and usually a sporadic food intake that includes concentrated sweets (candy, pop, desserts). Many doctors consider hypoglycemia a pre-diabetic condition because insulin production is abnormal. Your body produces too much insulin in response to sugars and carbohydrates in food which is opposite to a diabetic who produces too little insulin (Type 2) or none (Type 1).

I would not suggest you experiment with foods to see what works. As your blood sugar falls to around 50 mg percent, you may pass out. Your brain uses more glucose than any other organ in the body and when there is not enough fuel, you may lose consciousness. To another person, low blood sugar symptoms resemble alcohol intoxication and you may not be treated appropriately.

If you feel weak and shaky like you are going to faint (hypoglycemic), eat protein like cheese or luncheon meat. This is different than the recommendations for a diabetic experiencing an insulin reaction who is instructed eat sugar-containing foods like orange juice. Sugar would temporarily bring your blood sugar up, but it would fall rapidly again within a short time.

Nausea with or after eating is not normal and should be addressed by your doctor and a dietitian. The amount of food you eat (one piece of fruit or half sandwich) is probably not sufficient to prevent or cause hypoglycemic symptoms between meals. Do you sporadically eat much larger meals at other times? Or binge eat? Or fast?

One 12 ounce can of soda (carbonated beverage) contains 9 tsp. of sugar or 45 gm of carbohydrate. How much soda do you drink a day or at one time?

Simple carbohydrates are sugars like those found in candy, soda and desserts as well as fruit (fructose) and milk (lactose). Complex carbohydrates are starches and fiber found in bread, cereal, rice, pasta and vegetables like potatoes, corn and peas.

Protein containing foods are meat, poultry, fish, cheese, lunchmeats and sausages. Milk contains protein as well as milk sugar (lactose).

The dietary treatment for hypoglycemia is slightly reduced carbohydrates (50% of calories), slightly increased protein (20% of calories) and six small meals per day. With a regular meal pattern, your hypoglycemic symptoms should lessen and you will probably feel better. This diet is very similar to a diabetic diet that does not include sweets or sugars. Two 4" pancakes or 2 frozen round waffles are allowed and can be exchanged for 2 starch breads for breakfast, but no syrup. Try fresh fruit (1/4 to 1/2 cup) on the pancakes or waffles instead.

I would suggest you see a Registered Dietitian who is a professional trained in nutrition therapy who could provide you with a list of what foods to eat and plan a meal pattern of foods you like.

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Recently, my doctor told me I have a condition known a reactive hypoglycemia, which he explained could be a precursor of diabetes. I know I have to change the way I eat to stabilize my blood sugar, but I don't know what to eat to both lose weight and treat these sudden drops of blood sugar. Right now I follow a diet that is 17 - 25% fat, I have given up fruits because they seem to cause a "urinary tract infection" type sensation. I rarely eat sugar or sugar products. I like vegetables, basically raw (and of course the ones I like are high in sugar, i.e. corn, carrots, onions, peas)!

He told me to eat more often, but not MORE .. since I have suffered from compulsive overeating most of my life, I am scared to open that "can of worms" again.

Can you give me any help?

At first this may sound like the opposite of diabetes because your body makes too much insulin. Hypoglycemia in fact is considered a pre-diabetic condition. It can be diagnosed by symptoms, but more accurately with a 4-hour fasting glucose tolerance test. The good news is simply eating six small meals and avoiding simple sugars can reverse your symptoms.

Reactive hypoglycemia is an over production of insulin in response to eating simple sugars. Some persons who experience hypoglycemia don't eat regular meals and may over eat simple sugars. I have worked with hypoglycemia patients who have a can of soda and a candy bar for lunch. The pancreas over responds by producing too much insulin which causes a rapid and sharp decrease in blood sugar, usually falling below fasting blood sugar levels (normal fasting blood glucose 70 - 90 milligrams per deciliter) 2 hours after the meal. If your blood sugar falls below 45 milligrams per deciliter, you may experience symptoms such as weakness, sweating, shaking or headache.

Unlike a diabetic who eats something sweet when having an insulin reaction, you should eat protein. Try eating cheese, luncheon meat or a hot dog with or without the bun. If you were to eat sweets to get your blood sugar back up, you would experience hypoglycemia again within another 2 hours or less.

Your blood sugars can be evened out by eating six small meals per day. Usually the carbohydrate is restricted to 50% of total calories or about 200 grams per day. The protein is usually higher around 20% of total calories because protein does not increase blood sugar. Fat intake is recommended at 30% of total calories, not as low as your diet at 17 25%. In fact, when the fat content of a person's diet goes much lower than 25%, it can negatively effect satiety and lead to binge eating.

Your eating plan should include increased complex carbohydrates like starch and fiber (corn, peas, carrots and onions are OK in normal servings) and decreased simple sugars like candy, soda and desserts. Caffeine is sometimes restricted because it can produce the same symptoms as hypoglycemia. Also, you should avoid alcohol, which can lower blood sugar. If you were overweight, weight loss would improve your body's ability to use insulin because fat increases your resistance to insulin. What that means is that your body may need more insulin to get past the cell membrane and metabolize glucose to energy.

First, work on leveling out your blood sugars, then reduce the number of calories you eat to no less than 1200 per day.

Sounds like you could use some individual nutrition counseling. Call your doctor and ask to see a dietitian.

Also, fruit does not usually cause a "urinary tract infection" type sensation. A urinary tract infection is usually described by patients as a burning sensation when urinating. I would encourage you to discuss this with your doctor.

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My doctor diagnosed me recently as having hypoglycemia. He handed me a diabetic diet to follow. Am I a diabetic? I don't have to take any shots like a diabetic. So why do I have to follow a diabetic diet?

If your doctor diagnosed you as having hypoglycemia, you probably took a three-hour glucose tolerance test or at least a blood glucose test two hours after a meal. People with hypoglycemia (low blood sugar) produce too much insulin and their blood sugar drops rapidly after eating. A sharp drop in blood sugar can produce a faint feeling or weakness. This is especially evident when the blood sugar drops below a person's fasting level of 70 to 90 milligrams percent. If the blood sugar drops to 40 or 60, generally, a person will lose consciousness. The body uses its blood sugar as fuel for the body to function. The brain uses more blood sugar than any other organ. The faint feeling is the result of a low blood sugar and not enough fuel for your brain.

Yes, you do have to follow a diabetic diet, but no, you are not a diabetic. The diet that seems to work best for people with hypoglycemia is six small meals with 50% of your calories from carbohydrates. It is an excess of sugars in your diet that triggers the excessive production of insulin.

Until your symptoms are under control, you should not make any changes in the diet your doctor gave you. You must eliminate all simple sugars (cakes, pies, cookies, candy, ice cream and regular carbonated beverages). A diet fairly high in protein (20% of your calories from protein) also seems to benefit people with hypoglycemia. Until you are in better control, no alcohol either.

I would suggest you call your doctor and tell him/her that you don't understand the diet and you need nutritional counseling. In the meantime, if you feel faint, eat a slice or two of cheese, lunchmeat or a hot dog without the bun. Contrary to the diabetic who needs sugar when his blood sugar is low, a hypoglycemic needs protein. If you ate something sweet, your blood sugar would go up, but would drop sharply again within two hours because you produce too much insulin.

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My husband is hypoglycemic, has hyperacidity and intolerance to lactose in milk. What type of eating program will give him the necessary daily nutrients?

The diet your husband should follow is a high protein, low carbohydrate and bland, lactose-free diet in six small feedings. Your husband needs help in putting this all together. He should see a dietitian to individualize his diet to consider his food preferences.

To get him started, your husband should avoid all concentrated sweets such as cakes, pies, cookies, ice cream, candy and carbonated beverages. These foods trigger his hypoglycemia. He also needs six small meals per day to spread out the carbohydrate and calorie content of his diet.

His diet should have good sources of protein (beef, pork, veal, lamb, chicken, turkey, fish or eggs) at each meal. Breakfast should include peanut butter, cheese or an egg. At noon, a two-ounce meat sandwich would be good. At supper, a three or four ounce portion of meat is recommended. The carbohydrate foods at each meal are limited to one piece of bread or potato, one piece of fruit and a vegetable. The in-between meal snacks are light. Snacks of cheese and crackers or fruit and cheese would be all right. The snacks help prevent the possibility of low blood sugar.

In regard to the hyperacidity, you didn't state if your husband has an ulcer. Foods that stimulate the excess secretion of acid are alcohol, caffeine, chocolate, pepper, cayenne, chili powder and curry. These foods should be omitted from the diet of a person with an ulcer. He should also eat six small meals per day. This should be evaluated by a doctor and not by the person himself.

Your husband's hyperacidity and intolerance to lactose in milk limit the amount of milk he should drink to less than 2 cups per day. Any milk he does drink can be treated with lactase enzyme. Lactase is the enzyme necessary to break down lactose in milk. There is an over-the-counter product called Lactaid which when added to milk converts the lactose to glucose and galactose, which he should be able to tolerate. People with ulcers should not drink more than two glasses of milk per day. This is a big change from years ago when we had them drinking lots of milk and cream.

A diet that would supply the necessary daily nutrients is based on the Food Guide Pyramid. If an adult eats two to three meat servings, two milk servings, two to four fruits, three to five vegetable servings, six to eleven bread servings and use fats, oils and sweets sparingly by choosing a variety of food choices, he/she should be able to meet their Recommended Dietary Allowance (RDA).

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Ask the Dietitian ^SM Copyright © 1998 Joanne Larsen MS RD LD