Hypoglycemia – the truth about diet and
low blood sugar
Low blood sugar (hypoglycemia) is a major cause of chronic fatigue and
some experts believe up to 20 percent of adults in the western world
suffer from the condition. It is possible that chronic fatigue syndrome
is actually a severe case of hypoglycemia, although that might to too
simplistic an explanation. In any case, the treatment for hypoglycemia
is essentially the same as that for chronic fatigue syndrome - correct
diet and the avoidance of heavy exercise.
Hypoglycemia results in rapid rises and falls in the level of glucose in
the blood - due to a malfunctioning of the pancreas and liver,
predominantly. Exhaustion of the adrenal glands is also a factor.
I don't intend to get into a detailed medical explanation of
hypoglycemia because it is complicated and somewhat controversial.
However, in simple terms it is caused by overactivity of the pancreas
which produces too much insulin when sugar or sweet foods are eaten in
In a healthy person, the pancreas produces just enough insulin to
neutralise any sugar eaten, to bring the blood sugar back to normal. But
in those with hypoglycemia, the pancreas overreacts and produces too
much insulin in response to the sugar eaten. This over-abundance of
insulin metabolises not only the sugar which has been eaten but also
some of the glucose which was already present in the bloodstream.
Do you have the symptoms of hypoglycemia?
The result is a state of low blood sugar which can cause an alarming
number of distressing symptoms -fatigue being only one of them. Other
symptoms include headaches, dizziness and feeling faint, irritability,
depression, difficulty in remembering, blurred vision and in most cases
an overwhelming craving for something sweet or a stimulant such as tea
If any of those symptoms sound familiar, particularly if they are
accompanied by a craving for sweet food, then it is very likely you are
suffering from hypoglycemia. Strenuous exercise also lowers the blood
sugar, which is why those with chronic fatigue syndrome should be
careful not to over-do any physical activity. After heavy physical work,
a healthy person feels tired, his energy has been drained. However, if
he rests, his strength will return reasonably quickly.
What has happened? The exercise has burned up part of the glucose in the
blood. Stored glycogen in the liver is then used to bring the blood
sugar level back to normal - even if the person doesn't eat anything
immediately. The adrenal glands help raise the blood sugar level by
releasing catecholamines which convert glycogen into blood sugar.
Thus, the healthy body has a system of checks and balances, involving
mainly the liver, pancreas and adrenal glands, to ensure the blood sugar
level stays stable. But in a person suffering from hypoglycemia (and
chronic fatigue syndrome) the system doesn't work properly. After
strenuous exercise, the person's blood glucose is depleted and the
adrenal glands react by releasing catecholamines to convert stored
glycogen into glucose. But unlike the process in a healthy person, in
the hypoglycemic the new glucose stimulates the pancreas to produce more
insulin - which once again lowers the blood sugar level.
The pancreas of a hypoglycemic person is extremely sensitive to extra
glucose, whatever the source. It over-reacts to glucose with a secretion
of insulin too large to maintain an equilibrium in the body - and the
person suffers the symptoms of hypoglycemia.
The cure for hypoglycemia is to prevent large swings in the blood sugar
level, by eating little or no sugar and by avoiding excessive physical
exercise. But it is much more difficult than it sounds. Sugar is found
in so many foods these days, particularly packaged foods, which almost
always have sugar added. Some people are also sensitive to "natural"
sugars such-as those in fruit and even milk.
Diet for Hypoglycemia
Various diets have been proposed for hypoglycemia over the years The
earliest treatment was a high-protein, high-fat diet with a minimum of
carbohydrates, in the belief that all carbohydrates stimulated the
pancreas to produce insulin. Such diets had mixed results and are
certainly not healthy in the long run. They have largely been abandoned
but variations still exist, such as the Atkins diet and more recently
Barry Sears' "zone" diet which involves a 30/30/40 ratio between
protein, fat and carbohydrate.
The prominent American nutritionist Paavo Aerola started a change in
thinking about hypoglycemia treatment in the 1970s when he advocated a
largely vegetarian diet with an emphasis on complex carbohydrates.
Aerola's diet was popular for many years and very successful. However,
it relies heavily on dairy products for protein - which doesn't suit
More recently, a concept known as the "glycemic index" of foods has been
developed. The glycemic index represents the amount by which a food
raises the blood sugar level, with glucose having an index of 100. It is
interesting that foods such as white bread can raise the blood sugar
almost as much as ordinary white sugar, whereas as whole-grain breads
cause a much slower rise in blood sugar.
I have proved this myself - before I knew anything about glycemic
indexes. When I was experimenting with the high-carbohydrate, low-fat
diets I often had a white bread roll with a small amount of low-fat
cheese (no butter) and salad for lunch. I would always get a headache
during the afternoon following such lunches but I persisted because I
thought it was a "healthy" low-fat meal and it had no-sugar.
Occasionally, I would have a thick cheese sandwich on wholemeal bread
(with butter) and a glass of milk - supposedly a very bad meal from the
low-fat viewpoint. But I felt great during the afternoon after such a
lunch. Fats such as butter and cheese can be useful in controlling low
blood sugar because they slow down the absorption of carbohydrate. Of
course, that is not a licence to eat a lot of fat - nor a lot of
anything, for that matter.
A huge meal, even if it contains no sugar, can raise the blood sugar
more than a candy bar. Getting back to the glycemic index, it can be
confusing sometimes because different studies give different indexes for
the same foods. For example, some studies have found potatoes to have a
high glycemic index (making them unadvisable for people with
hypoglycemia) while others recommended potatoes as one of the best foods
for keeping blood sugar stable!
Fruit is another controversial food in relation to hypoglycemia. Some
experts advocate eating fruit because its sugars (mainly fructose) are
"natural" and thus don't affect the hypoglycemic like refined sugar
does. Others find better results by avoiding fruit, at least in the
initial stages of treatment. I found fruit often affected me adversely,
particularly sweet fruit likes bananas, grapes or water melon.
The best diet for hypoglycemia is a "balanced
I believe the best diet for controlling low blood sugar – and chronic
fatigue syndrome - is the good old-fashioned "balanced diet" with three
meals a day. You need to avoid sugar for the first few weeks and then
have sweet things occasionally in small amounts as you start feeling
I have experimented with different diets to see which has the most
beneficial effects on my blood sugar levels. I have found the best
results with a diet based on complex carbohydrates and adequate protein,
with a certain amount of fat to slow down the impact of the
carbohydrates on my blood sugar. Fat is usually regarded as the main
villain by modern diet writers but a certain amount of fat is essential,
particularly if you suffer from low blood sugar.
In fact, many people develop low blood sugar by following the popular
high-carbohydrate, low-fat diet theories to extreme. They think fruit is
a "good" food and eat lots of it while avoiding foods like eggs, cheese
and whole milk. But they could be better off avoiding fruit if they are
hypgolycemic and eating eggs for breakfast.
Eggs are a particularly valuable food. They help build up the adrenal
glands - a vital factor in recovery from hypoglycemia. Of course, they
contain cholesterol and should be eaten in moderation. But one or two
eggs a day will not harm most people's cholesterol levels and, in fact,
there is growing evidence that sugar is much more harmful in raising
cholesterol than foods such as eggs, dairy products or meat.
Many experts on hypoglycemia advocate six small meals a day rather than
three meals. It used to be almost universally accepted that frequent,
small meals was best. But some writers on the subject have recently
challenged this belief. The problem with eating six or more meals a day
is that it can easily lead to over-eating – something that can adversely
affect hypoglycemics because the body is flooded with extra sugar which
it doesn't need.
In the early stages, you might find you need a snack between meals to
alleviate extreme symptoms of low blood sugar. However, I believe it is
best to establish the habit of eating three balanced meals a day and
keep snacks to a minimum. Having said that, you shouldn't allow more
than five or six hours between meals or you will start to experience
hypoglycemic symptoms. Eating breakfast at about 7.30am, lunch about
12.30pm and dinner about 6pm should be fine for most people, without the
need for regular snacks. But if a meal is late, for some reason, then
it's best to have a snack (but not a sweet snack!).
Eating snacks can also be detrimental if you have a problem with
addictive eating or a tendency to binge on sweet foods which many people
with hypoglycemia do, in a desperate attempt to make themselves feel
better. If you find you can't stop yourself bingeing on sweet or starchy
foods, it's virtually certain you are suffering from hypoglycemia. By
eating three balanced meals a day, you have the best chance
to keep your blood sugar stable and avoid destructive sweet snacks.
A balanced meal should contain some protein and complex carbohydrate
plus a moderate amount of fat. A good breakfast is one or two eggs on
one or two slices of buttered wholegrain toast; or unsweetened porridge
or cereal plus one or two pieces of buttered toast.
Lunch could be sandwiches with wholegrain bread and butter plus a
filling of salad vegetables and a small amount of cheese, meat, chicken
or fish; or it could be a more substantial meal of meat or fish with
cooked vegetables, potatoes, pasta or rice. Forget dessert and, until
you feel better, avoid even fruit at the end of the meal initially.
If dinner is the main meal of the day, there is an endless variety of
suitable foods, according to your taste. The main principle is to eat
protein, complex carbohydrates and vegetables, and avoid refined sugar
in any form.
If you really need to finish with something sweet, try a small home-made
muffin, biscuit or piece of cake, made with just a small amount of sugar
and have only a small helping! You'll need to experiment to see how much
sugar you can tolerate.
Overeating overworks the liver - and causes
Eating sugar as part of a meal has less effect on blood sugar levels
than eating a sweet snack on its own. That's another good reason for
eating just three meals a day. It is important not to over-eat because
that overworks the liver, which plays a vital role in keeping blood
sugar stable. An overworked liver is the cause of much chronic fatigue
and it takes time for a damaged liver to restore itself.
So don't set back your progress by over-eating. Listen to your body and
stop when you feel comfortably full. If you are not eating sugar, you
are less likely to overeat because most over-eating tends to be of
sugary, fatty foods.
It usually takes at least a month to recover from hypoglycemia by
following a balanced diet. Some people start feeling better after a week
or two, while others who have been sick a long time might find they need
three months or more to really start feeling the benefits. Initially,
you will almost certainly feel intense cravings for something sweet and
may be tempted to lapse.
If you are hypoglycemic, you are essentially addicted to sugar and you
are fighting something which can be as difficult as an addiction to
cigarettes or alcohol. If you do slip, pick yourself up and start again.
The first week or two is the hardest in starting a low-sugar diet that's
when the cravings will be at their most intense. Eating even a small
amount of something sweet can actually trigger a full-blown binge
because of the way your body reacts to sugar.
Don't despair. You may have to pick yourself up many times before you
can stick to a balanced diet. It just proves that you have been
over-dependent on sugar for too long and that you must break the
addiction before you can ever expect to enjoy good health again.
Keep that as your motivation when the sugar cravings come. Tell
yourself: "I might feel bad now but I'll be ten times worse if I binge".
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