My internist diagnosed me with reactive hypoglycemia after 2 years of a series of doctors.


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?



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).


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.)


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 130 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.