Tuesday, April 03, 2007

Is Hypoglycemia A Hidden Low-Carb Side Effect?

One of the things I enjoy doing at my blog is providing information that people can apply to their daily lives that will help them solve an issue they are having while livin' la vida low-carb. Whether it's about weight loss, health, fitness, or whatever, I think you the reader can be best served with practical and scientifically-sound ways to live this lifestyle over the long-term as so many of us are.

Today I have a very special guest editorial from Dr. Keith Berkowitz, who is the medical director for The Center For Balanced Health. I was talking to him on the telephone recently about his fantastic new high-fiber NexGen muffins when the subject of blood sugar came up.

He said that the issue of hyperglycemia, or high blood sugar which is a precursor to diabetes, has been given almost a monopoly of attention from the medical community while an even more dangerous condition has gotten completely overlooked and ignored. It's the condition known as hypoglycemia.

Dr. Berkowitz went on to explain some of the symptoms of hypoglycemia, or low blood sugar, and how it could be the reason why your weight loss suddenly stops while livin' la vida low-carb. Also, if your energy is sapped and you begin feeling tired for no apparent reason at all, it's time to get a glucose tolerance test to see what your A1C levels are, he said.

I was so spellbound by the discussion of this issue that I asked Dr. Berkowitz to write a column for my blog so that all of us can be better informed of the warning signs that we may be suffering from hypoglycemia and how to treat it. Special THANKS to Dr. Berkowitz for sharing his wisdom on this issue with us today and I welcome your feedback to what he has to share. ENJOY!

The Forgotten Blood Sugar Disorder: Hypoglycemia
by Dr. Keith Berkowitz, M.D.
Medical Director for The Center For Balanced Health

According to the American Diabetes Association, 21 million Americans have diabetes and another 54 million American are at risk with pre-diabetes or elevated blood glucose.

Because of this, our attention has been concentrated on treating high blood glucose while largely ignoring other blood sugar disorders. Poor eating habits, the addition of unhealthy ingredients, increased stress and poor sleeping habits has led to the increased incidence of this underappreciated blood sugar disorder: hypoglycemia.

Hypoglycemia has been traditionally defined as a low blood glucose level (serum levels less than 70 mg/dl either taken fasting, randomly or after a glucose challenge). Unfortunately, most individuals I see in my practice do not present with these results but instead present with normal blood glucose levels, the ability to lose some weight but not the last 10 to 20 pounds or unexplained low energy levels.

One reason for this is that most individuals only have fasting blood glucose or an HgbA1c taken by their health professional. An HgbA1c level represents the average amount of glucose in the blood over a three month period. A level of 4.0% is equal to an average blood glucose level of 60 mg/dl while a level of 5.0% is equal to a blood glucose level of 90 mg/dl. HgbA1c levels between 4.8% and 5.9% are considered normal. Levels below 4.8% are usually consistent with hypoglycemia.

Individuals with hypoglycemia can often have symptoms that include: headaches, increased irritability, difficulty concentrating, palpitations, light-headedness, fatigue, anxiety, excessive sweating or urination, leg cramps, dizziness and clamminess. Other symptoms can be related to eating. Patients I see with this diagnosis often feel more tired after meals, feel “sick” when they either miss a meal or if a meal is delayed.

So, if you have significantly reduced calories or carbohydrates, are you still unable to lose weight? Are you unable to lose that last 20 pounds no matter what you try? Eating a low carbohydrate diet but still hungry and/or tired after meals? I just may have a solution for you.

Traditionally treatment for hypoglycemia has been to give sugar. Unfortunately, this treatment only provides temporary relief and in very sensitive individuals causes an even greater reaction thirty minutes to two hours later. Although, a strict low carbohydrate diet is helpful, it does not always solve the problem by itself.

In my practice, Center for Balanced Health, I see individuals with such pronounced hypoglycemia that their blood sugar drops almost immediately after a glucose challenge. It’s the equivalent of filling an automobile with gas only to find that the gas tank has a very large leak.

At the Center for Balanced Health, we help patients manage their hypoglycemia by telling them to:

- Eat five to six small meals a day about every three hours. Think of yourself as a fuel-efficient automobile. You want constant flow of energy (glucose) throughout the day.

- Avoid meals that are too small or too large especially at night. Meals that are too small will not provide enough energy to get you through the day. Meals that are too large place a larger burden on your metabolic system to process these nutrients and thus can trigger a hypoglycemic reaction.

- DON'T skip meals especially breakfast. Breakfast is the most important meal of the day because it sets the tone.

- Balanced eating. Always have some protein and fat at each meal or snack. Avoid and limit foods high in sugar or other refined carbohydrates especially on a empty stomach. Still utilize a controlled carbohydrate approach and get your carbohydrates from foods high in fiber (dark green leafy vegetables, non starchy vegetables, avocado, high fiber low carbohydrate crackers as examples)

- Get a good night’s sleep. Good sleep helps replenish your system so that your body works more efficiently.

- Use of a fiber supplement (make sure you take with enough water) or eating a high fiber food (without refined carbohydrates or sugar) before meals or snacks can help slow the absorption of carbohydrates and thus prevent rapid declines in blood sugar.

- Exercise regularly. Strength training can improve glucose metabolism

- Avoid alcohol, caffeine, tobacco use

- Avoid the use of stimulants

If you suspect hypoglycemia, the best diagnostic test is a glucose tolerance test with insulin levels and an HgbA1c. I usually do this test in my office because a glucose challenge can sometimes precipitate symptoms of low blood sugar.

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Blogger Science4u1959 said...

This is very intriguing information indeed!

4/03/2007 11:00 PM  
Blogger Jeff Hamlin said...

Sorry, but the body needs no carbs, from vegetables or anywhere else.

4/04/2007 12:06 PM  
Blogger Kevin said...

This is an interesting possibility. As we become more familiar with low-carb, we may gain clearer perspectives on many mis-diagnosed ailments. I would caution against letting this be taken the wrong way by anti-low carb types, who think that any reductions of blood sugar are automatically dangerous or deadly.

This does not mean that we should not be careful about the state of low blood sugar, as there can be negative effects from it. Low carb is powerful, and that power can be harmful if poorly understood.

I would also point out that the symptoms of hypoglycemia noted in the article can be extremely subjective, hard to verify, and can have many different causes. For instance, these are the same symptoms which describe a low-thyroid syndrome. Also, many people take anti-depressants for the same reasons, and numberless other chemical and natural remedies.

It seems that there are many people who feel that they should have more energy and feel more optimistic. So, do we all have hypoglycemia? Or low thyroid? Or imbalanced brain chemistry? Or are we all just imagining greener grass somewhere else and searching for a happy pill?

The things I have found that actually improve my physical or emotional energy in a noticeable way are vitamins, exercise, low-carb, sunlight, sleep, socialization, and anything else that boosts my mood or confidence. In other words, I am not yet convinced that my issue is a chemical imbalance, rather than just a mental one. I have found no magic chemical "treatment" yet.

4/04/2007 6:55 PM  
Blogger Fat Victoria said...

I went hypo once. I walked 6 miles with a friend, then had a low-carb dinner. I was feeling VERY tired when we got home. My friend suggested I take my blood sugar for kicks and when I did it was 43 (I am not diabetic)! Yike! No wonder I was tired. I tested 3 times on two meters and got the same result (within 10 points up or down), so I know I really was hypo. I ate some carbs and retested an hour later and I was back up again.

4/05/2007 9:32 PM  
Blogger Melting Mama said...

Interesting! Hmmm.

4/13/2007 11:00 AM  
Blogger The Bunnell Farm said...

I believe "Hypoglycemia" to be a false sugar addiction feeding program. Feeding the sugar "High", something similar to what Kevin said above. The "Sugar Addicts" love this diagnosis and will stomp all over you for saying so.

4/14/2007 7:04 AM  
Blogger Storm said...

I was diagnosed as hypoglycemic when I was young (it runs in my family). We're all tall, lanky and hypoglycemic. My average BG is between 60 and 80, and when I get low, I've gotten as low as 30 (very dangerous). I've fallen, fainted, injured myself, etc. Not fun.

It's certainly not a myth. Hypoglycemia can be perpetuated by the consumption of refined sugars and empty carbohydrates, and can also play a part in the blood sugar yo-yo that is a precursor to diabetes. However, this is a symptom of an overall bloodsugar problem, not hypoglycemia, proper.

On its own it is a valid condition, and while I have the priviledge of not fearing diabetes (as long as I maintain my healthy lifestyle), it can be a difficult thing to manage. Frequent eating and controlling bloodsugar is key, if you dont' want to end up falling or fainting in public. Special care should be taken while exercising.

4/23/2007 10:30 PM  
Anonymous Anonymous said...

An interesting paper is recently published in a journal (Current Diabetes Reviews ( Volume 5 Issue 2 pp.79-91) on hypoglycemia related complications. Possible therapuetic measures are discussed in it as well.

5/06/2009 4:05 AM  
Anonymous Anonymous said...

Just returned from the hospital where I was treated for low blood sugar(36) after 5 days on a low carb diet with regular exercise. Doc told me I was six points away from siezure and possible death.

Think I'm gonna let the low carb thing go...

4/01/2012 4:25 AM  
Blogger Jimmy Moore said...

Low-carb didn't "cause" this.

4/01/2012 6:06 AM  
Anonymous Anonymous said...

Hope you can help me with this Jimmy.
After seeing Robert Lustic on 60 Minutes last Sunday, there has been a debate going on in my family about the harmful effects of sugar.
One person made the comment that while too much sugar can lead to diabetes, having not enough blood sugar can also lead to diabetes.
I think this is a ridiculous statement.

I have tried looking on the web to see if a low carb diet can cause hypoglycemia and have not had much luck finding anything until I found this by you.
So my question for you is:
Can eating low carb lead to hypoglycemia and can hypoglycemia lead to diabetes?

As for myself, last Oct. I had bloodwork done and my glucose was 69, which is below the 70 that Dr. Berkowitz says traditionally defines hypoglycemia. I repeated the bloodwork after being on a low carb diet since Jan. and my fasting glucose went up to 91.
Also my triglycerides went from 168 to 68, HDL went from 62 to 73 and all my ratios improved a lot.

4/04/2012 5:15 AM  
Blogger Jimmy Moore said...

Can you email me about this at Thanks!

4/04/2012 5:58 AM  

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