Reactive Hypoglycemia

In the last post on Anorexia, I promised to discuss what I believe to be a very common problem for any long-term dieter – particularly one that has taken their metabolism down to the extremes seen among underweight anorexics. This is what is deemed “reactive hypoglycemia.”


The telltale sign of reactive hypoglycemia, without using a glucose meter, is tremendous hunger and shakiness within an hour or two of eating a meal. A glucose meter provides more hard evidence of the condition, and typically shows a high fasting blood sugar level that plummets after ingesting food.

The basics of reactive hypoglycemia, which are experienced most commonly by people who have lost a lot of weight and have entered into a functional state of starvation (whether going from 400 to 250 pounds on a low-carb or calorie-restricted diet, or going from 120 to 80 pounds via eating disorders seems to be somewhat inconsequential).

In this well-hidden Jimmy Moore podcast, a former colleague of Dr. Atkins, Keith Berkowitz (yeah, that slightly creepy looking dude up above - I don't think he has a twin brother), describes how, in those who have lost a lot of weight, he keeps repeatedly seeing the strange phenomenon known as reactive hypoglycemia in his patients.

CLICK HERE TO LISTEN

Traditionally, it is well known that eating a diet with a pretty high ratio of dietary protein to carbohydrate helps to medicate this problem. The high ratio helps to trigger glucagon release, which triggers the release of stored carbohydrate – keeping blood sugar levels more stable. One of the first to publish a book exclusively on hypoglycemia was Broda Barnes, who published Hope for Hypoglycemia: It’s Not Your Mind, It’s Your Liver with his wife Charlotte in 1978 – the year the world began (at around midnight between February 6th and 7th according to my mom).  More on Broda Barnes in this FREE EBOOK.

In the book, Barnes reveals some tremendous insights. The first is that he was able to give “hope” to hypoglycemics by supplementing desiccated thyroid extract in sufficient doses to raise basal body temperature to 97.8 to 98.2 degrees F (armpit temp). This appeared to completely eradicate the condition for many patients, allowing them to eat foods they never thought they’d ever be able to eat again, like chocolate cake, without having extreme hypoglycemic reactions (like that noted by Ailu in the comments in the last post, who has literally passed out after eating pancakes by themselves for breakfast).

This makes perfect sense when you consider that, when dropping well below the body weight set point, humans have been repeatedly shown to have huge drops in body temperature/metabolism – well beyond what can explained by the change in body mass. In fact, this quote by Robert Pool, author of what I consider to be perhaps the best book written on the puzzling illness of obesity in reference to Rudy Leibel’s work, says it all:

“Leibel found that the non-obese group, which consisted of 12 men and 14 women who weighed an average of 138 pounds, needed an average of 2,280 calories per day to maintain weight. By contrast, the obese group, an identical number of men and women who weighed an average of 335 pounds, needed 3,651 calories a day. This wasn’t surprising – the obese subjects weighed nearly two and half times as much as the control group, so it seemed reasonable that they might need an extra 1,400 calories a day to maintain that weight. What was surprising, though, was the comparison after the weight loss. After the 26 obese patients had lost an average of 115 pounds apiece, they weighed an average of 220, and at this reduced weight their bodies demanded just 2,171 calories a day. In other words, these reduced-obese patients, who still weighed an average of 80 pounds apiece more than the lean subjects, had to eat 100 calories a day less to maintain their weight.”

Might I also mention that these reduced obese subjects, when eating the 2,171 calories required to maintain their new weight, ALL experienced ravenous and gnawing hunger which persisted until every ounce of weight they had lost was regained.

Anyway, the point is that whether fat or thin, the starvation reaction of the body is the starvation reaction of the body – whether you weigh 220 or 60 pounds. And the result is often the same when it comes to reactive hypoglycemia, which very commonly affects the hypometabolic, and is a huge barrier for the anorexic and reduced obese alike when it comes to reintroducing carbohydrates into their diet. Because when they do – crash and burn. Not only that, but it re-awakens a beastly and outrageous hunger that is the worst nightmare of both Anorexics and obese alike. Fear of weight gain and out-of-control eating set in quickly.

So, what the hell do you eat if you are trying to overcome hypoglycemia? That’s a good question, because the standard high-protein, low-carbohydrate diet given to hypoglycemics since forever to control and medicate the condition, also happens to lower metabolism according to Dr. Barnes, who knew a thing or two about it…

“…it has been clearly established that a high protein diet lowers the metabolic rate, [therefore] symptoms of hypothyroidism will be aggravated… Hypoglycemia may be controlled on the high protein diet, but the other symptoms of thyroid deficiency which usually accompany hypoglycemia are aggravated.”

I agree, and it makes sense on some level that protein would lower metabolism. For starters, protein, calorie for calorie, is more satiating. Therefore, you eat less food – not good for the metabolism of someone in a functional state of starvation. Secondly, consuming EXCESS protein beyond what your body uses (and your body uses very little for muscle-building if you are not eating very many carbohydrates – the Taxi for getting dietary protein into muscle cells), forces the excess protein to be burned as energy (protein oxidation). Uh oh, you need a rise in adrenal hormones like cortisol to use protein as fuel, which are antagonistic to the thyroid, increase insulin resistance, etc.

And lastly, protein requires more energy to digest, which is one reason nearly all diet authors advocate big protein intakes. It causes a greater heat production (thermogenesis from food digestion) than any other type of food – grounds for saying it “raises your metabolism!” Well yes, it “burns more calories” and causes a postprandial rise in body heat, but when this causes your body’s resting energy expenditure to decline, then it’s actually counterproductive, not productive.

Anyway, what to do?

I think what Riles and JT proposed in the last comments section was very sound. Instead of jumping straight into a very high-carbohydrate intake to heal metabolism, build lean tissue, and feel better fast – it might be best to slowly transition into it.

For starters, matching starch and protein intake on a gram for gram basis is a good start. Tha boyz recommended 1 gram per pound of lean body mass of each – with a little fat to satisfy the appetite at first. Slowly, you begin increasing the ratio of carbohydrate to protein in the diet (by increasing carbs and slowly reducing protein – as well as fat) until you’ve reached what is more or less the preferred macronutrient ratio for high-body temperature, low cortisol, great muscle building, good physical performance, and great difficulty in gaining body fat – even when overfeeding and not exercising. That is at least a 5 to 1 ratio of carbohydrate to protein upon close scrutiny, with fat well under 20% of total ingested calories.

Another approach would be to eat high-fat/low-carb with the RIGHT amount of protein (1 gram per kg of body weight) and slowly displace an increasing amount of fat with carbohydrate. Not sure which route would make for an easier transition, but I would think trying to increase carb intake while fat intake is very high would be tough, and increase the likelihood of gaining weight.

For more on the importance of body temperature and how it can be brought up through dietary measures, read THIS FREE EBOOK.

Of course, supplementing with thyroid extract is a very viable option during the transition period as well.

“To date, when the symptoms of hypothyroidism are relieved, hypoglycemia, like the others, disappears.”

-Broda Barnes

I should also mention that reactive hypoglycemia appears to be caused by secreting WAY too much insulin in response to ingested food.  I believe this to be an aggressive attempt by the body to store food into cells - part of the programmed famine response of the human body.