In Endocrine System, Nutritional Therapies, Reactive Hypoglycemia

Glucose and insulin serve very important purposes for every cell in the body. Insulin is a hormone produced in the pancreas that helps the body manage glucose. Insulin keeps the body’s glucose in a normal range, not too high and not too low. If insulin is unable to do its job glucose levels can become too high or too low; which results in illness. We often think of hyper- and hypoglycemia as being related to diabetes, but for many people, these are an everyday reality of the ups and downs of our diets.

What is Reactive Hypoglycemia?

Reactive hypoglycemia is a condition that occurs when an individual experiences a significant fall in their blood glucose level. The “reactive” name originates in this being an effect of a post-meal insulin surge, which forces sugar into the cells and out of the blood. This is in contrast to spontaneous hypoglycemia, which is a drop in blood sugar that occurs between meals or in a fasting state. While the cause of reactive hypoglycemia and spontaneous hypoglycemia are different, their treatments remain similar and sometimes their terms are used interchangeably.

Reactive hypoglycemia remains a very common condition and may be related to nutritional issues. Many nutrition-oriented clinicians consider reactive hypoglycemia to be one of the most commonly encountered nutritional disorders.


Because some of the symptoms presented could also be the results of psychosomatic symptoms. Conventional practitioners believe that hypoglycemia may be overdiagnosed or is often used as a diagnosis when no other diagnosis can be determined.

A laboratory test called a glucose tolerance test can be used to diagnose reactive hypoglycemia but the merits of this test are questionable. There is no universal guideline for interpreting the results of this test. Without guidelines to interpret the test, practitioners and investigators determine their own guidelines for what represents hypoglycemia.

In my practice, I’ll often find this diagnosis by the patient’s history through specific interview questions. Patients experiencing the following may have reactive hypoglycemia: symptoms after eating sugar, craving sweets, symptoms of headaches, fatigue, and anxiety before meals, after a missed meal, or a short time after eating. I look for major differences in a patient’s feeling of alertness and energy related to their meal schedule.


The symptoms of reactive hypoglycemia present themselves in two different ways; an adrenergic syndrome or a neuroglycopenic syndrome. The adrenergic syndrome or “revved up response” occurs if blood sugar levels drop quickly causing a “fight or flight” reaction. The adrenergic symptoms may include anxiety, panic, hunger, palpitations, elevated heart rate, tremors, excessive sweating, weakness and abdominal pain. The neuroglycopenic syndrome or “crash response” presents itself when the blood sugar levels drop slowly over a few hours. This can result in headache, fatigue, blurred vision, mental confusion, memory loss, and even seizures and unconsciousness. It is not uncommon for patients to experience symptoms from both syndromes during a reactive hypoglycemic episode.

Many other symptoms have been attributed to reactive hypoglycemia. These include depression, insomnia, irritability, lack of concentration, mood changes, anorexia, stomach issues, muscle and joint pain, cramps, dizziness and vertigo.

Usually symptoms of reactive hypoglycemia occur or worsen before meals in the late morning and late afternoon or if a patient misses a meal. Symptoms are typically relieved by eating or by satisfying cravings – a key component with this diagnosis. Cravings of refined sugar (white sugar) and refined carbohydrates (white bread, white pasta) are frequent for individuals with reactive hypoglycemia. Consumption of these foods can provide temporary relief of symptoms but can also trigger additional episodes of rebound hypoglycemia. If this cycle occurs chronically it can lead to overeating, obesity, and poor energy management.


The most common cause of reactive hypoglycemia is diet related. The excessive consumption of refined sugar (white sugar) and refined carbohydrates (white bread, pasta) can exacerbate reactive hypoglycemia. These foods cause a rapid increase in blood sugar which cause the body to provide a rapid insulin response. Sometimes this insulin response is too much, resulting in a low blood sugar. Hypoglycemia triggers the release of cortisol, epinephrine, glucagon and growth hormones which further lower the blood sugar. If hypoglycemic episodes occur chronically, the functionality of these hormones can decrease which results in an even more incapacitated glucose response.

Other chronic conditions can also cause reactive hypoglycemia. Hypothyroidism, hypoadrenalism, and liver abnormalities are among these. Food allergies can also result in hypoglycemia though the reason why has not been determined. Individuals who have had gastrectomy surgery or gastric bypass surgery can develop hypoglycemia as well.

Dietary Treatments

The primary treatment of reactive hypoglycemia is avoiding refined sugar and refined carbohydrates. This means greatly reduced intake of white flours, white rice, and white sugar. Caffeine and alcohol should also be avoided. Consuming 6 small meals high-protein meals daily can prevent the body from having hypoglycemic episodes. A diet high in protein and complex carbohydrates can help to stabilize blood glucose levels. Lean protein such as fish, chicken and turkey are good sources of amino acids that promote healthy glucose levels. Complex carbohydrates include whole wheat (or a high-fiber gluten-free alternative), starchy vegetables, and legumes.

Nutritional Supplements

Many micronutrients play an important part in the regulation of blood sugar. Chromium, magnesium, B-vitamins, and niacinamide are among them. Not all of these supplements are indicated for all patient populations. It is important to talk to your practitioner about what may be appropriate for you.

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