Questions Anyone?

Frequently Asked Questions about Hypoglycemia are addressed here. Just click on the topic for the answer.

Some questions and answers are excerpted from The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar. Return frequently since we will be adding more Q & A’s. Please understand that the opinions expressed by the experts should not be construed as a specific diagnosis or treatment recommendations. These answers are offered to provide a framework of information pertaining to commonly asked questions about hypoglycemia and related metabolic health issues. Remember that nothing takes the place of a medical diagnosis and treatment plan. If your symptoms persist or are severe, seek medical attention!

What is hypoglycemia?

Hypoglycemia – hy-po-gly-ce-mi-a (n.)

An abnormally low level of sugar in the blood.

What does this mean?

In simple layman’s language, hypoglycemia is the body’s inability to properly handle the large amounts of sugar that the average American consumes today. It’s an overload of sugar, alcohol, caffeine, tobacco and stress.

In medical terms, hypoglycemia is defined in relation to its cause. Functional hypoglycemia, the kind we are addressing here, is the over secretion of insulin by the pancreas in response to a rapid rise in blood sugar or “glucose”.

All carbohydrates (vegetables, fruits and grains, as well as simple table sugar), are broken down into simple sugars by the process of digestion. This sugar enters the blood stream as glucose and our level of blood sugar rises. The pancreas then secretes a hormone known as insulin into the blood in order to bring the glucose down to normal levels.

In hypoglycemia, the pancreas sends out too much insulin and the blood sugar plummets below the level necessary to maintain well-being.

Since all the cells of the body, especially the brain cells, use glucose for fuel, a blood glucose level that is too low starves the cells of needed fuel, causing both physical and emotional symptoms.

-Excerpt from The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar by Roberta Ruggiero

What is reactive or functional hypoglycemia?

Functional hypoglycemia refers to decreases in blood sugar that cannot be explained by any known pathology or disease. It’s a nice way of saying, “Your glucose regulating mechanisms aren’t functioning normally, and we don’t know why.” Reactive hypoglycemia refers to hypoglycemia resulting from the body’s abnormal response to rapid rises in blood glucose levels caused by diet or stress. The terms are now frequently interchangeable.
– Dr. Douglas M. Baird

While there are many potential causes and types of hypoglycemia, reactive hypoglycemia is the most common form (frequently improperly diagnosed and treated) and can often be resolved by dietary and lifestyle changes.
Reactive hypoglycemia (RH) is the condition of hypoglycemia occurring postprandially 2-5 hours after food intake. Many conditions are associated with postprandial hypoglycemia. Postprandially, RH is defined in three main types:  alimentary RH (within 120 min), idiopathic RH (at 180 min), and late RH (at 240–300 min). 
Potential manifestations of reactive hypoglycemia include:
  1. Alimentary hypoglycemia (consequence of dumping syndrome; it occurs in about 15% of people who have had stomach surgery)
  2. Hormonal hypoglycemia (e.g., hypothyroidism)
  3. Helicobacter pylori-induced gastritis (some reports suggest this bacteria may contribute to the occurrence of reactive hypoglycemia)
  4. Congenital enzyme deficiencies (hereditary fructose intolerance, galactosemia, and leucine sensitivity of childhood)
  5. Late hypoglycemia (occult diabetes; characterized by a delay in early insulin release from pancreatic beta-cells, resulting in initial exaggeration of hyperglycemia during a glucose tolerance test)
  6. Dietary hypoglycemia (related to consumption of processed carbohydrates, and foods with high amounts of naturally occurring and added sugar)

“The backbone of successful management of reactive hypoglycemia is the diet.” 
– Fred D. Hofeldt, (1975). Reactive hypoglycemia. Metabolism, 24(10), 1193–1208. doi:10.1016/0026-0495(75)90156-0 

What are the signs and symptoms of hypoglycemia?

Because all the cells in the body require glucose for energy, the symptoms of hypoglycemia are as varied as there are people who have the condition.  Symptoms can be mental, such as depression, anxiety, confusion, insomnia, irritability, and even thoughts of suicide. Physical symptoms include fatigue, headaches, dizziness, fainting, convulsions, irregular heartbeat, sweating, and cold hands or feet.  Food addictions, food sensitivities, or food cravings are also common in hypoglycemia. Feeling hungry, in spite of having recently eaten, is also a sign of hypoglycemia.

What are the main causes hypoglycemia?

Medical conditions, such as tumors of the pancreas or adrenals can cause hypoglycemia.  Type I and II diabetes can result in hypoglycemia when insulin or other glucose lowering medications are not followed by food intake.  Gastric Bypass surgery can result in post-prandial (after eating) hypoglycemia due to “Dumping Syndrome.” Functional or reactive hypoglycemia, which is the kind we are addressing here, is  caused by poor diet, stress, and lifestyle. A diet high in refined sugars and carbohydrates is a common theme among diagnosed hypoglycemics.

Stress is another common cause of reactive hypoglycemia.  Poor diet and stress usually go hand-in-hand. Persons who suffer from a lot of stress often reach for those high sugar, high starch comfort foods to help them deal with the stresses in their lives.  This is a perfect breeding ground for the development of reactive hypoglycemia. People whose lifestyles gives them little time for sleep, relaxation, or play, can easily develop reactive hypoglycemia.

What are the best tests for hypoglycemia?

The five-hour glucose tolerance test (GTT) remains the gold standard for diagnosing hypoglycemia.  The patient fasts overnight and a baseline blood glucose level is drawn. A cocktail of glucose in water is then consumed.  Blood glucose levels are drawn at 30 minutes, one hour, two hours, three hours, four hours, and five hours from the time of the glucose consumption.  If the blood glucose falls below fasting levels at any time during the test the patient is diagnosed with hypoglycemia. Another common response to the five-hour GTT is what we call a “flat curve.”  Glucose levels do not fall below fasting, but they do not rise in response to the glucose load that was consumed. This, too, is diagnostic of reactive hypoglycemia.

There are many practitioners who consider the five-hour GTT  too stressful for patients. Therefore, alternative methods of diagnosing reactive hypoglycemia have been used successfully.  These include allowing the patient to eat a high carbohydrate breakfast as the glucose load prior to the 5 hour GTT. Other practitioners consider a fasting glucose below normal to be suggestive of reactive hypoglycemia and treat the patient accordingly.  Still other healthcare professionals, who suspect reactive hypoglycemia, place the patient on a high-protein, low carbohydrate diet. If the patient responds favorably, the clinical diagnosis is made.

How do you treat low blood sugar symptoms?

The best way to treat low blood sugar symptoms is to avoid a drop in blood sugar with the use of diet.  However, if symptoms do occur, the best response is to eat a high-protein snack with a small amount of whole food carbohydrate.  The small amount of whole food carbohydrate will help raise the blood sugar, but not too quickly. The protein will then help stabilize blood glucose levels without precipitating another drop.

What is the relationship between low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)?

Hypoglycemia and hyperglycemia are two sides of the same coin.  They are commonly seen together, particularly if the hypoglycemia is long-standing.  In reactive hypoglycemia the pancreas is producing too much insulin in response to a rise in blood glucose.  Inevitably the pancreas will become fatigued, at which point it will fail to respond to blood glucose increases in a timely manner.  Hyperglycemia is the result. When the pancreas finally does respond, it does so with too much insulin and a drop in blood sugar, i.e. hypoglycemia, occurs.  Eventually, the patient can develop full-blown diabetes as the pancreas becomes more and more fatigued.

What is the best diet for for those who suffer from hypoglycemia?

The best diet for hypoglycemia is one that emphasizes healthy fat and protein, and low in carbohydrates – especially processed carbohydrates. Frequent feedings are often necessary to control long-standing functional hypoglycemia. The diet for hypoglycemia is designed to avoid a drop in glucose, NOT fix it after it falls. Eating sugar in all its forms, as well as eating refined carbohydrates, triggers excessive reaction by the pancreas. They must be avoided. There is a genetic tendency towards this condition, but much of the your pancreas is doing is caused by poor diet and lifestyle choices.

How does hypoglycemia affect those with type 1 diabetes versus type 2 diabetes?

In patients with type I diabetes the pancreas can no longer secrete insulin.  It must be supplied by insulin injections. Hypoglycemia in type 1 diabetics is the result of excess insulin injections or insulin injections taken without food.  In type 2 diabetics, the pancreas has the ability to produce some insulin. However, it has been abused by poor dietary choices. Therefore, excess insulin production is seen as a desperate attempt by the pancreas to continue working.  This, as well as too much glucose-lowering medication, can result in hypoglycemic episodes. A type 2 diabetic will need to follow the same high protein low carbohydrate diet as the reactive hypoglycemic.

How does stress and lifestyle related to hypoglycemia?

Stress is a common cause of reactive hypoglycemia.  Just as eating refined sugars and carbohydrates rapidly raise blood glucose levels, stress can do so as well.  The adrenal glands, that sit on top of each kidney, produce adrenaline and noradrenaline in response to stress.  These hormones are designed to raise the blood sugar, raise the blood pressure, and ready the body to fight or flee.  Chronic stress will, therefore, produce chronically high blood glucose levels. The pancreas will respond to this condition by chronically secreting insulin.  The resulting hyperinsulinemia results in hypoglycemia. Too much work, lack of sleep, and chronic stressful relationships, can all result in hypoglycemia, even if the diet is adequate.  

What does hypoglycemia have to do with my mental health?

The brain’s preferred fuel source is glucose. Hypoglycemia starves the brain of this much needed fuel.   When blood glucose is low, the brain will not function properly and all the symptoms of disturbed mental health can result.  We have heard the term psychosomatic, which means emotions can affect our physical health, positively or negatively. In hypoglycemia our physical health (hypoglycemia) is negatively affecting our mental health.  The term is “somatopsychic,” and it is just as real.

What information is available for health professionals?

Most types of (reactive/functional) hypoglycemia are preventable and diet-related. Sadly, nutrition education is sorely lacking for doctors and healthcare professionals and has actually been declining over the last four decades. This is one reason why many healthcare professionals do not properly understand hypoglycemia and how to treat it, relying heavily on drugs and devices rather than diet and lifestyle change.

The Hypoglycemia Support Foundation is working to change this, by developing high quality Continuing Medical Education (CME) for health care professionals. The HSF works with leading health care providers and institutions to develop educational partnerships and projects, like the first comprehensive infographic on hypoglycemia for patients and their healthcare providers. As CME programs become available, we will post the links here.

I have to have a colonoscopy... however, I have hypoglycemia and need some suggestions...

We can only share with you what has helped many others.

Consider making a pot of homemade chicken soup / or vegetable soup the day before you have to fast. Remove all the solids from the soup leaving just the broth. If you can’t make it yourself, purchase it fresh locally. As a last resort, get it from your local market deli. On the day of the fast, sip the broth throughout the day. Rest as much as possible, sleep if you can and stay calm and positive. Do what works for you…read a book, watch TV and meditate…anything that doesn’t add stress. The day of the test, bring a snack with you, such as peanuts or whole grain crackers with cheese, that you can eat immediately after the procedure. 

Any tips on choosing a physician?
  • Do choose a physician carefully – and preferably not during an emergency situation.
  • Ask for physician referral from friends, neighbors, family and business associates, hospitals and organizations.
    (Check out the link page on this website, it has an extensive list of referral listings.)
  • If you have a physician’s name you are considering, first call the office and ask if this doctor tests and treats hypoglycemia? Do they provide nutritional counseling? If the answer is no, can they refer you to someone else? What is their fee and do they accept insurance?
  • Once you’ve made your appointment, prepare a written list of your symptoms, as well as past medical records and bring that with you to your first visit.
  • It is wise to also bring a diet/symptom diary, which should include a list of everything you’ve eaten, or medication you’ve taken in the past 5 to 7 days, as well as the times you ate and any symptoms or reactions afterwards. Click here to download and print your own, or here to view an electronic form.
  • Do prepare a list of questions, and don’t hesitate to ask them.
  • Write down any instructions you receive.
  • Discuss a complete prevention program.
  • Discuss your concerns and symptoms…it helps to have a list printed out when you arrive – sometimes we feel flustered or embarrassed when discussing personal health issues with a doctor and a list helps you to be sure you cover everything going on with you.
  • Be specific and to the point.
  • Get a second opinion, especially if you’re not satisfied with your first physician.
  • Remember that there are many caring, sensitive, trustworthy physicians out there who test and treat hypoglycemia. If at first you don’t succeed in finding one, try again!

Excerpted & condensed from The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar.


Can stress trigger hypoglycemia?

“I have just been diagnosed as having hypoglycemia. I have been under a lot of stress and was wondering if this could have triggered the condition?”

To understand how stress can adversely affect this condition, a little physiology lesson might be in order. You cannot separate the psychological from the physical.

When you suffer from stress (real or imagined), your physical body reacts with what is known as the “fight or flight” response. The adrenal glands secrete the catecholamines, epinephrine and norepinephrine (adrenaline), which raise the blood glucose levels to prepare the body to fight or flee. Once that occurs, the pancreas begins to over-secrete insulin, and the blood glucose yo-yo begins. The drop in blood glucose is real! So, you need to be even more diligent with your diet during times of stress. I also believe that once you understand how stress, like poor diet, can set off hypoglycemia, you will understand the need to control both. Also, the more overanxious you become about this condition, the more difficult it will be to get it under control.

– Dr. Lorna Walker

Hypoglycemia and Medications

I have been diagnosed with hypoglycemia and am grateful I already see a big difference in my health and attitude since going on a hypoglycemia diet. However, I would like to stop my medication. I take antidepressants and tranquilizers. I don’t think I need them anymore. Any suggestions?

Congratulations on that fact that just changing your eating habits has made such a significant change in your life. Most likely you’ve omitted one or more of the big offenders—sugar, white flour, alcohol, caffeine and tobacco. Whatever your approach, it is working. Hurray!

As far as decreasing your medications and eventually getting off of them, it is imperative that you work with a healthcare professional who not only tests and treats hypoglycemia but also who knows your medical history, the type of medications you are on and the dosage.

I can only share with you what helped me. After my official diagnosis of hypoglycemia, a physician who combined holistic healthcare with orthodox medicine was a huge help to me. In time, vitamins, exercise and stress reduction techniques aided in my healing process. Although my doctor slowly started reducing the dosages of my medication, it wasn’t until I was introduced to hypnosis that was I able to get off them completely. Through deep relaxation, guided imagination and suggestions, and the help of a professional hypnotherapist, my goals were reached.

If you ever think of using hypnosis or any other type of alternative therapy, I urge you to learn everything you can about the treatment. Then take this information to your physician and decide together if this may be something you should consider.

Since depression can be caused by a chemical imbalance, hypnosis alone may not work for you. DO NOT stop your medication on your own, and if you are advised that you can stop it, make sure you are under medical supervision while doing so and report any symptoms such as worsening depression, suicidal thoughts or other side effects immediately.

—Roberta Ruggiero, Founder of the Hypoglycemia Support Foundation and Author of Do’s & Don’ts of Hypoglycemia : An Everyday Guide to Low Blood Sugar Too Often Misunderstood and Misdiagnosed! 

Is there just one thing that causes hypoglycemia?

There are certainly some things in our life, that if we cut out, or significantly reduced, might help control hypoglycemia… like sugar or processed carbohydrates. But, as we point out in our infographic, there are many different types of hypoglycemia and many different causes. One concept that might help to understand this is called the “exposome“. Here is a great article introducing the concept and why it is the “next big thing in your health.” You might consider getting a hold of a copy of the Do’s and Don’ts of Hypoglycemia or watching “Sweet Revenge: Turning the Tables on Processed Foods“. These educational resources don’t propose radical steps – just cutting out or reducing the worst offenders. A more advanced technology solution is offered by our partner “perfact – a platform that allows you to filter out the thousands of potentially harmful ingredients in our food (and beauty product) supply…based upon your own preferences.

What are "obesogens" and what do they have to do with hypoglycemia?

You can start by reading this article introducing you to the subject of obesogens. Thousands of chemicals are added to our food supply, and many are not even listed in the ingredients (herbicide and pesticide residues, and chemicals from plastic food packaging, for example). There are some studies demonstrating a link between food additives, preservatives, colorants, fixatives, stabilizers, etc. that indicate they cause inflammatory and negative metabolic responses. A few studies specifically list symptoms such as hypoglycemia. There are very few studies showing what the effects of all these substances are when they are combined in processed food products…the food industry basically uses us a guinea pigs, and there is very little government oversight of these substances and their effect upon our health. The Hypoglycemia Support Foundation takes the position that we should try and eliminate as many of these substances as possible from our diet. But how? We offer a solution for this here:

What is the link between hypoglycemia and mental health?

“The condition of relative hypoglycemia is one of the most common causes of neuropsychiatric illness.” – Relative Hypoglycemia as a Cause of Neuropsychiatric Illness, by Harry M. Salzer, MD. Whole new fields of science are emerging that underscore the connection between diet and health and the neurophysiology of the food mood connection. In addition to established fields of neuroendocrinology and other metabolic specialties, new fields of research and practice are developing, such as nutritional psychiatry and nutritional cognitive neuroscience. The studies that have emerged so far are confirming what most of us already know intuitively and experientially – that what we eat profoundly affects both our physical and mental health. Many of the mental health symptoms associated with hypoglycemia are featured in our comprehensive infographic on reactive hypoglycemia.

What does hypoglycemia have to do with type 2 diabetes?

The HSF has conducted ongoing Hypoglycemia Questionnaires.  What was the most startling conclusion of the questionnaire?  Leslie Lee, RD, the HSF Medical Advisor who played a major role in its inception and results states that “There were many interesting conclusions. The most important result to me was what we learned about reactive hypoglycemia preceding the development of type 2 diabetes. Two-thirds of  respondents who have been diagnosed with type 2 diabetes or pre-diabetes reported they experienced hypoglycemia before their diabetes diagnosis. Most of them (85%) experienced hypoglycemia for two or more years before their diabetes diagnosis, which presents a very clear window of opportunity for education and diet improvement. I believe the same metabolic dysfunction that presents as reactive hypoglycemia now can develop into insulin resistance and type 2 diabetes later, if diet is not modified. That was always my hunch and my greatest fear. It’s a simple observation, but I think it’s highly significant in that we can now interpret reactive hypoglycemia as a red flag or a call-to-action to intervene with diet modification and prevent diabetes from developing.”

According to Anita Flegg, author of Hypoglycemia; The Other Sugar Disease.  “Hypoglycemia, a precursor of Type 2 Diabetes, affects as least 25% of North Americans.  That means that there are at least 80 million people living and working at much less than optimal productivity and creativity.” Given that prediabetes and diabetes no affect over 50% of the U.S. population, we can hypothesize that hypoglycemia affects over 50% of the population.

What is "relative hypoglycemia"?

Relative hypoglycemia is a clinical syndrome in which patients develop symptoms referable to any system of the body as the result of a relative drop in blood sugar level in response to a high carbohydrate food intake and drinks containing caffeine. In the past the syndrome has been called functional hyperinsulinism, essential hypoglycemia, functional hypoglycemia, dysinsulinism, hypoglycemic fatigue, and neurogenic hypoglycemia. These older terms according to Buehler’ are all inaccurate inasmuch as a patient may present this syndrome when there is only a relative drop in blood sugar levels without an absolute drop into low blood sugar or hypoglycemic levels. Also studies have never showed an excessive amount of insulin circulating in the blood. -Henry M. Salzer, MD, Relative Hypoglycemia as a Cause of Neuropsychiatric Illness

What is "personalized nutrition" and what does it have to do with blood sugar health?

For much of modern nutrition history, a rather large assumption/concept has dominated thinking by experts in nutrition as well as in the general population: “One size fits all.” An example is the U.S. government food pyramid, or the current iteration “MyPlate”. Almost every government peddles some version of this – and sadly most are wrong… just look at the pandemic of metabolic diseases plaguing our planet.

In reality, current science supports the idea that nutrition plans and diets should be tailored for individuals, their culture, genetics, microbiome, environmental exposures, metabolic health, etc. Science supports using data to make decisions about what you eat, not fads, macronutrient ratios, etc. Modern nutrition science requires us to learn some actual science, use validated information to support decisions about what we eat, and last but not least, to cook and eat whole, real food (not food-like products and additives).

This means, when you hear someone tell you how to manage your blood sugar by giving you rote directions from a standardized diet plan, or worse yet, proffers some half-baked diet philosophy, commercialized proprietary food product regimen, or snake oils in form of expensive supplements, health-shakes, etc., then walk away. Some may do better on a low-fat diet, some on a low-carb diet, some on plant-based foods, and others on an animal-based foods – or all of the above. Don’t let food fanatics and philosophers, and with all due respect, kettlebell instructors, mislead you about what is good for you. Added sugar? Processed carbohydrates? That isn’t food or nutrition, so it is a “no-brainer” to cut these out.

Regrettably, some (many) healthcare institutions and providers don’t have a clue about nutrition – just look at the last meal you had in a hospital – either as a patient or as a visitor. Less than 30% of doctors are required to take a nutrition course during medical school. This means you have to shop around, find the right expert to guide you: someone who uses actual data, and then tailors a plan for you based on what the data and the science say, not their opinion or belief system. It is relatively easy to sort out the charlatans from the professionals – the professionals gather information, ask questions, and then formulate a plan… the charlatans just prescribe the same thing to all their patients, like you are a member of a herd. Don’t be part of the herd – be heard! 

In closing, here are a few articles and resources for you to get acquainted with this issue:

Personalized Nutrition References

Personalized Nutrition Companies and Organizations

Doctors and Books That Might Help Expand Your Thinking on Nutrition

Technology Tools

Who is affected by reactive / functional hypoglycemia?

Sadly, the research on reactive / functional hypoglycemia is severely lacking, so we don’t know exactly how many people are affected by the condition. The history of hypoglycemia in the U.S. is fraught with misunderstanding and even denial.

We do know that only 12 percent of American adults are metabolically healthy.

Dr. Seale Harris, the pioneer researcher of hyperinsulinism, viewed hypoglycemia as a harbinger of more complex metabolic disease as early as 1924: “The low blood sugar of today is the diabetes of tomorrow.”

Today, low blood sugar is an issue that affects the majority of the population in some form or another, and is a key indicator that metabolic dysfunction is at play. Patients, adequately informed by their doctors, can take action to address diet and lifestyle factors that are driving the condition before more advanced diet-related disorders progress. Unfortunately, many doctors are poorly prepared to diagnose and treat the condition within the context of metabolic (systemic) dysfunction. In 1958, the year after Dr. Seale died, slightly more than 1.5 million people were diagnosed with diabetes each year. In 2015, the rate had increased to over 23 million per year. Since 1980, rates of type 2 diabetes have quadrupled. More than half of Americans are now either pre-diabetic or diabetic. Nearly half of adult Americans are obese, a rate that has nearly doubled since 1980, while childhood obesity and diabetes diagnoses have tripled. One in two adults in the U.S. has a chronic disease, and one out three children born in the year 2000 will go on to develop type II diabetes at some point in their lives. 

If you think you might be affected by reactive / functional hypoglycemia, consider taking this brief quiz. It might help you identify some symptoms or issues you can present to your health care provider to get a professional opinion.

What about eating fruit?

Assuming your metabolic system isn’t already impaired, or you aren’t fructose intolerant, whole fruit usually isn’t a problem because it comes with fiber, nutrients and beneficial biota.

Endogenous sugar (intact in the food matrix of fruits and vegetables) is very different than processed sugars. In real – whole – unprocessed – food, dietary macronutrients (carbohydrates, proteins and fats) are usually consumed in a complex food matrix rather than in their pure form. As a consequence, glycemic response may be modified because macronutrients, fiber, micronutrients, biota, etc., interact with each other while being metabolized. As a result, sugars are metabolized more slowly, and your liver and metabolic system is less likely to be overwhelmed with the sugar bolus (food that has been chewed and mixed in the mouth with saliva…chewing helps to reduce food particles to a size readily swallowed, and saliva adds digestive enzymes, water, and mucus that help chemically to reduce food particles, hydrate them for taste, and lubricate them for easier swallowing and metabolizing).

Processed sugars, juices, sodas, etc. make a rush to your liver, which is unable to process them adequately, and converts them to liver fat, or cause a cascade of other negative metabolic responses (like the blood sugar roller coaster). Your endocrine system goes awry, cells become insulin resistant, and you become at risk for having chronic blood sugar dysregulation (high and low blood sugar) and, if the sugar onslaught continues, type 2 diabetes or non-alcoholic fatty liver disease.

I have both high and low blood sugar - the blood sugar roller coaster. Why do I feel fatigued when my blood sugar is high and low?

Cells need insulin to absorb glucose from the blood. If the cells do not take in enough glucose, it can build up in the blood, causing high blood sugar. The cells need glucose to provide energy. … Low blood sugar can also cause fatigue, especially in people who do not get enough warning that their blood sugars levels are dropping.

Glucose, a form of sugar, is the primary source of energy for every cell in the body. On a carbohydrate based diet, the brain is dependent on sugar as its main fuel. On a ketogenic (extremely low carbohydrate) diet, the brain is mainly fueled by ketones (produced in the liver when carb intake is very low).

Is there connection between hypoglycemia and alcholism?

An often overlooked aspect of alcoholism is its relationship to your blood sugar and diet.

“I have never, ever seen an alcoholic who was not hypoglycemic. It just doesn’t occur; it’s the same problem.”
-Dr. Douglas M. Baird

Dr. Douglas M. Baird, a physician in South Florida, brought the hypoglycemia-alcoholism connection to light in his first presentation for the Hypoglycemia Support Foundation (HSF) in 1982, where this one pronouncement, to a spellbound audience, made a powerful and lasting impression.

Dr. Joan Mathews Larson, author of 7 Weeks to Emotional Healing, agrees wholeheartedly. In an interview she had with Larry Hobbs, she stated: “It is an absolute must that alcoholics change their diet to control their hypoglycemia or they will never get their alcoholism under control…It is very clear that the success rate in stabilizing alcoholism is shamelessly low because one of the main contributing factors, hypoglycemia, is not being addressed.”

Read the full article by clicking here.

What about "healthy" forms of added sugar?

There are hundreds of names being given to added sugars to make them sound healthier – this is called “health-washing” – companies trying to sell their products by making claims that one form of sugar is healthier than another. 100% Glucose based sweeteners may be safer than those with fructose, but the problem is the TOTAL amount of added sugar in the average diet… so called “healthy sweeteners” all add up to a flood of sugar for the average person by the end of the day, and this is playing havoc with our metabolic systems. Once you become insulin resistant, your body’s ability to process ANY sugar becomes problematic, and most people would be benefit by being hyper-vigilant about avoiding added sugars in their diet.

The American Heart Association (AHA) recommends limiting the amount of added sugars you consume to no more than half of your daily discretionary calories allowance. For most American women, that’s no more than 100 calories per day, or about 6 teaspoons of sugar. For men, it’s 150 calories per day, or about 9 teaspoons. The AHA made three recommendations: Children over age 2 years should consume no more than 6 teaspoons (25 grams) of added sugar each day. Children should not drink more than one 8-ounce sugar-sweetened beverage per week. THESE ARE MAXIMUM LIMITS for healthy individuals… and most humans are already exceeding these by 3X or more – the average American consumes 17 teaspoons (71.14 grams) every day. Half of the U.S. is prediabetic or diabetic. Only 12% are metabolically healthy. If you are metabolically compromised, there are no “safe” added sugars. How much added sugar do you need? ZERO.
Are there different types of reactive hypoglycemia?

There are many different types of hypoglycemia… the kind we most concerned with, because it is the most common, is reactive or “postprandial hypoglycemia”… a fancy way of saying that your “hypos” most often occur in the hours following a meal. 

Several types of reactive hypoglycemia have been described – alimentary, prediabetic, hormonal, and idiopathic – each differentiated by glucose tolerance curves.

  1. Alimentary hypoglycemia is associated with persons who rapidly digest their food, persons with irritable bowel or persons who have ulcers or gastric surgery. Food passes rapidly from the stomach to the small intestine and hypoglycemia can occur.
  2. Prediabetic hypoglycemia – a condition of dysinsulinism exists. The pancreas is initially sluggish and does not put out enough insulin to manage the sugar bolus, later it overshoots by putting out too much insulin just at the time the blood sugar is dropping. 
  3. Hormonal dysfunction hypoglycemia. For example, these persons, if tested for cortisol or growth hormone, may show increases in these hormones which indicate that a state of hypoglycemia existed due to calling in excessive amounts of these normally occurring regulatory hormones. 
  4. Idiopathic hypoglycemia (relating to or denoting any disease or condition which arises spontaneously or for which the cause is unknown). There are many possible health conditions which may trigger hypoglycemia.
What is an "Acellular Carbohydrate"?
Acellular carbohydrates are particularly evident in modern ultra-processed foods, such as added sugar and flour, but the overwhelming majority of plant-based foods prevalent in the modern food supply (so-called Standard American Diet) are acellular highly-processed products. For someone who’s struggling with metabolic disorders such as hypoglycemia or type 2 diabetes, understanding concepts like cellular vs. acellular carbs can make a major difference in achieving health outcomes. In contrast, cellular carbohydrates are found intact in the cellular matrix of plants, remain relatively intact during cooking, and are essentially whole, unprocessed or minimally processed.


  1. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity
  2. Carbohydrates: Why Quality Trumps Quantity
What about sugar and my pregnancy?

How dangerous is added sugar for a baby in the womb? 
There are many good reasons to be concerned about too much added sugar in a mother’s diet.

Can added sugar be compared with alcohol or drugs?
There are many common denominators, including the metabolic pathways of fructose and alcohol are basically the same.

Can a baby become dependent on sugar if a woman eats a lot of it during pregnancy? 
Probably, but is impossible to do a controlled study using infants to prove the hypothesis. The good news is that Dr. Lustig has conducted a study that shows merely restricting fructose for 9 days can have an enormous and positive impact on children’s health.

What is the influence of excess sugar on the baby while it is inside the womb? 
Not enough research here, but here is one example:

How much of the add sugar in my diet goes to the baby? 
Hard to say, but the evidence is clear – too much sugar in the mother’s diet is dangerous. The American Heart Association recommends that women consume no more than 6 teaspoons (25 grams or 100 calories) of added sugar per day – but keep in mind there is NO requirement for added sugar in the diet. 

Can a baby in the womb self-regulate how much sugar it metabolizes?
If you flood any organism with too much of something, you are asking for trouble… this includes water, etc.

How can hypoglycemia be a "gift"?

With an ever-growing body of scientific studies and findings, hypoglycemia is proving to be one of the most confusing, complicated, misunderstood, and often misdiagnosed conditions.” But HSF’s own research suggests that reactive hypoglycemia can be a red flag or a call-to-action to intervene with diet modification and prevent diabetes or other chronic metabolic disorders from developing into chronic conditions. The HSF was founded by an amazing patient advocate who had to suffer medical malpractice before receiving a proper diagnosis. We hold the simple belief that conditions such as low blood sugar offer us early warning signs, like a canary in the coal mine, that can spare us years of suffering and progressive chronic metabolic disease, such as hypoglycemia, type II diabetes – a condition which now affects over 50% of the U.S. population. The “gift” is that, despite the suffering inflicted by a condition such as hypoglycemia, it can be sign to take action that can be life-saving – if we pay attention, and make changes in our diet and lifestyle, if required.

What is normoglycemia?

The term normoglycemia refers to blood glucose levels that are within the ideal range most of the time. Stable blood glucose levels are important – constant changes in the blood glucose levels may be harmful to our long-term health. Glycemic variability or glycemic dysregulation are well-established risk factors for hypoglycemia and a suspected risk factor for diabetes complications and other metabolic disorders.

What about hypoglycemia outside of diabetes?

What is hypoglycemia? 

While much less common than diabetes (high blood sugar), hypoglycemia (low blood sugar) is also an established medical disease. Severe hypoglycemia can be caused by uncontrollable and excessive insulin production from within the body, due to genetic disorders, tumors of the pancreas (insulinoma) or prior stomach or intestinal surgery, all of which cause uncontrollable surges in insulin levels; these high insulin levels cause the glucose levels to drop quickly to dangerous levels. 

Since glucose is a critical fuel for brain cells, low glucose can cause abrupt change in brain function, as the brain requires glucose as a fuel in order to function properly. This can be dangerous, causing loss of thinking skills, reduced reaction time, loss of consciousness, seizures, motor vehicle accidents, coma, and even death. Many patients with severe hypoglycemia (glucose concentrations less than 3.0 mmol/L or 54 mg/dL) become disabled by this condition, and are no longer able to work due to inability to drive or maintain employment. 

If hypoglycemia is mild, it can be treated with food or glucose. Medications and strict dietary measures are used to try to reduce the frequency and severity of low glucose, but these are often not fully effective. Insulin secretion remains uncontrollable, causing glucose levels to drop to dangerous levels at unpredictable times. 

If hypoglycemia is severe, patients require the assistance of others in order to treat, and may require injections of a hormone called glucagon which elevates glucose levels back to the normal range. If hypoglycemia happens repeatedly, patients are often unaware of hypoglycemia until it is so severe that they are no longer able to treat it themselves. With loss of warning signs, patients may experience sudden loss of brain function and loss of personal safety without warning. 

In what conditions can hypoglycemia occur? 

Hypoglycemia occurs often in diabetes, when the doses of insulin or medications which stimulate insulin release are too high relative to food or activity. However, hypoglycemia can occur also when the body is making too much insulin on its own. This can occur due to an insulin-producing tumor (insulinoma), or when the pancreas makes too much insulin after meals due to abnormal function of the insulin-producing cells, or due to abnormally high levels of hormones which direct the pancreas to make too much insulin. This can occur after a variety of types of gastrointestinal surgery. These conditions are not as common as diabetes, so are less recognized by the general public. However, for those patients affected by hypoglycemia, it is just as dangerous whether associated with diabetes or whether it occurs outside of diabetes. 

Why are glucose monitors helpful in hypoglycemia? 

Continuous glucose monitors have been exceptionally powerful tools to assist patients in managing diabetes and to maintain their health and safety. These monitors analyze glucose levels in the fluid under the skin every 5 minutes. Data from the monitor is transmitted to a receiver or phone, which then displays the result. If glucose levels fall below a certain threshold, an alarm is generated which alerts the patient about a dangerous level of glucose, allowing the patient to treat and correct the glucose before it becomes severe and life-threatening. This is especially critical for those patients who do not have awareness of hypoglycemia, as the meter provides the information to them even though they have no symptoms.

What are the levels of hypoglycemia?
Levels of hypoglycemia
  • Level 1 (mild) hypoglycemia: Blood glucose is less than 70 mg/dL but is 54 mg/dL or higher.
  • Level 2 (moderate) hypoglycemia: Blood glucose is less than 54 mg/dL.
  • Level 3 (severe) hypoglycemia: A person is unable to function because of mental or physical changes. They need help from another person.
Does hypoglycemia always present with diabetes?

Hypoglycemia occurs most often in diabetes, when the doses of insulin or medications which stimulate insulin release are too high relative to food or activity. However, hypoglycemia can occur also when the body is making too much insulin on its own. This can occur due to an insulin-producing tumor (insulinoma), or when the pancreas makes too much insulin after meals due to abnormal function of the insulin-producing cells, some cases of prediabetes, or due to abnormally high levels of hormones which direct the pancreas to make too much insulin. This can occur after a variety of types of gastrointestinal surgery. These conditions are not as common as diabetes, so are less recognized by the general public. However, for those patients affected by hypoglycemia, it is just as dangerous whether associated with diabetes or whether it occurs outside of diabetes.”
– Dr. Mary-Elizabeth Patti
nationally recognized expert on hypoglycemia.

Over the years, a number of books have been written on Hypoglycemia. Only one has been reprinted in a 5th Edition – Hypoglycemia Do’s and Don’ts, written by Roberta Ruggiero, Founder of the Hypoglycemia Support Foundation. Click below to learn how to get your own copy of this book.

Check out this detailed infographic about reactive / functional hypoglycemia!

Parker has chronic hypoglycemia. In the past, he had daily symptoms, was hospitalized frequently, and struggled to stay focused in school. The Do’s and Don’ts of Hypoglycemia has been a true blessing for us. Parker relates to some of the personal stories and information on foods, and learning what to add or subtract from his diet has been a wonderful tool for me. The chapter of FAQ’s has been an invaluable resource that we refer to time and time again. Parker still struggles, however Roberta’s book enables us to make changes in his diet that ensure his success.

Fiona Flowers

Roberta Ruggiero saved my life.  When I was first diagnosed I didn’t know where to turn for help.  I stumbled on her book, The Do’s and Don’ts of Hypoglycemia, at the local library and decided to contact her for some advice. I was a total stranger and this amazing angel called me weekly to give me advice and make sure I was doing okay for months.  I will forever be grateful to her.

Roseanne Giannoni

Our 21st century lifestyle is causing so many diseases, with hypoglycemia being high on the list. Here is a book that explains in detail the relationship between diet and behavior, and important steps to recovery. It can be easily read with solid facts and simple suggestions. If followed, Roberta Ruggiero’s book can do wonders for not only people with hypoglycemia, but any blood sugar concern.

Dr. Nancy Appleton

Author, Lick The Sugar Habit

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