Can you relate?

For many, the symptoms of hunger are a little more than a mildly irritable mood, a grumbling stomach, and a little fatigue. In fact, many people don’t even feel hungry in their stomachs when they need to have a snack, which can make it difficult to identify that blood sugar levels are at risk of dropping. If going long stretches of time without eating, skipping post-workout snacks, eating sweets on an empty stomach, or having an especially busy day causes symptoms such as the above (fatigue, irritability, weakness, dizziness, feeling cold, breaking out in a sweat, fainting, headaches, stomach pain) then you may be struggling with reactive hypoglycemia.

Just like some individuals struggle to maintain blood sugar balance because their cells are less sensitive to insulin than normal or they don’t produce enough insulin (as with diabetes), individuals who struggle with hypoglycemia have difficulty maintaining blood sugar balance because their cells are more sensitive to insulin than normal or they produce too much insulin. The number one way to promote healthy blood sugar balance with reactive hypoglycemia is to eat balanced, regular meals. That means more food, more often.

The idea of “more food, more often” sometimes seems counter-intuitive, especially if you have a goal of weight loss. It may seem like eating more is the last thing you’d want to do. However, the case I’ll make in this post and what I want you to know is that for women, especially women with health concerns like PCOS, perimenopause, hypothalamic amenorrhea or hypothyroidism, eating more is exactly what you want to do.

As with everything on my blog, this post is not intended to diagnose, treat, or cure any illness. If you are experiencing symptoms of reactive hypoglycemia or any health condition, talk to your doctor.

What Is Reactive Hypoglycemia?

Reactive hypoglycemia is a condition where blood sugar levels drop too low (typically below 70 mg/dL) within a few hours after eating, particularly following a high-carbohydrate meal. It occurs when the body produces too much insulin in response to the rise in blood glucose, leading to a rapid and excessive decrease. Symptoms can include shakiness, sweating, fatigue, irritability, and dizziness. While not usually imminently dangerous, reactive hypoglycemia can be a sign of underlying metabolic dysfunction and may be managed through dietary changes or a targeted supplementation strategy.

What Causes Reactive Hypoglycemia?

As with any condition, the contributing factors to reactive hypoglycemia are complex and varied. More often than not, a person has a genetic predisposition to the development of the condition, which is ultimately triggered by environmental/lifestyle factors, namely stress. As I explain in this post about hormones, stress affects almost every system of our bodies, especially our metabolism. Stress interrupts the delicate web of signals between our brains and our organs, and over time this can lead to more long-standing patterns of dysfunction.

Stress comes in many forms, though we most classically think of it as being related to emotional or relationship triggers. But just like a hectic schedule, tight deadlines, or unhealthy relationships contribute to stress, too much exercise, not eating well, poor sleep habits, chronic illness or allergies, and other environmental exposures can contribute to our levels of stress. I like to describe our stress tolerance as a bucket, and each of those different types of stressors fills the bucket. When the bucket gets full, our bodies start to overflow into dysfunction and disease.

But just like stress contributes to the onset or exacerbation of our symptoms, stress management and self-care can help increase our body’s margin, making us better able to handle triggers. When we’re taking care of ourselves well, missing a snack is less likely to send me into a crisis.

Note: Stress is the most notable contributing factor to metabolic dysfunction like reactive hypoglycemia, but other factors can also contribute such as alcohol use, surgeries, liver or kidney disease, tumors, or other metabolic disorders. If you are concerned about any of your symptoms, always make an appointment with your doctor.

What Are the Symptoms of Reactive Hypoglycemia?

The symptoms of low blood sugar are varied, which is why it can be challenging for some people to recognize patterns between their eating habits and their health. Personally, I find that paying attention to my body’s signals and checking in with myself regularly has helped me to better understand how to care for myself. This helps me know when my body needs food even if it isn’t a “normal” meal time.

Some of the symptoms of low blood sugar include:

• Feeling shaky
• Being nervous or anxious
• Sweating, chills, and clamminess
• Irritability or impatience
• Confusion
• Fast heartbeat
• Feeling lightheaded or dizzy
• Hunger
• Nausea
• Color draining from the skin (pallor)
• Feeling sleepy
• Feeling weak or having no energy
• Blurred/impaired vision
• Tingling or numbness in lips, tongue or cheeks
• Headaches
• Coordination problems, clumsiness
• Nightmares
• Insomnia or waking during the night
• Seizures

Many of my patients liken the feeling of low blood sugar to feeling drunk. They describe feeling tired, disoriented, and like they have tunnel vision. They say their muscles also get weak, they might feel sweaty, or their moods becomes either anxious or irritable.

How Is Reactive Hypoglycemia (Low Blood Sugar) Diagnosed?

There are a number of different ways to evaluate a person’s blood sugar. In my practice, here are a few key flags that I look for on blood work:

• Low fasting insulin levels (less than 4 mUnits/L)
• Low fasting glucose at the time of the blood draw (<75 mg/dL)
• Low a1c (less than 4.8%)
• Low levels of LDH (less than 100 units/L)

Bear in mind that these are functional labs, which means that not all healthcare providers are willing to run them (however a fasting glucose level is usually included as part of a comprehensive metabolic panel on annual preventative wellness labs run by most primary care doctors. A1c is also often included.) You might need to ask for insulin and LDH to be run as well, to get a complete picture.

Testing for Reactive Hypoglycemia at Home

If you don’t want to make an appointment with your doctor, there are two ways that you can test your blood sugar at home. The first is with an old-fashioned fingerstick and the second is with a newer piece of technology: a continuous glucose monitor.

Finger Stick:

To test your blood sugar using a finger stick, you’ll need test strips, a lancet and a glucometer. Often, these tools can be purchased together as a package, such as the iHealth glucometer kit, which is FSA eligible. I recommend starting out by testing your blood sugar several times per day, including:

• Fasted levels, first thing in the morning
• 30 minutes after meals
• 60 minutes after meals
• 2 hours after meals

Continuous Glucose Monitor (CGM)

As an alternative to using a finger stick method, you could consider tracking your blood sugar using a continuous glucose monitor. This method tests glucose levels in the interstitial space (tissue just below the skin) which changes and updates the Bluetooth app in real time. To use, a subdermal needle connected to some adhesive and a Bluetooth device is applied to the arm, abdomen, hip or thigh and continuously monitors blood sugar levels. For many, this is less painful than recurrent finger sticks. Stelo by Dexcom is a continuous glucose monitor with both iOS and Android-compatible technology.

When tracking my blood sugar with a CGM, I log the following data:

• Meals and snacks I ate that day
• My quality of sleep
• My stress levels
• My exercise
• Blood sugar levels overnight, 30 minutes after meals, and 2 hours after meals

How Is Reactive Hypoglycemia Managed with Diet?

The number one way to manage reactive hypoglycemia is to eat frequently, and make sure to pair carbohydrate foods with protein, fiber and fat to stabilize the release of glucose into the blood stream. I often recommend that my patients consume a fiber supplement, like a teaspoon of chia seed of psyllium husk with water, about 15 minute sbefore meals. It’s also a good idea to eat a protein-rich snack with fiber before bed to keep blood sugar stable enough for a good night’s sleep.

A good recommendation is also to avoid alcohol, as this can be a big trigger for hypoglycemia. Of course, there are situations when moderate alcohol use is part of a normal, healthy lifestyle, and so my recommendation is usually to restrict drinking to no more than 1 drink at a time, no more than 3 nights per week, always taken with a meal or snack that contains protein.

It’s also really important to manage stress—all types of stress. That means addressing relationship conflicts, creating boundaries to support work/life balance, eating high-quality food, exercising in moderation, developing productive coping skills, and practicing sleep hygiene. These are the most effective ways to support a healthy stress response, but in a clinical setting, I also sometimes use adaptogenic herbs and other supplements to balance inflammation, manage cortisol, and support a healthy blood sugar response for my patients. If you are interested in using herbs or supplements to manage stress or blood sugar, always check with your doctor first. Even better, work with a functional medicine doctor to find the herbs that are right for you. (This is important because some adaptogens have a blood sugar lowering effect, which could worsen symptoms of hypoglycemia.)

While reactive hypoglycemia can be extremely debilitating, it’s not the end of the story for your health. It isn’t a sentence for weight gain and you definitely aren’t doomed to feel that way your whole life. With a little digging and some strategic hacking of your nutrition and supplements, you can feel like 100% again, no matter your season of life.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Reactive Hypoglycemia Diet: How to Manage Low Blood Sugar Naturally appeared first on Dr. Alexandra MacKillop.

One of the most common stories I hear from my patients when they come to me for functional medicine treatment is that they primary care doctor told them they were “fine.” In some cases, their doctors even ran a blood panel, reviewed the test results, and proudly told the patient that nothing was wrong. The problem is, for these patients, that wasn’t good news.

That’s because they didn’t feel like everything was “fine.” Quite the opposite, actually! These patients had made appointments with their doctors (and often waited a long time to see them) because they were dealing with troubling, debilitating symptoms. From fatigue and brain fog to digestive distress, and more. Seeing a healthcare provider only to be told there is no diagnosis feels dismissive, invalidating, and frustrating because no answers means no treatment; and no treatment means they need to keep feeling bad.

The Problem With Traditional Medicine and PCPs

The traditional medical model sets us up for failure in these cases. If a PCP exhausts his or her tools for screening a patient, that patient is left in the dark to figure things out on their own, or to find another model for medical care. That’s where functional medicine comes into play.

Functional medicine’s goal is to identify the root cause of disease. That means understanding the patterns of breakdown in bodily systems that lead to devlopment of disease. Diagnosing disease, for the most part, is not that hard. You simply need to run the right tests and conduct the right clinical exams. In some cases, doctors do a bad job of this, but that phenomenon isn’t simply a consequent of traditional medicine. (There are good doctors and bad doctors everywhere!) But where a given disease process isn’t obvious, we need to also recognize that underlying processes which will one day result in clinical disease, create pathological symptoms in the mean time.

Take blood sugar problems, for example. Type 2 Diabetes is a disease in which the pancreas fails to produce enough insulin, and the body’s cells fail to respond effectively to insulin, enough to keep blood sugar levels from rising dangerously. In this disease, the high blood sugar levels cause poor blood circulation, organ damage, vision problems, nerve pain and loss of sensation, low energy and weight gain. However, before Type 2 Diabetes develops, we see prediabetes. Before prediabetes, we see insulin resistance. Before insulin resistance, we see patterns of abnormal blood glucose spikes and drops. Where traditional medicine says “You’re good! You’re not diabetic!” in thise early stages, functional medicine recognizes the red flag that those early pathological states are, and validates the fact that patients in those early disease states still experience symptoms worth addressing.

But we need to be able to clinically diagnose those early disease states, because the feeling of rising-and-falling blood sugar are similar to the early stages of subclinical hypothyroidism, perimenopause, allergies, anxiety, and so many other things. In the absence of accurate test results, it’s easy to tell a middle-aged woman that her symptoms are “probably” due to aging and perimenopause, for example, or a a young adult with chronic allergies that the other symptoms are “probably” just part of those allergies. “Allergies are bad this year!”

But “probably” is not a diagnosis. “Probably” doesn’t help anyone.

Functional Medicine Tests to The Rescue

With the blood sugar example outlined earlier, in order to understand whether a non-diabetic patient is dealing with prediabetes, or insulin resistance, or poor blood sugar control, or a problem entirely separate from metabolic dysfunction, we need to run testing to identify what’s going on.

To do that, functional medicine doctors use two types of testing: more comprehensive standardized tests, and specialized functional medicine tests.

Comprehensive Standardized Tests

In this discussion, “standardized tests” refers to testing that a traditional medical provider could and may actually run, but typically doesn’t. As an example, about 50% of PCPs that I co-manage care with run vitamin D tests on patients as part of an annual screening and the other 50% do not. My husband’s primary care doctor ran it without him even asking and mine did not put the order in until I directly asked. Some others flat out refuse even though it’s completely reasonable for them to do so.

Similarly, with the topic of metabolic health, PCP’s could run fasting insulin levels in addition to hA1c, fasting glucose and triglycerides. In the realm of cardiovascular health, a PCP could easily test LDL Particle Number in addition to LDL levels on a cholesterol panel. It’s not typical but it is definitely possible.

Here are some other examples of comprehensive testing that could be run in a standard medical office:

• Fasting insulin in addition to hA1c, fasting glucose and triglycerides
• A full thyroid panel instead of just TSH
• Inflammatory markers, like hs-CRP and sedimentation rate
• Cycle-specific testing of estradiol, testosterone, progesterone and DHEA levels
• Ferritin, serum iron, % saturation and TIBC in addition to a CBC
• Vitamin B12, folate, zinc, magnesium and vitamin D levels

The Cost of Testing

Because these tests are available through traditional labs, they are often able to be covered by traditional health insurance, provided they are used correctly and coded for correctly. In some cases, however, you should be aware that insurance companies may refuse to pay for certain tests to be used as screening. So, if a provider orders them for you, as with all testing and procedures, you should call your insurance company first to know what you might be expected to pay.

The reason most primary care doctors don’t run these comprehensive tests is because it’s not the easy, standard model. It’s more complicated to code for these tests, and more comprehensive follow-up is necessary. Unfortunately the way our current medical system is built, doctors just don’t have time for those things. The average doctor’s appointment is less than 20 minutes, and patients typically see their doctors less than once per year. It’s an overburdened and broken system for sure. That’s why we need not only functional medicine doctors to fill gaps, but a reform of the system to provide better care in general.

Functional Medicine Specialty Testing

Beyond the comprehensive testing that’s available through traditional labs, functional medicine doctors sometimes run tests that are not available through the traditional medical model. Additional training and enrollment in laboratory services is required for these higher-level tests. These tests are at the cutting edge of medical testing, and they don’t necessarily lead to diagnosis of a clinical disease, like Type 2 Diabetes, for example. However, they help identify some of the earlier disease processes that lead to both current symptoms and future development of disease.

Here’s an example: there is no medical diagnosis in the traditional model for a deficiency of beneficial bacteria in the human body. However, we all know just how important probiotics are for human health, and the problems that are caused when we wipe them out (like from overuse of antibiotics.) We know that bacterial imbalances cause severe digestive distress, and also that they create a breeding ground for new infection (C. diff for example.) Functional medicine offers stool testing to identify bacterial imbalances which both create risk of future disease as well as present-day symptoms.

Here are some other examples of “above-and-beyond” testing in functional medicine:

• Salivary and urinary hormone metabolite testing
• Microbiome testing
• Intestinal markers of digestive enzyme activity, inflammation, and short-chain fatty acids
• Cardiovascular markers like LPA PLA2, lipoprotein(a), omega-3 levels and more
• Comprehensive heavy metal testing
• Mold testing
• Organic Acids Testing
• SIBO Testing
• Continuous Glucose Monitoring

…and so much more

Cost of Testing

Because these tests are highly specialized and on the cutting edge of medical advancement, most insurance companies will not pay for them. While some testing panels may include elements that would be covered by traditional insurance, such as occult blood in stool or 17-hydroxypregnenolone, for example, the laboratories themselves do not contract with insurance companies and therefore it is not possible to have coverage for them. The cost of individual tests that may have coverage outside of the panel are negligible when run as a full panel, which offers much greater value than trying to piece together individual tests a-la-carte and not having the full picture. The primary value of these tests, of course, comes from their ability to explain symptoms where traditional labs fall short.

The beauty of functional medicine tests is that they provide a way of diagnosing and describing a person’s symptoms and health status with objective, medical data, creating the possibility of creating a treatment plan as a next step. When doctors and patients understand the health condition at play, the suffering person can finally find healing.

Because, I think we can all agree that if a person is experiencing symptoms, they aren’t “fine.” If the lab tests come back normal, it means the right lab tests haven’t been run yet. And until a diagnosis is made, that person is going to keep on feeling terrible and potentially create lasting health problems in the long run. But functional medicine offers the solutions needed to meet patients where they are and help them restore their health before it is too late.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post What Are Functional Medicine Tests and How Can They Help Your Health? appeared first on Dr. Alexandra MacKillop.