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.

“Okay, okay, hypothalamo-whatta-whatta?“

If that’s what you’re thinking, you’re in good company. The hypothalamic-pituitary-adrenal-thyroid-gonadal axis is quite the tongue twister. But don’t worry, it sounds more confusing and overwhelming than it is. In short, the HPATG-Axis is the system of hormone balance in our bodies. To understand how to balance hormones naturally, we need to first understand what hormone balance looks like through this great, big web of connections.

In a nutshell, the HPATG-Axis phrase refers to is the fact that a part of our brain called the hypothalamus communicates with our adrenal glands, thyroid, and ovaries (aka gonads) through a series of hormones produced by the pituitary gland (also located in our brain). In physiology, we often talk about those interactions separately, referring to them as the hypothalamic-pituitary-adrenal axis, or the hypothalamic-pituitary-thyroid axis. But in reality, they’re all connected, and this post will explain everything you ever wanted to know about how and why. (Okay, maybe not everything, but the basics…)

The HPATG Axis (AKA Endocrine Axis)

HPATG physiology can basically be summed up like this: the hypothalamus talks to our pituitary gland using hormonal signals, telling the pituitary gland when and how to stimulate our thyroid, our adrenal glands, and our ovaries. All of those glands send hormonal messages back to our brain with information about how much activity is going on, and whether or not there are any problems. In response, the brain tells the body to amp up activity in each of those sites, or tone it down. This is called a negative feedback loop.

When we face periods of stress (or rather, when we face too much stress for too long), our HPATG axis is completely intercepted. This is where we can run into imbalances in our thyroid hormones (such as hyperthyroidism or hypothyroidism), adrenal hormones (such as “adrenal fatigue”), or fertility problems, (such as hypothalamic amenorrhea). These problems can occur one at a time, or all at once, leading someone to feel really sick, and probably also really confused! Stress is a biggie when it comes to a properly functioning HPATG axis. In most cases, if you’re wondering how to balance hormones naturally, we need to start by addressing stress because stress is the single most powerful influence over the HPATG axis.

Stress and Stress Management

When we think about stress, we typically think about the psychological or emotional—deadlines at work, an overly packed schedule, a bad breakup, or a death in the family. But stress comes in many forms, and can even be triggered by good life events…

• Under eating (not enough calories or carbs)
• Nutritional deficiencies
• A significant/sudden change in diet/eating habits (especially yo-yo dieting)
• Over exercising (or a sudden change in the type of exercise)
• Lack of sleep or change in sleep schedule (i.e. night shift)
• Illness or injury (including surgery)
• Travel (even if it’s fun!)
• Moving
• Starting a new job or educational program
• Getting married
• Certain medications, or drug use
• Depression or anxiety
• Emotional distress (like the loss of a loved one)
• Psychological distress (like work deadlines or studying for exams)

Many of these things are normal parts of life, and when we are following a pattern of self care, our bodies are able to accommodate the stressors without falling into dysfunction. But when our self-care routine falls out of balance (or we begin struggling with disordered eating) we detract from the foundation of health. When that happens, everything else starts to crumble. One of my favorite ways to explain this relationship between stress and self-care is the bucket analogy:

Self-care fills our bucket, but stress drains our resources. When the bucket gets low, we start to notice symptoms of burnout. When the bucket gets empty, it leads to hormonal disaster, interrupting our whole HPATG axis at a biochemical level in our brains (big red stress arrow on the infographic at the top of this post). Ultimately, learning how to balance hormones naturally means learning how to identify and cope with the small, daily stressors in our lives.

Dysfunction, one axis at a time

The reason we often talk about the HPATG axis in terms of its separate components (HPA, HPT, HPG axes) is because unilateral dysfunction is common. For example, an autoimmune disease called Hashimoto’s Thyroiditis can lead to destruction of the tissue of the thyroid gland and subsequent hypothyroidism. When this happens, the thyroid loses its ability to produce thyroid hormone. When the pituitary gland realizes that thyroid hormone levels are so low, it amps up its secretion of thyroid-stimulating hormone in an attempt to tell the thyroid to do a better job. The problem is, the thyroid itself has been damaged—it can’t do its job until the autoimmune reaction is addressed. (Here’s where stress pops up again: if you’re wondering how to balance hormones naturally in terms of your thyroid hormones, you still need to pay attention to the stress piece because stress is one of the primary drivers of autoimmune disease.)

Low levels of thyroid hormone create a further stress response in the body, signaling back to the brain that something’s off. This consequently affects the signaling between the pituitary gland and the adrenals/ovaries as the body tries to balance things out. Low levels of thyroid hormone, for example, creates a dangerous environment for a growing baby, and so the reproductive system is one of the first to get shut down (via the HPATG axis). On the other hand, pregnancy causes the body to re-prioritize its hormonal resources. When a woman is pregnant, the body needs different levels of thyroid hormone, cortisol, and other hormones to carry the pregnancy to full-term. These body signals these changes through the same negative feedback loop. (All of this takes place without us ever having to think about it. You’ve got to admit, God’s design is pretty amazing!)

The HPATG Axis and Healthcare

When a patient complains of problems like fatigue, weight gain or weight loss, thinning hair, or irregular periods (just to name a few), the solution is never as simple as writing a prescription for birth control pills or Synthroid. There’s always more to the story, and that’s why its so important to identify the root cause of the problem when considering how to balance hormones naturally. In my practice, I do this primarily by talking with my patients in detail about their health history, and taking a closer look at the lab work. From a functional medicine perspective, it’s never safe to assume that the other components of the HPATG axis are functioning properly, even if we’ve already identified that one of them is out of sync. That’s why holistic healthcare means addressing the whole person, and not just using a symptom-by-symptom, band-aid approach.

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!

Love this post Share it!

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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 How to Balance Hormones Naturally (Understanding the HPATG Axis) appeared first on Dr. Alexandra MacKillop.