If you or someone you know has been diagnosed with reactive hypoglycemia, you likely have many questions, including what changes you might need to make to your diet.
While relatively uncommon, reactive hypoglycemia can occur in people of all ages, which can be disruptive to your everyday life.
In this article, we’ll explain what reactive hypoglycemia is, its symptoms, what causes it, and what types of foods to eat and avoid to prevent symptoms.
What is reactive hypoglycemia?
Hypoglycemia is the medical term for low blood sugar. It’s defined as having a blood glucose level of less than 70 mg/dL. There are many causes of hypoglycemia, and taking insulin for diabetes is one of the most common.
In a person without any blood sugar issues, your pancreas releases the hormone insulin in response to your blood sugar rising after you eat.
The amount of insulin released is enough to lower your blood sugar without being so much that it causes hypoglycemia.
Reactive hypoglycemia tends to affect people without diabetes and occurs when your pancreas releases too much insulin in response to eating, especially a meal high in carbohydrates.
While some cases of reactive hypoglycemia are idiopathic (the cause is unknown), certain conditions are related to reactive hypoglycemia, such as:
- Drinking alcohol
- Gastric bypass or other bariatric surgeries
- Genetic factors (you might be more likely to have reactive hypoglycemia if a family member does)
- Certain types of tumors
The symptoms of reactive hypoglycemia typically show up within 2-5 hours of eating a meal. However, they might occur sooner if you ate on an empty stomach or ate a particularly high-carb meal.
Reactive hypoglycemia symptoms to watch out for include:
- Fast heartbeat
- Shaking
- Sweating
- Nervousness or anxiety
- Irritability or confusion
- Dizziness
- Hunger
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Considerations for your diet with reactive hypoglycemia
Eat regular meals and snacks
Skipping meals or going a long time between eating might increase your risk of developing reactive hypoglycemia.
Aim to eat small meals and snacks without going much longer than three hours in between eating, especially if you’re also active.
Include a source of protein with each meal or snack
Protein is a nutrient that doesn’t raise your blood sugar like carbs do. Eating protein with carbs can slow the rise in your blood sugar after you eat, which can help reduce reactive hypoglycemia symptoms.
Treat low blood sugar
There’s a fine line when it comes to treating reactive hypoglycemia. On one hand, you don’t want to over-correct low blood sugar and cause another bout of reactive hypoglycemia later, but you also don’t want low blood sugar to go untreated, especially if it’s causing symptoms like dizziness.
If your blood sugar is in the more severe range (less than 60 mg/dL), you should drink something containing 15 grams of carbohydrates, such as a half cup of orange juice to bring it above 70 mg/dL.
42 foods to eat
Fiber-rich carbs
Carbohydrates (carbs) are a type of nutrient that provides your body with energy. Carbs break down into glucose in your bloodstream, which provides your cells with energy.
Not all carbs are created equally. Refined carbs and added sugars raise your blood sugar levels much more quickly than fiber-rich carbs in whole foods such as fruits, vegetables, and whole grains.
Eating fiber-rich carbs can slow the rise in your blood sugar because fiber takes longer for your stomach to digest.
Fiber-rich carbs also tend to be lower in total carbs than more processed and refined foods.
Some examples of fiber-rich carbs include:
| Whole grains | Whole wheat bread, brown rice, barley, oatmeal, bulgur, millet, whole grain crackers, pancakes, etc. |
| Fruits | Raspberries, blackberries, blueberries, apples, bananas, etc. |
| Vegetables | Green peas, broccoli, Brussels sprouts, potatoes with the skin on, etc. |
| Legumes | Dried peas and beans, lentils, soybeans |
Nuts and seeds
Nuts and seeds are low in carbs while being rich in protein and healthy fats. Some types of seeds are especially high in fiber, such as chia seeds.
Eating nuts and seeds with your meals and snacks (or on their own as a snack) can help promote more stable blood sugar levels.
There are several types of nuts, but here are a few to give you some ideas:
- Almonds
- Chia seeds
- Flaxseeds
- Mixed nuts
- Peanuts (not technically a nut, but has a similar nutritional profile)
- Pistachios
- Pumpkin seeds
- Sesame seeds
- Walnuts
Protein-rich foods
As we mentioned earlier, protein is a very important nutrient to include in your reactive hypoglycemia diet.
Protein doesn’t stimulate your body to release insulin like carbs do, and it slows your digestion which can support a more gradual rise in your postprandial (after eating) blood sugar levels.
- Eggs
- Beef
- Pork
- Poultry
- Fish
- Legumes
- Dairy products like Greek yogurt, cheese, and milk
- Nuts and seeds
- Soy (edamame, soy products like tofu, etc.)
- Whey protein (to add to smoothies, etc.)
Healthy fats
Like protein, fats don’t stimulate as much of an insulin release as carbs do. Eating a balanced meal with fiber-rich carbs, protein, and fat is one of the best strategies to prevent reactive hypoglycemia.
While saturated fats in animal products (mainly meat and full-fat dairy) are fine to have in moderation, try to include plenty of healthy fats from plant-based and marine sources, such as:
- Nuts & seeds
- Vegetable oils (olive oil, avocado oil, flaxseed oil, etc.)
- Fatty fish like salmon, mackerel, herring, etc.
- Avocados
14 foods to avoid
Sugary beverages
Sugary drinks like soda, sweetened fruit drinks, and flavored coffees are some of the worst things you can consume for reactive hypoglycemia.
How do they make reactive hypoglycemia worse?
First, sugary drinks are packed with added sugar. These sugars are simple sugars in the form of sucrose (table sugar), corn syrup, or high-fructose corn syrup, which break down into glucose very quickly.
For reference, one 12-ounce soda contains around 40 grams of added sugar – the equivalent of 10 sugar cubes’ worth of sugar.
Sugary drinks don’t require any time to digest, so they empty from your stomach quickly. This rapid release of sugar into your bloodstream stimulates your pancreas to release a large amount of insulin at once, which then lowers your blood sugar and can cause reactive hypoglycemia.
Refined carbohydrates
Refined carbohydrates are those that have been stripped of their fiber content during processing. These carbs raise your blood sugar more quickly, which can contribute to reactive hypoglycemia.
Many types of refined carbohydrates also contain added sugar, which makes them even more likely to contribute to blood sugar spikes (and later crashes).
Some examples of refined carbs include:
- Any grain made with white flour (enriched flour) – this includes bread, tortillas, bagels, most pizza crusts, etc.
- White rice
- Many cold breakfast cereals
- Pastries, muffins, etc.
Foods high in added sugar
Many foods have added sugar in them, even those that you might not suspect. Added sugar is prevalent in processed foods as a flavor enhancer and even as a preservative.
Aim to keep your added sugar intake below 24 grams per day if you’re a woman and below 36 grams per day if you’re a man.
Reading nutrition facts labels can help you identify added sugar in the foods and drinks you consume, which is a great first step in making a plan to cut down on added sugar.
Some examples of foods that have added sugar include (but are definitely not limited to):
- Pasta sauces (sugar helps balance the acidity in tomatoes)
- Soups
- Fruit packed in syrup
- Condiments & salad dressings
- Flavored cereals (instant oatmeal, cold cereal, etc.)
- Flavored yogurt
- Some nutrition bars
- Bread (even some types of whole wheat bread have added sugar)
- Flavored teas
Example 3-day meal plan
Below is a sample 3-day meal plan for a reactive hypoglycemia diet.
Day 1
Breakfast
- Two slices whole grain toast
- ½ cup cottage cheese
- Avocado slices
Lunch
- Whole grain tortilla filled with 4-6 ounces chicken breast, salad greens, and ¼ cup shredded cheddar cheese
Dinner
- Salmon filet
- Salad with chopped nuts
- One cup of berries
Snacks
- Edamame (soybean pods)
- One medium apple with 2 tbsp. nut butter
Day 2
Breakfast
- ½ cup oatmeal, cooked, with one ounce of walnuts and ¼ cup of blueberries as a topping
- 1-2 boiled eggs
Lunch
- Sandwich with two slices whole wheat bread, 4-6 ounces of natural turkey, and one slice of cheese; add mayo or mustard to moisten
- One cup of baby carrots
Dinner
- Taco salad with 4-6 ounces of seasoned lean ground beef, ½ cup black beans, salsa, and avocado slices
Snacks
- One serving of whole grain crackers with cheese slices (1-2 oz. total)
- Celery with ¼ cup hummus
Day 3
Breakfast
- Veggie omelet with 2-3 eggs, tomatoes, olives, mushrooms, spinach, and ¼ cup shredded cheese
- One medium apple
Lunch
- Smoothie made with one cup of plain Greek yogurt, one ripe banana, one cup of berries, and milk of choice (enough to blend); add additional whey protein powder if desired
Dinner
- 4-6 ounces pork tenderloin
- ¾ cup cooked brown rice
- Oven roasted broccoli and cauliflower (no set portions; these are low-carb veggies); add olive oil, salt, and pepper to taste
Snacks
- ½ cup cottage cheese with ½ cup of mandarin orange slices (canned in juice)
- Hard-boiled egg
Conclusion
A reactive hypoglycemia diet should include high-fiber carbohydrates, protein, and healthy fats, ideally in balanced meals and snacks throughout the day.
Avoid foods and drinks like sugary beverages, refined carbohydrates, and foods with a lot of added sugar if you have reactive hypoglycemia.
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