So you’re trying to lean out, and you’re cutting down on carbs. But every time you swap out the rice for more greens and you hit the gym, you end up shaky, nauseous, cold, and clammy, and you’re stuck with a killer migraine for the rest of the day.
Sound familiar? You could be dealing with low blood sugar, also known as reactive hypoglycemia. As a nutritionist, I have many clients who struggle with this issue—but they’re often unsure how to manage it.
When your blood sugar levels take a nosedive, dieting becomes difficult, if not impossible. Every time you try to eat less or exercise more, you crash hard and crave fast carbs to get your blood sugar up. If you’re struggling with reactive hypoglycemia but still want to lose weight, here’s how to make it work.
Reactive hypoglycemia occurs when blood sugar levels drop too low about 3-4 hours after eating carbohydrates. This can be a result of your body consistently releasing too much insulin for the amount of carbohydrates you eat. When that’s the case, every time your body signals for insulin release, it removes more carbohydrates from your bloodstream than you need. When blood sugar drops too low, symptoms like dizziness, nausea, and headaches can occur. These symptoms are alleviated by eating carbohydrates.
The only problem: If you’re cutting, eating more carbohydrates probably isn’t part of your fat-loss strategy.
Exercise is great for weight loss, but can be dangerous if you have hypoglycemia. In addition to overactive insulin release, hypoglycemia can also be caused by underactive glycogen release. Glycogen is your body’s storage form of carbohydrates, so your body releases it to keep your blood sugar at a safe level when you’re using more energy than you’re taking in (during exercise, for example). If your body doesn’t properly release glycogen, your blood sugar can drop dangerously low during your workouts.
With reactive hypoglycemia working against you, how do you make fat loss happen?
1. Don’t cut all carbs, just choose the right types
Cutting out all carbs may seem like a good idea for avoiding blood sugar spikes and their resulting drops, but if you have hypoglycemia, avoiding carbs entirely can be dangerous. Your body can transform fat and protein into glycogen if needed, but if you have hypoglycemia, your body can’t necessarily release glycogen fast enough, meaning your body won’t be able to achieve healthy blood sugar levels through release of stored carbohydrates alone. Turning fat and protein into glycogen is inefficient and slow, so if you experience a hypoglycemic episode, eating foods without carbohydrates won’t mend your symptoms quickly. (The keto diet may work well for some people, but if you have hypoglycemia, you’re not one of them.)
Keeping some carbohydrates in your diet is important for maintaining healthy blood sugar levels, but make sure to choose the right ones. Whole grains, vegetables, fruits, and legumes are high in fiber, which helps slow digestion. This keeps your blood sugar levels consistent while keeping you full, so you can eat less without feeling hungry or experiencing hypoglycemia.
2. Limit refined carbohydrates and alcohol
It’s no secret that the refined carbohydrates—like those found in candy, cake, cookies, and white bread—are trouble for your waistline. These foods are mostly empty calories: They provide little nutritional value, but lots of sugar and refined flour.
Refined carbohydrates are also bad news for managing hypoglycemia. While the simple sugar in a piece of candy can restore your blood sugar levels quickly in an extreme hypoglycemic episode, the goal of hypoglycemic management is to prevent those extreme drops in the first place. Regularly eating refined carbohydrates raises your blood sugar quickly, resulting in a dramatic release of insulin followed by a dramatic drop in blood sugar. Break this vicious cycle by limiting refined carbohydrates and sticking to nutrient- and fiber-rich carbohydrates like whole grains, fruits, and vegetables. This is key for both your weight loss and blood sugar management goals.
Alcohol lowers blood sugar levels on its own, and especially on an empty stomach. Alcohol also isn’t helpful for weight loss efforts because it provides calories without significant nutritional value. Avoid alcohol or limit your intake, and be sure to drink with a meal to avoid dangerous drops in blood sugar.
3. Forget about intermittent fasting
Intermittent fasting—in which you alternate between periods of eating and fasting for 16 hours or more—can be dangerous if you have hypoglycemia. When your blood sugar levels drop too low after a meal, fasting can worsen symptoms and lead to fainting.
Eating a huge meal and then eating again a few hours later to avoid hypoglycemia won’t likely lead to weight loss. The key here is to expect drops in blood sugar, and plan your meals accordingly. Basically, there couldn’t be a worse diet for someone with hypoglycemia than intermittent fasting.
4. Eat several smaller, balanced meals throughout the day
Rather than having a large meal followed by a long break before you eat again, or eating more than you’re hungry for to avoid hypoglycemia, eat several smaller meals throughout the day. Eating every 3-4 hours keeps your blood sugar levels stable and gives you energy to exercise without bonking.
Just be sure to keep your small meals balanced. A meal made entirely of carbohydrates will raise your blood sugar significantly, signaling for more insulin release and resulting in a more drastic blood sugar drop. Protein and fat affect insulin and blood sugar levels much less than carbohydrates, so eating healthy sources of protein and fat at every meal will help keep you full without throwing your blood sugar levels out of balance. Aim for a source of lean protein (like meat, fish, poultry eggs, tofu, or beans), a source of healthy fat (like nuts, seeds, avocado, or olive oil), and a source of whole grains or starchy vegetables and nonstarchy vegetables at every meal.
Stable blood sugar means you won’t have to load up on carbs to feel human again, so eating smaller meals regularly helps keep your calories and overall carbs down. Eating more often can also be helpful for weight loss. Eating small meals frequently keeps you from getting overly hungry, and when you’re satisfied, you can more easily avoid binging on potato chips or giving in to ice cream cravings.
5. Create a weight loss meal plan for hypoglycemia
Nutrient needs are very individualized and vary greatly from person to person, so I always recommend working with a registered dietitian to create a plan that works with your specific needs. But if you’re looking for a starting point on how to stay healthy and fuel up for an active lifestyle with hypoglycemia, this sample meal plan can help.
Sample hypoglycemia meal plan:
Breakfast (376 calories, 17g fat, 30g protein, 32g carbs, 7g fiber, 15g sugar)
1 cup plain 2% Greek yogurt
½ cup blackberries
2 Tbsp chopped walnuts
¼ cup oats
Morning snack (181 calories, 8g fat, 4g protein, 26g carbs, 6g fiber, 17g sugar)
1 small apple
1 Tbsp peanut butter
Lunch (368 calories, 12g fat, 39g protein, 30g carbs, 10g fiber, 6g sugar)
2 cups shredded lettuce
½ cup black beans
4 oz cooked chicken breast
½ cup chopped bell peppers
¼ cup shredded cheddar cheese
2 Tbsp salsa
Pre-workout snack (254 calories, 12g fat, 11g protein, 26g carbs, 8g fiber, 7g sugar)
1 cup baby carrots
3 whole-grain crackers
2 Tbsp hummus
1 hard-boiled egg
Dinner (495 calories, 21g fat, 38g protein, 36g carbs, 4g fiber, 7g sugar)
6 oz baked salmon (w/ lemon juice & herbs)
½ cup cooked brown rice
½ cup steamed green beans
1 cup mixed greens with 1 Tbsp vinaigrette dressing
Evening snack (250 calories, 4g fat, 31g protein, 18g carbs, 4g fiber, 15g sugar)
1 cup low-fat cottage cheese
1/2 cup blueberries
Total: 1,924 calories, 168g carbs, 74g fat, 153g protein, 41g fiber, 68g sugar