Reactive hypoglycaemia keto transition

#1

Hello everybody,

I’m officially about to go keto for the rest of my life after I have finally figured out what has been my long term undiagnosed problem for many years…. I have reactive hypoglycaemia, self diagnosed but I am pretty certain after 5 years of trying to figure it out!

This explains my struggle with transitioning to keto in the past, everyone always screams electrolytes but in my case it was low blood sugar…or my cells not taking in the glucose…I don’t know, whatever I’m just an electrician :joy:

My question is… I’d like to begin lowering my carb intake to get down to ketogenic levels, I at the moment am consuming about 100 to 150g of carbs mainly from dairy, rice and vegetables. The rice is cooked in big batches parboiled and cooled so the GI should in theory be a lot lower with a higher resistant starch content, and I only eat it with plenty of fat and protein. Should I eat most carbs in the evening or spread them out throughout the day? Also my meals should they be smaller and more frequent whilst my body adjusts and then ween onto longer times between meals?

Please only answer if you have had the same personal experience or you have seen it discussed before and have some idea… I know the advice of keeping carbs super low, doing high intensity exercise, fasting for as long as possible to push through the barrier as quickly as possible will not help my particular situation!

TLDR - I have reactive hypoglycaemia, what is the best way to transition to keto with minimal disturbance and still being able to function like a fairly normal human being?

(Edith) #2

https://betterhumans.pub/how-the-ketogenic-diet-and-intermittent-fasting-cured-my-non-diabetic-hypoglycemia-841968623949

Maybe this will help?

(You've tried everything else; why not try bacon?) #3

Treating rice in this way raises the resistant starch content from something like 2.3% to 2.6%, so I wouldn’t consider it important. Also, if you reheat the rice the wrong way, the resistant starch returns to being edible starch, so this is very tricky to try to deal with.

As for the question you pose, there is something going wrong, besides the hypoglycaemia. As your glycogen stores are depleted, the liver should be taking up the slack immediately with ketogenesis and gluconeogenesis. Have you been tested for glucagon-resistance? It is a rare condition, but it does occur.

(Laurie) #4

Exercise and fasting are not necessary on keto.

Whatever the theory or benefits of eating cooled rice, that isn’t keto. Do you have a reason for not lowering your carb intake to 20 grams?

(Bob M) #5

Do you have a way to measure blood sugar? If so, I’d start measuring it. The effects may or may not be hypoglycemia.

#6

Yea I know it’s not Keto, I really struggle during the transition. I’m not keto yet, I was just mentioning what I’m currently eating. The reason behind not wanting to cut to 20g is because it ■■■■■ me up big time and I can’t afford to be half the man I am for the next month. This is why I asked for people that don’t understand what reactive hypoglycaemia is to not suggest anything, because you probably aren’t aware how bad it can get with really low blood sugar.

#7

Hi mate, yea I’ve just subscribed to a continuous glucose monitor company. I’m really looking forward to hooking it up and seeing what it has to say.

#8

Hiya,

Yes I’ve read that article! She mentions higher protein keto, it was something I was going to try in all honesty.

(You've tried everything else; why not try bacon?) #9

What level is your serum β-hydroxybutyrate at, when you have these reactive hypoglycaemic episodes?

(Michael - When reality fails to meet expectations, the problem is not reality.) #10

I was hesitant to respond because I do not personally have the “same personal experience or…”.

None-the-less, first I’ll say that I accept/respect that we experience individually and have to act/react accordingly. Thus, if you are hypoglycemic while eating a ‘normal’, ‘regular’ SAD (ie ‘high carb’ diet), then something is meteabolically wrong. Just switching to a low carb/keto diet is not necessarily going to fix it. You will have to identify what is wrong and deal with that.

On the other hand, eating a ketogenic diet may make it less difficult to pinpoint the dysfunctional process(es). For example, as @PaulL points out, your β-hydroxybutyrate level during hypoglycemic episodes could indicate that while glycemically low ketogenesis is inhibited. That would indicate liver dysfunction.

(Bob M) #11

That will be helpful.

One problem is that what’s “hypoglycemic” for you might not be for other people. After 4.5 days fasting, I got an official glucose blood test of 62 (US units, so 3.4 European/elsewhere units). I felt fine.

That was after years of low carb/keto, though.

62 + feeling bad = bad
62 + feeling fine = OK

If he’s consuming 150g rice, I doubt he’s in ketosis. I could be wrong, though.

(Butter Withaspoon) #12

Hi MrMorty
Transitioning gradually is fine. people seem to choose whether to go :100: and deal with the shock but get there quicker, or make changes one at a time to be confident they can stick to it. Gradually replacing carby foods, gradually removing snack events, making one meal zero carbs (I do this with breakfast but I can’t remember whether breakfast or dinner is recommended for this), walking after dinner or first thing in morning are all good changes.
Unless you are about to go on insulin or similar there is not an emergency (probably).

I changed gradually over 8 years really. Good luck and stick around.

#13

The plus of reactive hypoglycemia is in the name, it’s reactive. Reacting to your meal, your blood sugar can’t come crashing down if it doesn’t get shot up in the first place. Re-access your diet of 100-150g and the problem will most likely self correct.

I’d say it’s the other way around (because it typically is). I’d say your reactive hypoglycemia is from your attempt to transition into keto vs just jumping in head first. There’s a reason we don’t recommend a transition phase, this is one of them. You’re playing a game of tug of war with your body right now, you can’t run it out of glycogen and force it into ketosis when you keep giving it carbs like that, I say that as somebody that does TKD/CKD and does eat more carbs than many here, but that’s in a very specific context.

What are your glucose readings at fasting and postprandial when you’re having the symptoms of going hypo? That’d be your first step, hopefully there’s some real keto meals in there to compare to the carb ones.

(PJ) #14

Rambling and it’s like 5am for me so forgive the likely stream of consciousness style

When I first went keto, and lost a lot of weight very fast, eventually I got reactive hypo with almost any big breakfast (meat and eggs was the common one)

Back then, a few people in my sitch were reporting the same thing online. Dr. Mike Eades when told this by a commenter on his blog implied the guy was a liar, maybe he was just having a bad day but it’s been like 15 years and I still haven’t forgiven him :rofl: In part because I couldn’t understand why an expert wouldn’t already know this happens, like what, had he been assuming any patient reporting this was lying all that time, or dismissing it, because this is a pretty common thing esp with ppl who have lost a lot of weight and still eat really big amounts of protein, but I digress

Fortunately at the time blogger-etc. Jimmy Moore was having the same experience himself and talking about it and eventually ran into what was going on which helped the rest of us who were mostly having the gall to ask experts on their blogs for help at least until we were afraid to be publicly humiliated while doing so

Yeah ok so probably I still hold a grudge :rofl: but I should say that the Drs Eades’s book ‘Protein Power Life Plan’ saved my life so I should give him some slack

Meanwhile while I was looking for an explanation or solution, Dr. Ray Peat had the input that basically there was too much insulin – I guess (my translation here) it was a hyperinsulinemic reaction (which all of us fat folks had as a base condition) to the big bolus of protein (and especially eggs which are “unusually insulinogenic”), and why this was a bigger deal for people who’d lost a bunch of weight in our case, when it hadn’t been when we began, who knows, I forget if I ever had some understanding of that – anyway, he suggested a small amount of orange juice after the big meal, as if to give the insulin something to actually mop up, so it didn’t tank the blood sugar so low. And despite my horror at OJ at the time (since I was in the pick carrot shreds out of my salad mix phase of keto hahaha) he was right, this actually did work to address it (and did not, oddly, throw me out of keto, but note it was like 4oz and only then).

I improved this later by simply not eating so bloody much protein with eggs in the morning all at once

Although it’s possible that over additional time/life I was simply lesss hyperinsulinemic so it just didn’t happen so often

I never tested high for blood sugar despite my biggest size, I had low blood sugar, because hyperinsulinemia causes that BEFORE it’s to the degree of wrecking your pancreas sufficiently to show up as then, high blood sugar, if you see what I mean

I’m no doctor “I’m just some fxckin’ guy” as my favorite satire news report says, but since you posted on a forum I’m going to respond like with advice anyway

There is no transition to keto, you are either ketogenic or you are not

You are probably hyperinsulinemic like most of our society

You start toward keto and likely increase your protein as part of reducing your carbs which might make this insulin dysregulation show up even more

I would stop messing with some hybrid wishy washy thing you think is middle of the road ‘gradual’ which is preventing you the advantage of a variety of biological responses which are features and adaptations that keto provides as part of its state

The biggest thing is to stop eating so much at one sitting

Most people who do keto love eating a lot and it can be good, they can even eat a day or two of protein and calories at a single meal some of them, and all is peachy

But that’s them and obviously that’s not you

Your insulin generation is dysregulated and you’ll need to keep it as low as possible and improve some health markers and give your body some time to heal so it doesn’t overreact like that

So unlike most of keto eating that is large meals I suggest more frequent smaller meals until you’re a bit more normalized

Since reactive hypo for me could pretty much knock me unconscious when it first began I mean thank God I was working from home at the time and in management to where as long as there wasn’t a meeting that second it was not so apparent and hence wrecking my life but most people aren’t in that easy sitch

PJ