Saturday, October 24, 2009

Hypoglycemic or Neurotic?

Do you become irritable during the day? Do you lash out at people and regret it afterward? Are you too busy to stop for a snack? You may be suffering from low blood sugar.

This is not the hypoglycemia (hypo=low, glyc = sugar, emia = in the blood) that can be measured with a glucose tolerance test, this is the hypoglycemia I see regularly in my practice, and suffer from myself. Last week I went out to dinner with a couple of friends. As usual, because I’m a dietitian, people feel that any social occasion is counseling time. One of my friends started to tell me her problems. She doesn’t eat meat, is anemic, forgets to eat until she’s ravenous and gets tired and irritable quickly. She thinks her blood glucose is low. Her doctors (she’s been to a few) say she doesn’t have the clinically diagnosed hypoglycemia, it’s psychological/all in her mind and perhaps she should gain weight and go into counseling. So frustrating! Why don’t doctors send these patients to dietitians? The problem is obvious to us once we take a dietary history. Even over dinner, I told her hypoglycemia is a real problem, the symptoms are real and they affect one’s quality of life.

The best news is that it’s totally treatable with a small change in eating habits. Usually the symptoms are with women, occur mid-morning and mid-afternoon, and seldom at night. They include a feeling of hunger soon after breakfast or lunch, dizziness, weakness, nervousness, shakiness, rapid heartbeat, fatigue, stress, headache and agitation.

To prevent these symptoms, simple rules need to be followed:
Avoid certain foods:
• High sugar foods and beverages
• Refined starches
• Alcohol on an empty stomach

To keep your blood glucose steady, your meal plan will now include:
• Three smaller meals (to maintain weight)
• Two larger snacks (keep snacks handy for emergencies)
• A light snack in the evening (optional)
• High fiber starch, protein and a little fat at each meal
• No skipping of meals
• No late meals
• Alcohol on rare occasions, only after food is eaten.

Examples of three day’s food intake are below. Exchange foods according to your taste:

Day 1:
Breakfast: ½ cup cereal containing 6 gm fiber; ½ banana; ½ cup 1 % milk
Snack: 1 slice whole grain bread and 1 tbs. peanut butter; coffee with milk
Lunch: Large salad with a wide variety of vegetables, ¼ cup tuna, 1 oz. cheese and an oil and vinegar dressing; tea
Snack: 1 cup yogurt; chopped apple; 1 tbs. nuts (together it’s like a dessert)
Dinner: 1 oz. ground beef, 1 cup pasta, ½ cup pasta sauce, ½ cup carrots, 1 cup green beans; tea
Snack: 1 apple

Day 2:
Breakfast: 1 slice whole wheat bread, 1 tsp margarine, 1 scrambled egg, ½ cup orange juice; coffee
Snack: 1 piece of fruit (the breakfast will sustain you longer); café latte
Lunch: ½ bought vegetable sandwich with one slice of cheese, small salad,1 fruit
Snack: ½ bought sandwich; tea
Dinner: 3 oz fish, 1 cup brown rice, ½ cup peas, 1 cup ratatouille
Snack: ¼ papaya, 1 cup of 1% milk

Day 3:
Breakfast: ½ cup granola; 2 tbsp raisins; 1 cup low fat yogurt; coffee with 1 % milk
Snack: 1 slice whole grain bread and 1 oz cheese
Lunch: Large salad with a wide variety of vegetables, chicken pieces and an oil and vinegar dressing
Snack: ½ cup nuts and raisin mix (keep in drawer or bag for emergencies); café latte
Dinner: Baked potato with stir-fried frozen mixed vegetables and 1 oz. cheese
Snack: ½ mango

For the low iron count, I recommend one multi-vitamin and mineral tablet every day, containing around 15 gm iron. Take the pill with a meal, as iron is hard on the stomach. Keep your fiber intake high as iron supplements can cause constipation.

If you want to start eating meat, start with one ounce twice a week, gradually increasing to three ounces twice a week. A sudden large piece of steak will lead to great pains in your stomach and it will be quite some time before you’ll try it again.

Follow the suggested meal plans and see how different you feel. Don’t let people think you’re neurotic. Every time you lose your temper, reread this column. Enjoy your new energy, happy disposition and normality.

For individual meal plans, find a dietitian near you at