4.1 WHAT IS THE RIGHT DIET FOR HYPOGLYCEMIA?

First of all, a diet is very personal. 'Right' only means 'right for you', so you should find out what diet is appropriate for your condition. It is true that there are several diets that help people to control their hypoglycemic symptoms. All these diets are blood sugar regulating diets and have the following in common:

• frequent small meals/snacks, depending on your needs 1.5 to 2 hours;
• no sugar, honey, or products containing sugar (check food labels);
• no adrenal stimulants as caffeine (found in coffee, coke and diet-coke, black tea), no alcohol, no chocolate (cacao is a stimulant too) and no nicotine;
• take care with fruit juice (no more than 1 glass) and high-sugar fruit as dried fruit, bananas or grapes, see Section 4.4;
• no other simple carbohydrates as white bread and white flour.

Next to these, there are several methods to slow down absorption and even out your blood sugar values even more:

• use mixed meals, i.e. combine carbohydrates with proteins/fat, e.g. cracker with cheese/peanut butter;
• use high fiber food (whole grains, vegetables);
• snack before going to sleep.

To contact others about diet maintenance you could subscribe the following newsgroups:
alt.support.diet (diet, losing weight, nutrition), sci.med.nutrition (nutrition and diet), rec.food and its subgroups.

4.2 WHAT DIETS CAN BE FOLLOWED BY HYPOGLYCEMICS?

People who try to control their hypoglycemia symptoms generally are on one of the following diets (in random order):

1. DIABETES DIET -- This diet is fairly high in carbohydrates, about 50-60% carbohydrates, no sugar is allowed, use complex instead of simple carbohydrates: brown bread/rice, etc. Frequent meals are also highly recommended. You might contact people with diabetes on Usenet, via the heavy-traffic newsgroup misc.health.diabetes .

2. KRIMMEL DIET -- The Krimmel diet is very akin to a standard diabetes diet, but it limits starchy foods as bread, pasta, rice, potatoes and corn, and recommends non-starchy foods as carbohydrate source instead. Krimmel has a 'food ethic' that is low protein, high *complex* carb, and low fat. The ratio is 10-12% protein, 50-65% carb, and 20-30% fat and has to be maintained in a structured fashion according to Krimmel. Patricia and Edward Krimmel are authors of the "Low Blood Sugar Handbook" and "Low Blood Sugar Cookbook". Information about the Krimmels' HELP-institute can be found in Section 10.4, and also on the Web at: http://www.dynanet.com/~bodychem/ .

3. HAI DIET -- The Diet of the Hypoglycemia Association, Inc. This diet is adequate (fairly high) in protein, limits carbohydrates and uses slightly more fat. In the initial phase 100 g of complex carbohydrates and 100 g of protein are proposed as a daily intake. Complex carbohydrates are to be obtained from vegetables, nuts/seeds, and a limited amount of fruit, not from starchy foods like bread, pasta, rice, etc. In the second phase (after 3-6 months) some rice, bread, etc. can be built gradually into the diet. On the Web, the HAI diet can be found at: http://www.fred.net/slowup/haidiet.txt . The address of the HAI can be found in Section 10.1.

4. DR. ATKINS DIET -- This diet is very low carbohydrate and high in fat. The goal of the diet is to reach and maintain ketosis, the state of fat burning. If one eats less than 30-50 g carbohydrates daily ketons, a side-product of fat burning, instead of glucose, will provide the body with fuel. By means of urine test strips one can test the level of ketosis. The diet is designed to allow people to lose weight, but some hypoglycemics claim to have gotten their symptoms under control too, as the diet contains virtually no carbohydrates to trigger their hypoglycemia. Futher info can be found at the Low Carbohydrate Diet Information Center: http://ncms.clever.net/lowcarb .

5. THE ZONE DIET -- After the book "The Zone" by Barry Sears, a biomedical researcher. In his book Sears promotes a diet with a 40% carbohydrate, 30% protein and 30% fat ratio. Some Zone resources on the Web:
http://www.cs.umass.edu/~swan/zone.html (Russ Swan's FAQs about Zoning)
http://www.harpercollins.com/bsellers/zoneh.htm
http://www.silver-bayou.com/whatsama/diet.htm

6. FIT FOR LIFE DIET -- Harvey and Marilyn Diamond, authors of the "Fit for Life" book. The Diamonds strongly support (just like e.g. Dr. Hay) eating in food combinations. In this theory a meal should either exist of (complex) carbohydrates (like lettuce and potatoes or bread and vegetables), or proteins (bacon and eggs). Fruit and vegetables are considered neutral. In addition, during the morning (until noon) eating fruit is promoted, Don't eat fruit with or after other meals, but in between of meals. Only natural sugar in fruit allowed, no additional.

7. DR. FREDERICK'S DIET -- Dr. Carlton Frederick's diet, as described in his Low Carbohydrate Diet, consists of high protein, low carbohydrate, no sugar. It can be considered as an early version of the HAI-diet (which nowadays recommends *adequate* protein, instead of just high).

8. PRITIKIN'S DIET -- Consists of no fat & only 3 oz (100 g) of protein and primarily carbohydrates. This diet claims it helps hypoglycemia too.

9. PROTEIN POWER DIET -- from the book Protein Power by Drs. Michael and Mary Dan Eades. This is a protein-rich, moderate-fat, low-carbohydrate diet designed to help one lose weight and also bring one's insulin levels into balance. The diet consists of Intervention and Maintenance. Intervention Part I: 30 grams of carbohydrate per day. Intervention Part II: 55 grams of carbohydrate per day. Once desired weight and/or stable insulin levels have been reached, you begin Maintenance, where your carbohydrate level is 30% more than your protein intake. The diet is very similar to the Zone diet (see above). Info on the Web: http://www.bdd.com/newrl/bddnewrl.cgi/02-01-96/prot .

10. CARBOHYDRATE ADDICT'S DIET -- from the book The Carbohydrate Addict's Diet by doctors Heller and Heller.A carbohydrate addict is a person who suffers from hyperinsulinism, i.e., their body produces too much insulin when they regularly consume carbohydrates. Hyperinsulinism produces strong cravings for carbohydrates, making it hard to stop eating them once you start.With this diet you can eat 2 or 3 meals a day and an optional snack. All but one meal must be low carb, with no food having more than 4 g carb per serving. The other meal, called the Reward Meal, is 1/3 low carb veggies, 1/3 protein, and 1/3 carbs (anything you like). More info can be found at the website of the CAD support group: http://www.toon.org/~cadis/ .

There are several other hypoglycemia diets available. In Section 4.8 you can find an overview of diets and their respective macronutrient ratios.

4.3 WHEN SHOULD I NOTICE ANY EFFECTS OF A DIET?

Generally, at least two to three weeks are usually required to show marked change. At start you may (not necessarily) feel worse as a result of withdrawal symptoms. After that, a period comes in which one feels better. It is possible that you go through a second dip after which you will gradually feel better day by day. So when evaluating a diet, try it for at least two to three months before switching to another.

4.4 IS FRUIT OR FRUIT JUICE OK?

It depends. Generally, fruit is ok, and healthy too. A lot of hypoglycemics can tolerate small amounts of fruit. All fruit contains a combination of fructose and glucose, in a range of proportions. The glucose portion is what causes problems with hypoglycemia. Fructose can be converted to glucose in the body, but very slowly; it has about 10% as much effect on blood glucose as does glucose, perhaps even less. Just be careful with the fruits that contain higher amounts of carbohydrates, as bananas and grapes. Dried fruit is a no-no too. If you do have problems after eating fruit, try eating smaller amounts of it, along with some protein and fat, e.g. yogurt.

Some care should be taken with fruit juices. When the fruit is pressed to juice, some of the natural (absorption slowing) fiber is removed, causing a somewhat higher rise in blood sugar than fruit does. This rise may trigger hypoglycemic symptoms a few hours later. Consider juice as food, not as a drink. Drink juices in small amounts, using them as a thirst quencher (i.e. drinking several glasses within the hour) might get you into trouble several hours later. Diluting juice with water might be a better idea if you like some taste to your water.

More care should be taken with bottled juices from the supermarket. Some of them are pure juice from pressed fruit (mostly from concentrate). However, some cheaper brands have sugar added, and are likely to cause you trouble. When in doubt, read the labels. Vegetable juices without added sugar are ok.

Some hypoglycemics use orange juice as a life saver: when they feel their hypo symptoms coming up, they take a few sips (less than half a glass!) to increase their blood sugar levels a bit. A few sips are sufficient to prevent further symptoms, but not enough to trigger your hypoglycemia again.

4.5 DO SUPPLEMENTS LIKE CHROMIUM HELP STABILIZING?

There are several indications that nutritional supplements (vitamins, minerals and trace elements) can help partially restore normal metabolism or suppress the symptoms of hypoglycemia. The difficulty is that everyone is different, and that our hypoglycemia can have different causes. Therefore, not all people show equal benefit when using a supplement. Some feel even worse when taking a particular supplement that others swear by.

Swallowing vitamins and other nutritional supplements by perfectly healthy individuals has become pretty normal in our society. We should not forget that good eating habits and balanced meals (ok, that's a problem for many) provide for all biochemicals our body needs. The hypoglycemic body could need some help, though, because the endocrine system is out of balance. I would advise you to see a doctor or nutritionist before taking any supplement. In addition, I would like to emphasize that supplements are exactly what the word means: helpful *additions* to your hypoglycemia diet, and by no means a replacement of it.

Popular supplements taken by hypoglycemics are:

• chromium (helpful with blood sugar regulation; available with different binding elements: Glucose Tolerance Factor, picolinate or nicotinate)
• B-vitamins (supports metabolism, also helpful to people who are on a low-carb diet and therefore are on B-vitamin shortage)
• C- and E-vitamins (some use it as a rescue/remedy supplement, other people for stabilizing)

There are many more supplements, some of herbal origin, some containing a glandular extract. In May 1997 a survey about supplements and their effects is organized by the Hypoglycemia Survey Team of the Hypoglycemia Mailing List. More info about the team can be found at: http://www.silver-bayou.com/whatsama/survey.htm . Some Web-resources about supplements:

Chromium Information Center: http://www.chromium.edu/
Vitamins and minerals info: http://www.vitanet.net/vitanet/vitamin_min/chromium.html

4.6 WHAT IS THE GLYCEMIC INDEX?

The glycemic index is a measure for the effect of certain food on your blood glucose level, ranging from 0 to 100 %
Zero corresponds to no rise in blood sugar, and 100% to a blood sugar rise as high as with a pure glucose intake. The high index foods should be avoided by hypoglycemics.

On the WWW you can find several lists of foods and their glycemic indices. Here are two I know: http://www.cruzio.com/~mendosa/gi.html and http://www.diabetesnet.com/gi.html .

4.7 COULD YOU RECOMMEND ME SOME DIET SOFTWARE?

Several companies are offering free limited diet software, shareware or demo programs on the web. Such a program allows you to count calories, control protein/carbohydrate ratios or perform other nutritional analyses. A comprehensive database of foods is mostly included. You could try these websites:
 

Nutrisoft	:	http://users.aimnet.com/~food
Nutrigenie	:	http://users.aimnet.com/~food/ngzdmp44.html
Fitnesoft	:	http://www.fitnesoft.com/down.html
Mastercook	:	http://www.mastercook.com

If you like to calculate food contents by hand, visit one of these sites:
 

Alejo's site	:	http://www.cs.princeton.edu/~ah/food/index.html
USDA nutrient values	:	http://www.fatfree.com/usda/usda-intro.html
Nutrition fact sheets	:	http://www.eatright.org/nufactsheet.html

 

4.8 WHAT DO THESE DIET RATIOS LIKE 40/30/30 MEAN?

They indicate the ratios of macronutrients in your daily menu, by convention: Carbohydrates / Proteins / Fats. The ratios are expressed in percentages of total energy requirements (occasionaly grams ratios are used). Human energy requirements depend mainly on activity level, gender, and age. For example: a 40 year old with medium activity level would need approximately 2500 kCal/day (male) or 2000 kCal/day (female).

Sometimes diets are listed in grams, like 130/100/100 g. In that case the *net* grams of digestable nutrients is meant. E.g. if a food list states that "100 g of yoghurt" contains 5/4/2 g, 11 g of nutrient total, then 89 g must be water and fiber (no calories). You can convert these grams to calories yourself: carbs and proteins supply 4 kCal/gram, fat supplies 9 kCal/gram. Oh, FYI: alcohol supplies 7 kCal/gram. SI-minded folks can convert the calories to Joules: 1 kCal = 4.184 kJ.

A 'normal' healthy diet contains about 300-400 g carbohydrates, 60-70 g protein, and 70-90 g fat per day on average. Hypoglycemics generally can't tolerate these amounts of carbohydrates, so most hypoglycemic diets have limited carbohydrate content, and therefore increased protein and fat intake to provide for the energy. Below several diets and their ratios are listed. Can you help me to fill in the blanks?

Legenda : C = Carbohydrates, P = Protein, F = Fats
 

Diet	grams			kCal			total  kCal	energy  ratios
.	C	P	F	C	P	F	.	%C	%P	%F
1. Normal healthy diet	294	63	63	1195	256	572	2023	59	13	28
2. Diabetes diet	240	80	80	975	325	727	2027	48	16	36
3. Krimmel diet	295	74	55	1200	300	500	2000	60	15	25
4. HAI diet	100	100	100	406	406	908	1720	24	24	53
5. Dr. Atkins start	25	144	107	102	585	972	1659	6	35	59
6. Dr. Atkins stable	97	144	107	394	585	972	1951	20	30	50
7. The Zone diet	197	148	66	800	600	600	2000	40	30	30
8. Fit for Life diet	.	.	.	.	.	.	.	.	.	.
9. Dr. Fredericks diet	.	.	.	.	.	.	.	.	.	.
10. Pritikin's diet	100	100	low	.	.	.	.	.	.	.

 

Diet	grams			kCal			total  kCal	energy  ratios
.	C	P	F	C	P	F	.	%C	%P	%F
11. Protein Power I	30	107	100	122	435	884	1448	8	30	62
12. Protein Power II	55	107	100	223	435	884	1542	14	28	58
13. Protein Power M	.	.	.	.	.	.	.	.	.	.
14. Tintera Diet	133	100	100	540	406	884	1830	30	22	48
15. Hypoglycemia Fnd.	133	100	100	540	406	884	1830	30	22	48
16. Vegetarian	352	45	45	1430	183	409	2022	71	9	20
17. Dr. Murray's Diet	330	78	42	1320	320	380	2000	66	16	19
18. Dr. Murray's vegan	330	79	35	1360	320	320	2000	68	16	16
19. Dr. Cooper's diet	341	108	41	1386	440	374	2200	63	20	17

Comments:

4)

fat varies per person

5)

less than 30-50 g carbs/day to reach ketosis

6)

derived fat from menus

7)

set protein based on formula, then establish 40/30/30 ratio

10)

low fat

11)

Intervention I, fat varies per person

12)

Intervention II, fat varies per person

13)

Maintainance, carb level 30% more than protein intake

14)

Dr. Tintera Support Group (disbanded)

15)

adequate protein, adapt carbs to tolerance

17)

"2000 Cal omnivore"

18)

"2000 Cal vegan", derived fat from menus

19)

"Low-Fat Living"

Note : a diet can't be completely described by means of these macronutrients only. Next to balanced macronutrients and calories a healthy diet contains also: water, calcium, iron, vitamins, and minerals.

The most up-to-date copy of this FAQs can always be obtained from:
Hypoglycemia Homepage Holland: http://huizen.dds.nl/~hypo/faq

Next section: 5. Coping