CISRA’s Synergy Health Newsletter

Issue 5. Practical Tips for the Low Carbohydrate Diet for Hypoglycemia (1999)

by J. C. Waterhouse, Ph.D.

Part I. Introduction

Many types of symptoms are helped by a low carbohydrate diet that reduces blood sugar fluctuations. With age and increased stress and illness, the ability to regulate blood sugar levels often declines. When blood sugar drops below a certain level (sometimes still within the so-called normal range, Genter & Ipp, 1994, also see Harrison’s Principles of Internal Medicine, 1997, p. 2082 & 2086, discussion of pseudohypoglycemia), a surge of stress hormones are released to bring the blood sugar levels up. These stress hormones can result in dizziness, anxiety, headaches and sleep disruptions. Fatigue and difficulty concentrating also occur, and there are many other consequences for the body’s various hormones and regulatory systems. For instance, the surges of insulin which occur with carbohydrate consumption may cause important amino acids to be driven into the body’s cells, leaving less available for the brain to produce important brain chemicals, like serotonin, that affect mood. In susceptible people, excess carbohydrates are converted into triglycerides and low density lipoprotein (LDL) cholesterol. By elevating insulin (a fat storage hormone), excess carbohydrates contribute to the development of obesity and diabetes (Heller and Heller, 1995; Reaven, 1991; Reaven, 1997).

Dr. R. Paul St. Amand (St. Amand & Marek, 1999) finds that many of his fibromyalgia patients have hypoglycemia and benefit from a low carbohydrate diet. In my own case, going on Dr. St. Amand’s suggested low carbohydrate diet for hypoglycemia helped a great deal with my fibromyalgia and chronic fatigue syndrome (Waterhouse, 1998). In this article, I will share some practical tips on using the low carbohydrate diet, arising mostly from my own experiences. I will include my own experience on how food allergies/sensitivities/intolerances may affect success in using the diet. I will also share some tips regarding meal preparation and the psychological aspects of the diet that may be helpful. The concluding section will briefly describe a few of the many books on the benefits of various types of low carbohydrate diets.

Allergy/Sensitivity/Intolerance

I have found that if you have a tendency to food reactions, in order to get maximal benefit from the low carbohydrate diet, you need to be careful not to add large amounts of allergenic proteins to your diet (see other article, this issue). Unfortunately, four of the favorite non-meat proteins can be problematic in susceptible people due to relatively high levels of hypersensitivity and/or allergy: soy, dairy, eggs and peanuts. For example, years ago I switched to a low carbohydrate diet that involved a lot of eggs, and within a few weeks, my egg sensitivity had increased. I didn’t know that this was the problem; I just realized that after a while the diet wasn’t helping anymore, either with weight loss or my sense of well-being. If you can’t do one or more of the various clinical and lab tests for food allergy/sensitivity reactions, you can use the pulse test (greater than 10% pulse increase 30 minutes after a meal or 2 minutes after placing the food on the tongue), as well as symptom diaries and/or elimination diets to help figure them out. If food cravings persist on the low carbohydrate diet, it may be that there are still some foods that you are having an allergy/sensitivity reaction. Most people will do better if they remove the reactive foods from their diet, at least temporarily. These reactive foods stimulate the nervous system and stimulate insulin release, so you may go through withdrawal symptoms, like headaches and sleep disturbances for 3-10 days after stopping them. Fortunately, newer less allergenic protein sources are now being used for protein powders, like rice and bean derived proteins. In my own case, I do best with skinless chicken breasts or lean pork for protein; sunflower seeds (particularly raw, non toasted) or sunflower butter are also relatively well tolerated. Of course, there is a lot of variation in what people react to. Fish, shellfish, beef, wheat and corn can also cause reactions in some people. Chemicals, either in food or inhaled, can also affect insulin levels and moods. Many people with food and chemical sensitivities can detect and eliminate a few items and be much improved. For others it may take more effort (for much more on this topic, see other article, this issue).

Some research supports the idea that reducing food allergy/sensitivity helps lower insulin and excess body fat. Studies using the ALCAT test for food reactions showed that hunger could be reduced, and weight loss or improved muscle to fat ratios could be achieved using the test results (for more information on the ALCAT and the studies, call 800/881-AMTL, or go to www.alcat.com). Preliminary results in a study of diabetes using the ELISA/ACT Lymphocyte Response Assay showed glucose tolerance test results could be improved in diabetics by removing the foods and chemicals identified as reactive using the assay (for more information on the ELISA/ACT LRA, call 800-553-5472).

Adjusting to the Dietary Change

I also wanted to mention that the time it takes to respond to the low carbohydrate diet varies. If you try it, you may even feel worse for the first few days, and possibly a week or two, as your body adjusts to the change. Dr. St. Amand finds people experience the greatest benefit by the end of the second month on the diet. I found I was feeling considerably better within a few days. The diet reduced dizziness, fatigue, anxiety, cognitive problems and night sweats. It also made it easier to maintain weight or lose it if I chose to do so. I find that the people for which this diet is least appealing are often those who need it most. They tend to be carbohydrate cravers, as I was, and really only feel alive for a short time after filling up on carbohydrates. It is usually the first week or so on the low carbohydrate diet that is the hardest, until you can begin to get off the roller coaster ride of fluctuating blood sugar levels (reactive hypoglycemia).

The Benefits of Giving up Your Carbohydrate Addiction

In some ways, the most difficult part of going on the diet is the psychological adjustment it takes. People with hypoglycemia are used to relying on carbohydrates to give them a surge of energy. In fact, the carbohydrates almost act like a drug. But the problem is that they soon “crash” and need another “fix.” I was amazed that after a week on a low carbohydrate diet, I would begin to find myself typing away at the computer when I hadn’t eaten for 4 or 5 hours, whereas before, I would be feeling shaky with hypoglycemia by then and have trouble functioning at all.

Until you adjust to the new diet, which may take 1 week or several, it may be hard. I found that it helped if I had the next low carbohydrate meal prepared and ready on a plate in the refrigerator, well before meal time, so I would be less tempted to resort to excessive carbohydrates when meal time came. I also would not have to be preparing food when hungry, which may be harder during the first few days of the new diet. Sometimes, watching a humorous video or T.V. program during my meal helped to replace the temporary lift I used to get at meal times from the excessive carbohydrates. If I was eating with other people, I would focus on them and the conversation, instead of the food. In fact, I enjoyed social times even more, because my focus was on being sociable and appreciating the people and the interaction (at times I have found it easier to bring my own food to social occasions, but this is usually only necessary if you have extensive food allergies). I also found that I didn’t mind not having dessert on these occasions. I knew I was not having it, and I didn’t have to go through the inner struggle, which I used to find so difficult when sweets were around. At times when I was not feeling well, I found I could also use the dessert time to go lie down and rest a bit. The longer I went without the splurging, the less tempted I became until now I am out of the habit of imagining the taste of things whenever I see high carbohydrate foods in commercials or elsewhere. Imagined tasting seems to rouse the craving. On a few occasions, after months on the low carbohydrate diet, I have tasted a tiny amount of a dessert and found it rather disappointing. Most people find that their tastes change and sweets start to be cloying and unappealing after a while on the low carbohydrate diet. All this does not mean you can never have dessert. Most of the diets I discuss below allow dessert occasionally, particularly after the initial phase of the diet.

I also have found it interesting that the pattern of my appetite during a meal has changed. As before, I start out hungry and during the first half to 2/3 of the meal, the food tastes good and is satisfying. But toward the last 1/3 of the meal, it stops tasting as good. In fact, by the end, it tastes rather unappealing. If I was feeling sorry for myself and still stuck in my old thinking patterns, I might wish I was eating my old carbohydrates, foods that always left me wanting more and looking forward to the next “fix.” One day I realized how really perfect the situation on my new low carbohydrate diet actually was–in fact this was actually normal. The food should taste great when you are hungry and not very appealing when you are full, toward the end of the meal. When it stops being appealing, you just stop eating. At last I could relate to certain people I knew who were naturally thin and seemed indifferent to having seconds or having dessert, when I would be having inward struggles with myself to avoid overeating. Those of us with a tendency to produce high levels of insulin in response to carbohydrates are thought to have what is called a “thrifty gene.” Our easily sparked insulin gives us a greater drive to eat and makes our bodies especially good at storing fat. This genetic makeup made us less likely to starve during human evolution. However, it makes us less well-adapted to our modern diet of high amounts of concentrated carbohydrates. And with age, the problem worsens, as evidenced by increasing obesity with age and the failure, for many, of the high carbohydrate diet approaches usually touted.

Simple Cooking

The many low carbohydrate diet books available now contain multitudes of delicious recipes. Here, I will simply offer the basics of how I cook chicken. If you are like me, you have not been very interested in cooking meat, preferring a quick carbohydrate. Thus, these instructions may be useful. I prefer simplicity. In my own case, for convenience, I often cook a very large amount of skinless boneless chicken breasts (I prefer organically-raised chicken, but if you minimize the fat, even non organic chicken should be O.K. for most). I then store some in the freezer after it is cooked. I use a large roasting pan.

Lately, I have tried cooking 12 pounds at 475 degrees for about 65 minutes. After the first 40 minutes, I take the chicken out and rearrange the pieces so the least cooked pieces are on top. Another, tastier way to cook the chicken, if you have enough energy to do it more frequently, is to put about 2 to 5 pounds in one or more large flat pans, with a little space between each piece, if there is room. You can put foil on the bottom of the chicken to make it easier to clean. Preheat the oven to 450 degrees. Then put the uncovered chicken in the hot oven and then, after 40 minutes, take it out and turn over each piece and put the pan back in the oven for about 20 minutes. If you do not have a timer on your oven, I highly recommend purchasing a small kitchen timer. If the pieces are small, you might reduce the cooking time by 5 minutes, or if they are very large, you might add on a few more minutes, perhaps turning them one more time, if you prefer them more browned. The times may have to be altered slightly based on the number of pounds cooked and the temperature of your particular oven. Be sure to cook the chicken thoroughly. Also, wash your hands and any utensils that come in contact with the uncooked chicken to prevent the spread of any food-borne illness, like Salmonella. If the pieces vary in size, it may help to put the smaller pieces in the middle. I find this method will result in more uniformly cooked chicken.

Some people, particularly those with irritable bowel syndrome (usually associated with diarrhea and/or constipation and abdominal cramping), find fried foods and too much fat tend to worsen their condition. I find if the meat is too browned, it has a similar negative effect. Overcooked meat has also been associated with cancer. To avoid too much browning, you can cook the chicken in a covered container, with ½ cup added water, for 60-90 minutes at 450 degrees until done to your taste. There is no need to turn the pieces over. Wrapping pieces of chicken in foil is another way to achieve well done, tender chicken that is not browned.

I would suggest putting what you aren’t going to use at that meal into a covered container or pot and into the refrigerator soon after cooking, to minimize the tendency for the chicken to dry out. At the table, you can add about a tablespoon of olive oil and plenty of salt for seasoning at meal time (excess salt is not a problem in most people with chronic fatigue syndrome, since we usually have low blood pressure, but consult your physician about your own salt intake, especially if you have high blood pressure). After placing the chicken on my plate, I then add whatever small amount of non-starchy vegetable I might have and the carbohydrate (I use about 10 grams of carbohydrate from a grain to approximate Dr. St. Amand’s suggested carbohydrate ration of a piece of bread or fruit allowed per 4 hours). When reheating meals in a microwave, I recommend placing the carbohydrate and any vegetables on top of the chicken to keep it from drying out. Also, certain polyunsaturated vegetable oils (like sunflower oil or safflower oil) are healthier if not heated, so you may want to add them after taking the plate from the microwave. Olive oil, however, is O.K. to heat or cook with. I don’t use spices because of my allergies and sensitivities, but others may if they wish to. Most of these tips should apply to other types of meat and poultry. It is possible to have a quite varied diet, if you are like most people and have fewer food sensitivities than I do. So, I encourage you to consult recipes contained in cookbooks and those found in most of the low carbohydrate diet books discussed below.

Part II. Brief Survey of a Few Low Carbohydrate Diet Books

Dr. St. Amand has one of the simplest approach and he has found it to be effective for many years for his fibromyalgia patients who also have hypoglycemia or carbohydrate cravings. He finds 40% of his female and 20% of his male fibromyalgia patients have hypoglycemia and an additional 20% of both genders have carbohydrate cravings and both groups benefit from the diet. I will describe his approach first and then proceed to some other low carbohydrate diet books. They offer recipes and menu plans and information about the research on health and weight loss benefits. I will primarily discuss the ways in which they differ and highlight information that may be of interest.

What Your Doctor May Not Tell You About Fibromyalgia: The Revolutionary Treatment that Can Reverse the Disease. By St. Amand, R. Paul, M.D. ,and Claudia Marek, M.A. 1999. Warner Books, New York, NY. This book’s recommendation for avoiding blood sugar fluctuations and associated symptoms is to limit carbohydrates to the equivalent of 1 piece of bread or 1 piece of fruit for every 4 hour period of the day. High protein foods, vegetables, nuts, and vegetable oils are not restricted. The book also specifies certain foods that are to be avoided entirely for 2 months (see below). The authors caution that, at first, you must follow the diet perfectly for optimal results. In general, they find patient’s symptoms improve by 75% after a month of strictly adhering to the diet, with maximal improvement after 2 months. At this point, if you want to, you may cautiously experiment with adding a little more carbohydrate, but should be prepared to return to the strict diet if symptoms begin to worsen. Although a relatively large amount of animal protein may be consumed, cholesterol need not rise if animal fat is minimized and replaced by vegetable oils like olive, sunflower or canola oils. The book also contains a stricter version that forbids a few more items, in case the liberal version presented here is not sufficient to reduce symptoms or obtain weight loss. It should be remembered that the primary goal of this diet plan is to eliminate symptoms associated with hypoglycemia, with weight loss as a secondary consideration. Thus, you do not need to be overweight to benefit from this diet. Dr. St. Amand has found the liberal version of the diet to generally be compatible with pregnancy, but you should always consult your physician first.
Foods to strictly avoid for St. Amand’s low carbohydrate diet for hypoglycemia:
Sweet wines, fruit brandy and champagne, Dried Fruits and Fruit Juices, Baked and Refried Beans,
Garbanzo Beans (Chickpeas), Barley, Bananas,
Black-eyed peas (Cowpeas), Rice, Pastas (All types),
Lima beans, Lentils, Burritos and flour, tortillas, Potatoes,
Corn, Sweets of any kind, Tamales
DO NOT USE PRODUCTS which contain: Dextrose, Glucose, Hexitol, Maltose, Sucrose, Honey, Fructose, Corn Syrup, or Starch. NO CAFFEINE or ALCOHOL.

Dr. Atkins New Diet Revolution, 1992, by Robert C. Atkins, M.D. M. Evans & Co., New York. This book stresses rapid weight loss and very low carbohydrates, although it also offers an intermediate and a maintenance program. It aims to achieve a ketogenic fat-burning diet, which, according to Dr. Atkins and others, is perfectly safe for most people (in fact, some children on epilepsy are put on ketogenic diets; however, see Cautions below). It has chapters on nutrition, the yeast (Candida albicans) and allergies/sensitivities, as well as covering the research on health benefits of the low carbohydrate diet. If you have trouble during the first few days of the diet, he suggests 500-1500 mg of the amino acid L-glutamine, 4 to 5 times per day, to help with cravings. His program shows how many patients can actually increase their saturated fat and still eventually achieve much lower triglycerides and cholesterol levels. Others are critical of his failure to limit saturated fats; however, in many of the recipes, one can substitute leaner meats and add vegetable oils, like olive oil.

Healthy for Life, 1995, by Richard R. Heller, Ph.D. and Rachael F. Heller, Ph.D. Penguin Books. New York. This book presents a more gradual and flexible approach to lowering insulin levels and losing weight. They stress the need to lose weight slowly (1-2 pounds per week) so that the body does not go into “efficiency mode,” which causes weight loss to plateau. Some of their options might not be adequate to control hypoglycemia, particularly in more severe cases. For instance, they tend to allow a lot of carbohydrates at dinner, but keep it in balance with protein and fat intake. They recommend beginning meals with a low or non carbohydrate food, like a green salad or protein, so as to reduce the insulin response. A vegetarian version of the diet is also presented, using mainly soy, eggs and dairy products for protein. The book also covers research on the benefits of this type of diet for preventing heart disease and diabetes, as well as intriguing information on possible benefits in cancer prevention. Two newer books by these authors focus on the idea of the “carbohydrate addict,” but present a generally similar approach.

Coping With Candida Cookbook, by Sally Rockwell, nutritionist. This book is helpful because it gives low carbohydrate recipes that allow those with allergies and sensitivities to avoid their problem foods. The author sees a low carbohydrate diet as a good way to reduce overgrowth of the yeast, Candida albicans. It can be ordered from N.E.E.D.S. ( 800-634-1380). They also sell other books on the subject of allergies/sensitivities through their catalog. For those who are sensitive to chemicals and foods, another resource for books, and other products and services is the American Environmental Health Foundation (800-428-2343, www.ehcd.com/ehc.html; for example, they carry the classic, An Alternative Approach to Allergies, by Randolph & Moss; for more resources for the food allergic individual, see the first article in this issue).

Protein Power, 1998, by Michael R. Eades, M.D., and Mary Dan Eades, M.D. Bantam Books. New York. This book stresses a high protein, low carbohydrate diet for weight loss, insulin reduction and overall health. Their approach involves counting carbohydrates and has 3 phases, involving different amounts of carbohydrates, that can be used according to each person’s needs. Phase I allows 30 grams of carbohydrates daily, phase II allows 55 grams of carbohydrates and phase III allows a gradual increase in carbohydrates until the optimal level for the individual is achieved. In this plan, there is no restriction as to the source of the carbohydrate (even sugar is allowed), as long as the totals for the day are within the above limits. They stress that if you are on medication to lower your blood pressure, blood sugar or cholesterol, you should be under close supervision by your physician, as you will probably need to gradually decrease your medication. The book has an excellent chapter answering questions regarding complaints and criticisms of this type of diet and either refutes them or offers ways to mitigate certain drawbacks. A brief chapter on eicosanoids points out the benefit of replacing saturated and trans fats with olive oil and fish oil. They express the view that this can reduce fatigue and other symptoms arising from arachidonic acid excess or sensitivity experienced by certain susceptible people. There are also details on how excess insulin in the bloodstream leads to obesity, diabetes, high blood pressure, high cholesterol, plaque formation in the blood vessels and resulting cardiovascular disease. This book states that their program is not intended for women who are pregnant or planning to become pregnant.

Eat Right for Your Blood Type, 1996, by Peter D’Adamo, Putnam, New York. This book is focused on avoiding lectins occurring in some foods that may react negatively with the blood of people with various blood types. I think it is useful to know which foods have lectins that are proposed to be incompatible with your blood type (see the “Avoid” lists in the book). However, one should remember that you may be allergic or sensitive to other foods that the book says are O.K. as far as lectins. Also, the book implies that only people with Type O blood need to limit their carbohydrates, yet I know at least two people with Type A blood who also have hypoglycemia. So, you can’t rely only on blood types to determine whether a lower carbohydrate diet might be helpful.

The Zone, 1995, by Barry Sears, Ph.D., Harper Collins. This book recommends relatively low carbohydrate diets and may work for some people. However, he spends a lot of time on his theory on how the “zone” diet can balance eicosanoids, which is so far unproven. You may or may not want to go to the additional effort of doing the steps he recommends to “balance” eicosanoids. The easier part is changing the types of fat you eat, but there are other parts involving balancing portions, which is more complicated, and perhaps is unnecessary for most people.

For me, the bottom line for those who have hypoglycemia, is Dr. St. Amand’s recommended diet. He has found this sufficient for even the most severe hypoglycemics among his fibromyalgia patients. The above books and many others recommend cutting sugar, or reducing carbohydrates. They may help lower insulin, but some may not work for true hypoglycemics, as Dr. St. Amand defines them. So, if you have tried other low carbohydrate, hypoglycemia or Candida diets, you still might want to consider Dr. St. Amand’s dietary approach for at least 2 months to determine what is the maximal benefit you might obtain by the end of that time. If this diet doesn’t work for you, I would suggest trying the strict version of Dr. St. Amand’s diet and/or trying to identify food allergies/sensitivities/intolerances that you may be unaware of (see above, and other article, this issue).

Cautions: Patients with existing renal failure should not go on a high protein diet, and patients with gout or diabetes should consult their doctor, as should all patients with a medical condition, before changing their diet. Pregnant women or women trying to get pregnant should also consult their doctor before making significant dietary changes. Changes in diet and supplements (e.g., chromium) may affect the dosage needed for insulin and other medications. Some weight loss programs, particularly those resulting in very rapid weight loss, can lead to imbalances in electrolytes (e.g., low potassium levels), thus a doctor’s supervision is recommended. Low potassium levels can be dangerous to the heart, if not detected by routine blood chemistry tests and remedied. These tests can also pick up unsuspected electrolyte problems due to diuretics (pills to reduce fluid retention) or from unsuspected kidney disease, which is not uncommon in diabetics. Adult-onset diabetes, which is more frequent in obese individuals, often has minimal symptoms and may go undiagnosed in its early stages. This is another important reason to have a thorough physical exam with urine and blood tests.

References

Heller, Richard F., Ph.D., and Rachael F. Heller. 1995. Healthy For Life. Penguin Books, NY.

Reaven, G.M. 1991. Insulin resistance and compensatory hyperinsulinemia: role in hypertension, dyslipidemia, and coronary heart disease. Am. Heart J., 121(4 Pt 2):1283-8.

Reaven, G.M. 1997. Do high carbohydrate diets prevent the development or attenuate the manifestations (or both) of syndrome X? A viewpoint strongly against. Curr. Opin. Lipidol., 20 Suppl 8(1):23-7.

St. Amand, R. Paul, M.D., and Claudia Potter, MA., 1997. The use of uricosuric agents in fibromyalgia: theory, practice, and a rebuttal to the Oregon study of guaifenesin treatment, Clin. Bull. of Myofascial Therapy, Vol. 2(4):5-12, The Haworth Press.

St. Amand, R. Paul, M.D., 1998. A description of fibromyalgia and hypoglycemia: their combined morbidity and therapy with guaifenesin and diet. American Academy of Environmental Medicine Annual Meeting. Baltimore, MD.

St. Amand, R. Paul, M.D., 1999. Papers on “Fibromyalgia: For Patients,” “Fibromyalgia: For Physicians,” Available at http://guaidoc.com and further information from http://www.csusm.edu/public/guests/nancym/fibromt.htm

St. Amand, R. Paul, M.D. ,and Claudia Marek, M.A. 1999 (in press, available in December). What Your Doctor May Not Tell You About Fibromyalgia: The Revolutionary Treatment that Can Reverse the Disease. Warner Books, New York, NY.

Waterhouse, J.C. 1998. A case history of FMS/CFIDS/MCS and the roles of guaifenesin, a low carbohydrate diet and environmental medicine in recovery, CISRA’s Synergy Health Newsletter, Issue 2, Vol. 1(2).

Disclaimer: All articles provided on the SynergyHN website are for information only and are not intended as medical advice. An effort is made to be accurate, however readers are advised to verify what is presented here and check with their own doctors. No guarantee of accuracy is expressed or implied. Neither CISRA nor the author receives any funding or income from any organization or manufacturer connected with the topics discussed.

Written by synergyhn

October 30, 2008 at 1:15 am

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