I experience energy highs and lows every day that seem more severe than normal swings should be. I notice that I have a lot of nervous energy after eating, followed soon after by periods of exhaustion. My diet is well-rounded and healthy, although I am lactose intolerant. Sometimes the lows that I experience interfere with my ability to socialize because I feel so tired. What might be causing these daily peaks and valleys?

A.

The first thing that comes to mind with daily energy swings associated with meals is a condition called reactive hypoglycemia. Reactive hypoglycemia causes wide fluctuations in blood sugar levels that can cause an initial increase of energy after eating, followed by an energy drop 1-3 hours later. Other symptoms can include irritability, headache, forgetfulness, shakiness, blurred vision, depression and mood swings. The cause of reactive hypoglycemia is an abnormal insulin response to refined carbohydrates in the diet resulting in wide swings in blood sugar levels. Eating simple carbohydrates (sugars) causes a rapid rise in blood sugar ( you feel more energetic) then the body secretes too much insulin to lower the blood sugar which causes a rapid decrease ( you feel less energetic). There is good evidence that oversecretion of insulin for many years can lead to insulin resistance and type 2 diabetes, so it is important to diagnose and treat reactive hypoglycemia.

Reactive hypoglycemia can be diagnosed with a simple test called a glucose tolerance test (GTT) with a hypoglycemic index (a measure of the rate the blood glucose level falls). Many people with reactive hypoglycemia experience symptoms while undergoing the test, further confirmation of the condition. The test is simple, after a period of fasting, you drink a concentrated solution of glucose and blood samples are taken at 1/2 or hourly intervals for 3 or more hours. The pattern of blood sugar rise and fall diagnoses reactive hypoglycemia. Your health care provider can order and evaluate the results of the test, as well as determine if other testing is needed to rule out other causes of fatigue like hypothyroidism, anemia and depression.

The main treatment for reactive hypoglycemia is dietary. All refined carbohydrates including sugars, sweets, and fruit juices should be strictly avoided as they cause a rapid rise in blood sugar levels. Alcohol and caffeine also affect blood sugar and should be eliminated. The diet should include protein and high fiber foods to prevent rapid rises in blood sugar. Eating more frequently, six smaller meals instead of three large ones, is helpful to balance blood sugar. A good multiple vitamin and mineral supplement will assure that essential nutrients for carbohydrate metabolism are provided. The mineral chromium has been shown to help alleviate hypoglycemic symptoms in a dose of 200 mcg (micrograms) per day.

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* The information presented in this web site is intended to inform and educate. It is not intended replace a qualified medical practitioner to diagnose or treat medical conditions.