RH after keto

Tony4456 said:

Hi all, a couple months ago after a SIBO diagnosis I started tapering my carb intake down to 100g/150g a day and upping my healthy fats. Over time I started to find it easier and ended up doing a bit of keto and IF. I only actually did full keto for about a week at which point I broke it and had a sunday dinner with family. This knocked me off my feet and I woke up during the night with my first hypo. Caused diarrhoea, sulpher burps, nausea and generally just made me feel quite unwell. I blamed keto for this so started to up my carbs back towards 150g a day thinking its what my body wanted. Over the next few weeks I had several hypos and always after eating junk food. I spoke to a GP last week and they suggested RH but tbh the only advice they gave me was stop eating junk food. I did have a full MOT done and my bloods were fine, HbA1c 5.2. Since then I am really struggling on a daily basis with food. Eating causes muscle weakness, fatigue, brain fog, migranes and such. Up until going keto I had never knowingly had any issues with blood sugar and feel like ive broken my body. 5.2 was only about a month ago but atm my daily fasting glucose has been as high as 6.2 but it doesnt raise too much after eating and as long as I dont eat simple carbs it doesnt crash too hard. Do I need to go back to my GP for a confirmed diagnosis? Is this my bodys over reaction to keto and will it settle down and go away? I would be keen to see if any others have had RH brought on by doing low carb/keto and what advice they would have for improving it. Thanks

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Hi, and welcome to our forum,
On first reading, my initial thought was, if you were ok before the Sunday lunch, why aren't you blaming something that was in the dinner?
As far as I am aware keto has not caused RH!
The nature of the condition, if you have RH, is that you create too much insulin from what you eat something and from being a guinea pig in my type of RH, it is the carbs and sugars that are the trigger for the reaction.
I would say that you need to follow up with your GP, and either get a referral or get more tests done, starting with an extended glucose tolerance test. This test will give the doctors an idea what happens after the glucose is drunk.
It does seem to me you have had something that just didn't agree with you.
As far as the bloods you recorded, they are, I would say, in normal levels, your hba1c levels are well in normal levels, which is where I am now, without carbs in keto!
My blood levels are in control with a very low carb diet and it wouldn't cause the trigger, for me to create the excess insulin or cause the hypos!

I hope this helps!

Tony4456 said:

Looking back now I absolutely blame the dinner, I ate mashed potato and some dessert after keto but obv I didnt know at the time it was RH cus its never happened in my life and im 34, I just thought it was now getting use to running on fat and didnt like the change so quickly. The timing could of course be a freak coincidence but I highly doubt it. I felt fine in myself before lowering carbs. I took carbs out and tbh I felt good, I was exercising daily and felt energised and was fasting 16 hours a day no problem, didnt particularly enjoy the diet as Im not a big meat guy but my body clearly didnt mind it as its refusing to go back. I also read on a keto forum that the body can mimic diabetes or glucose sparing and make itself insulin resistant to make sure your muscles dont use what little glucose you have and instead saves it for your brain. Ive also read in places that if you improve your insulin sensitivity you can improve RH but others seem to suggest its just stuck with you. I can eat a good 150g of complex carbs a day as long as I spread it out without having a hypo but even without the hypos I feel really fatigued, muscle weakness, eyes feel strange, headaches etc. I am going to follow up with my GP when he comes back off holiday cus the locum just told me to stop eating junk and get on with it but im really not happy with that as a diagnosis

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Yeah, looking at the meal you had,, I can really understand why the reaction happened, potato in any form is far too high in starch (high carbs) and will certainly cause the trigger for the excess insulin. The mash is made up of crushed potato, butter or milk, stirred into a mash. This concentration of starch is bad for me!
If you do have a good intolerance, for example, you do spread what carbs you do have and the good fats will help with suppressing the glucose spike, then that is fine, but be careful which carbs you do have cos even though the gms do matter but the make up of the carbs can be different even tho the gms in carbs is the same. For example, potato 20g can be a worse result than 20g of rice or pasta.
The mimicking of diabetes is not surprising as it clearly has so many similar symptoms. But it is non diabetic cos it is not hyper-glycaemic, it is hypo-glycaemic! And the best way to differentiate, between diabetes and hypoglycaemia is hypoglycaemia is too much insulin. With diabetes it is the opposite.
You can have insulin resistance, insulin levels that course through your blood, that can make you ill, high circulating insulin levels. Hyperinsulinimia is a part of RH unless controlled. Insulin that is not used goes to your liver and eventually causes fatty liver problems.
I have constantly come up against this notion of you must have carbs or glucose for good brain function.
That for myself is total bs!
When I was having a fasting test in hospital, before the test, my brain had been numb and dumb for years. Brain fog lasted all day every day! After a couple of days my brain became clear, like a veil lifting from my concious. I couldn't believe my energy levels, after so long being tired always!
My body can cope for days without food. And nothing happens! But I only eat mid afternoon and before 7pm! That is what I have realised helps me get through this last decade since diagnosis!
We all eat too much anyway!

Hope this helps!
Keep asking!

@Tony4456 - Forgive me if I missed it, but what was your blood sugar during your hypo?

I like to keep things simple, but most of us have a food or number of foodstuffs that are like our cryptonite - we have disproportionate responses to them. I wonder if you just discovered one or more of yours.

The craving is the carbs, and your brain telling you to eat them!
my spike is around 45minutes, and I believe my trigger is around 7mmols. But obviously I try to avoid this..
to stop having having a low overnight, don't eat four hours before bed. This will give your body a chance to stabilise in normal levels. If you fast in normal levels overnight you are unlikely to go hypo!
Unless, it's not RH, but a pancreatic condition instead!
you will only find out if you get the tests!

Now, to be clear, I am not making any sort of diagnosis, but were I a betting person, I would bet you have some food intolerances, triggering these symptoms.

That eating causes symptoms, then your body goes into overdrive trying to cope with the assault of whatever it is that doesn't agree with you.

I am a long-term (8yrs+) low carber. I'm well and content on it on it.

Due to something else, I had a raft of blood tests, including a coeliac panel, which was "just" negative - in other words I had antibodies (- many, MANY folks do), but at a level just a bit below diagnostic thresholds. The Endo I see suggested I adopt a strictly gluten-free diet. Being low carb, my gluten intake was already minimal and(, with his support), I had not gluten loaded in the lead up to the test.

Cutting to the chase, despite denying I had any symptoms of gluten intolerance prior to going GF, it became clear after a couple of months I was feeling better, and if I do have gluten by mistake, my symptoms are

Crushing, crushing fatigue
Headache
Joint pain
Constipation, then around 3 days later, that resolves,........ enthusiastically (yes, that is what I mean).

Bering a low carber, my blood glucose is regularly in the 3s and if I am very hungry I dip into the 2s. Generally, I feel absolutely fine on those numbers, although if I do see a number with a leading 2, I am usually very hungry. That hunger is because I am hungry and need my next meal, not as a result of the 2. It's a chicken and egg situation.

Again, I stress I am not diagnosing you with anything, but asking you to open your mind to the bigger picture.

Vis-a-vis sweet cravings? I am fortunate never to have had a particularly sweet tooth, so I can literally have chocolate sitting in front of me for months and never feel the need to consume it. In fact, it is a matter of mirth I have a pack of Hotel Chocolate 85% chocolate batons of near antique status.

I like savoury things, but even those cravings abate once routine of eating well to a satiated state is adopted. The flavours and seasonings I can get on low carb food, so I just don't bother.

If my OH has crisps (or my favourite Kettle Chips), I might steal the odd one (provided they are gluten free - many seasonings aren't), and just move along.

I'm not sure if that helps you a lot.

@Tony4456 - I just popped back to clarify that I do NOT consider low carbing gave me an intolerance to gluten, but that prior to low carbing, my body had found a level to which it could function, either asymptomatically or with symptoms at a very low grade, and were I consuming gluten daily (very likely, bearing in mind where gluten hides itself) I had low grade symptoms, but for me that was my "normal".

I believe the extreme reaction now is because my body does not routinely prepare the required digestive juices and enzymes to digest gluten, so any gluten ingestion hits hard.

I daresay if I reintroduced gluten to my diet the symptoms could moderate a bit, but I'm not interested in doing that. I don't find gluten to be any poss.

I'm not suggesting you retrain your body on pizza or whatever, just explaining my situation and my conclusions.

I have had almost exactly this discussion with the Endo when I described what happens when I "get glutened" and he has largely agreed with my conclusions.

Our bodies like to run on routines and produce the sort of digestive juices it needed yesterday and routinely. That's why events like birthdays and Christmases when there might be a blow out/carb-fest often lead to digestive distress and carb hangovers.

Our bodies are amazing things.

Tony4456 said:

Last night I was at 5.8, ate an apple with 50g meridian peanut butter. 20/30 mins later, 7.1 so no major spike and 5.7 when I woke this morning. Few days ago 5.7 upon waking, had overnight oats, 40g gluten free oats, 80g frozen berries, 15g chia seeds and 32g peanut butter. Again 30 mins later 7.2 so complex carbs dont appear to cause major spikes but they do still effect how good I feel and my energy levels so my nutritionist also agrees that its most likely a sensitivity. I will have to play around with my carb intake from fruits/veg to see where my body feels happier. Ive really been enjoying the apple/peanut butter combo so hopefully that can stay.

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In your OP, you stated issues after your Sunday dinner. What was in the dinner, in terms of carbs??

From my viewpoint, in order to make any sense of this, in terms of food, or drink, intolerances in a decent timeframe, you need to keep a detailed food diary. By detailed I mean every morsel you consume, amounts eaten and how you felt at the time and later - especially recording ANYthing you feel to be symptoms. This will allow you to look back to observe any patterns that may emerge, or any consistency for any given foodstuff.

Bearing in mind one of my worst glutening experience was eating a bunless burger, from the GF menu in a decent restaurant which claims only meat in their burgers, I can only conclude the issue was in a added seasoning or an apparently benign dressing or such likes.

(Just FYI, gluten is not just in bread or pasta, it's in soy sauce, Worcestershire Sauce, most colas and so on. It's a tricky little devil.)

Again, I stress I am not trying to persuade you you have a gluten intolerance, but explain and demonstrate how tricky these things can be to pin down.

Tony4456 said:

The Sunday dinner I had aside from the mash potato for carbs had both yorkshire puddings and stuffing which im assuming has gluten. I am supposed to be gluten free now but I know stuff slips through. For instance I often put some Worcestershire Sauce in the pan along with some spices, I had no idea that contained gluten so there is likely other stuff too. The intolerance symptoms that I seem to now have daily I have been getting after having yoghurt/nuts/seeds/cinnamon for breakfast so this morning I just had the nuts/seeds/berries with some almond milk and it still happened but to a lesser extent. Tomorrow I plan on trying to skip the fruit and see if thats any better. Im tracking on myfitnesspal so hopefully Ill find some relief now that Im heading back down the low carb route. edit: the gluten im pretty sure I am sensitive too. Seems random but everytime I start eating bread again I seem to get some pain/irritation in my prostate. Ive had a few recurring bouts of prostatitis in past couple years and I am now certain bread is a big trigger so I dont have it anymore.

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If you are supposed to be GF then you're going to have to do quite a lot of homework.

GF is hard work - far more hard work than low carbing, or keto. The Coeliac UK has a lot of good information, but I didn't buy any of their booklets or lists. I simply Google "Does x, y or z contain gluten?"

Gluten is a very common allergen, but so is lactose, many of the nuts and so on.

Tony4456 said:

Not from my doctors advice, I was tested for Celiac about 18 months back and I was ok but my nutritionist said that I can still be sensitive without being fully celiac so she advised that I just cut it out.

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What your nutritionist said is absolutely correct.

One thing about gluten is unfortunately, it's an all or nothing thing. You can't just cut down, unlike some other more "forgiving" intolerances, like lactose.

Just to confuse things further, I am wheat intolerant (and grain) but not gluten intolerant!
The madness of it all!

The bottom line, is fine tune your true individual nutritional balance that suits your body and not the opinion of a supposed trained professional, who doesn't know your body without getting the necessary tests!

Tony4456 said:

I will looks to get all of my carbs from fruit/veg

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Be careful on the fruit front.. I'd just try veg or maybe even give carnivory a go and see how that works out for you.

Your Doctor by the way sounds hopelessly outdated.