RH and intensive exercise

campros

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Hi everyone, I'm new here, but have been perusing this forum for a few months.

A bit about me:
I'm 28 with no previous health conditions worth noting. A couple of years ago (immediately before the original 2020 lockdown, actually), I began experiencing symptoms of low-blood sugar: pounding heart, sweating, confusion/inability to focus, lightheadedness, general weakness, shakiness, anxiety, and fatigue like no other. At the time, these symptoms were mind-boggling and I attributed them to simply being hungry (despite having never previously felt like this when hungry), but I eventually came to notice a pattern: I would eat breakfast around 8am, and without fail, these symptoms would come on around 10.30-11 in the morning. Eventually, I called my GP, but this was now right in the middle of the original 2020 lockdown. I was invited to the surgery for a blood test, but the test was at 2pm and I wasn't experiencing any symptoms, so I knew that it would come back normal, which it did. Things were chaotic at the time and GPs were (rightly) occupied with other matters, so no further investigations were done. I did some of my own research, discovered that white bread was a common culprit of these symptoms (and indeed, I was usually have white toast for breakfast), so I stopped eating toast and the symptoms became far less frequent.

Over time however, it seems like this has gotten worse. I went back to my GP last year and mentioned my symptoms again. I was tested for indications of diabetes, which came back negative, and then for any indications of a tumour that might be impacting my pancreas; again, this came back normal (I don't know what specifically was tested, but they were blood tests by my GP).

I'm currently focusing on trying to figure out what foods are causing me to feel like this. I've started a food diary and am making notes. I've noted that I can't eat bread on its own at any point during the day now, so I'm trying to eat more fruit, vegetables, and plant-based sources of protein (I'm vegan). I typically drink Huel in the mornings, which generally sets me up for a good day, but Huel is expensive and I don't want to have to rely on it for breakfast every day of the weak. So I'm experimenting, I guess.

Anyway, I've done quite a bit of reading up on this topic, and I generally understand what is happening (or I guess what could be happening, since I don't have a diagnosis). I'm keen to understand my body more so that I can start to feel better, but I find that I keep getting stuck on one thing: exercise.

Typically, my preferred forms of exercise are cycling and long-distance running. I find that when I exercise shortly after breakfast in the morning, regardless of the length or type of exercise, the hypo doesn't come on (does anyone know the science behind why this is?) and I feel pretty good (obvously I can't always exercise in this very specific time frame). What I'm concerned about though is fuelling before and during long-distance runs in particular. My understanding of fuelling for exercise is very basic, but this is what I think I know (correct me if you know I'm wrong): you need to be consuming fast-acting carbs regularly throughout your long runs/rides. Running differs from cycling in that your stomach is generally is unable to handle any substantial types of food, so this means that people are eating sweats and energy bars during their runs. I do this as well, and in general, this works well for the run itself.

However, this brings me to my main question (tl;dr): would fuelling like this while running be counter-productive to my overall goal of stopping these hypos? I keep reading information about how I should be eating a low-carb diet to prevent the hypos, but because I do long-distance sports where more carbs = more running/cycling/whatever, I feel conflicted and unsure of what to do. I feel like knowing more about how exercise impacts RH would be beneficial to understanding what is good for me to eat and what isn't, but in general, I'm just trying to figure things out.

Anyway, like I said, this is all a big learning experience for me right now, and I'm committed to figuring out what's best for my body. Maybe this is a super niche topic, but any insights/discussion would be very much appreciated!

Thanks. :)
 
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EllieM

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Hi @campros and welcome to the forums. I'll tag @Lamont D and @Brunneria who are RH experts.

Disclaimer, I'm not a doctor and the only hypoglycemia I get is insulin induced, but I have read a bit about the subject.

My understanding is that there are a number of causes of non medication induced hypoglycemia and you really need to see an endocrinologist to get the correct diagnosis. I wouldn't have massive confidence in a GP on this subject. Without the tests, you can't be sure that you have RH.

Are you testing your blood sugar? If you want to work out what is triggering you then I would have thought that keeping a blood sugar diary along with your food diary would be helpful.

Good luck.
 
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campros

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Yeah, I would definitely love to see a specialist about this! My GP never offered this, but I'll see if I can get referred.

I'll also purchase a blood glucose monitor. For some reason, it had never crossed my mind to obtain one of these before.
 
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Lamont D

Oracle
Messages
15,950
Type of diabetes
Reactive hypoglycemia
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I do not have diabetes
Hi everyone, I'm new here, but have been perusing this forum for a few months.

A bit about me:
I'm 28 with no previous health conditions worth nothing. A couple of years ago (immediately before the original 2020 lockdown, actually), I began experiencing symptoms of low-blood sugar: pounding heart, sweating, confusion/inability to focus, lightheadedness, general weakness, shakiness, anxiety, and fatigue like no other. At the time, these symptoms were mind-boggling and I attributed them to simply being hungry (despite having never previously felt like this when hungry), but I eventually came to notice a pattern: I would eat breakfast around 8am, and without fail, these symptoms would come on around 10.30-11 in the morning. Eventually, I called my GP, but this was now right in the middle of the original 2020 lockdown. I was invited to the surgery for a blood test, but the test was at 2pm and I wasn't experiencing any symptoms, so I knew that it would come back normal, which it did. Things were chaotic at the time and GPs were (rightly) occupied with other matters, so no further investigations were done. I did some of my own research, discovered that white bread was a common culprit of these symptoms (and indeed, I was usually have white toast for breakfast), so I stopped eating toast and the symptoms became far less frequent.

Over time however, it seems like this has gotten worse. I went back to my GP last year and mentioned my symptoms again. I was tested for indications of diabetes, which came back negative, and then for any indications of a tumour that might be impacting my pancreas; again, this came back normal (I don't know what specifically was tested, but they were blood tests by my GP).

I'm currently focusing on trying to figure out what foods are causing me to feel like this. I've started a food diary and am making notes. I've noted that I can't eat bread on its own at any point during the day now, so I'm trying to eat more fruit, vegetables, and plant-based sources of protein (I'm vegan). I typically drink Huel in the mornings, which generally sets me up for a good day, but Huel is expensive and I don't want to have to rely on it for breakfast every day of the weak. So I'm experimenting, I guess.

Anyway, I've done quite a bit of reading up on this topic, and I generally understand what is happening (or I guess what could be happening, since I don't have a diagnosis). I'm keen to understand my body more so that I can start to feel better, but I find that I keep getting stuck on one thing: exercise.

Typically, my preferred forms of exercise are cycling and long-distance running. I find that when I exercise shortly after breakfast in the morning, regardless of the length or type of exercise, the hypo doesn't come on (does anyone know the science behind why this is?) and I feel pretty good (obvously I can't always exercise in this very specific time frame). What I'm concerned about though is fuelling before and during long-distance runs in particular. My understanding of fuelling for exercise is very basic, but this is what I think I know (correct me if you know I'm wrong): you need to be consuming fast-acting carbs regularly throughout your long runs/rides. Running differs from cycling in that your stomach is generally is unable to handle any substantial types of food, so this means that people are eating sweats and energy bars during their runs. I do this as well, and in general, this works well for the run itself.

However, this brings me to my main question (tl;dr): would fuelling like this while running be counter-productive to my overall goal of stopping these hypos? I keep reading information about how I should be eating a low-carb diet to prevent the hypos, but because I do long-distance sports where more carbs = more running/cycling/whatever, I feel conflicted and unsure of what to do. I feel like knowing more about how exercise impacts RH would be beneficial to understanding what is good for me to eat and what isn't, but in general, I'm just trying to figure things out.

Anyway, like I said, this is all a big learning experience for me right now, and I'm committed to figuring out what's best for my body. Maybe this is a super niche topic, but any insights/discussion would be very much appreciated!

Thanks. :)
Hi @campros welcome to our forum.
Yes, I would ask for a referral or find a specialist endocrinologist who can help you, the reason is that only an endocrinologist can get the diagnostic tests necessary. Also, you need a specialist endocrinologist who understand the reasons why you go hypo. (Low blood sugar).
Exercise especially long distance is a bit tricky because it all depends on the individual how intolerant they are to the amount of carbs your blood glucose levels can cope with without triggering an episode of hypoglycaemia.
The reason you don't feel it straight away is twofold. The first is that you have probably been doing this level of exercise for a good while and your body has gotten used to the level of fitness because of it. Secondly, the episode of hypoglycaemia if you do have RH, usually occurs somewhere between three to five hours after food.
Also I would include any insulin resistance you may have, or how much insulin your pancreas over produces that drives your blood glucose down. To add, I wouldn't think you have hypo awareness either, that means the symptoms are more acute.
I am not surprised your results came back normal, they were done at the wrong time. When, before diagnosis and I did eat breakfast then, I was diagnosed because of a hypo I had in front of my endo three hours (ish) after porridge.
A fasting test (if you have RH) will be normal.
What to eat before exercise?
I'm twice the age you are and my exercise is a walk. Yeah that is it!
But then I'm in ketosis and also do intermittent fasting. My intolerance to food that trigger the episodes of hypoglycaemia are quite extreme, in fact, I have been known to call my RH, a carb intolerant.there is not carbs that doesn't cause a reaction. That is why I use a keto diet!
Can a keto diet work for you and still do the exercise?
Yes!
But then again it depends on how intolerant you are to carbs that is why you need a glucometer. You have already mentioned bread, yeah, that is baked flour and full of carbs, but then there is sugary foods such as cakes, cereals, pastries and so on. Then there is catchy foods such as rice, pasta, potatoes, carrots, turnips. Then again, if you are on high sugar fruit could also be a problem, if you don't test, you just don't know, spurs are my nemisis, they are really bad for me.
As for being vegan, I'm not! But as long as you get your protein and good fats, salad vegetables are great, mushrooms, onions, dairy or similar, cheese is very good, I can't, lactose intolerant. But if you get your dietary balance then being in keto shouldn't effect your exercise, your health or your working life.
If you do have hypoglycaemia you need to know what is causing it. If it is food and drink, a food diary and consistent testing of your blood glucose levels will give you the knowledge of those foods.
Keep asking, let us know how you get on.
 
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campros

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Thanks so much for all that info @Lamont D ! A lot to think about and work with here just now. I'll see about getting a referral but also give keto a try. I've found some resources about vegan keto, which I'd previously disregarded as being something of an oxymoron. It sounds like it'll be a huge change for me, but at this point, I just want to feel/be healthy again.
 
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Lamont D

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Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Thanks so much for all that info @Lamont D ! A lot to think about and work with here just now. I'll see about getting a referral but also give keto a try. I've found some resources about vegan keto, which I'd previously disregarded as being something of an oxymoron. It sounds like it'll be a huge change for me, but at this point, I just want to feel/be healthy again.

Just to add, keto works because there is no trigger for symptoms.
If you look at it logically, if it is carbs, sugar, which starts the trigger for the excess insulin. Then why eat them?
It is a preventative measure which I found does improve your health! And the bonus is no symptoms!