Low glycaemic index diet
The first step in tackling hypoglycaemia is a low glycaemic index diet. The GI is a measure of the ability of foods to raise one’s blood sugar levels. Sugar (ie disaccharides) have arbitrarily been given a GI of 100. High GI foods are the grains (wheat, rye, oats, rice etc), root vegetables (potato, sweet potato, yam, parsnip), alcohol, sugars, and fruits, dried fruits and fruit juices. But if you change your diet to the low glycaemic diet, expect to see withdrawal symptoms which can persist for weeks.
Glycaemic Index (GI)
This is a measure of the ability of food to increase blood sugar. This can be affected by many factors, not just the food itself.
- Foods that are cooked will be more rapidly digested and therefore have a higher glycaemic index. Raw carrot slowly releases its sugar, cooked carrot is much more quickly digested. Juices have higher GI than whole vegetables or fruits.
- Foods that are finely divided such as flours, again are more rapidly digested and therefore have a high glycaemic index. Baked potato has a lower GI than crisps.
- Carbohydrates that are very soluble such as sugars and alcohol again are rapidly absorbed and so have higher GIs
- Small amounts of food will obviously have a lower GI than large. A small potato with meals may be fine, but a large pile of mash will increase blood sugar and trigger insulin release.
Food should be slowly eaten
What causes insulin to be released is the rate at which the blood sugar level rises. A quick rise will produce a pulse of insulin which then hangs around for a long time and causes subsequent hypoglycaemia. So eat foods slowly, don’t gobble them, and mix carbohydrates with high fibre foods, vegetables, meat and fats so that the absorption of carbohydrate is slowed.
It is easy to identify the carbohydrate addicts – they like their carbohydrates highly refined such as sugar, sweets, crisps, white bread, pasta and refined breakfast cereals and fruit juice. They tend to gobble their food. They are not content with a normal meal of meat and vegetables without the sweet sticky pudding to follow!
The glycaemic index of common foods can be found by going to The Home of the Glycemic Index
These foods have no carbohydrate content:
Butter is also a zero glycaemic index food, but is not recommended on a true paleo ketogenic Diet.
Low glycaemic index
These foods can also be eaten freely.
- Nuts: brazil, peanuts, cashews, walnuts, almonds, hazelnuts
- Seeds: sesame, pumpkin, sunflower, pinenuts
- Herbs and spices
- Salads: lettuce, tomato, cucumber, radish, parsley, celery
- Green vegetables: cabbage, sprout, cauliflower, kale, kohl rabi, spring greens, asparagus, purple sprouting
- Berries - blackcurrants, raspberries, strawberries, gooseberries, blackberries etc
- Rhubarb (but this doesn't count if you smother it with sugar!)
Medium glycaemic index
Ration yourself to 2-3 portions daily of foods from this list. Don't forget that the GI index of a food depends also on the quantity of that food: a grain of sugar doesn't have a very high GI (i.e. it won't have much effect on your blood sugar) but a teaspoon will.
- Vegetables: onion, squash, sweetcorn, carrot
- Fruits: all citrus fruits, and also apple, apricot, cherries, peaches, pears, plums, strawberries, kiwi
- Pulses: chickpeas, beans, lentils and soya
- Some root vegetables: swede, turnip and sweet potato
High glycaemic index
Avoid these - asking for trouble! One portion at most daily.
- Sugars: honey, syrup, jam, marmalade, sweets, chocolate, and anything ending in "-ose" (fructose, glucose, maltose), granulated sweeteners
- Fruit juices: best to drink diluted
- Cereals: wheat, rye, oats, barley, short grain rice - even worse if they have been finely ground or bleached i.e. flour, white rice, instant rices, water biscuits, rice cakes, ryvita cornflakes, weetabix, puffed wheat, tinned pasta, white pasta etc)
- Root vegetables: Parsnip and potato (inc. crisps)
- Sweet fruits: banana, peach, grapes, melon, mango, pineapple, grapes
- Dried fruits: dates, figs, sultanas, banana
- All cakes and pastries: croissants, doughnuts, pancakes, cereal bars, cakes, biscuits.
GI rating for some common carbohydrates
A Glycaemic Index of less than 55 is considered Low, 56 to 69 Medium and greater than 70 is High. Values will vary depending on brand, variety, ripeness, preparation etc.
- All Bran (43)
- Apple (37)
- Apple juice (clear) (44)
- Apricot (dried) (30)
- Apricot (jam) (55)
- Apricot (tinned) (64)
- Baked beans (tinned) (46)
- Banana (ripe) (58)
- Banana (unripe) (30)
- Beetroot (64)
- Butter beans (31)
- Carrots (51)
- Cashews (22)
- Cherries (22)
- Chickpeas (33)
- Chocolate (49)
- Cornflakes (81)
- Croissant (69)
- Dark rye bread (76)
- Dates (dried) (72)
- Digestive biscuit (60)
- Doughnut (76)
- French baguette (68)
- Fructose (46)
- Glucose (100)
- Grapefruit (25)
- Grapes (48)
- Hazelnuts (33)
- Ice cream (61)
- Jelly beans (80)
- Kidney beans (28)
- Kiwi fruit (53)
- Lentils (28)
- Mango (56)
- Mars bar (65)
- Milk (full fat) (27)
- Milk (skimmed) (32)
- Mixed grain (49)
- Muesli (58)
- Oat bran (50)
- Orange (44)
- Orange (juice( (55)
- Parsnips (68)
- Pineapple (66)
- Peach (42)
- Peanut butter (29)
- Peanuts (22)
- Pear (36)
- Peas (48)
- Pineapple juice (46)
- Pinto beans (40)
- Pitta bread (58)
- Plums (32)
- Popcorn (55)
- Porridge (46)
- Potato (boiled or mashed) (74)
- Potato (jacket, baked) (72)
- Potato crisps (54)
- Potato: new (62)
- Puffed Wheat (80)
- Raisins 64)
- Rice Krispies (83)
- Rich Tea biscuits (57)
- Rye bread (65)
- Shredded Wheat (70)
- Sourdough 57)
- Soya beans (20)
- Spaghetti (white) (43)
- Spaghetti (wholemeal) (39)
- Special K (54)
- Split peas (32)
- Strawberry (32)
- Sultanas (57)
- Swede (72)
- Sweet corn (55)
- Sweet potato (54)
- Table sugar (65)
- Tomato juice (38)
- White bread (70)
- Wholemeal bread (69)
- Yoghurt (low-fat, sweetened) (33)
- Yoghurt (low-fat, unsweetened) (14)
While GI is a very useful concept, it cannot be taken as the sole predictor of the effects of eating a particular type of carbohydrate. That is because blood glucose response is also determined by the amount of food eaten. A more reliable rating system is the 'glycaemic load' (GL), which takes account of both the quality (GI value) of a given carbohydrate and the amount consumed, so more accurately predicting its effects on blood sugar. The glycaemic load, in units, of a portion of carbohydrate is expressed as:
- GI rating x grams of carbohydrate in portion size / 100.
Note that each unit of GL produces the same effect on blood sugar as eating 1g of pure glucose.
- A 120g banana contains around 24g of carbohydrate, which has a GI value of 58.
The GL is: (58 x 24) / 100 = 13.92 units.
- 120g of chocolate provides 75g of carbohydrate, which has a GI value of 49
The GL is: (75 x 49) / 100 = 36.75 units.
By totalling up the GL units for foods you eat during the day, you can arrive at an overall GL for the day. A Glycaemic Load of Less than 80 units is considered Low, 80 to 120 units is Medium and greater than 120 units is High.
Starting on the low GI diet
Put in place as many of the other interventions to help stabilise blood sugar levels. Do not make changes too quickly or you will get such awful withdrawal symptoms the diet will not be sustainable!
- Get breakfast in place first. This is the most important meal of the day. There is an old Chinese saying "Breakfast like an emperor, lunch like a king, supper like a pauper".
- If you cannot initially face a cooked breakfast, (many people with hypoglycaemia feel nauseous in the morning), just have a handful of nuts and seeds and go for a cooked brunch or lunch.
- DO NOT eat carbohydrate at breakfast- this triggers the whole cycle of craving and hypoglycaemia.
- Organise some low GI snacks to eat to combat hunger in the day eg nuts and seeds, oat cakes, nut butter, boiled egg, tinned fish, cold meat, salad bits etc.
- Then change lunch and finally supper.
- Eat regularly even if you are not hungry- have something!
- If sleep is affected, eat a snack last thing at night and perhaps eat again in the night. Eventually you will sleep through the night.
It may take some months for the body to adjust fully and the many symptoms of hypogycaemia to settle down.