Blood sugar issues: where to start?

Note: this post has been updated.
I’m putting on my Nutritional Therapy Practitioner hat today.
If you’re consistently exhausted at 3 o’clock in the afternoon (I call it Liz’s College Crash) or have intense sugar cravings that send you into an eye-clawing catfight over the last M&M in the office candy dish, that’s a bright, flashing sign that you’re dealing with major, chronic metabolic or blood sugar imbalances.
That is not fun. For anybody.

These imbalances can seriously screw with your work life, too. As I said in a prior Email Monday (sign up to get access to the archives), at one of my previous jobs – which shall remain unnamed – I would crawl under my desk nearly every day at 3pm for a nap.
As much as I dislike Snickers, those “you’re not yourself when you’re hungry” commercials (even though they present the exact opposite of a sensical solution to the Blood Sugar Crazies – ie, eat a Snickers) are fairly accurate. When you’re hungry in the throes of a crash, you’re not yourself.
Even folks who follow a whole-foods diet can deal with this. If you’re massively intolerant to sugar of any kind, even healthy carbohydrate-dense foods can send you crashing. Then again, it may not even be the carbs themselves that wonk you out – in fact, carbs may be the scapegoat for what’s really a sign of a depressed metabolism brought on by years of crash dieting – manifesting as extreme reactivity to sugar.
Whatever the cause, nobody likes the guy who drools all over the keyboard.

I am NOT carb-phobic (read why in the Carbs chapter of my book, Eat the Yolks). I absolutely love my fruit, my sweet potatoes, my butternut squash, and all that starchy-sweet deliciousness. But my blood sugar is well-controlled, my metabolism has begun to heal from a decade of crash dieting, and I know how many carbs are right FOR ME.
I don’t count carbs, though; I follow the EE plan: Eyeball it, then Eat it. Amiright?
(And those carbs are always just one part of my overall nutrient-dense diet. I no longer have to fear any aspect of my food, whether calories, fat, or carbs. Freedom!)
Most people CAN handle dense sources of whole-food carbohydrates, like fruit, roots or tubers, even on a blood sugar balancing plan. Usually, when blood sugar problems seem apparent, we’re told to cut out carbs and sugar, but, for some of us, that might NOT be the perfect place to start.
For some people, carbs ISN’T what’s wonking out blood sugar and causing crashes. It’s an imbalance of carbs to healthy fats and protein; poor meal timing or composition; or a depressed metabolism that can actually be depressed further by yanking out all healthy sources of carbohydrate.
In fact, many folks feel a heckuva lot better incorporating healthy carb sources consistently. (Contrary to the beliefs of some more militant low-carbers, fruits and starchy veggies actually DO have nutritional value.)
Yes, for some, a low-carb plan is the only one that works. This may be because their metabolism is so imbalanced that they simply can’t tolerate carbs OR sugar, whatever the source, no matter what. Some have an evolutionary heritage rooted in carb-scarce environments that shaped their metabolic composition (there are cultures across the world that fit this bill).
But what about everyone else? What if cutting out all carbs isn’t the only solution?
I don’t believe the solution to blood sugar imbalance is always wiping out all carbs from the diet (sure, get rid of the junk food, but the sweet potato? The fruit? Not always needed). I’ve seen going blanket low-carb without some truly conscientious planning cause a “rebound effect” that ends up feeling much like “more of the same” after the honeymoon period has passed.
(Thankfully, a few smart programs like the 21 Day Sugar Detox understand this, and make appropriate allowances for healthy sources of carbohydrates while stripping away sneaky sources of simple and unhealthy carbs.)
The good news about healthy sources of carbs (against the backdrop of a diet rich in healthy fats, veggies and properly raised animal foods) is that they round out a diet rich in the nutrients our bodies need to process sugar effectively, heal metabolically, and restore blood sugar balance:

  • B vitamins
  • Magnesium
  • Chromium
  • Vitamin C

So I propose a different start to tackling blood sugar issues – looking at the WHOLE food plan for a strategic solution to restore functional metabolism (including blood sugar balance) by sending the proper signals to the body through good, consistent, nourishing meals.
Here’s where I’d start:
As a baseline, breakfast is the place to begin.
In my Nutritional Therapy practice, I quickly noticed problems of metabolism being mistaken for problems of blood sugar imbalance. The place to start to re-regulate and boost the metabolic rate? Breakfast.
This strategy re-teaches the body to keep stress hormones low, which helps regulate blood sugar long-term; it also primes the body to accept and utilize the nutrition from food, steadily, all day.
Some folks aren’t hungry at breakfast time, and if your blood sugar and metabolism are problem-free, that’s cool as can be. Do what you want. But if your blood sugar is whack and your metabolism is wonk, start with breakfast. As in, eat it. And make it good.
Prioritize dense protein (not shakes) and healthy fats first, and add a starchy vegetable rather than a more simple sugar (fruit, honey or syrups). This helps send the proper digestive and reward signals to the body, keeping the famed “sugar addiction” monster at bay. A few ideas:

  • Grass-fed steak & eggs with buttered acorn squash.
  • Eggs, sweet potato & Hollandaise sauce. (Over sauteed spinach if you like).
  • Roasted carrot hash with sage, cinnamon & bacon
  • Bison Butternut Bowl (with spaghetti squash). Fabulous for crappy cooks – like me.

These types of breakfasts have been powering sane, stable hard work since long before Kashi GoLean Krunch.
You don’t have to have a huge plate of this stuff, but don’t judge quantity with your eyes – judge with your stomach. Just eat – slowly, not scarfing – until you’re full. Seriously – to be sure you’re stimulating natural satiety signals, don’t do your best impression of a Dyson or a kid sucking down a Capri Sun during halftime of a youth soccer game. Take your time. Eat patiently. Enjoy your food.
From there, your breakfast-balanced-body will be equipped with the sound mind to choose something equally healthful and metabolically re-charging at lunch, like Orange Krab Salad (and you’ll likely make it to lunch without needing a Snickers bar “snack.”)
Here’s the most important thing: continue to eat a full, nourishing plate o’ food at every. single. meal. Even if you’re not hungry. As your body re-regulates, trust me: you’ll be hungry.
This means: don’t skip meals. You’ve got to send your body the proper signals – in this case, sufficiency signals – to repair a damaged metabolism and keep blood sugar balanced long-term. There’s no free lunch here. You’ve got to monitor yourself.

  • Don’t get swept away with work such that you look at the clock at 4:30 and you haven’t so much as thought about lunch.
  • Don’t eat “light” all day so you can eat a heavy dinner – every meal should be substantial enough to give your body what it needs in real time.
  • Don’t skip meals. When it comes to recovering metabolism and blood sugar balance, you’ve got to get 3 squares. If your hunger is still high, add a fourth.
  • Don’t concern yourself with calories. At this point, you need nourishment. This may feel scary, but if you actually want to heal for health and not just “fix” something while keeping aesthetics at the front of your mind, you’ll move forward. (Read my book for more on calories.)

Adjusting to this may take a week or two, especially if you’re used to skipping meals, skimping on fat or stacking your food intake at dinner. Once you’ve got the hang of it, though, it should be smooth sailing (if not, it’s time to talk to a practitioner who can dig a little deeper).
Above all, keep a calm, balanced mental state. This is not a punishment. It’s not a pass-fail grade. You might falter. Be forgiving of yourself. Alleviating that self-imposed pass-fail pressure is the only way to nudge yourself toward sustaining a healthy plan WITHOUT “falling off the wagon.” No insane mental drama or punishing pass-fail food ideals. Just do the best you can, learn as you go, be patient (not permissive) and START.
How do you identify when you’re in the throes of sugar-crash induced drama? How do you keep your blood sugar in check? If you’ve got some good advice, leave it in the comments!
Thanks for reading!

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17 Responses

  1. Hi Liz! Do you think there’s any value in adding snacks in for someone who is dealing with blood sugar control? I’m thinking snacks that are fat and protein heavy. Would love to hear your thoughts. Thanks!

    1. Hey Amy! It honestly all depends on the individual and how severe the problem. Many people are surprised at how quickly they’re able to get over the “hump” by just ripping of the band-aid…Some people’s reliance on snacks is more psychological than physical! However, some folks do legitimately need some way to keep their blood sugar within safe levels as they adjust. This shouldn’t go on for more than a few weeks, though. I think you’re right – and focusing on the fat/protein heavy snacks is the way to go first to see if it helps bridge the gap. If not, some soluble fiber-rich carb, like sweet potato, could be added to a protein/carb snack to keep blood sugar in a safe range…the challenge is not using that as a crutch 🙂

  2. My problem is that my glucose numbers are fine, and I generally feel pretty stable when I eat right (though I do think I need to eat more some days). It’s my fasting insulin numbers that run high, which I now know thanks to my fancy Functional Medicine doc. I’m getting it down, slowly, by being extra careful with my sugar intake, but is the constant insulin high a problem?

    1. Hi Dana! I can’t advise you personally as I’m not a doctor (I know you know that, but it’s important I say it!) but I think you should develop a healthy strategy and have patience as you work to correct this. It does take time, but it can be corrected. There are genetic defects that cause chronic hyperinsulinemia, but they are rare.

  3. I think I actually know more about how I feel when I’m running really well on *fat* than I do about when my blood sugar is getting wacky.
    I’m a long-time low-carber and eat mostly good quality food, but still let more junk (including SAD sugary & grainy junk…I know!) than I care to admit creep into my diet. Still, I’m probably in the best shape of my life, both weight and fitness/strength-wise, so I seem to have found a sweet spot for myself in terms of my food.
    But even the best fat-adapted among us will still have blood sugar fluctuations now and then, and boy, can they be a doozy. If I get stuck in DC traffic, fuhgeddaboudit!! (Originally from NYC, hehheh.) I will honestly feel like murdering everyone around me — violently, passionately, murdering. I will think the most horrid, vile thoughts of people at the office. Every single thought in my inner monologue is negative, bitter, and angry. The simmering rage…the feeling like I could literally tear someone limb from limb with my bare hands if I hear one more person whistling/jingling the change in their pockets/having their music (with earphones, no less!) turned up loud enough for me to hear it/insert irritating behavior of choice. And the donuts…the office donuts and people’s candy jars will call my name like nobody’s business. (And sometimes I’m only too happy to answer.)
    When I’m coasting along happily in fat-burning mode, I am GOLDEN. I feel like a million bucks — physically, mentally, intellectually, and maybe above all, *emotionally.* Nothing can get to me. I stay on an even keel and observe with humor the absurdity of the office nonsense all around me instead of wanting to rip people’s heads off.
    When I’m what I’ve come to think as “a fat-burning demon,” I can go for hours and hours without eating and still feel fantastic. Super-clear thinking, tons of energy…it’s almost like the universe is “buzzing” around me. (In a good way.) And I don’t crave crap foods at all. They could be having a pot luck at work, or somebody brings in a cake, cookies, or whatever, and it doesn’t interest me in the slightest. And when I finally *do* get hungry, what I can really go for is usually a steak, or a pork chop, or something equally delicious, meaty, and fatty, with some roasted or steamed vegetables.
    Running on fat is *awesome.*
    And yet…I do still have those sugar issues now and then. I’m only human and I try to do the best I can. I figure that if I eat great most of the time, then the little things aren’t that big a deal. (No gluten or dairy issues here, no allergies, AI, etc. I stay lowish carb mainly for weight control.) As long as they *stay* “little things” and don’t displace any of the good fats and other nutrient-rich foods.

  4. Liz, do you know of anyone who has solid recommendations about how to meal plan based on these issues? I am eating the right types of foods, but it seems like the quantities/proportions are not helpful. For instance, I had probably 2/3rds of a cup of spaghetti squash and 2/3rds-1 cup of (Melissa Joulwan’s) chocolate chili on top. Somehow, that combination was enough to murder my energy the rest of the afternoon. Is it the starchy carbs? Too much protein? Not enough green veggies?
    I would be really interested to see Paleo educators talk about how to balance not just the right kinds of foods but the proportions and such throughout the day.

    1. Hi Brian! This is a tough one. I hesitated to write this post at all, because I think many responsible practitioners (and I hope I’m one of them!) tend to shy away from making blanket recommendations about this, because it is highly individual. Some people actually need to KEEP carbs in, at punctuated times and in varying amounts, to get blood sugar under control. Others need to pare down. Sometimes fatigue and lethargy can be a problem of too FEW carbs, though often it’s a sign of too many FOR YOU. There is absolutely, positively no way to state how or why certain proportions work well for some and not others; or why some “rules of thumb” are totally inappropriate for certain people. I guess what I’m saying is: it takes some concerted self-experimentation, while using posts like this as not so much a GUIDE, but as a reference point, to figure out your own individual needs. Sometimes 1:1 help from a practitioner is the ticket to figuring things out more quickly; other times it just takes patience and trusting your gut. I hope that helps!
      Many of us USED to make broad recommendations for these types of things, but quickly found that there are far too many “ifs, ands and buts.” People were starting to feel like there was something wrong with THEM because the standard recommendations didn’t work for them. But there’s nothing wrong with them, of course – it’s just their individual landscape, heritage and tolerance 🙂

  5. Hi Liz, I like your email today,
    I am noticing how I have left strict paleo since I started dancing again. I def incorporate dairy regualy and usually just have lean chicken b and also cottage cheese. I have airpopped pocorn and yams as I need carbs! ANyway – thanks for all your efforts

  6. About a year ago, I switched to Paleo & a lower carb diet (compared to SAD or what I had been eating). After about a week, I really didn’t need snacks anymore. Now, sometimes I have a mug of bone broth around 11am if I’m feeling peckish or low in energy before lunch. I tend to save my carbs for dinner, because if I eat them early in the day I crave them all day. But over the winter I realized I need to eat a little less meat & veg at dinner and actually “save room” for a small serving of carbs – like half a sweet potato or grapefruit, because otherwise my thyroid & sleep go all wacky. I’m still working on finding the right balance of carbs for me, because my fasting blood sugar isn’t ideal. It just takes patience, mindful eating, and listening to your body – kind of being brave enough to trust your own self-wisdom despite the 18,871 different opinions on who should eat how many carbs. Judgement never helps!

  7. Liz, can you make a recommendation for a home blood-sugar testing kit? I’m on a strict digestive healing protocol which seems to be going well, but occasional bloating after tiny sugar consumption has me interested in the whole blood-sugar/cortisol reaction and I’d like an inexpensive, reliable way to check myself daily. Thanks for all you do. I LOVE the Balanced Bites podcasts : )

    1. Hi Hayley! Thanks for listening to the podcasts 🙂 I can’t honestly say I’ve seen much of a difference between the standard BGMs that they sell at Walgreens or CVS. You should do fine with those!

  8. Hey Liz,
    Can you point me in the direction of studies and info about post menopausal night waking (it is not related to menopause symptoms, those are long gone). I have my blood sugar and insulin in check, I think cortisol is ok (will eventually figure out how to get the doc to order a set of tests). But no matter what I cannot stay asleep all night. I do go right back to sleep, but it is annoying to wake up 2-3 times during the course of a 7 hour night. I don’t feel tired the next day. There is definitely a couple of patterns I vary between, but typically wake about 1.5 hours after falling asleep, then around 3am or 5:30am depending on what? I am not sure. Have tried lots of things like magnesium, melitonin, Sephos at bedtime. Nothing works reliably. I need more data, or is it just post menopause hormonal profile and I am stuck with it?

    1. Hi Denise! This is a little beyond me, unfortunately! You seem to have tackled everything I would have looked at in a nutritional consult. The only other thing I’d possibly look at is vitamin D levels and potentially some DIM and/or Calcium D-Glucarate. Sorry I can’t be of more help right now!

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