Keith wrote:

Hi Georgie, I just recently found your website and I’ve been reading it for the last few days. Lots of good info! So, here’s my situation/problem/question: In the last couple years, I’ve been teaching myself to eat better and exercise and generally live a healthier lifestyle, and I’ve had some success. However, I have hypoglycemia which makes it difficult to lose weight because when I manage a calorie deficit, I tend to have sugar crashes. Any thoughts?

Hi Keith!  You’ve got it right that limiting calories is essential to losing weight (as evidenced by your success) but you can also employ some strategies to help keep your blood sugar from dropping. I know that road, I used to have a ton of trouble with my own glucose levels going wonky. Here are some tips that have worked great for me and many of my patients/clients:

As much as you can, avoid rapidly digesting carbohydrates, such as sugar. Despite the fact that sugars, sweetened foods, and refined grain foods like bread, cake, crackers and breakfast cereal raise your blood sugar, the swift upswing can set off a chain of events starting increased insulin release that lead to an equally swift decline in blood sugar a couple hours later. The result? Low blood sugar and feeling crappy, often craving more sugar to lift you up again! Not a fun cycle. What you want to eat instead is steady, slow fuel that will keep your blood sugar on an even keel.

Turns out that the very same foods which keep blood sugar stable ALSO are great for filling you up and keeping your appetite satisfied too, so it’s additionally beneficial for weight loss.

• Go high fiber. Fiber is a term used for indigestible carbohydrates found in plant foods like beans, whole grains, fruits, and vegetables. Because it is not digested, the carbohydrates in fiber don’t add to blood sugar swings, nor do they provide calories. Fiber also slows the digestion and absorption of the non-fiber carbs in that food. Try substituting beans for rice or pasta in a side dish or soup, or toss some chickpeas onto a green salad to add fiber (and filling protein). Steer clear of low fiber carbohydrate choices like most breads, crackers, bagels, etc, which often are providing low-nutrition calories anyway. Berries are rich sources of fiber and packed with nutrients, and contain less sugar per weight than many other fruit choices, so they can help with contributing to blood sugar stability.
• Have protein with each meal. Some of the amino acids from dietary protein are used to generate blood glucose, so even though protein rich foods like meat and eggs don’t have any appreciable amount of carbohydrate on their own, they help contribute to blood sugar too. The conversion causes the glucose to be produced steadily over several hours, which is favorable for preventing blood sugar lows. And as you may have heard, protein satisfies appetite better than fat or carbohydrate, and helps maintain your lean mass while you trim down, so there are bonus reasons include protein as well. Lean meats, Greek yogurt or cottage cheese, seafood, eggs, or soy foods are all great options.
• Reduce overall carbohydrate consumption. The foods that many dieters turn to to cut calories are high in carbohydrates: low fat crackers and cookies, pretzels, popcorn, cereal bars, etc. Especially in the context of a very low fat diet, this can lead to carbohydrates providing 70% or more of the calories in the diet. Dialing this back to <40% of dietary calories from carbohydrate is often the solution to bring errant blood sugar numbers under control. (In some cases, I have found success with limiting carbohydrates even more, but if it’s not necessary, I’d prefer to leave as much room for vegetables and fruit in the diet as possible.)
• Watch portions, but don’t fear the fats. Since fats are calorically dense (9 cal per gram, or 120 calories per tablespoon) limiting fat is a standard strategy to curb total energy intake and achieve weight loss. I do recommend being aware of your fat intake as a means to moderate your energy intake (no chugging olive oil from the bottle, okay?), but don’t skip it entirely, especially when cutting back dietary carbohydrates.  Choosing so that about 30% of your daily calories come from fat is a good ballpark area to start.

In summary, to lose weight while avoiding blood sugar lows, I recommend limiting carbohydrates to 40% or less of total calories and getting those from beans, vegetables and fruit as much as possible. Have some protein and healthy fat with each meal to help promote satiety and keep blood glucose steady. Before you break out your calculator, let me rescue you from doing the math: At each meal, fill half of your plate with vegetables, and include 4-6 ounces of lean protein depending on your body size. Add 1-2 teaspoons of healthy oil (use it to cook the veggies or the meat) or sprinkle on a few nuts. Enjoy 1-2 pieces of whole fruit per day (or 1-2 cups of berries), and get a 1/2 cup serving of beans in several times per week, daily if you can. No need to obsess about the details.

Hope this helps!