Hypoglycaemia means low blood sugar and the term ‘functional’ refers to an inability of the blood sugar stabilising mechanisms to function in an appropriate manner, leading to poor glucose tolerance. Functional hypoglycaemia often accompanies other complaints, especially those associated with prolonged periods of stress or anxiety, including chronic fatigue syndrome and post-viral fatigue syndrome sufferers. Premenstrual syndrome has many symptoms which are similar to those of functional hypoglycaemia, and is often improved by a hypoglycaemic diet.

Table Questionnaire for suspected functional hypoglycaemia Score symptoms from 0-3 depending on severity or frequency

1 Common desire for sweets and quick energy foods
2 Fatigue relieved by eating or drinking
3 Irritability before meals
4 Get shaky if hungry
5 Feel better after breakfast or early morning coffee, etc.
6 Need to eat often
7 Faintness when meals delayed
8 Headaches or heavy head relieved by eating or drinking
9 Sleepy during the day and after meals
10 Heart palpitations if meals missed or late
11 Number of cups of tea/coffee: Score 1 for 2-3 cups, 2 for 3-5 cups and 3 for more than 5 cups daily
12 Number of teaspoons of sugar in beverages: Score 1 for 1 teaspoon, 2 for 2 teaspoons and 3 for 3 or more teaspoons
13 Low energy
14 Reduced stamina, tire easily and quickly on exertion
15 Sluggish or lethargic in the morning
16 Tiredness in mid or late afternoon
17 Sleep disturbances or dream disturbed sleep
18 Hot flushes and/or night sweats
19 Difficulty concentrating
20 Cannot decide easily
21 Fluctuating emotions
22 Frequent anxiety
23 Become tearful easily for insufficient reason
24 Bouts of anger or unreasonable behaviour
25 Magnify insignificant events
26 Periods of depression or melancholy
27 Above symptoms worse premenstrually
28 Cigarette smoking

Score 1 for 1 -10/day, 2 for 10-20/day, 3 for more than 20 per day

29 Alcohol consumption

Score 1 for average 1 glass daily, 2 for 2 glasses daily, and 3 for more than 3/day

A diverse group of symptoms can be associated with hypoglycaemia — having one or a few symptoms is not necessarily diagnostic of hypoglycaemia because these symptoms could accompany other complaints. True hypoglycaemia should respond to adequate dietary change within a week. If this does not occur, other reasons for the symptoms should be sought.

The main symptoms

• Tiredness, vagueness or shakiness which is alleviated by eating.

• Tiredness or irritability if meals are late, or first thing in the morning.

• Sugar cravings.

• Hungry all the time or soon after eating.

• Headaches when meals are delayed.

• Inappropriate feelings of anxiety or inadequacy which disappear after eating.

• Waking in the middle of the night feeling abnormally hungry.


• Prolonged stress

Prolonged periods of stress trigger the ‘fight or flight’ mechanism which causes a series of changes in hormone levels and fluctuations in the blood sugar levels.

• Diet

A number of dietary factors adversely affect glucose tolerance including an over-consumption of refined carbohydrates and sugars,119 and an inappropriate alcohol intake (alcohol without eating, or alcohol with sugar-based mixers).120

Dieters often develop hypoglycaemia because of their low energy diets. This causes them to ‘break out’ and eat large amounts of starchy or sugary foods. The rapid drop in blood sugar initiates a very counterproductive cycle of sugar craving, hypoglycaemic symptoms121 and, no doubt, weight gain. Following the diet for hypoglycaemia (below) is a successful way to lose weight slowly and progressively because it breaks the cycle of ‘fast and feast’.

Chromium,122 niacinamide123 and magnesium supplements124 improve glucose tolerance.


The most effective treatment for functional hypoglycaemia is dietary change. Usually strict adherence to the diet is required for about three weeks and then a slightly more relaxed routine can be adopted. This will depend on each individual’s response to the regime and the severity of both the complaint and the underlying causes.

Some general guidelines

• Eat small amounts of protein regularly at meals and with snacks.

• Eat small, frequent meals.

• Avoid all sugar, honey and dried fruit.

• Consume only small quantities of unsweetened, diluted fruit juice.

• Avoid all stimulants such as tea, coffee, chocolate and cola drinks.

• Avoid alcohol and cigarettes.

• Eat only whole grain foods. Avoid white flour and refined cereals.

Always eat breakfast.

Complementary proteins

All animal protein is ‘complete’, and therefore meals containing milk products, eggs, meat or fish provide first-class protein. Incomplete (plant) protein foods, however, need to be combined to provide the same quality protein as animal protein.

Beans with grains: tofu and rice, lentils and rice, corn and beans, buckwheat and tempeh, muesli and soya milk, kidney beans and barley.

Beans and seeds: tahina and beans, tofu and sesame seeds.

Grains and nuts: nut butters on bread, rice and cashews, rice and peanut sauce.

Suggested menus


• Fruit with yoghurt, seeds and ground almonds.

• Whole grain bread toast with nut butters, hommus or egg.

• Homemade muesli: oats, rolled barley, triticale, rice flakes, rice bran, seeds, coconut, and crushed almonds or cashews. Add fresh fruit and soya milk, low-fat milk or yoghurt as desired.

• Cooked cereal: e.g. oats, rice or buckwheat, with a selection of seeds.

Morning, afternoon or supper snack

• Mixed seeds and nuts.

• Avocado, tuna and balsamic vinegar dressing.

• Soya milk with seeds and nuts.

• Small container of low-fat yoghurt.

• Whole grain dry biscuits with nut butters or hommus.

• Energy drink: Blend together: Vi cup fresh fruit or juice, Vi cup low fat yoghurt, and seeds with almonds, and/or wheatgerm and lecithin.


• Mixed vegetable salad with protein — either fish, cheese, hommus, meat or other appropriately combined vegetable proteins.

• Salad sandwich with protein as above.

• Vegetable soup with yoghurt, cheese, or a combination of beans and grains.

• One of the dinner choices. Dinner

• Bean and grain dish: e.g. stir-fry vegetables with rice and tofu, dhal with vegetables and rice, tortilla and beans, buckwheat noodles with vegetables and tempeh, vegetable soup with barley and red kidney beans.

• Grain and nut meal: e.g. steamed vegetables with rice and peanut sauce, stir-fry vegetables with cashew nuts, pasta and pesto sauce (wheat and pine nuts).

• Beans and seeds: many of the Middle Eastern vegetarian meals are based on this principle, e.g. felafel and hommus.

• Meat or fish with plenty of vegetables.

Meal sizes should be reduced so that the overall food intake does not increase above normal: six snack-size meals should be substituted for three normal-size meals.


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