Athletes and Hypoglycemia—Is it true? & What to do.

Richard Maurer, ND
We all know the narrative of the couch potato with high blood sugar—The blood sugar (glucose) goes up with a combination of inactivity and insulin resistance. But is there an opposite? Could eating a low-carb-high-fat, Paleo diet and exercising optimally result in low blood sugar?

The true answer is yes, sometimes, but it is rarely black and white. With interval training and a low carb, lower calorie diet, your body will move away from insulin resistance and high blood sugar and toward a healthier insulin sensitivity. The insulin sensitive state results in a bogy that is leaner, carries lower blood sugars, and uses less insulin—the hormone that signals storage of calories in your body. This is good overall, you will be leaner, your circulating fats (as triglycerides) will be reduced and you will likely have lower overall blood sugars.

But too much of a good thing can occur, especially in my clinical experience, with endurance athletes. With regular training and exercise frequently going longer than two hours, and with interval and strength workouts integrating into the week, insulin sensitivity can be overly expressed.

I check for this with a combination of tests including the following. (These are all part of the Blood Code Metabolic Discovery Panel:

HgbA1c which should be 5.2-5.7% in athletes. I see the most hypoglycemic instances in those with HgbA1c <5.1%.
Fasting Blood Sugar (glucose) of 75-95. Again, lower than 75 and I do suspect that episodes of hypoglycemia are occurring.
Serum Insulin will likely be on the low side, but if it is below 2.0 uIU/mL, finessing higher carbohydrates into the diet might be required.
Triglyceride / HDL ratio: On a fasting lipid panel, your body is lean and fit when the ratio is between 0.5 and 1.0. But below 0.5, hypoglycemic “bonks” probably occur during your day or week.
I also rule out low levels of ferritin and B12, which can complicate the symptom picture.
Another option is to purchase an accurate glucometer (I personally use the old school Bayer Contour: – This is a simple way to check your blood sugar easily at home. Do a glucose check about SIX times in one day with a diet and fitness log on that same day. This gives a nice visual of what is happening with you circulating glucose. I must warn you that very often, what feels like hypoglycemia is NOT in fact low blood sugar, but something else. Often, I discover that the feeling of weakness is due to inadequate recovery time and/or over-training or some other factor that is not identified.

And if I need to take labs one step further, I look at the stress & anabolic hormones to assess recovery capacity of the endocrine system. This adrenal stress response includes DHEA-sulphate, testosterone both total and free, and cortisol.

I could write about what I recommend with these results but suffice to say, I am conservative with prescribing hormones and rely upon other health improvements to alter and improve these findings over time.

Your body requires adequate recovery time between bouts of training and fitness, adequate protein intake to recover from tissue damage, and a healthy replenishment of the storage sugars (glycogen) back into the liver and muscles. A low carb Paleo diet will certainly help you become leaner and more insulin sensitive, but for recovery, some healthy carbohydrates often need to be added into the diet to support and recover from sustained activity. Sweet potato, any root vegetables, winter squashes, and even some properly prepared pulses/legumes are great ways to get these starchy carbs into your diet.
Out of transition w/a smile

I believe blood tests are a necessary step to see how your diet, metabolic tendencies and fitness interact. Myself personally, I tend toward high blood sugar (pre-diabetes) and have a strong family history of type 2 diabetes. I can remain low carb and exercise for 2 hours and I never go hypoglycemic. I can’t get my blood sugars very low at my age now. I view my slight insulin resistance as a beautiful and magical trait that allows me to go long distances without food while keeping adequate glucose as an optional fuel source. But don’t do as I do. You may not have the same type 2 trait. So run some blood tests and make some changes—Discover what your body needs to find glycemic balance and perfection.