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Thyroid, Blood Sugar, and Metabolic Syndrome


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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

According to the American Association of Clinical Endocrinologists, 27 million Americans suffer from thyroid dysfunction – half of whom go undiagnosed. Subclinical hypothyroidism, a condition in which TSH is elevated but free T4 is normal, may affect an additional 24 million Americans. Taken together, more than 50 million Americans are affected by some form of thyroid disorder.

Metabolic syndrome (MetS), also affects 50 million Americans, and insulin resistance, one of the components of metabolic syndrome, affects up to 105 million Americans. That’s 35% of the population.

Metabolic syndrome has become so common that it’s predicted to eventually bankrupt our healthcare system. Both metabolic syndrome and insulin resistance are risk factors for heart disease and diabetes, two of the leading causes of death in the developed world. It’s also closely related with diabesity.

With such a high prevalence of both thyroid dysfunction and metabolic syndrome, you might suspect there’s a connection between the two. And you’d be right.

Studies show an increased frequency of thyroid disorders in diabetics, and a higher prevalence of obesity and metabolic syndrome in people with thyroid disorders.

That’s because healthy thyroid function depends on keeping your blood sugar in a normal range, and keeping your blood sugar in a normal range depends on healthy thyroid function.

Thyroid, Blood Sugar, and Metabolic Syndrome

Metabolic syndrome is defined as a group of metabolic risk factors appearing together, including:

Metabolic syndrome is caused by chronic hyperglycemia (high blood sugar). Chronic hyperglycemia is caused by eating too many carbohydrates. Therefore, metabolic syndrome could more simply be called “excess carbohydrate disease”. In fact, some researchers have gone as far as defining metabolic syndrome as “those physiologic markers that respond to reduction in dietary carbohydrate.”

When you eat too many carbs, the pancreas secretes insulin to move excess glucose from the blood into the cells where glucose is used to produce energy. But over time, the cells lose the ability to respond to insulin. It’s as if insulin is knocking on the door, but the cells can’t hear it. The pancreas responds by pumping out even more insulin (knocking louder) in an effort to get glucose into the cells, and this eventually causes insulin resistance.

Studies have shown that the repeated insulin surges common in insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease. As the thyroid gland is destroyed, thyroid hormone production falls.

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How Low Blood Sugar Affects the Thyroid

But just as high blood sugar can weaken thyroid function, chronically low blood sugar can also cause problems.

Your body is genetically programmed to recognize low blood sugar as a threat to survival. Severe or prolonged hypoglycemia can cause seizures, coma, and death. When your blood sugar levels drop below normal, your adrenal glands respond by secreting a hormone called cortisol. Cortisol then tells the liver to produce more glucose, bringing blood sugar levels back to normal.

The problem is that cortisol (along with epinephrine) is also a sympathetic nervous system hormone involved in the “flight or fight” response.

This response includes an increase in heart rate and lung action and an increase in blood flow to skeletal muscles to help us defend against or flee from danger. Cortisol’s role is to increase the amount of glucose available to the brain, enhance tissue repair, and curb functions – like digestion, growth and reproduction – that are nonessential or even detrimental in a fight or flight situation.

Unfortunately for hypoglycemics, repeated cortisol release caused by episodes of low blood sugar suppresses pituitary function. And as I showed in a previous article, without proper pituitary function, your thyroid can’t function properly.

Together, hyperglycemia and hypoglycemia are referred to as dysglycemia. Dysglycemia weakens and inflames the gut, lungs and brain, imbalances hormone levels, exhausts the adrenal glands, disrupts detoxification pathways, and impairs overall metabolism. Each of these effects significantly weakens thyroid function. As long as you have dysglycemia, whatever you do to fix your thyroid isn’t going to work.

How Low Thyroid Function Affects Blood Sugar

We’ve seen now how both high and low blood sugar cause thyroid dysfunction. On the other hand, low thyroid function can cause dysglycemia and metabolic syndrome through a variety of mechanisms:

  • it slows the rate of glucose uptake by cells;
  • it decreases rate of glucose absorption in the gut;
  • it slows response of insulin to elevated blood sugar; and,
  • it slows the clearance of insulin from the blood.

These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose. So although you may have normal levels of glucose in your blood, you’ll have the symptoms of hypoglycemia (fatigue, headache, hunger, irritability, etc.). And since your cells aren’t getting the glucose they need, your adrenals will release cortisol to increase the amount of glucose available to them. This causes a chronic stress response, as I described above, that suppresses thyroid function.

How to Keep Your Blood Sugar in a Healthy Range

It’s important to understand that whether you have high or low blood sugar, you probably have some degree of insulin resistance. I described how high blood sugar causes insulin resistance above. But insulin resistance can also cause low blood sugar. This condition, called reactive hypoglycemia, occurs when the body secretes excess insulin in response to a high carbohydrate meal – causing blood sugar levels to drop below normal.

In either case, the solution is to make sure your blood sugar stays within a healthy range. There are two targets to consider. The first is fasting blood glucose, which is a measure of your blood sugar first thing in the morning before eating or drinking anything. I define the normal range for fasting blood glucose as 75 – 95 mg/dL. Although 100 is often considered the cutoff for normal, studies have shown that fasting blood sugar levels in the mid-90s were predictive of future diabetes a decade later. And although 80 mg/dL is often defined as the cutoff on the low end, plenty of healthy people have fasting blood sugar in the mid-to-high 70s (especially if they follow a low-carb diet).

The second, and much more important, target is post-prandial blood glucose. This is a measure of your blood sugar 1-2 hours after a meal. Several studies have shown that post-prandial blood glucose is the most accurate predictor of future diabetic complications and is the first marker (before fasting blood glucose and Hb1Ac) to indicate dysglycemia.

Normal post-prandial blood sugar one to two hours after a meal is 120 mg/dL. Most normal people are under 100 mg/dL two hours after a meal.

Now that we know the targets, let’s look at how to meet them. If you’re hypoglycemic, your challenge is to keep your blood sugar above 75 throughout the day. The best way to do this is to eat a low-to-moderate carbohydrate diet (to prevent the blood sugar fluctuations I described above), and to eat frequent, small meals every 2-3 hours (to ensure a continuous supply of energy to the body.

If you’re hyperglycemic, your challenge is to keep your blood sugar below 120 two hours after a meal. The only way you’re going to be able to do this is to restrict carbohydrates. But how low-carb do you need to go? The answer is different for everyone. You figure your own carbohydrate tolerance by buying a blood glucose meter and testing your blood sugar after various meals. If you’ve eaten too many carbs, your blood sugar will remain above 120 mg/dL two hours after your meal.

I highly recommend you pick up a blood glucose meter if you have a thyroid and/or blood sugar problem. It’s the simplest and most cost-effective way to figure out how much carbohydrate is safe for you to eat. There are tons of meters out there, but one that gets a lot of good recommendations is the ReliOn Ultima. It’s pretty cheap, and the test strips are also cheap, which is where the major expense lies.

Finally, if you have poor thyroid function it’s important that you take steps to normalize it. As I’ve described in this article, the cycle works in both directions. Dysglycemia can depress thyroid function, but thyroid disorders can cause dysglycemia and predispose you to insulin resistance and metabolic syndrome.

Maintaining healthy blood sugar is not only critical for thyroid health, it’s essential for overall health. Sadly, half of Americans has or is at risk of having diabetes, with one-third diabetics unaware that they have it. 

There are many causes of high blood sugar. One of the most significant but least-known is nutrient deficiency. Several vitamins and minerals are required for proper blood sugar regulation, and the majority of Americans don’t get enough of several of these micronutrients

This is where smart supplementation can play a role—and it’s why I created the Adapt Naturals Core Plus bundle. It’s a daily stack of 5 products designed to restore optimal nutrient levels so your body can function as it was intended to, and you can feel and perform your best. 

From metabolism-boosting vitamins and minerals like vitamin B12, folate, magnesium, and vitamin D, to phytonutrients like bioflavonoids, carotenoids, and beta-glucans, Core Plus has you covered.

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  1. 128 is high for 2-hour.  You want it to be under 120 2-hours after.  If it’s higher than that, it means you ate more carbs than you can tolerate.  If you also had a significant amount of fat at that meal, it probably slowed down the absorption of the carbs which is why your blood sugar was still low one hour after the meal.  Take another reading at 3 hours out next time you have a meal like that.  I suspect it will still be high.

  2. thanks.  Was 7.1 two hours post prandial…which is 127.8 mg/dL.  Which I would say is on the high side…but maybe not after such a heavy carb load.  I will take it fasting in the morning the next few mornings and then some different meals too.  Normally I don’t eat that many carbs at all…but I figured it would be interesting to see how my body is “coping” with that many carbs.
    Thanks again!  Your blog seriously rocks!

  3. I’m so confused!!
    I have also been curious about my blood sugar levels as when I was pregnant the second time and had the Oral glucose test at 28 weeks.  It showed I was hypoglycemic.  But no one ever has checked me not pregnant.
    So…I bought a glucose monitor today.  Ate a large carbohydrate meal and tested one hour after eating….it was 4.3 mmol/L!  Which translates to 77.5 mg/dL!  That’s one hour after a heavy carb meal of 93 g of carbohydrate.
    What gives?  I am going to test in one more hour to see what it is at 2 hours post prandial…

    • Sounds suspicious. When we look at blood sugar, patterns are more important than single readings. Take your fasting BS for a few days in a row, as well as 1- and 2-hour post-prandial readings with different types of food. Then we’ll see what pattern emerges. If you are persistently hypoglycemic, you definitely need to address it.

  4. My thyroid was destroyed some time ago, and I depend on Synthroid. Years of stress, also wore my adrenals out, and doctors just pooh pooh that when I suggest it to them. If you don’t have a measurable disease, you get no help from almost all doctors. I say this from years of having many doctors, always the same results.

  5. Great Post!! I have to eat mostly SCD. I have Celiacs and Crohn’s, but even gluten-free grains give me fatigue and sugar cravings. I’ve been wanting to figure out what my issue with grains is, and have been tempted to get a glucose meter after reading Blood Sugar 101. I had no idea my thyroid could be involved in this too. In fact, before your articles I really did not know much about the thyroid. Wow, I wonder how many thyroids the food pyramid has destroyed!

  6. ok, I’m cool with eating eggs but have cut back consumption of eggs and nightshades due to Cordain’s work in Paleo nutrition with people with auto-immune disorders.
    I think I am the 70% that won’t be able to raise my cholesterol with diet….
    So no more fish oil? I googled foods with high saturated fat…and as you are probably well aware I got nothing but the SAD pushed…so crazy. (I’ve read good calories, bad calories, so I am not buying their junk).
    Other suggestions for reducing inflammation? I took the ALCAT two weeks ago and showed a reaction to 50 different foods. (in addition to what I already knew of wheat and dairy).
    I think my immune system is stronger than terminator…I never get sick….and my body perceives everything as a threat. including sadly my thyroid…..

    • If you’re concerned about a potential reaction to eggs, limit your consumption to yolks. When people are sensitive to them, it’s almost always to the whites.

      EPA & DHA are both anti-inflammatory, and can help improve hormone receptor site sensitivity, so I wouldn’t cut it out. Good sources of saturated fat are butter, cream, ghee, coconut oil, palm oil and beef tallow. I respect Cordain and his work, but I don’t necessarily agree with him on dairy – especially the milk-fat products like butter and cream, which are exceptionally nutrient-dense and healthy, especially for someone in your predicament. My sense is you need more nourishment, and it’s hard to come up with more nourishing foods than egg yolks, butter, and cream.

      I don’t believe in the food allergy tests. There are a number of problems with them, and I don’t think they’re accurate. The only way to really determine food sensitivities is an elimination/provocation protocol. Even then, most people find that when they heal their gut, they are able to tolerate foods they were sensitive to before.

      I’d suggest investigating the GAPS diet (www.gapsdiet.com) as a means of addressing some of your issues. It’s the best method I know of for restoring gut mucosal barrier integrity and reducing intestinal inflammation.

    • Just want to emphasize again, though, that my sense is reducing stress and balancing your adrenals is going to be the key to your recovery. When I say stress, I’m using the term in a broad sense – physiological (overtraining, leaky gut, inflammation, etc.), psychological and emotional. Stress causes something called the “pregnenolone steal” (Google it to learn more), where pregnenolone, the precursor to all sex hormones, is preferentially diverted to cortisol production. This is an evolutionary response. Cortisol raises blood sugar levels so we can produce more ATP (energy), which is necessary in times of stress (fight or flight). But if this happens persistently, there’s no pregnenolone left over to make the other vital hormones (like DHEA, estrogen, testosterone, aldosterone). This is probably why you haven’t had a period for several months.

  7. Hi Chris,
    Thanks for the quick response. My Cholesterol has always been low, and yes my doctor does comment on how awesome it is…although my naturopath doesn’t think so, she says that with no cholesterol I don’t move hormones in my body either. I also have very low blood pressure 97/49 avg. and always have. I don’t get dizzy easily either. When I first got sick the only thing that made me feel remotely normal was training…I had a 24 hour test done…but haven’t had the Saliva done.
    Do you think acupuncture for encouraging the HPA axis?
    I am done with Ironman in 4 weeks so my goal is to focus on my health and getting the TSH up. I haven’t been adhering to a low carb diet as a result of training…just can’t get the 20 plus hours a week in on pork chops, but I feel good when I can low carb it, and don’t get me wrong I don’t eat terribly either. I can count on one hand the number of times I have eaten out this year and have a garden I am quite proud of and Im not scared of a big steak. I consider sweet potatoes and an extra piece of fruit cheating. When I can get things together I weigh about 124 pounds and right now I am at least 20 pounds heavier…all gained since April. (while training and eating properly).
    If you could recommend someone to work with who would that be? Aside from fish oil, anything else I could do to raise my cholesterol?
    Thanks again!

    • As your naturopath may have told you, cholesterol is the precursor to all sex hormones in the body. If you don’t have enough cholesterol, you can’t make hormones.

      Saturated fat will raise your LDL (increasing large, buoyant LDL and decreasing atherogenic small, dense LDL). In 30% of people eating cholesterol will raise in in the blood, but in 70% of people it has no effect. I’d suggest eating 2-4 eggs a day. Fish oil will likely lower – not raise – your cholesterol.

      Acupuncture is great for regulating the HPA axis.

      Try this to find a practitioner.

  8. Wow, Phoenix, your system is really out of whack. You need some good care by an alternative type practioner, or at least someone very knowledgable about nutrition, plus an endrocrinologist who knows what the heck he is doing.

  9. Hi Chris
    Great blog! I’m a long time reader, first time commenter. I have been struggling with a number of problems and thought it would do no harm to ask you, although I understand you are studying profusely and looking forward to a vacation in mexico 🙂

    Basically my scenario is thus: I got diagnoised with Hashimoto’s by my naturopath approx. 4 years ago. (TPO was 900). I was already wheat free and mostly gluten free by then as I have severe digestive reactions to those foods. She put me on a bio-identical hormone and for the next 18 months or so I have the highest quality of life I had ever had. I was able to finially lose weight (with careful food monitoring…nothing is for free) and felt like a normal person again after years of flailing with symptoms and no diagnosis.
    Then the government here in Canada took away naturopath’s right to prescribe medication, so I ended up going through my primary care MD to get onto more main stream synthetic drugs. In the interm I stopped cold turkey the old meds…my TSH shot up and my T3 and T4 plummetted. I was able after many month and a fairly high dose of meds to get my T3 and T4 into “normal” range. I now take Thyroid (by Efra) at 180 mg, and Cytomel 50 mcg. daily

    But unfortunately in order to achieve this symptom free state I had to keep my TSH at 0.01…fast forward a couple of years later and I have been diagnoised with Ostepenia as evidenced on a recent bone scan. Also I have now been in menopause for months…I’m 32…..no estrogen apparently. I should mention I am now into my third year of training for Ironman competitions.

    In the past couple of months the old problems have returned and I have gained gads of weight. I actually had been testing my blood sugar prior to this post so was pleasantly surprised. It isn’t perfectly controlled. But I wake with it in the high 5’s (5.7 or 5.8 on average). I can drop it to under 5 with intense or very long exercise (6 hour ride). I can also spike it to 8.5 if I drink anything with sugar in it (like a mocha) on an empty stomach.

    If I don’t eat carbs and have nuts and protein my blood sugar stays below 6 even after eating.
    So my question is this: since my current T3 and T4 are now well below normal and continue to drop at every test, and my TSH remains at 0.01 it is pretty clear that adding meds to this isn’t helping, and the low tsh is causing bone loss. How do I get myself a) off the meds and b) converting t4 to t3, or whatever it is that I need to do on a cellular level.

    Other numbers of interest
    Cholesterol 3.77
    Triglycerides .3
    HDL 2.35
    LDL 1.28
    (all considered LOW…sorry these are canadian measurements in mmol/l)
    free T4 9.0
    Free T3 1.0

    Chris, any thoughts or opinions will be greatly appreciated. I read Dr. K’s book, but to be honest much of it went over my head in terms of trying to figure out which dominate I am, and there are no practictioners in Canada.
    from Canada

    • Phoenix,

      I wish it were possible to advise in a situation like this, but the complexity of thyroid physiology (which you got a taste of in Dr. K’s book) makes it difficult.

      My guess from reading your post is that your adrenals are taxed from training and that has thrown your blood sugar and hormones out of balance. I’m guessing you have high cortisol from your training regimen, and possibly some underlying inflammation, both of which are dampen receptor site sensitivity. That could explain why you’re not responding as well to your meds, even at doses high enough to severely inhibit TSH.

      Also, your total cholesterol is very low. Has it always been this way? Sometimes this can simply be genetic, and nothing to be concerned about. However, if it’s induced by your training and/or diet, it’s probably not healthy. Cholesterol levels under 160 mg/dL carry a higher risk of heart disease, depression, and other mental health issues. Your triglycerides are the lowest I’ve ever heard of. While most doctors would be patting you on the back, I don’t think levels that low are physiologically normal. Oddly, we might expect to see a TG count that low with hyperthyroidism. But it also happens with malabsorption syndromes and extremely low-carb diets. Your LDL is also very low, and it raises the same concern for me as your total cholesterol and TG reading. Your HDL, however, is in an excellent range.

      It’s very likely you won’t be able to get off meds. I’ll be writing an article about this in the future, but it’s my believe that Hashimoto’s patients with persistently low T4/T3 readings need replacement. Thyroid hormone is just too essential to the body to be deficient in for any significant length of time. But hopefully by improving receptor site sensitivity and addressing the underlying metabolic imbalance, you’ll be able to reduce the dose you need to have the same effect and get your TSH back into a normal range.

      Overall I’d say you’re experiencing a metabolic derangement probably related to overtraining/stress. The key will be supporting your adrenals, regulating blood sugar, eating plenty of saturated fat and cholesterol, bringing your cortisol levels down and reducing inflammation. Perhaps you could find a practitioner that’s willing to work with you on the phone.

  10. >When your blood sugar drops too low, the pancreas secretes insulin to get whatever glucose remains in the blood into the cells where it can be used for energy.
    Pure nonsense. The body’s goal is autoregulation and not suicide through even worsened hypoglycemia… Silly mistakes like these really threaten your image as the well informed “science writer” you claim to be. You would be very well advised to correct this immediately! Gary Wu already gave the necessary hints above.
    Cheers, guzolany

  11. Chris – great post. Having spent a frustrating afternoon listening to friends talk about “sugar issues” and cholesterol numbers, I’m delighted to find your work and will send the website info on to them. I really appreciate all the detailed information, and so, I hope, will they.

    One small caveat: people could be confused by the following (non-medical) issue:

    “Your body is genetically programmed to recognize low blood sugar as a threat to survival. Severe or prolonged hypoglycemia can cause seizures, comma, and death.”

    Should be coma, no? I seriously doubt that anyone has been done to death by punctuation!


  12. Thank you, Chris, for showing the connection of low blood sugar and hypothroidism. I have had both since an early age and no doctor ever addressed the connection. I have to eat frequent meals, but I avoid carbohydrates. It’s my understanding that protein keeps blood sugar normalized, and it does for me. Just before bedtime, I have a glass of milk to hold me through the night, or I will wake up hungry after about five hours.

    I used to get migraines from low blood sugar, or from any physical stressors. Now that I’m taking 4000 i.u. vitamin D3 daily, I haven’t had a migraine in months. I was getting them about every two weeks.

    I did have a five hour test for low blood sugar about thirty years ago, when I was fifty. The test was given because of fatigue. I don’t remember the exact results, but afterwards I was so hungry, on the way home, I picked up brownies, went home and ate all with a cup of coffee. Needless to say, that threw me into bed with a massive migraine. I didn’t know any better at the time and wasn’t warned.

    I’ve had very poor hypothroid management over the years. In the early years, doctors raised my medication in response to my symptoms, but in later years began to lower the meds because the tests showed too low TSH. Every time the medication was lowered, I gained ten pounds. That’s without increasing my calorie intake. When I got to 170 lbs, I started fighting the doctors to keep them from lowering my Synthroid any further. I had to go through a few doctors to finally find an endocrinologist who will let me stay on my present dose as long as I don’t show any hyperthyroid symptoms. My TSH is 0.01, but my free T4 and T3 are normal. This doctor did agree to adrenal testing, but unfortunatly not the saliva test.

    I’ve tried dieting using high protein, low carbohydrate diet, but can’t lose weight. I still have some hypo symptoms, but overall I’m feeling balanced. I can’t afford to go all organic in my food choices, but do the best I can. And I avoid all sugar products, except for some dark chocolate, and eat mostly low carbohydrate. My snacking is always nuts and/or some protein and fruit.

    From all the responses here, I see that this whole subject is quite controversial.

  13. > When your blood sugar drops too low, the pancreas secretes insulin to get whatever glucose remains in the blood into the cells where it can be used for energy. Eventually this lowers the response of cells to insulin, creating insulin resistance.
    It seems counter-intuitive to say that your body will secrete insulin in response to low blood glucose, since the immediate effect will be a further reduction of blood glucose levels.
    My understanding of the rough mechanism is that in a hypoglycemic condition, cortisol and glucagon are secreted to raise hepatic glucose production.  At the same time, some mechanism (details of which I forget) is used to signal the muscle and adipose tissues to become temporarily resistant to insulin so that the increase in blood glucose is not immediately consumed, thereby bringing blood glucose levels back to normal range.

  14. “The problem is that cortisol also stimulates the sympathetic nervous system, causing a group of effects known as the “flight or fight” response. This response prepares us to defend against or flee from danger. It includes an increase in heart rate and lung action, increased blood flow to skeletal muscles and inhibition of organs and tissues not immediately involved in fighting or fleeing (such as endocrine and digestive organs.)”
    Really? According to Endocrine texts it’s Ephidrine (Adrenaline) that does that? Having LOW Cortisol can cause huge Adrenaline spikes. And Adrenaline uses up Glucose so can cause precipitous drops in Blood Sugar levels.
    Of course HIGH Cortisol is bad too. And low thyroid is a big stressor on th body & can cause you to overproduce Cortisol. High Cortisol can also cause Hyperglycemia.
    Adrenals should be treated before Thyroid. It can be dangerous to do it the other way round.

    • Lethal Lee,

      Sorry, that was a poorly written paragraph. I’m probably trying to do too much right now, writing this series with my state board licensing exams coming up. My brain is tired.

      I’ve re-written it so that it’s more clear:

      The problem is that cortisol (along with epinephrine) is also a sympathetic nervous system hormone involved in the “flight or fight” response. This response includes an increase in heart rate and lung action and an increase in blood flow to skeletal muscles to help us defend against or flee from danger. Cortisol’s role is to increase the amount of glucose available to the brain, enhance tissue repair, and curb functions – like digestion, growth and reproduction – that are nonessential or even detrimental in a fight or flight situation.

      • Both high cortisol and low cortisol are bad news for blood sugar. When cortisol is elevated it shuts down receptor sites and glucose can’t get into cells. Low cortisol will lead to reactive hypoglycemia and eventually adrenal exhaustion. I agree that adrenals and blood sugar need to be addressed before directly addressing thyroid – that’s one of the reasons I wrote this article.

  15. Hi Chris,
    just a huge thank you for your great blog. One of the fewest with really new informative and well researched articles.
    I have hashimoto with low T3. Over 12 years LC and the last year nearly keto. Now trying some berries again. I´m also hypoglycemic with fasting BG under 50, postprandial 85 sans carbs, 115 con carbs. TG are 35, LDL 120 and HDL 199. I can´t eat more carbs because of allergies, intolerances and overeating problems. Basic is meat, fatty fish, yolks, chicory, cucumber, ghee, red palm oil and fish oil. Can someone be a really hypoglycemic without  feeling any symptoms?
    Sorry for my english. Greetings from Munich.

    • Byron,

      Are you on thyroid replacement? The two major causes of hypoglycemia (outside of poor diet, which doesn’t sound applicable to you are adrenal problems and hypothyroidism. If your T4/T3 has been normalized, I would investigate adrenal health. If your T4/T3 has not been normalized, I would attend to that. Thyroid hormone is just too important to the body to allow to be low for any significant length of time. With a fasting BG under 50 and a post-prandial (with carb) BG of 115 with carbs, it sounds like there may be an insulin issue. That’s a large spike in blood sugar after a carb rich meal. Although it’s still below 120, it’s a 65 point elevation from your fasting level.

  16. This is great information, thanks.  Except the advice at the end is lacking.  The best way to normalize blood sugar is to eat plenty of high quality animal fats, rich in cholesterol, saturated fats, essential fatty acids and the fat soluble vitamins ADE&K that keep your hormones, adrenals, thyroid, and brain healthy.
    I normalized my blood sugar and got rid of candida by going on a milk diet, and eating (drinking) nothing but raw milk for several weeks, followed by a period of adding bone broths, and then soups and stews into my diet.  It was very transformational.
    My thyroid and blood sugar problems were further healed with important supplements in addition to a healthy nutrient-dense diet, which included fermented skate liver oil (similar to cod liver oil but higher in vitamin D) and iodine (Lugol’s and Iodoral).
    I’m not sure whether your information comes out of books, from observing your patients, or from your personal experience.  However, in my experience, education, and observations, a person must do much more than tinker with their blood sugar levels in order to get well from serious chronic diseases like metabolic syndrome and thyroid disease.
    If your goal is just any type of improvement, than fine, but there are so many other things that can be done to support complete or at least extensive healing, and no special equipment or lab tests are necessary.

    • Maria,

      Please read my other articles on thyroid and nutrition. You’ll find that I’ve already addressed most of your points, and those that I haven’t yet will be addressed in future articles. This article is only one of an ongoing series.

      I don’t believe iodine is a good choice for most people with hypothyroidism, which I explained here.

  17. Assuming your diet isn’t poor, which it sounds like it’s not, adrenal fatigue and hypothyroidism are the two most common causes of hypoglycemia.  Have you had your thyroid checked and your adrenal hormones evaluated (using a saliva test)?

    It’s possible you’re stuck in a vicious cycle where low blood sugar stresses the adrenals, which in turn suppresses pituitary function, which reduces thyroid hormone output, which wreaks further havoc on blood sugar and the adrenals, etc.

    Probably worth finding someone who’s good at figuring this stuff out to work with.

    • wow this is , or was exactly my problem, low bg, stressed adrenals, low thyroid, and more low bg, etc etc,stressed, over exercising to address weight gain of a lb a week despite clean eating and low iron made my life a living hell. eyebrows and eyelashes fell out. my skin hurt I could barely walk for the stiffness and joint pains. yet everything on tests was “normal”
      and then Menopause on top of that, and WHAMMO! complete adrenal exhaustion, severe hormone imbalance, and a year and a half of trying to fix it.
      bio identicals were necessary, plus gluten free, plus rest rest rest and no stress.
      thyroid still didn’t pick up the pace. adrenals good now, and hormones balanced. sugars better. but had to go on metformin plus natural thyroid pills in the end. so far so good. I’m no longer “walking dead” and feel well enough to return to work after being totally disabled. my sugars are always between 4.6-5.4 (in canada thats how we measure.) still mostly grain free and no gluten. this has helped me the most I believe. I work with a Naturopath and a very knowledgeable GP who specializes in bio hormones and she fixed me up , one long process, but Progesterone was the first thing she put me on. It is miraculous!

          • I live in West Lincoln, Niagara. I see Dr Switchuk for hormones and drop Mike Frosina for Naturopathy

      • Anita, I’m printing out your post to take to my doc. This sounds exactly like what I have experienced for quite some time! Thanks for doing the leg work and “brain” work for me!!!

      • Anita, you should be checked for Hashimoto’s I have it and it does not show up on a standard thyroid test, but they need to do an antibody test (TPO)

      • Hi Anita, I just stumbled upon this website and your post is sooo similar to me. I scrolled down only to find out you are in the Niagara region, exactly where I live—-what are the odds of this! I’m suffering in silence as no one can “see” what is wrong with me. It’s one thing to read what people post, but a whole different story to actually talk to someone who can relate and is going through the same or similar issues. I don’t know if you will even see this post as its over a year later from when you posted. I would love to speak with you directly….is this something you would be interested in doing? Not sure how I could do this, but please let me know if you would be willing to converse!! Thanks. Christine

    • Hi Chris – I have just been diagnosed with Diabetes 2. My history is readings which flirt with diagnosis of type two diabetes. However one GP detected low thyroid function not diabetes?
      I was put on thyroxin but have still been diagnosed with type two. I have a history of anxiety disorder sine I was 17 (now 53) I seem to be very sensitive to low blood sugar now with trembling and weakness even though my BG isn’t that low 4.8 to 5 when sensation begins. Do you think my Doctors are missing something?

  18. I’m not high SFA yet, thats the reason. Mostly monounsaturated, moderate protein. gluten free. I don’t know why blood sugar is so low. It is a little strange, but it seems idiopathic. Any ideas?

  19. Hey Chris,
    Thanks for the excellent post. I struggle with hypoglycemia, usually with a fasting blood sugar in the sixties, sometimes upper fifties, sometimes lower seventies. I don’t have much of a problem with handling high carb meals (no reactive hypoglycemia), but just have to eat often. I would like to keep my carbohydrate intake moderate for long term health reasons, and am curious what you personally think about moderate carb intake + high saturated fat, particularly in a hyper caloric environment ( I am trying to gain weight.) It is my opinion that the body is much better equipped to handle SFA in a low insulin and/or hypocaloric enviornment, but that when insulin is present or calories are above maintenance, there is the potential for poor cholesterol metabolism or reduced insulin sensitivity. I will note that it wouldn’t hurt if I increased my Cholesterol a little! (130 total)

    • I doubt high SFA + moderate carb intake would be a problem in your case, with numbers like those. But if you’re concerned you can simply monitor yourself using a blood sugar meter as I described. If your blood sugar is going above 120 two hours after meals, you’re exceeding your carbohydrate tolerance. And I agree that it wouldn’t hurt in the slightest if your TC went up. I’m surprised it’s that low on a high saturated fat diet. As you know, we often see higher LDL, HDL and TC on a high SFA diet, but lower triglycerides and small, dense LDL.

      What I’m wondering is why your blood sugar is so persistently low. Have you investigated this?

      • Hey Chris,

        I know this article was written about four years ago (haha) but I’m writing this in hopes you are still around and might have a second opinion for me.

        I believe I am suffering from either primary or secondary addisons disease. It all started in February of 2014 when I was thrown into a 3 day coma after “drinking too much water. ” I am now under the impression it was partly this, but also partly an adrenal crisis as the whole three months prior (and even up to two to three years prior, three months prior being the worst) I was experiencing an intense amount of stress and anxiety. So anyways fast forward to me now, ever since that coma I have been experiencing nightly attacks that can possibly be attributed to hypoglycemia. I wake up from strange dreams always before they happen; I get hot and sweaty and irritated and my thoughts race and I have an immense amount of adrenaline rushing through my chest. So much it feels “hot”. It sometimes gets so bad I feel I’m going to go crazy from how hard my heart beats, how much brain fog I have, and how my whole body feels like it’s vibrating from the inside out. I get weak and shaky and so immensely hungry. These happen more so during the week before and the week of my period (were all human here, sorry if tmi) but sometimes they can happen in the day Times. It’s mostly during this time of the month. The rest of the month I have brain fog every day (haven’t had a clear day in over two years) digestive issues (it varies from extreme constipation for three weeks, the week before my period I have more than my normal amount of craps, and when I do crap it’s either pale, floating, shiny or yellow.) most of the time I have undigested food in the toilet, so I have been taking digestive enzymes and probiotics for this and it seems to be helping with the undigested food a bit.
        I have always had trouble with gaining weight, and since February most days I am really nauseous and some days even trying to swallow solid food makes me feel like im going to puke. So soup and milk are my go tos for days like this. One morning I had ten slices of bacon and I vomited it back up in my mouth from feeling so nauseated from it (involuntarily). I assume this is a sign of fat and protein malabsorption/intolerance and have read addisons can contribute to this. If I eat anything with high carbs I instantly become tired and my brain fog gets worse. I don’t eat anything with gluten, I don’t eat a lot of fruit; I eat mainly meat, vegetables, and low glycemic things. I drink only water with lots of salt and lemon. Sometimes with baking soda. I drink lots of water. 1600ml or more a day.
        I am mostly bed ridden. I have absolutely zero energy most days. My top complaints would be tired all the time, brain fog, mood swings, cold intolerance, persistent eye floaters and digestive issues. Also those night time hypoglycemic type episodes can give me so much adrenaline and anxiety I admit myself to the ER but of course the hospital I go to sucks ass for leaving me in the waiting room for five hours before I’m even seen by anyone. Of course by that time all of my symptoms dissolve and I’m deemed with a clean bill of health.
        I was supposed to go for an acth stimulation test this week but I have to purchase the test myself and it’s $1200 freakin dollars. I haven’t been to work since February, actually the last night I worked was an 11 hour shift before I went into the coma. I’m too weak to stand up most days to make myself food. I don’t have the money to pay for that!! I’m hoping I can find an endo who believes in the saliva cortisol testing…

        The worst part about this all is that Im only 20. My birthday is in March….

        • Brianne, I just stumbled across your comment on one of my google rampages to try to get down it the bottom of my health problems… I am experiencing so much of what you are. Would like to chat more if you can.

        • Hi Brianne

          I have experienced exactly what you describe and I’m healing. After tons of stress my body failed and I spent months feeling the same way. I had super low vitamin d. Started taking that, then added two packs emergency vitamin d I have hashimoto thyroiditis.

        • Hi Brianne

          I have experienced exactly what you describe and I’m healing. After tons of stress my body failed and I spent months feeling the exactly as you described even with er visits. I had super low vitamin d. Started taking that, then added two packs emergency vitamin c 1000 mg. but the biggest changes came when I stopped all sweets and added Phillips colon health probiotics. I sleep by 10 most nights and get a solid 7 hours now. What ever is stressing you quit it leave it or avoid it. Turn off all negative stimulation. I’m so sensitive for this crazy world and was so depressed about things out of my control but I’m so much healthier and happier. About 50 percent recovered! I have hashimoto thyroiditis for 15 years and my numbers are better than ever. This has taken 9 months to recover from so far. This has worked for me. Please get well and take care. I love this website too. Awesome info! Good luck

        • I can relate to you too unfortunately. my downfall mostly came after a large round of vaccines in the peace corps almost 20 yrs ago. i have dealt with hypoglycemia for years, wrecked gut, pathogens. i have flat lined cortisol and went on hydrocortisone following STTM protocol at 25 mg. i gained 20lbs mostly in my stomach. so despite having low cortisol, HC made me go into insulin resistance i think and gain tons of weight. i’m still exhausted, but fat now too.
          I eat very healthy (auto-immune paleo) and have lost nothing on this diet and still exhausted.

          i have mercury poisoning come to find out and am chelating on andrew culter’s protocol (am 5 months in to a 2 yr program). mercury hinders progress of the adrenals…which hinders progress of blood sugar. that could be a missing piece for you. but make sure you chelate safely via AC protocol – low and frequent dosing on the half life of chelators to prevent redistribution of metals and thus reinjury. that does mean getting up at night, which sucks, but i have to get the metals out safely.