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| Just start Keto? Feeling Shaky? Here's why Keto can give you temporary hypoglycemia |
Last Updated: January 15, 2021
If you've recently started Keto and you're feeling tired, shaky, and a nervous wreck, you might be wondering what is going on.
Why does the Keto Diet make you feel shaky?
The first two weeks of a low-carb diet requires the body to make a series of adjustments and adaptions when switching from a glucose metabolism to one that predominantly uses fatty acids and ketones for fuel.
During these first two weeks, you are:
Why does the Keto Diet make you feel shaky?
The first two weeks of a low-carb diet requires the body to make a series of adjustments and adaptions when switching from a glucose metabolism to one that predominantly uses fatty acids and ketones for fuel.
During these first two weeks, you are:
- restricting the body's predominant fuel source
- emptying out your glycogen stores
- dumping any excess water due to protein deficiency
- coaxing the liver to break down stored body fat
The labels and ideas that the low-carb community has adopted for this situation are not accurate. You do not:
The truth is this:
Only 1 in 3 overweight individuals do not respond to insulin correctly. Just one-third of the overweight population have metabolic issues. Two out of every three dieters have a normal response to insulin.
In addition, everyone does not have blood glucose levels that rise above 120 mg/dl after eating carbs, either, and this includes pure sugar.
These types of problems are a signal that something is metabolically wrong.
And while low carbers don't typically like to hear the truth, most people are overweight because they overeat or are not active enough.
This isn't a lie.
Low-carb diets actually became a thing because Dr. Atkins was afraid of being hungry.
Low-carb diets usually result in a sharp decrease in appetite and cravings, making it easier for you to eat at a calorie deficit.
You do experience body changes that will take several weeks to adjust to, and one of those changes is a drop in your basal insulin level, which you'll experience right away, as well as a lowered glucose response to the foods that you are eating.
You'll also get a lower post-meal insulin response, as well.
- get the flu
- detox from sugar
- go through carbohydrate withdrawal
The truth is this:
Only 1 in 3 overweight individuals do not respond to insulin correctly. Just one-third of the overweight population have metabolic issues. Two out of every three dieters have a normal response to insulin.
In addition, everyone does not have blood glucose levels that rise above 120 mg/dl after eating carbs, either, and this includes pure sugar.
These types of problems are a signal that something is metabolically wrong.
And while low carbers don't typically like to hear the truth, most people are overweight because they overeat or are not active enough.
This isn't a lie.
Low-carb diets actually became a thing because Dr. Atkins was afraid of being hungry.
Low-carb diets usually result in a sharp decrease in appetite and cravings, making it easier for you to eat at a calorie deficit.
You do experience body changes that will take several weeks to adjust to, and one of those changes is a drop in your basal insulin level, which you'll experience right away, as well as a lowered glucose response to the foods that you are eating.
You'll also get a lower post-meal insulin response, as well.
If you have normal blood glucose control, your body's sensitivity to insulin will quickly take care of the small rise in glucose that you get after you eat. The rise in insulin and blood glucose is only problematic for those who do not respond to insulin in a timely manner.
If you're shaky on Keto, however, this is a sign that your blood glucose has either fallen too low, or it is falling too quickly.
If you had a moderate-to-high blood glucose level before going Keto, you might be feeling pretty awful after restricting carbs. This is because the body believes that the moderate-to-high blood glucose level you had before is normal.
Improving your blood glucose numbers through healthier food choices causes the body to go into a panic, believing you are in a dangerously low blood sugar situation.
This is especially common if your blood glucose falls too quickly.
Blood glucose doesn't have to be dangerously low for your body to go into stress-mode and think your life is in danger.
Any time you feel threatened, be it a real-life physical danger or just an emotional one, stress hormones like cortisol and adrenaline are secreted to help you with that emergency situation.
In this case, what's happening is a fall in blood glucose from where it peaked after you ate.
The fall causes a rise in glucagon, which instructs the liver to convert its glycogen stores, the storage form of carbohydrates, into glucose to furnish the brain with the glucose it needs to handle the emergency.
This will happen, even if your blood glucose is at a normal level or even above. The liver can't see your blood glucose level at all. It uses the amount of insulin or glucagon in the bloodstream to determine when it needs to start breaking down glycogen into glucose.
This is key to understanding how low carb works.
If you're shaky on Keto, however, this is a sign that your blood glucose has either fallen too low, or it is falling too quickly.
Shaky on Keto? Maybe It's Pseudohypoglycemia!
If you had a moderate-to-high blood glucose level before going Keto, you might be feeling pretty awful after restricting carbs. This is because the body believes that the moderate-to-high blood glucose level you had before is normal.
Improving your blood glucose numbers through healthier food choices causes the body to go into a panic, believing you are in a dangerously low blood sugar situation.
This is especially common if your blood glucose falls too quickly.
Blood glucose doesn't have to be dangerously low for your body to go into stress-mode and think your life is in danger.
Any time you feel threatened, be it a real-life physical danger or just an emotional one, stress hormones like cortisol and adrenaline are secreted to help you with that emergency situation.
In this case, what's happening is a fall in blood glucose from where it peaked after you ate.
The fall causes a rise in glucagon, which instructs the liver to convert its glycogen stores, the storage form of carbohydrates, into glucose to furnish the brain with the glucose it needs to handle the emergency.
This will happen, even if your blood glucose is at a normal level or even above. The liver can't see your blood glucose level at all. It uses the amount of insulin or glucagon in the bloodstream to determine when it needs to start breaking down glycogen into glucose.
This is key to understanding how low carb works.
If your blood glucose level isn't low when the body begins to panic, it's called pseudohypoglycemia because your body can mimic some of the same symptoms as reactive hypoglycemia.
Since the body isn't in a dangerous situation, there isn't a whole lot that you can do about the:
Real hypoglycemia kicks in when your numbers consistently drop below 60 mg/dl, with the key word here being consistently.
When the blood sugar gets too low, the body secrets cortisol and adrenaline to help bring your blood sugar back up to normal levels.
But it's not the low blood sugar that causes all of these nasty symptoms. It's the presence of adrenaline in the bloodstream that makes you feel shaky and upset.
Adrenaline is uncomfortable.
However, once you feel shaky, your body has already taken care of the problem!
Adrenaline isn't the problem.
Adrenaline is the solution.
If your glycogen stores are severely depleted, which they will be if you're doing a very low-carb diet, it's perfectly normal for your blood glucose to drop down into the 60s before the body is able to bring your blood sugar back up.
This is because the body has to use alternative sources of glucose, instead of glycogen.
This dip in blood sugar is a temporary situation.
I have never had this happen to me for more than a few days.
Converting amino acids into glucose is a long, complex process, and breaking down the triglycerides in your fat cells isn't a fast process either. Both take time, especially during the early stages of a ketogenic diet when the brain hasn't fully adapted to burning ketones for fuel yet.
Occasionally, the body can find itself in a slightly hypoglycemic condition, while the body is adapting to burning fatty acids instead of glucose, but you also could have real hypoglycemia.
The body is always striving for homeostasis. It likes things to stay in balance, so anytime things get out of balance, the body makes adaptions to get back to homeostasis.
The body will do whatever it has to, to make that happen.
Normal blood sugar doesn't bounce all over the place. It stays within a very tight margin.
Normal blood glucose runs about 82 to 84 mg/dl, which is where your fasting blood sugar or baseline blood sugar should optimally be, at least until you eat something.
Then, it's goes up as food is broken down into its usable nutrients.
In a healthy individual, the blood glucose rise after meals never goes above 120 mg/dl, regardless of what or how much you eat. But if you have insulin resistance or diabetes, that's not going to be true.
Many people coming to Keto have elevated blood glucose levels.
When blood glucose rises, first phase insulin is dumped into the bloodstream to help shuttle glucose into your body's cells. This is called first phase insulin response because it's the amount of insulin that your body has stored up to use during digestion.
This isn't basal insulin, the amount of insulin secreted into the bloodstream every few seconds, and what I'm referring to when I talk about insulin levels dropping on low carb. The insulin level that drops is your basal insulin level and not the insulin that is secreted during and after meals.
First phase insulin is different and determined by how many carbs you ate at your previous meal or snack.
It's what the body assumes you're going to need to take care of what you might be eating right now. The body has no clue what you're eating until it breaks it down, so it uses your eating pattern as a rough guide.
If there is enough insulin to bring your blood glucose back down into the safe territory, then great. Blood sugar level returns to normal and insulin stops being made, resulting in insulin returning to a normal level, as well.
Second phase is when the first phase was not enough.
You're eating more carbs than you ate at your last meal or snack, so the body needs to quickly create more insulin to take care of what you're eating.
The amount of time this takes, depends on what you're eating and how much.
In general, it takes 2 to 3 hours for your blood glucose to return to a normal baseline level. After that, it pretty much stays there, regardless of how long you go without eating because the liver will use it's stored glycogen to keep things steady and balanced.
There are three types of hypoglycemia:
Reactive hypoglycemia is when you produce too much insulin.
The spike causes the blood glucose level to either go below baseline, or blood sugar falls too quickly.
This occurs within 5 hours of eating.
Generally, you hit your lowest level somewhere between 1 and 3 hours after eating, at which time, other hormones come into play to kick your blood sugar back up to normal.
But it doesn't always work that way with reactive hypoglycemia. Usually, the hormone kick results in lower than baseline glucose levels somewhere between 2 and 3 hours.
Fasting hypoglycemia is when you're either fasting for longer than 5 hours, or you find yourself in a situation where you can't eat for that long, or longer.
As a result, your blood sugar drops below 60 mg/dl.
This also occurs in those who have depleted glycogen stores and can possibly occur if you're attempting Intermittent Fasting without being Keto adapted.
Fasting hypoglycemia has many causes:
Hypoglycemic symptoms do not come from the level of glucose in your blood.
They come from adrenaline which is secreted whenever the blood sugar level begins to fall too quickly, or when glucagon isn't high enough to get the liver to release its glycogen stores.
The following are hypoglycemia symptoms and need to be taken seriously:
However, symptoms can also be caused from the stomach emptying too soon. But most of the time, it's caused by defects in metabolism.
Mild reactive hypoglycemia isn't life threatening, but it does interfere with weight loss and health because whenever blood sugar rises, or is in a bouncing situation, insulin also goes up and continues to stay elevated until blood glucose comes back down.
It's easy to get use to the energy rush that comes from adrenaline and even become addicted to that rush of hormones.
Many people mistakenly believe the energy pick up they get after eating is a healthy response to food.
It's not!
When blood sugar is up, a hypoglycemic is hyperactive, energetic, and feels happy. When the blood sugar starts to drop, you feel shaky, irritable, tired, and begin craving a quick pick-me-up.
If you use diet caffeinated drinks or coffee to pick you up, energy drinks or whatever, the caffeine stimulates the adrenal glands to encourage the liver to release glucose into the bloodstream.
This is what caffeine does.
One of the problems with getting a hypoglycemic diagnosis is that there is often a very small window when the blood sugar actually falls to the point where a release of cortisol and adrenaline are absolutely necessary to save your life.
This window is only open for about 5 minutes, or so.
Testing every hour or even every half an hour can easily miss your lowest point and make you think that you're healthy, when you are not.
One of the keys to diagnosis, in Dr. Atkins professional opinion, was comparing your blood sugar curve to a normal blood glucose curve. There are some very interesting things that happen when you're caught in hypoglycemic cycles.
Typical body response to falling glucose levels is to first activate glucagon, which informs the liver that it needs to convert its glycogen stores into glucose to keep the glucose level in the blood from falling too low.
However, if the liver doesn't have any glycogen stores it can use, this condition will be problematic. In addition, the liver simply might not respond to glucagon's presence or maybe can't manufacture glucose fast enough.
When the blood sugar level drops to a dangerously low level, stress hormones are called on to initiate an alternative plan to save your life.
When adrenaline is used, it almost always overshoots the mark, so rather than returning the glucose level to baseline, it raises the blood sugar above baseline, and you end up with bouncing values.
Most people who are officially diagnosed with hypoglycemia, either reactive or fasting, have been known to demonstrate very low glucose levels -- way below the 60s that we've been discussing here.
This is mostly because of the high glucose that's required for testing. It isn't just a matter of checking what your blood sugar is doing within a low-carb diet.
Low carb is the typical corrective treatment.
A low-carb diet helps correct these metabolic imbalances by restricting carbohydrates. If you give your body time to adjust to these new, normal blood glucose levels, the shakiness you're experiencing on Keto will go away as your blood glucose becomes stabilized.
In fact, shakiness on Keto means there is something wrong with the way your body is metabolizing the food you eat.
However, the 20 grams of carbohydrates per day that the Atkins and Keto diets recommend isn't a hard-and-fast rule. Twenty carbs is a recommendation meant to get as many people as possible into the state of Nutritional Ketosis quickly and effortlessly.
If you're having a difficult time dealing with the consequences of cortisol and adrenaline secretion, Atkins Nutrtionals, Inc. advises you to:
Move into the Ongoing Weight Loss Phase, Phase 2, even if you haven't finished with Induction yet, and add an additional 5 grams of vegetable carbohydrate per day to your current plan -- see if that fixes the problem.
What you don't want to do is go back to the food choices that caused your high blood glucose levels in the first place because that will just push you closer to experiencing a real hypoglycemic episode.
While eating a bowl of Lucky Charms or snatching a couple of chocolate chip cookies might make you feel better right now, it won't help correct your metabolic issues. It will just prolong the time it takes for your body to adjust to and learn what a normal blood glucose level is.
If you have metabolic problems, high glucose comes from eating more carbohydrates than you can use.
Until your body learns what a normal blood sugar level is, you might have to grin-and-bare several stress hormone reactions.
This is what I've had to do in the past myself.
Many Keto dieters have learned to handle the difficult situation by calling these problems detox or withdrawal symptoms, but that's not really what they are.
A low-carb diet works in the same way as an elimination diet.
It becomes a diet you can build for yourself one food at a time.
In the same way that Atkins asks you to return 5 grams of carbohydrate per day to your diet, at realistic intervals, elimination diets do the same thing.
While initially, these ketogenic healing programs are hard, and the shakiness can make you want to quit and walk away, a Keto diet can help you discover which foods will keep your blood glucose within safe parameters.
And that can well be worth the effort.
Are you feeling shaky on Keto? Let's talk about it in the comments below!
Since the body isn't in a dangerous situation, there isn't a whole lot that you can do about the:
- shakiness
- pounding pulse and heart beat
- sweatiness
- and anxiety
Real hypoglycemia kicks in when your numbers consistently drop below 60 mg/dl, with the key word here being consistently.
When the blood sugar gets too low, the body secrets cortisol and adrenaline to help bring your blood sugar back up to normal levels.
But it's not the low blood sugar that causes all of these nasty symptoms. It's the presence of adrenaline in the bloodstream that makes you feel shaky and upset.
Adrenaline is uncomfortable.
However, once you feel shaky, your body has already taken care of the problem!
Adrenaline isn't the problem.
Adrenaline is the solution.
If your glycogen stores are severely depleted, which they will be if you're doing a very low-carb diet, it's perfectly normal for your blood glucose to drop down into the 60s before the body is able to bring your blood sugar back up.
This is because the body has to use alternative sources of glucose, instead of glycogen.
This dip in blood sugar is a temporary situation.
I have never had this happen to me for more than a few days.
Converting amino acids into glucose is a long, complex process, and breaking down the triglycerides in your fat cells isn't a fast process either. Both take time, especially during the early stages of a ketogenic diet when the brain hasn't fully adapted to burning ketones for fuel yet.
Occasionally, the body can find itself in a slightly hypoglycemic condition, while the body is adapting to burning fatty acids instead of glucose, but you also could have real hypoglycemia.
What is Real Hypoglycemia?
 |
| Make sure that you don't have real hypoglycemia before ignoring your hypoglycemia symptoms |
The body is always striving for homeostasis. It likes things to stay in balance, so anytime things get out of balance, the body makes adaptions to get back to homeostasis.
The body will do whatever it has to, to make that happen.
Normal blood sugar doesn't bounce all over the place. It stays within a very tight margin.
Normal blood glucose runs about 82 to 84 mg/dl, which is where your fasting blood sugar or baseline blood sugar should optimally be, at least until you eat something.
Then, it's goes up as food is broken down into its usable nutrients.
In a healthy individual, the blood glucose rise after meals never goes above 120 mg/dl, regardless of what or how much you eat. But if you have insulin resistance or diabetes, that's not going to be true.
Many people coming to Keto have elevated blood glucose levels.
When blood glucose rises, first phase insulin is dumped into the bloodstream to help shuttle glucose into your body's cells. This is called first phase insulin response because it's the amount of insulin that your body has stored up to use during digestion.
This isn't basal insulin, the amount of insulin secreted into the bloodstream every few seconds, and what I'm referring to when I talk about insulin levels dropping on low carb. The insulin level that drops is your basal insulin level and not the insulin that is secreted during and after meals.
First phase insulin is different and determined by how many carbs you ate at your previous meal or snack.
It's what the body assumes you're going to need to take care of what you might be eating right now. The body has no clue what you're eating until it breaks it down, so it uses your eating pattern as a rough guide.
If there is enough insulin to bring your blood glucose back down into the safe territory, then great. Blood sugar level returns to normal and insulin stops being made, resulting in insulin returning to a normal level, as well.
Second phase is when the first phase was not enough.
You're eating more carbs than you ate at your last meal or snack, so the body needs to quickly create more insulin to take care of what you're eating.
The amount of time this takes, depends on what you're eating and how much.
In general, it takes 2 to 3 hours for your blood glucose to return to a normal baseline level. After that, it pretty much stays there, regardless of how long you go without eating because the liver will use it's stored glycogen to keep things steady and balanced.
The Three Types of Hypoglycemia
There are three types of hypoglycemia:
- Medication-induced hypoglycemia
- Reactive hypoglycemia
- Fasting hypoglycemia
Reactive hypoglycemia is when you produce too much insulin.
The spike causes the blood glucose level to either go below baseline, or blood sugar falls too quickly.
This occurs within 5 hours of eating.
Generally, you hit your lowest level somewhere between 1 and 3 hours after eating, at which time, other hormones come into play to kick your blood sugar back up to normal.
But it doesn't always work that way with reactive hypoglycemia. Usually, the hormone kick results in lower than baseline glucose levels somewhere between 2 and 3 hours.
Fasting hypoglycemia is when you're either fasting for longer than 5 hours, or you find yourself in a situation where you can't eat for that long, or longer.
As a result, your blood sugar drops below 60 mg/dl.
This also occurs in those who have depleted glycogen stores and can possibly occur if you're attempting Intermittent Fasting without being Keto adapted.
Fasting hypoglycemia has many causes:
- medication
- organ failure
- hormonal deficiency like adrenal fatigue
- non beta cell tumors
- congenital and/or enzymatic disorders (hypoglycemia in kids)
- elevated insulin levels caused by Insulinoma (tumor of the beta cells)
- autoimmune situations to either insulin itself or the insulin receptors
- drinking and eating carbs at the same time
- a damaged liver
Hypoglycemia Symptoms
Hypoglycemic symptoms do not come from the level of glucose in your blood.
They come from adrenaline which is secreted whenever the blood sugar level begins to fall too quickly, or when glucagon isn't high enough to get the liver to release its glycogen stores.
The following are hypoglycemia symptoms and need to be taken seriously:
- irritability
- dizziness or vertigo
- weakness
- hunger
- craving for something sweet
- need for caffeine to pick you up
However, symptoms can also be caused from the stomach emptying too soon. But most of the time, it's caused by defects in metabolism.
Mild reactive hypoglycemia isn't life threatening, but it does interfere with weight loss and health because whenever blood sugar rises, or is in a bouncing situation, insulin also goes up and continues to stay elevated until blood glucose comes back down.
It's easy to get use to the energy rush that comes from adrenaline and even become addicted to that rush of hormones.
Many people mistakenly believe the energy pick up they get after eating is a healthy response to food.
It's not!
When blood sugar is up, a hypoglycemic is hyperactive, energetic, and feels happy. When the blood sugar starts to drop, you feel shaky, irritable, tired, and begin craving a quick pick-me-up.
If you use diet caffeinated drinks or coffee to pick you up, energy drinks or whatever, the caffeine stimulates the adrenal glands to encourage the liver to release glucose into the bloodstream.
This is what caffeine does.
One of the problems with getting a hypoglycemic diagnosis is that there is often a very small window when the blood sugar actually falls to the point where a release of cortisol and adrenaline are absolutely necessary to save your life.
This window is only open for about 5 minutes, or so.
Testing every hour or even every half an hour can easily miss your lowest point and make you think that you're healthy, when you are not.
One of the keys to diagnosis, in Dr. Atkins professional opinion, was comparing your blood sugar curve to a normal blood glucose curve. There are some very interesting things that happen when you're caught in hypoglycemic cycles.
What Happens When You Have a Hypoglycemic Episode?
Typical body response to falling glucose levels is to first activate glucagon, which informs the liver that it needs to convert its glycogen stores into glucose to keep the glucose level in the blood from falling too low.
However, if the liver doesn't have any glycogen stores it can use, this condition will be problematic. In addition, the liver simply might not respond to glucagon's presence or maybe can't manufacture glucose fast enough.
When the blood sugar level drops to a dangerously low level, stress hormones are called on to initiate an alternative plan to save your life.
When adrenaline is used, it almost always overshoots the mark, so rather than returning the glucose level to baseline, it raises the blood sugar above baseline, and you end up with bouncing values.
Most people who are officially diagnosed with hypoglycemia, either reactive or fasting, have been known to demonstrate very low glucose levels -- way below the 60s that we've been discussing here.
This is mostly because of the high glucose that's required for testing. It isn't just a matter of checking what your blood sugar is doing within a low-carb diet.
Low carb is the typical corrective treatment.
When Stress Hormones Interfere with Your Life
A low-carb diet helps correct these metabolic imbalances by restricting carbohydrates. If you give your body time to adjust to these new, normal blood glucose levels, the shakiness you're experiencing on Keto will go away as your blood glucose becomes stabilized.
In fact, shakiness on Keto means there is something wrong with the way your body is metabolizing the food you eat.
However, the 20 grams of carbohydrates per day that the Atkins and Keto diets recommend isn't a hard-and-fast rule. Twenty carbs is a recommendation meant to get as many people as possible into the state of Nutritional Ketosis quickly and effortlessly.
If you're having a difficult time dealing with the consequences of cortisol and adrenaline secretion, Atkins Nutrtionals, Inc. advises you to:
Move into the Ongoing Weight Loss Phase, Phase 2, even if you haven't finished with Induction yet, and add an additional 5 grams of vegetable carbohydrate per day to your current plan -- see if that fixes the problem.
What you don't want to do is go back to the food choices that caused your high blood glucose levels in the first place because that will just push you closer to experiencing a real hypoglycemic episode.
While eating a bowl of Lucky Charms or snatching a couple of chocolate chip cookies might make you feel better right now, it won't help correct your metabolic issues. It will just prolong the time it takes for your body to adjust to and learn what a normal blood glucose level is.
Keto Helps You Achieve Safe Blood Glucose Levels
If you have metabolic problems, high glucose comes from eating more carbohydrates than you can use.
Until your body learns what a normal blood sugar level is, you might have to grin-and-bare several stress hormone reactions.
This is what I've had to do in the past myself.
Many Keto dieters have learned to handle the difficult situation by calling these problems detox or withdrawal symptoms, but that's not really what they are.
A low-carb diet works in the same way as an elimination diet.
It becomes a diet you can build for yourself one food at a time.
In the same way that Atkins asks you to return 5 grams of carbohydrate per day to your diet, at realistic intervals, elimination diets do the same thing.
While initially, these ketogenic healing programs are hard, and the shakiness can make you want to quit and walk away, a Keto diet can help you discover which foods will keep your blood glucose within safe parameters.
And that can well be worth the effort.
Are you feeling shaky on Keto? Let's talk about it in the comments below!
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