Blood Glucose

Postprandial Reactive Hypoglycemia (PRH): Information and Dietary Management

January 11, 2017   /
Nutrition411 Staff
Sophia Bernazzani, Community Manager of Nursing@Simmons

What is PRH?

  • Postprandial: symptoms occur after a meal, within 2-4 hours
  • Reactive: symptoms occur in response to food, as opposed to a fasting state
  • Hypoglycemia: low blood glucose/sugar. A normal glucose range is 70-99 mg/dL

What are the common symptoms?

  • Anxiety
  • Blurred vision
  • Confusion or difficulty thinking
  • Dizziness
  • Faintness
  • Hunger
  • Irritability
  • Palpitations
  • Rapid heart rate
  • Sweating
  • Tingling sensation
  • Tremors

Who is at risk for PRH?
The cause of PRH is largely unknown, and up for debate. 

  • Some people may be more sensitive to the body's normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Deficiencies in glucagon secretion may also lead to reactive hypoglycemia.
  • It is occasionally seen in patients who have Roux-en-Y bariatric surgery, because certain foods pass more rapidly into the small intestine.
  • Rare enzyme deficiencies, such as hereditary fructose intolerance, also may cause reactive hypoglycemia.

What can help stabilize blood glucose levels?

  • Eat small meals frequently, every 3-4 hours:
    • Understand that skipping or delaying meals can make symptoms worse
  • Avoid simple sugars and refined carbohydrates, especially on an empty stomach:
    • Limit sodas, soft drinks, sweetened beverages, honey, jam, jelly, sugar, syrup, sweet desserts, fruit juice, etc
    • Try artificial sweeteners, which do not affect blood sugar
  • Eat balanced meals/snacks, choosing from a variety of foods, for example:
    • Breakfast: cooked oatmeal with sliced banana, chopped walnuts, and milk
    • Snack: peanut butter or cheese on apple wedges or an English muffin
    • Lunch: vegetable-bean soup, turkey sandwich on wheat bread, and an orange
    • Snack: baby carrots and wheat crackers with hummus dip
    • Dinner: broiled fish or poultry, baked sweet potato, tossed salad, and milk
    • Snack: mixed berries, topped with fruit yogurt and slivered almonds
  • Include high-protein foods with meals/snacks:
    • Select lean meats, fish, eggs, skinless poultry, low-fat milk and other low-fat dairy products (yogurt, cheese, etc), dried beans, lentils, legumes, tofu, soy milk, peanut butter, and other meat alternatives
  • Choose high-fiber foods, particularly soluble fiber:
    • Eat whole grains (like oatmeal), beans/legumes, fruits, and vegetables
    • Drink extra fluids (like water) when increasing fiber intake
  • Limit alcohol and caffeine:
    • Understand that alcohol can cause low blood sugar
    • Know that caffeine can make symptoms worse
  • Eat a high-carbohydrate snack before exercise:
    • Try fresh fruit (like a banana), cereal, pretzels, or a granola bar

References and recommended readings

Hypoglycemia. National Institute of Diabetes Digestive and Kidney Diseases website. Published October 2008. Accessed May 9, 2016.

Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012. 

Medical nutrition therapy: Reactive hypoglycemia. University of Wisconsin Hospitals and Clinics website. Accessed May 9, 2016.