Postprandial Hypoglycemia in Eating Disorders

Aubry Orlino
1 hour ago
3 min read

Postprandial hypoglycemia—commonly referred to as low blood sugar after eating—is a lesser-known but significant concern for individuals recovering from eating disorders. Understanding how and why it occurs can help those in recovery better manage symptoms and support their healing journey.

What Is Postprandial Hypoglycemia?

Postprandial hypoglycemia is a drop in blood glucose levels that typically occurs 1 to 3 hours after eating. Symptoms may include:

Shakiness
Sweating
Dizziness or lightheadedness
Anxiety or irritability
Fatigue
Heart palpitations
Difficulty concentrating

These symptoms can be scary, but they’re common during the early stages of recovery from an eating disorder.

Why Does It Happen in Eating Disorders?

In those with restrictive eating patterns or chronic undernutrition (as seen in anorexia nervosa, ARFID, or long-term disordered eating), the body undergoes metabolic adaptations. Over time, insulin sensitivity may increase, and the pancreas may overproduce insulin after meals, particularly when reintroducing carbohydrates. This excess insulin can lead to a rapid drop in blood glucose—triggering hypoglycemic symptoms.

The Impact on Recovery

Experiencing postprandial hypoglycemia during refeeding or early recovery can feel discouraging or even frightening. Some individuals may misinterpret these symptoms as a sign that their body is “reacting poorly” to food, which can increase food-related anxiety and hinder progress.

However, it’s important to remember: these symptoms are temporary and often improve as the body reestablishes metabolic balance with consistent, adequate nourishment.

How to Manage It

Here are a few strategies that may help:

Structured, balanced meals: Aim for regular meals and snacks every 3–4 hours that include protein, complex carbs, and fats. Avoid skipping meals.
Limit simple sugars initially: Until blood sugar stabilizes, overly sugary meals may increase insulin spikes. Focus on complex carbs like whole grains, fruits, and starchy vegetables, gradually reintroducing and exploring food again.
Work with your care team: This structured meal plans require professional expertise and should be done with medical monitoring, especially during nutritional rehabilitation. It is crucial to seek help with an HAES-informed primary care provider, eating disorder specialist, dietitian, or therapist before taking large steps to help ensure safety and individualized progress.

When to Seek Help

If you experience frequent or severe symptoms of hypoglycemia during recovery, it’s important to speak with a medical provider familiar with eating disorders. In some cases, further evaluation or temporary dietary adjustments may be needed to support your body as it heals.

Postprandial hypoglycemia can be unsettling, but it is often a sign that your body is working to readjust after a period of deprivation. With the right medical support and continued nourishment, symptoms usually resolve over time. Recovery is not linear, but every step, including the difficult ones, is a move toward healing.

If you or someone you know is navigating eating disorder recovery and needs medical support, our team is here to help.

References

Mayo Clinic Staff. (n.d.). Reactive hypoglycemia: What causes it? Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/reactive-hypoglycemia/faq-20057778

OER Commons. (n.d.). Postprandial (Reactive) Hypoglycemia. OER Nutrition Fundamentals.

https://oercommons.org/courseware/lesson/85833/student/?section=19

Matsumoto, Y., Tsukada, T., Kagawa, Y., & Nakamura, K. (2003). A characteristic reactive hypoglycemia induced by rapid change of eating behavior in anorexia nervosa: A case report. Psychiatry and Clinical Neurosciences, 57(5), 551–552.

https://doi.org/10.1046/j.1440-1819.2003.01161.x

ResearchGate article link

Mather, K., Kim, C., & Johnson, M. (2021). Reactive hypoglycemia. StatPearls.

National Center for Biotechnology Information.

https://www.ncbi.nlm.nih.gov/books/NBK560650/

Mikolajczyk, R. T., & Döring, F. (2023). Eating behavior and glycemic response: A focus on the metabolic outcomes during recovery from anorexia nervosa. Nutrients, 15(19), 4260.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507855/

Sy, R., Maglalang, D. D., & Durrani, M. (2021). Hypoglycemia in anorexia nervosa: A clinical concern. Cureus, 13(12), e20656.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666139/

Wikipedia contributors. (2023, March 15). Idiopathic postprandial syndrome. Wikipedia.

https://en.wikipedia.org/wiki/Idiopathic_postprandial_syndrome

Center for Discovery. (2021, June 10). How to stop binge eating: A Health at Every Size and Intuitive Eating approach.

https://centerfordiscovery.com/blog/how-to-stop-binge-eating-a-health-at-every-size-and-intuitive-eating-approach/