Hypoglycemia and endurance exercise: dietary considerations.

Until recently, common dietary prescription for chronic hypoglycemia has been a high-protein, low-carbohydrate regimen (Airola, 1977; Danowski, 1978). Increasing evidence suggests, however, that a diet rich in complex carbohydrates may be more suitable for those involved in endurance exercise (Costill & Miller, 1980; Sherman & Costill, 1984). Although little original research has been undertaken which deals with the effects of performance-enhancing nutritional techniques on the hypoglycemic exerciser, such practices need to be examined in order to understand the mechanisms involved. Specifically, carbohydrate loading would seem to be as important, if not more so, to the hypoglycemic individual as a means of supercompensating glycogen stores prior to endurance performance. The roles of pre-exercise supplements and carbohydrate feedings during exercise in this context are less clear. Although results are mixed, increasing evidence (Snyder et al., 1983; Okano et al., 1988) suggests that carbohydrates may be consumed before exercise with beneficial effects on performance. Because of rapid gastric emptying characteristic of reactive hypoglycemia, it would appear that pre-exercise supplementation may be of particular value to the hypoglycemic exerciser. Further, recent studies (Bergstrom & Hultman, 1967; Coyle et al., 1983; Foster et al., 1986; Leatt & Jacobs, 1986; Horton, 1988) indicate that carbohydrate solutions taken during exercise are effective in maintaining serum glucose levels and improving endurance performance. Careful monitoring of nutritional factors would appear to be critical in creating a suitable dietary environment for the hypoglycemic endurance exerciser.