Paleo Plan

A warning about intermittent fasting

An empty bowlThere’s a lot of talk about intermittent fasting (IF) these days in the Paleo community, and we have a few posts on it coming up by our favorite fitness guru, Max Shippee, pretty soon. However, I think before you go jumping on the intermittent fasting express train, there are some things you should know.

Blog posts by Martin Berkhan of leangains.com, Mark Sisson, Arthur De Vany, and so many more will tell you about the potential benefits of intermittent fasting and how exactly one goes about doing it. To sum it up, you could get super ripped, more fit, and maybe even kick cancer’s ass with IF. I truly believe that intermittent fasting can help people lose weight and feel amazing if done properly by the right people. After all, we didn’t evolve always having 3 square meals a day, so our bodies are, in theory, well-equipped to deal with fasting. By the way, when I say “fasting”, I’m talking about going for longer periods than normal without eating. So, for instance, that could mean eating your last meal at 6pm and not eating again until 10am the next day (only missing breakfast) or it could mean not eating for an entire day.

So let’s jump right in here. Some people can intermittently fast, but a lot of people are going to have problems with it.

The hangries need time to heal.

A large population of people get hangry (hungry+angry=hangry) when they don’t eat for long periods of time. They get headache-y, weak, shaky, irritable, and even black out sometimes. This phenomenon is known as hypoglycemia. It can happen even while on a Paleo diet because the blood sugar problems of some people’s Standard American Diet (SAD) days have still not healed. It can take months or years on a Paleo diet for some people to stop having those energy crashes.

Also, a lot of Paleo people still graze throughout the day on small meals full of carbohydrates (almond flour baked goods, Larabars, fruit, nuts, etc.). If you have a history of hypoglycemia, then grazing on carbs is a recipe for disaster, even when it’s technically Paleo foods you’re grazing on. Don’t get me wrong: eating Paleo carbs is generally way better for hypoglycemia than the carbs in a SAD diet. If you try fasting while you still have hypoglycemic tendencies, you’re probably going to experience the hangries. Regularly letting your blood sugar get super low is stressful on your body and it can contribute to inflammation and adrenal fatigue. Here’s more on that – it has to do with cortisol and epinephrine.

Enter caffeine.

It’s no surprise that when people get really hungry, they crave caffeine. Caffeine can suppress hunger and make you feel like you’ve eaten an entire meal because it acts like a meal in your body. When you consume caffeine, you’re telling your body that something terribly stressful is happening. It’s a stimulant drug, after all. Caffeine stimulates epinephrine and cortisol to be released in your body. Epinephrine causes fat stores to be released and cortisol causes glucose stores to be released into your bloodstream to give you energy. Those are the same hormones that are released when you’re being chased by a murderer. Very stressful for your body. It’s certainly not meant to happen every day at 6am, 10am, 3pm, and a decaf after dinner.

A lot of intermittent fasters are using caffeine just like you’d use diet pills to alleviate hunger and give them energy while they’re starving themselves. Do you know what the main ingredient is in the very popular diet pills, Hydroxycut and Zantrex? Caffeine. 600 mg in Hydroxycut to be exact. That’s less than 2 16-oz Starbucks drip coffees. Curiously,some trainers are even recommending caffeine pills (200mg per pill) to get through fasts and to help with stubborn body fat. I’m sorry, but I’ll leave diet pills to the Jersey Shore girls. Consuming caffeine regularly can overwork your adrenals and wreak havoc on your health over time.

Eventually, tired adrenals can give you heinous fatigue, leaky gut, thyroid problems, stubborn fat, insomnia, poor athletic performance, weak immunity, and low sex drive, among many other things. But this will never happen to you, right? Right. Look around – this is 2/3 of America. But I’m sure that bragging to your friends about how you fasted for 72 hours with only espresso to fuel you through 6 grueling WODs will have been totally worth it… Seriously, though, is fasting at any expense really worth it?

Some Practical Tips

Here’s my advice to you if you recently switched over to Paleo and you’re intrigued by the concept of IF.

1. Try it yourself only after you’ve been Paleo for at least a couple months and only when you’re not having energy crashes anymore.

2. Then, start to experiment with going for longer periods of time between meals to see how you do. Check out the different ways of doing IF (see the references in the second paragraph) and see which of the methods works for you.

3. Be honest with yourself. If it doesn’t work for you, it doesn’t work. Maybe it will later. For now if you want to lose fat, play with your macronutrient ratios and/or your calorie intake at regular meals. Hint: higher fat content helps satiate you for longer.

4. Do NOT use caffeine to get you through your day (whether you’re intermittent fasting or not) unless you’re prepared for serious adrenal problems later in life. Here’s another fun post on that.

Intermittent fasting can be an awesome thing, especially for people who really have a lot of weight to lose and/or whose adrenals are pretty healthy. Just use it with care. You’ve most likely already done damage to your body by eating Neolithic crap your whole life up until your induction into Paleo nirvana (myself included). There’s no need to do more damage with caffeine and intermittent fasting.

I’m sure I’m going to hear it from some highly caffeinated IF-ers on this one. I’d love to know your thoughts!

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32 Comments

  1. Zernike

    Hello, In this post you say, “tired adrenals can give you heinous fatigue, leaky gut, thyroid problems, stubborn fat, insomnia, poor athletic performance, weak immunity, and low sex drive”. You also connect this to caffeine, while others imply caffeine is beneficial (e.g., recommending the intake of “bulletproof coffee”). Could you please refer me to research studies/reports that offer solid evidence? All I’ve been able to find is websites referring to other websites, lots of opinions, but no actual research and would like more information on this subject. Thanks!

    • Zernike – My pleasure. I’d like to write a whole book about this because it affects so many people. I have to say that there aren’t many (any?) longterm studies that just track caffeine intake and many of the symptoms I listed. There are some epidemiological studies – like the big nurses health study – that talk about caffeine, but I don’t really like to cite that kind of info because it’s not causative. However, there are many studies about stress and cortisol, and that’s the link I think we need to make with caffeine. Caffeine simulates stress and it stimulates cortisol production. If you’re consuming it chronically, then you have chronically stimulated cortisol levels in your body, just like you would if you were chronically stressed. Also, many people drink coffee BECAUSE they’re stressed in their jobs, personal life, etc, which compounds the amount of cortisol and adrenaline being stimulated. After a while of overstimulating cortisol (either with stress or caffeine, etc), it’s believed that your body has a hard time producing enough cortisol and that’s where “adrenal fatigue” comes into play.

      Alright, here’s an article stating that caffeine does, in fact, elevate cortisol levels. This is one of many that state this: http://www.sciencedirect.com/science/article/pii/S0091305796001050

      Here’s an article that states that one of the big reasons people see “benefits” from caffeine is simply due to “withdrawal relief”: http://www.sciencedirect.com/science/article/pii/S0091305797005157

      This study shows that people with chronic fatigue and/or fibromyalgia have cortisol levels that are abnormal compared with people who don’t have chronic fatigue and/or fibromyalgia, just to show that these things are related: http://www.sciencedirect.com/science/article/pii/S0889159104000212

      I think the biggest thing is to understand how cortisol works and what happens when you overstimulate it. For lack of time and space here, wikipedia has a really awesome page with tons of references about how all of the symptoms I mentioned correlate with cortisol: http://en.wikipedia.org/wiki/Cortisol

      I hope that helps. Honestly, I’m disappointed by the lack of research out there on this topic. I think people are in denial about how detrimental it can really be, and no big pharmaceutical company is going to fund a study that says that caffeine is bad for you. That would just lead to the conclusion that you should cut out caffeine – no drug necessary. I’d love to hear your thoughts.

  2. Zernike

    Thank you so much for the time you took researching these links!

    I guess my question boils down to: is drinking a cup of high-quality coffee equal to drinking Red Bull or popping NoDoz? Some of the links you posted are interesting, but the connection between adrenal fatigue and coffee drinking seems vague to me. To be a fair study, they had to isolate caffeine, otherwise there are too many variables involved. People were given caffeine pills or maybe a specifically prepared caffeine beverage.

    If we are to recommend abstaining from coffee, and anything that naturally contains caffeine, then the focus should be on those items rather than caffeine. You’d also have to ask where the coffee came from; was it tested for mold or other contaminates; how was it prepared; how much is consumed and when? I think there are too many variables involved to nail it all on a single plant source and announce that people should not consume it – because even though you have observed in your practice, that is still opinion, which can be influenced when too many variables come into play.

    While I’m not defending caffeine or taking any drugs, I don’t recommend accepting a conclusion that is not well substantiated or comes across as vague. There’s a lot of research studies defending the avoidance of fats, also a single ingredient that is not available naturally isolated. Are all fats created equal? Should we avoid everything that has fat in it? Does eating fat make you feel good – it does me! Do people overindulge? Could eating too much fat cause fatigue?

    Here’s why I am curious. I have an extremely sensitive system and spent many years living with debilitating pain, and determined not to live on drugs. After years of isolated experimentation, I no longer eat starch, dairy, or additives. I came to the “Paleo” conclusion on my own, a lifestyle that allows me to live comfortably, much to the amazement of my husband who happens to be a physician.

    I do not tolerate caffeine well, in the majority of it’s forms. Most coffee makes me anxious and very uncomfortable. However, I can drink a cup of high quality, single source coffee without issue, no jitters, no stress, no crash in the afternoon, and also no pain. If I don’t drink it, there are no headaches or other withdrawal symptoms, other than “missing it”. I drink such coffee for enjoyment; it’s not bitter; it can be consumed black – it gives me a pleasant boost in the morning, especially when I add high-quality fat to it.

    However, I am rethinking my consumption after reading your articles. I’m sure our Paleolithic ancestors did not drink coffee, although apparently wild goats ate the berries… But then, I don’t think our ancestors ate breakfast, coconut oil, almond flour, or equally spaced out meals. Neither did they drive cars, which is probably more stressful than a cup of coffee.

    Just saying… there may be more to this caffeine issue than seems obvious. While it’s easiest to say “avoid it all”, we don’t get to understand the topic, which is why I’m asking questions. I appreciate your time and this website!

    • Zernike – You make some good points about the studies not being conclusive. And while I put some stock into scientific research, I think there’s a lot of terrible research and unscrupulous researchers out there, so I don’t live my life by the research all the time. There’s not much research out there stating that the Paleo diet is the way to go, but I wholeheartedly believe that it is for me. And I totally 100% agree with you that every person is different, and while you may be able to tolerate that high quality cup of coffee, if I tried that I’d launch off into space and quite immediately thereafter have to go take a nap :) In my practice, of all the people I’ve convinced to remove caffeine from their diet, only one has said that they didn’t feel better after they took it out. That’s my main motivation for being the coffee nazi that I am. I’ve seen and heard from so many people that they sleep better, have more energy, and sometimes even start losing weight (among other things) after taking it out. It just seems like a no brainer to me. Most of all, I just want people to reconsider it as a staple in their lives. Yes, I think that there are/were primitive cultures who had stimulant plants they partook in regularly, but not across the board. We all didn’t evolve with a stimulant on a regular basis. And like you said, they didn’t have a lot of the everyday stressors we have today like cars, 9-5 jobs, etc, so the stress of the stimulant wasn’t compounded by those things like it is today with people. Anyway, I appreciate this conversation and your thoughts on this. It sounds like you’ve put a lot of thought and work into your health and diet. Good luck to you!

  3. Zernike

    Thank you for your responsiveness and thought! I will take on your double dog dare, and leave off the coffee to see what happens. Appreciate your support. :)

  4. I thought that I would weigh in on the coffee debate: my mother has had two cups of organic, high quality coffee every day for years now, and can easily live life without it when high quality coffee is unavailable. She’s gone weeks without coffee because she couldn’t find a brand that reached her exacting standard and has suffered no ill effects.

    I, too, enjoy the taste of good coffee and go through phases of either drinking or abstaining with no noticeable difference. My memory increases with coffee when I am studying, If I don’t have coffee, I feel fine. There’s nothing different in my mannerisms or how the day wears on me. I sleep poorly either way (I have intermittent insomnia. Which has yet to abate due to any diet I’ve taken up.) Some studies have shown that 2-3 cups of coffee a day can prevent brain deteriorating diseases such as Alzheimers.

  5. Thank you for writing this. I quit coffee a year ago due to the problems you outlined. I was completely burned out! I had to drink the stuff just to feel halfway normal. Not any way to live. After the three days of hell coming off it, I have felt pretty good on a consistent basis. My energy levels are pretty steady and I get a strong pull to go to bed around 10:00 and fall asleep easily.

    That being said, you’re going to think what I write next is nuts: I’m about to try the Bulletproof IF protocol. I actually started a modified version of it today, using cocoa instead of coffee because I don’t want to try the coffee until I get the really high quality stuff. I’m about 16 hours into the IF and I feel really great. I used lots of kerrygold and coconut oil in my cocoa so I’m pretty fueled on fat. Prior to discovering BC, I never would have considered IF or going back to drinking any kind of coffee, for that matter. The fact that this theory asserts that the fat does not negate the benefits of fasting really intrigued me. I don’t know if the coffee part is strictly necessary or even if it would be that good for me. But, I’m willing to give it a try and see if good quality coffee without contaminants really does make any sort of difference. If I notice any sort of withdrawal when I don’t have it, I will nix it. For me, this is just a good way to get off the eating frequently rollercoaster. I’ve been low carb Paleo for a year and still feel the (probably emotional) need to eat frequently. I think it’s holding me back so I’m going to try this out in an effort to make sure I’m able to burn fat primarily as opposed to sneaking in the glucose by eating too much protein too often. I’ll let you know how it goes!

    I wrote all about my decision to try this here: http://ameliashealthylife.blogspot.com/2012/04/im-trying-bulletproof-fasting.html.

  6. Hello, I have read that acute caffeine consumption increases cortisol, but chronic does not. This is an older study:

    http://deepblue.lib.umich.edu/bitstream/2027.42/27342/1/0000367.pdf

    • JuicyJ – Thank you for this article – this is awesome! I’ve had such a hard time finding anything like this, and it really makes me want more articles like it. I’d have to look more into this particular article to understand exactly what it means because the methods are a little tortuous and they used only depressed individuals for their sample. I’m not yet willing to say that chronic caffeine doesn’t affect their cortisol levels at all, since the dexamethasone suppression test has some limitations: http://www.felipedia.org/~felipedi/wiki/index.php?title=Dexamethasone_suppression_test. Moreover, though, it has to be noted that caffeine doesn’t only affect cortisol, but also epinephrine and norepinephrine levels, which contribute to anxiety, inflammation, etc.

      Anyway, again, this is cool. Thank you.

  7. ceacondos

    Hi Neely,

    You made a comment above about how even paleo carbs (fruit, nuts, seeds) can be detrimental to someone who is hypoglycemic.

    I’m hypoglycemic and prior to starting paleo, I always had to snack between breakfast and lunch, between lunch and dinner, and again usually later in the evening. Since I started consistenty eating paleo (using the meal plans) about a month ago, I have noticed that my need to snack is much less – I can usually make it from breakfast to lunch without a snack and often can make it from lunch 1pm-5pm without a snack, which was never possible before. However, there still are times when I need something to keep from getting dizzy.

    If even paleo carbs are not good snacks, what would you recommend for a snack to tide me over until dinner (usually 7pm)?

    Thanks!
    Chelsea

    • Neely

      CeaCondos – I’d like to stress that I didn’t mean to say that “even Paleo carbs are not good snacks”. I don’t think they’re BAD, but you may have to figure out how to make them better for you. For instance, instead of eating just fruit, eat fruit covered in coconut milk so the glycemic load is less. And I don’t actually consider nuts and seeds a great source of carbs, so they’re not really in that category. So eat those, meat in all its forms, hard-boiled eggs, avocado with a little salt, or leftovers from lunch or dinner. Or anything else you can think of that’s more substantial than just fruit. Sometimes it’s not the fact that it’s carbs you’re eating that gives you dizziness between meals – it’s just that you’re not eating enough food. Hope that helps!

  8. Odd, but after starting on IF (which is quite recently) my coffee consumption dropped instead of being the “expected” go-to. I used to drink as much as 8-10 cups of brewed coffee, but the most I have now is 3 cups black (1 in the morning, and either 1 or 2 during the feeding hours). The funny thing is I don’t crave it either as much as I did before IF.

  9. Luiza

    Have you tried IF yourself prior to writing this?

  10. Thank you all for the very thoughtful comments here! Just as a disclosure, I do practice IF and recommend it to many of my patients (I work in clinical medicine).

    I think its important to also realize that caffeine is a component of many different beverages, and not all caffeinated beverages are the same. For example, there is research that suggests that tea (yes, with caffeine) actually has a cortisol lowering effect. Here’s the link to the study:

    http://eprints.ucl.ac.uk/189393/

    I don’t recommend that my patients who practice IF use coffee or soft drinks during fasting days, but regular tea consumption has so many documented health benefits (everything in moderation), its hard not to recommend it.

  11. @Henry Thanks for mentioning tea, the beverage of the gods! Thought for a moment it’s not known in the US :)

    I have also read that thing about tea being different, despite the caffeine in it, which is a massive relief, as I love my tea and am one of those people who get the ‘hangries’ really badly (I get migraine-type headaches, weakness, lightheadedness, churning stomach, inability to sleep at night for hunger, it’s that bad) and think I have a chronic high cortisol problem, as my memory has become really bad for my age since my mid-thirties (am 43 now), which can be one of the things affected by chronically raised cortisol I believe.

    I’m feeling a bit daunted right now, as I have just heard about IF and all the massive health benefits, and would really like to try the 5:2 fasting method (eat 5 days, fast 2), but now I’m a bit worried I might do more harm than good :(

    Fasting is sooo hard for me and makes me feel so bad, although I’ve had a few experiences where I’ve managed to overcome it, i.e. after a while it got easier, like once when I had such a bad mouth ulcer I could hardly eat :)

    The other time I managed to beat the hangries was when I was on holiday and had insomnia. I used a technique from a book to induce heart coherence, and suddenly my nightly hunger pangs and insomnia were completely gone, for that night but also for the rest of the holiday – like magic! The coherence thing must have switched my cortisol trigger off, or so it seemed. Sadly I’ve not managed to replicate this on an ongoing basis.

    Sorry about this life history – I was actually just meaning to post a brief comment on tea! So any advice welcome, maybe I should try something like paleo to repair my adrenal/digestive system… it was good to read your description of the hangries, as soemtimes i feel no one acknowledges that this problem exists. My mum for example can go for yonks without eating and isn’t affected, and she just doesn’t get what a life-or-death need for food it is. I know I’d find it really hard to give up refined carbs as I crave and love them, espeically bread, the worst of culprits I imagine, but will have a go. To make things even harder, I can’t eat nuts in any significant amounts. (I guess I’m not alone in that.)

  12. neoen93

    Hi .. so i see a lot of coffe debate. :))
    Well to be honest it seems to me that you are trying to judge coffe by a structure that’s already made in your head.
    The facts have to create a theory, when you try to twist facts to fit the theory you will not get the “real” thing.
    As its true for coffe, its true for Paleo & IF .. you have to try it .. you have to be prepared for some pains and bad moments. But you also can figure out what works and what doesn’t by experimenting.
    Don’t be fooled with what “scientist” say .. we are in totaly new teritory here and you should become your own little scientist if you are really trying to make a change.
    I will not say coffe or IF is good or not; because if you honestly experiment with yourself and your body you will find that sometimes things work and sometimes doesn’t .. so, you need to run the experiment again, and again, and again .. and keep record .. don’t allow yourself to judge something if you fail at first.
    Remember also that power of your mind and intention can overcome some fails at the begining .. it could be Placebo but .. if it works for you .. great.

  13. “when people get hungry they crave caffeine” I’ve never heard of this. The last thing I want when I’m hungry is caffeine. People crave caffeine after meals and when tired. Caffeine makes me hungry and irritable it doesn’t “cure” hunger. The act of of smoking or sipping on something takes your mind off of eating not caffeine.

    Caffeine is put in diet pills because it is a stimulant. It also increasing the effect of numerous ingredients and speeds up digestion. If you read up about diet pills there are different ingredient to help curb hunger and most websites explain each individually. They also have hundreds of non-stimulant diet pills.

    I’ve done every diet you can think of and the only one that actually works IMO is the IF diet. At least it works when busy and is the only diet that can be tailored easily to peoples lifestyles. It is also a complete contradiction to every other diet out there and can be considered the ONLY diet that allows you to maintain low body fat without drastic changes to your lifestyle.

  14. That’s a weird article.. Your IF warning is basically.. don’t do it if you have to depend on caffeine because IF might be fine but caffeine is bad for you? Is caffeine consumption somehow exclusively tied to IF?

    I think this should be title ‘A Warning About Caffeine’ and IF shouldn’t even be discussed in it. It’s completely out of context.

    • Steve – Yes, that was the basic premise, that in a lot of cases IF and caffeine are linked. I don’t think it’s out of context at all.

  15. Intermittent fasting does not require caffeine as part of it’s protocol. So you shouldn’t clump the two together.

    One of the ‘many’ benefits of caffeine pre workout is appetite suppression, so naturally those who train fasted whether following IF or not will appreciate this.

    As long as caffeine dosage is reasonable, you don’t have heart conditions, and you cycle off of caffeine from time to time, caffeine is a very beneficial aid for exercise whether your goal is adding muscle mass or especially in cutting body fat.

  16. Neely, I do not see a direct affect of Caffeine on your specific claims.

    I will go on to further say is that what you are supporting here anacdotal.

    Does the effects vary based on fasting periods? 16hr? 20hr?

    Please advise how much caffeine can one consume before it starts to affect someone?

    What about persons sensitivity to caffeine? If someone is already consuming say 3 cups of coffee a day based on 6 meals a day plan and then switches to IF?

  17. Hi Neely,

    any comments on yerba mate (mate tea)?

    • Seba – Just that if you’re trying to avoid caffeine, don’t drink it. I know it has a different effect on people – less of a jittery feeling and more of just an awake feeling. But it’s still a stimulant :)

  18. “Don’t get me wrong: eating Paleo carbs is generally way better for hypoglycemia than the carbs in a SAD diet”

    To the best of my knowledge, as I am an avid reader of the journals that both proponents and opponents of paleo derive much of their supporting arguments, this has long been proven false. If you’re referring to the institution of the GI index, GLoad Index to bolster this statement, these two measures are greatly misleading. They do not take into account a combined meal that includes various fats, sugars, and proteins, but instead just focus on lets say “the bread in a sandwich”…when you add meat, and cheese to that sandwich, both lower the GI of that meal and the resulting GL greatly. Just like a 20g shot of pure fructose will give you the relatively same insulin reaction as an apple, despite its fiber content. Also, quick digesting amino acids (protein) also trigger blood insulin spikes, but for some reason Paleo proponents don’t share that information. I’m not knocking paleo, but I do not believe that IF is a diet. It’s an eating protocol that aspires to include your total nutrient and caloric intake for a day, at a convenient time, within a designated window. The studies that represent IF as an advantageous protocol over traditional dieting, assuming exact same intake of macronutrients have been mostly done on mammals. Human testing is still in its infancy, though there are a few cases worth noting that I won’t go into. Lets also just say that the studies on IF are mostly independent and peer reviewed, whereas Paleo studies are cluttered with those sponsored by Paleo advocates, and published with affirmative outcomes—a rarity in responsible health studies (as 80% or more of them usually produce more questions or the dreaded statement “we still don’t know”)

  19. I remember reading somewhere that caffeine ACTUALLY proves catalytic against cancer cells in a fasted state.

    http://www.ncbi.nlm.nih.gov/pubmed/21081844

  20. You lost me when you said fasting for however long = starving yourself. Fasting and starving are two different things.

  21. This was a great article. The people criticizing this article are obviously IF’s and coffe drinkers getting defensive. I appreciated the fact that the author specifically went into how fasting can be harmful to those with hypoglycemia and adrenal issues. This is something that proponents of IF often leave out, causing the dangerous misconception that IF is or everyone. Every body is different and people have different types of health issues thank you for this REAL article for REAL people.

  22. Aaron

    Not sure where you getting the info about raised cortisol with IF. This seems like your a good writer with a healthy opinion. Quote some studies…

    • Neely

      Aaron – It’s a basic function of human physiology. When your blood sugar gets low, such as it does when you fast, cortisol is released in your body, which tells the liver to release glucose. That can be found in any physiology textbook, but here’s a wiki page to explain it. It’s called gluconeogenesis. http://en.wikipedia.org/wiki/Cortisol. Also, in your comment, it should be “you’re” – not “your”.

  23. I tried to skip breakfast in the past and only eat lunch but I used to get reactive hypoglycemia immediately after eating because (I suspect) a cortisol spike. It could go up to 180 immediately right after eating and 1h after it would be very very low. Now I eat breakfast and it still happens but I don’t get the hypoglycemia only the hyper after eating. It goes up to 170-180 if I test right after I finish eating but 1h after it will be fine. I have hashimotos but have no clue if this is relevant somehow. Also I was used to having 5-6 meals a day and constant hypoglycemia and now I can get 3 meals and a little snack in the afternoon so maybe it’s the transition. What can I do to prevent this from happening/overcome this? Is it a cause for concern and why do you think this happens?

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