Adrenergic Postprandial Syndrome: What is it?

If you have normal blood sugar concentrations (from 70mg/dL to 120mg/dL) but are experiencing hypoglycemia symptoms (palpitations, sweating, tremors, anxiety and nausea), you could be suffering from adrenergic postprandial syndrome.

What is Adrenergic Postprandial Syndrome?

Adrenergic postprandial syndrome is caused by abnormalities in the autonomic adregenic counterregulation system in your body. The adrenergic syndrome gives you the same symptoms as hypoglycemia but avoids the actual blood sugar crash by using epinephrine and adrenaline to counter the biochemical mechanisms that would have caused true hypoglycemia. It isn’t a “false” disease — you’re still experiencing actual symptoms due to an excess of hormones and chemicals in your body.

What causes Adrenergic Postprandial Syndrome?

Adrenergic postprandial syndrome is a dysregulation of your autonomic nervous system. It’s sometimes called pseudohypoglycemia or non-hypoglycemia but in fact, hypoglycemia isn’t involved in the process at all.

Why Do I get Symptoms if I don’t Have Hypoglycemia?

When blood sugar gets too low, the body produces epinephrine and glucagon to counteract the low blood sugar and return levels to normal. In normal people, this counterregulation happens at under 50mg/dL. However, in adrenergic postprandial syndrome, the response occurs at much higher levels. Epinephrine (adrenalin) is the hormone that makes you feel jittery when something suddenly happens (like being in a fender bender). Put simply: the symptoms you experience with adrenergic postprandial syndrome are due to the release of epinephrine into your bloodstream.

What is the Treatment for Adrenergic Postprandial Syndrome?

adrenergic postprandial syndrome

Can food be causing your adrenergic postprandial syndrome? Image: Moyan Brenn | Flickr

Although you don’t get a blood sugar crash, the syndrome has the same root cause as reactive hypoglycemia: your diet. Therefore, you should eat a reactive hypoglycemia diet, free of simple carbs (like sugar and white pasta) and full of protein, vegetables, nuts and other healthful choices. See this article on the reactive hypoglycemia diet for where to start.

18 thoughts on “Adrenergic Postprandial Syndrome: What is it?

  1. Jeri

    Caffeine intake seems to cause the same reaction in me as does carb intake. Is there a connection between caffeine intake and this response?

    As far as my diet is concerned, I do eat small, frequent meals and I try to include a good protein intake with any carbs I eat. When I do this, I am able to avoid the unpleasant symptoms of this condition.

  2. Christina

    Hi Stephanie,
    When I was first diagnosed with reactive hypoglycemia (after getting tested because of diabetes like symptoms and a family history) I quickly became frustrated because recording my sugars throughout the day didn’t show any glucose levels below normal. What I noticed instead were the quick drops in glucose which I believe result in my hypoglycemic symptoms.
    Would it be correct to assume that my symptoms then are most likely caused by adrenergic postprandial syndrome and not reactive hypoglycemia?

  3. Alin

    Over the last 5 years I developed a symptom that bothers me and I’ve been trying to find a cure. No success yet.
    The symptom is this: extremely strong heart beat after eating carbohydrates food mostly (but sometimes happened when eating chicken wings, for example), that if it happens in the evening, it won’t allow me to sleep the entire night. I feel the heart pounding in my ear, stomach, arms, very strong, and cannot sleep at all.
    Yesterday I went to do a glucose tolerance test and the results are the following:
    0 hour glucose level (fasting) – 78
    here is where I drank the glucose solution
    1 hour glucose level – 166
    2 hour glucose level – 101
    3 hour glucose level – 53
    then, when I got home, I used my tool to take the glucose level at the
    4 hour and was 90.
    Now, I really have to mention that about 20-30 minutes after I drank the solution, I got the symptom of strong heart beat, as I usually get when eating carbs and lasted for about an hour. The blood pressure went up from 118/70 (before drink) to 136/72. The symptom of strong heart beat lasted for about one hour and a half. Then, I felt like it went down.

    My physician is not sure what to say about numbers. She thought that the drop to 53 from 101 is too much and I might be to some degree insulin resistant or have adrenergic postprandial syndrome or hypoglycemia , but she is not sure.
    What do you think it is?

    1. Steph_anie

      I’m not a physician, so I can’t say. But I would go to an endocrinologist. If your insulin levels were taken at the same time as glucose, they will be able to narrow the field down.

  4. Pat Acker

    Thank you for this article. My mother, my sister’s and I all have suffered from this for years. I am so grateful to have a place to start in exploring this. Why has none of my doctor’s ever had an answer to this!

  5. Ashley

    I’m almost a hundred percent sure I have this syndrome. The only reason why I say is almost is because I have yet to be diagnosed by a doctor. However, my picture should be put next to the symptoms of this syndrome as I experience ALL of them either when I have a high-carbohydrate meal that is not balanced with the right amount of protein and fats, when I have a sugary sweet, or when I have caffeine. My whole life, keeping my blood sugar steady so that I do not experience what I call a “blood sugar attack” has been quite the balancing act! I’m having a hard time understanding why this syndrome occurs though. I know it has to do with the autonomic counterregulation system, but why do some people’s bodies overreact like this? Why doesn’t low blood sugar ever occur in a person with this syndrome? Is it an inborn error? It’s almost like my brain senses an insulin spike as an attack and does whatever it can to raise my blood sugar even if it is not low or going to be low. I was reading an article on Wikipedia about the glucose counterregulatory hormones and it says that recurrent exposure to these glucose hormones that counterract insulin renders a person insulin resistant. I have developed insulin resistance (at the age of 19, healthy weight, very active) and am predicted to have diabetes in 10-20 years, so I’m almost a hundred percent sure that undiagnosed adrenergic postprandial syndrome for 19 years has caused me to become insulin resistant. Does anyone else have a similar experience?

  6. Kevin Somers

    First let me thank you for helping others through your own experiences. I am a 48 year old male and I have been battling a phantom for as long as I can remember. I have spent a lifetime of savings trying to feel better. My main symptom is chronic migraines, 15 to 20 a month, that I have had for most of my adult life. I found your site and wanted to ask about your knowledge and experiences with migraine headaches related to RH. I, like many I have read about, I eat constantly to try and fight off the headaches. I am on a very strict diet, no sugar, GF, only water to drink, very little dairy, vegetables, and healthy meat. I eat 6 to 8 tines a day and I do find that it helps my headaches somewhat. Unfortunately, this diet has not stopped the headaches, anxiety, etc. I have had the G Test and it showed normal. I test my blood often and it is always normal but I never see levels over 100 no matter what I eat. I was diagnosed with RMSSF back in July but I question if that diagnosis was correct. I show antibodies, like I have an infection, but I don’t. My doctor has no clue. I would appreciate any information you have on anyone you are aware of that has these issues and what they have found out. Thank you for your help….

  7. Ben

    I have the same thing as Jeri * who is the first commenter on this blog.
    I have had this experience for years actually, and when I first started having this I thought I was going mad. Doctors of course dismissing it for anxiety, but how can anxiety exist ONLY when I consume caffeine and never before in my personal history? Of course the answer to me was simple, I didn’t understand why but I of course avoided caffeine like the plague.

  8. lois taylor

    I need to know where you got the technical info on adrenergic postprandial etc. I know I have it very severely but can’t find a Dr. to confirm or even will recognize it. please help if you can.Send info to my email. thanks,Lois.

  9. Joelma Moser

    Hi Stephe! Your website is fabouls!
    You put in the place all stuff about hypoglycemia! I could discover all kind o fit is my type, but I was in a diet low carb diet and low glicemic diet. Months after I started having problems, like reactive hypoglicemia. Probably this kind in this topic….the worst part is that I having a kind of periferic neuropatia :-( do You thing that some antioxidant suplement could help wit this?
    Thanks a lot.

  10. Lynn Manheim

    I’m now 66 and have had reactive hypoglycemia (probably more accurately “postprandial adrenergic syndrome) since my mid-20s which I controlled merely by never eating white rice, flour or any kind of refined sugar. I would feel the symptoms if I accidentally ate something with a concentrated sweetener in the ingredients.

    About two months ago, after eating the same breakfast I’d had for many years (two oranges and plain oatmeal), I was overwhelmingly fatigued–a clear postprandial adrenergic reaction. I stopped eating that, and other fruits, which caused the same reaction, although not as severe. A few days later, after acquiring a glucose meter, I experimented with the oranges and oatmeal breakfast. An hour after the meal my glucose was at 158. Just 13 minutes later it (and I) had crashed to 95. Out of test strips, I couldn’t ascertain how low it actually went.

    My doctor, and subsequently a really nasty endocrinologist I saw, obviously have little to no experience with this. I want to know what has changed in my body to make me suddenly so sensitive to fruit, and what the underlying cause is. My (regular) bloodwork is absolutely perfect in every way, showing no insulinoma, no thyroid problem, and no diabetes (with fasting glucose right at 80).

    I’m in the New York City area, and sometimes in the Scranton, Pennsylvania area. If anybody can recommend an endocrinologist or other kind of doctor who: 1) believes that this exists; and 2) works actively with patients to determine the cause, I would be very grateful to know his/her name! Please email me at LManheim at aol dot com.


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