Reactive hypoglycemia, allergies, or other suggestions?

I struggle with palpitations - an intense pounding in my chest and a rise in pulse AFTER eating. I've had a full cardiac workup and been told that the heart is not the cause. Heart monitors confirmed that my pulse rises anywhere from 30 min. to a couple of hours after eating and can stay there for hours, but the monitors also show that the palps are the symptom of "something else" and not caused by the heart. Had to go on beta blockers as a precaution. My cardiologist is confused and wants me to look into other causes as the heart is being greatly affected. Even my mood changes after eating - irritable, nervous, lethargic, anxious, weak and general uncomfortable feeling - lasts for several hours after food. Can't determine specific food triggers other than wine which I've stopped drinking as it intensified the symptoms. Only 1 glass with dinner would rev up my entire nervous system. SO uncomfortable. Don't drink any other type of alcohol. I've had a fasting glucose test (normal) but wondered why I would get a fasting glucose when I feel best in the morning before eating and between meals. As soon as I eat something, my body, metabolism, nervous system etc. goes into some kind overdrive. Insulin reaction?? Diabetes runs in both sides of my family.

Questions:
1) Could I have REACTIVE hypoglycemia? If so, what is the best test for that? GP tells me fasting glucose would cover that....even though I have the problems in response to food.
2) Don't get hives/rash after food so my GP won't test for food allergies/sensitivities. Could this be a possibility? If so, what kind of test is ordered for food sensitivities?
3) Any other suggestions? I know these symptoms are odd, but they are consistent and I have recreated them many times on the heart monitor after ingesting food (shown as sinus tachycardia but without the cause).

It is frustrating as it is getting worse. Started with only wine and has progressed to every meal. Doctors seem to lose interest once they are confused by the symptoms so I have not been tested for things that may be obvious.

* I don't smoke or consume caffeine. Have normal blood pressure (more on the low side of normal), no heartburn/GERD, no anxiety/depression, normal basic blood work up, and have had a 24 hour urine test for hormones.

Many thanks in advance for your thoughts.

[Kevin Pho, MD]

To answer your questions:
1) A fasting glucose would make reactive hypoglycemia less likely.  One option would be to take a fingerstick glucose test in the midst of your symptoms.

2) Food allergies are possible.  Allergy testing with an allergist would be the reasonable next step to evaluate this cause.

3) If the heart has been looked at thoroughly and cardiac cause ruled out, you can consider carcinoid syndrome - which can cause palpitations and flushing after food.  A urine test for 5-HIAA can be considered.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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