title: Treatment of reactive hypoglycemia with the macrobiotic Ma-pi 2 diet as assessed by continuous glucose monitoring: The MAHYP randomized crossover trial.
abstract: OBJECTIVE
  Nutritional therapy is recommended for management of reactive hypoglycemia (RH), a condition characterized by hypoglycemia that occurs within four hours after a meal. The macrobiotic Ma-Pi 2 diet improves glycemic control in subjects with type 2 diabetes. We explored the effect of this diet on outcomes in non-diabetic individuals with RH.
  
  
  METHODS
  Twelve subjects with RH were randomized to the Ma-Pi 2 diet for three days and a control diet for three days in a randomized crossover design. Subjects received snacks on two days out of each three-day period only, and were monitored using continuous glucose monitoring. The 24-h period was divided into daytime (08:00-22:30h [subdivided into 'daytime without snacks' and 'daytime with snacks']) and night-time (22:31-07:59h). The effects of the two diets on the number of RH events (blood glucose <70mg/dL [3.9mmol/L]) and the percentage distribution of glucose readings within each of 16 glycemic intervals from <40mg/dL (2.2mmol/L) to >180mg/dL (4.4mmol/L) were determined.
  
  
  RESULTS
  There were significantly fewer RH events on the Ma-Pi 2 diet than the control diet during daytime without snacks (-2.5 events; 95% CI: -7.5, 0.0; P=0.022) and daytime with snacks (-4.25 events; 95% CI: -7.5; -2.0; P=0.013) but no difference at night. The percentage of glucose readings in the interval 71-80mg/dL (3.9-4.4mmol/L) was significantly higher on the control diet during daytime with and without snacks (P=0.03 for both), while the percentage of glucose readings in the interval 91-100mg/dL (5.1-5.6mmol/L) was significantly higher on the Ma-Pi 2 diet during daytime without snacks (P=0.02).
  
  
  CONCLUSIONS
  The macrobiotic Ma-Pi 2 diet reduced blood glucose excursions during the day, thereby facilitating glycemic control in subjects with RH. The Ma-Pi 2 diet represents an effective nutritional tool for management of RH.
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Andreea
authors.initials: A
authors.lastname: Soare
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Yeganeh Manon
authors.initials: YM
authors.lastname: Khazrai
authors.affiliation: Unit of Dietology and Diabetology, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Fontana
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Del Toro
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Lazzaro
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Di Rosa
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Antonia
authors.initials: A
authors.lastname: Buldo
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Fioriti
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Maddaloni
authors.affiliation: Laboratory of Clinical Pathology and Microbiology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Angeletti
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Mauro
authors.affiliation: Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic Marche University, Ancona, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Gesuita
authors.affiliation: Center of Epidemiology, Biostatistics and Medical Information Technology, Polytechnic Marche University, Ancona, Italy.
authors.forename: Edlira
authors.initials: E
authors.lastname: Skrami
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Tuccinardi
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Fallucca
authors.affiliation: International Study Center for Environment, Agriculture, Food, Health and Economics, Tolentino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pianesi
authors.affiliation: Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy; Centre for Immunobiology, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK. Electronic address: p.pozzilli@unicampus.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pozzilli
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D001835:Body Weight; D018592:Cross-Over Studies; D015623:Diet, Macrobiotic; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D062410:Snacks; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: Continuous glucose monitoring; Macrobiotic Ma-pi 2 diet; Reactive hypoglycemia; Type-2 diabetes