Background and AimsNutritional 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. Materials and MethodsTwelve 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. ResultsThere 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). ConclusionsThe 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.