Richard Podell, MD, is a clinical professor at New Jersey's Robert Wood Johnson Medical School. He has special interests in chronic fatigue syndrome, fibromyalgia, stress-related disorders, and clinical nutrition. Dr. Podell has offices in Springfield and Somerset, New Jersey. For more information, see DrPodell.org.
Dr. Podell has found in his clinical practice that “people with any chronic illness tend to develop a set of self-defeating vicious cycles” – and places high priority on reversing them. (See “Reversing Eight Vicious Cycles that Block Healing.”) Blood sugar instability is one of these cycles.
Low blood sugar or hypoglycemia symptoms typically worsen several hours after a meal. However, scientific studies now show that there’s much more to hypoglycemia symptoms and hypoglycemia treatments than just stabilizing blood sugar. The adrenal stress hormones, adrenalin and cortisol, are critically involved.
In fact, most hypoglycemia symptoms are caused not by low blood sugar per se, but by an over-reaction of adrenalin and cortisol discharge – part of the body’s defense against blood sugar’s falling too low. A broad holistic approach to hypoglycemia treatments provides the best results. (Following is a description of hypoglycemia symptoms, diagnosis, and the four elements of holistic treatment & healing.)
Potential Hypoglycemia Symptoms
– Feeling hungry or needing to eat very often
– Feeling anxious or nervous
– Feeling light headed or foggy
– Sweating, palpitations or rapid heart
– Chronic fatigue
– Poor sleep
– Anxiety and/or depression
– Feeling faint
– Hyperventilation or shortness of breath
If unusually severe, hypoglycemia symptoms can also include fainting, epileptic seizures, or even a heart attack or a stroke. However, don’t assume that hypoglycemia is the one or only cause of these symptoms. Other forms of illness can be the main cause, with hypoglycemia playing either no role at all, a minor but significant part, or as a major exacerbating factor to any other physical or mental illness.
Diet-induced Hypoglycemia Symptoms versus Hypoglycemia Symptoms Due to Diabetes
Too much insulin or oral medicine for diabetes can drive blood sugar (glucose) down very low. This directly can cause hypoglycemia symptoms. Hypoglycemia treatment for a person with diabetes requires promptly taking sugar, orally or by intravenous.
Dietary hypoglycemia symptoms trigger by a different, somewhat indirect path. Normally, for people who don’t have hypoglycemia symptoms, blood sugar (glucose) rises after a meal. Then the pancreatic hormone, insulin, kicks-in, driving blood sugar back down. The low point or nadir of the blood sugar curve occurs three or four hours after eating.
At the low blood sugar nadir, the adrenal glands fire-off modest amounts of two anti-hypoglycemia hormones, adrenalin/epinephrine and cortisol. These anti-hypoglycemia hormones, promptly drive blood sugar levels back up to the level it was before you ate – in effect, a natural hypoglycemia treatment. No hypoglycemia symptoms occur. Among people who are well, no further hypoglycemia treatments are needed.
People with diet-induced hypoglycemia, in contrast, are hormonally-primed so that their hypoglycemia-regulating hormones tend to over-react.
Among people with dietary hypoglycemia:
• As blood sugar rises after eating, the pancreas tends to overshoot, firing too much of the blood-sugar lowering hormone, insulin.
• This drives blood sugar down faster and further than it should.
• In response, the adrenal glands somehow "recognize" the need for an emergency hypoglycemia treatment to block blood sugar from crashing.
• The body reacts with a massive discharge of adrenalin and cortisol.
• Adrenalin and cortisol do brake, and then reverse, the falling blood sugar.
But now, the body’s anti-hypoglycemia treatment itself becomes the problem. In excess, these “natural hormone” hypoglycemia treatments can cause a terrible range of symptoms.
• Adrenalin/epinephrine, the “fight or flight” hormone, grossly over-stimulates, causing “low blood sugar symptoms” of anxiety, rapid heart rate, foggy thinking and fatigue.
• High cortisone, if frequent or prolonged, also mimics low blood sugar symptoms, tending to make us fat, sluggish and depressed.
So for dietary hypoglycemia, most often, it’s not low blood sugar per se that causes most of the symptoms. They’re primarily the side effects from too much adrenalin and cortisol.
Researchers at the National Institutes of Health proved the critical role of adrenalin and cortisol for hypoglycemia symptoms way back in 1984, publishing in JAMA – the Journal of the American Medical Association.
How to Diagnose Hypoglycemia Symptoms – the first step toward hypoglycemia treatments
• Suspect low blood sugar symptoms if any symptoms tend to get worse if your meal is delayed, or if symptoms increase 3 to 4 hours after eating.
• Suspect low blood sugar symptoms if symptoms worsen several hours after eating a large amount of sugars, refined carbohydrates, caffeine, alcohol or “junk” food, and if you tend to improve after “cleaning up” your diet.
• Suspect hypoglycemia symptoms if you feel a need to eat many times a day.
• Suspect that low blood sugar symptoms may be part (not necessarily all) of the problem if you are chronically tired or nervous or just not feeling well with or without a clearly diagnosed illness.
Note: Almost any physical or mental health problem increases vulnerability to hypoglycemia symptoms. Hypoglycemia symptoms, in turn, worsen physical and mental illness. The result: a vicious cycle that helps keep people ill. Hence, the importance of proper hypoglycemia treatments, and these, therefore, require attention to: Your standard medical therapies, dietary hypoglycemia treatments, and broad and consistent support for the body’s natural healing systems.
Correcting Hypoglycemia – The Four Elements
Correcting low blood sugar or hypoglycemia requires four crucial elements. Low blood sugar diets are only one of these main components. All four are important.
1. In consultation with your health professional advisor choose one from among the several different available hypoglycemia diets. Making this choice correctly is a major focus of our office consultations.
2. Select nutritional supplements to increase the effectiveness of your low blood sugar diet
3. Identify and treat physical and psychological illnesses that bring out or worsen vulnerability to hypoglycemia. Such accompanying health issues are almost always also present.
4. Provide holistic support for your body’s natural healing systems, thereby reducing low blood sugar reactivity. The most important of these strategies:
– Relaxation skills
– Training to reduce the effects of stress
– Retraining distressed breathing
– Just the right amount of exercise
– Better sleep.
Hypoglycemia Diets (Low Blood Sugar Diets)
There are two main, different types of low blood sugar diets:
• Low carbohydrate hypoglycemia diets, which reduce all forms of carbohydrates, thereby increasing protein and fat.
• High carbohydrate low blood sugar diets. These hypoglycemia diets reduce intake of simple sugars, breads, and all processed grains. In contrast, they expand emphasis on vegetables, fruits, berries and whole grains.
Despite their key differences, both of these low blood sugar hypoglycemia diets have important factors in common:
1. These hypoglycemia diets all recommend eating smaller but more frequent meals, with between meal snacks.
2. All low blood sugar diets reduce intake of sugars of all kinds (including molasses and honey) and, as important, simple, processed carbohydrates; for example, most breads, cereals, potatoes, and rice. The reason for reducing these frequently eaten foods: The digestive system converts most processed carbohydrates rapidly into sugar. Thus, for hypoglycemia diets, whole wheat bread is just as bad as white bread.
3. Reducing or eliminating caffeine is an effective aide to any hypoglycemia diet. (But taper off slowly since caffeine withdrawal symptoms can be fierce).
4. Reducing alcohol is also important for low blood sugar diets (But taper off in steps if you drink a lot, since alcohol withdrawal symptoms can be very dangerous).
5. Adding a small amount of protein or a modest amount of fat along with each carbohydrate serving helps most hypoglycemia diets. This slows the rate of food passing through the stomach.
With slower passage through the stomach, blood sugar increases less rapidly after eating. The less rapid rise in blood sugar reduces the insulin response. Less insulin means that blood sugar falls more slowly. Blood sugar falling slowly makes the destructive over-reaction of adrenalin and cortisol less necessary to prevent sugar from falling too low. With adrenalin and cortisol under control, hypoglycemia symptoms resolve.
6. Olive oil is particularly effective for low blood sugar diets, because of its exceptionally high ability to slow the stomach down. A giant benefit, for relatively few calories. Add one to three teaspoons of olive oil to each meal to strengthen your low blood sugar diet. Spread the olive oil on your food or take it straight from the teaspoon. Once the low blood sugar diets are working well, you can cut back on your olive oil dose.
Which of the low blood sugar diets is best for your individual needs?
Each version of the hypoglycemia diet has its pros and cons. When we see patients in the office, we help you select which diet is best for your individual needs.
Surprisingly we find that for about 80% of our patients with hypoglycemia the best hypoglycemia diets are those that are relatively high in total carbohydrates, but very low in sugar and most grains. Instead, take your carbs almost all from colored fruits, vegetables, berries, and selected, coarse whole grains.
Dr. Walter Willett, chairman of nutrition at the Harvard School of Public Health, has endorsed this eating style, as probably the healthiest nutrition for most of us – whether or not we need a “hypoglycemia” diet. Dr. Willett’s research has completely revised the traditional food pyramid. Instead of breads and grains forming the broad base with fruits, vegetables, nuts and seeds an afterthought, the new, modern pyramid creates a much larger space at the base for these highly nutritious, whole foods. [As explained in his book, Eat, Drink, and be Healthy: The Harvard Medical School Guide to Healthy Eating.]
However, despite the increasing recognition of this Mediterranean Style approach to eating, in our office we still find that about 20% of people continue to do better on an over-all low carbohydrate diet, much as older generation nutritionists advocated, including Robert Atkins, MD, and Carlton Fredericks, PhD.
Select Nutritional Supplements that Increase the Benefit from Hypoglycemia Diets
Nutritional supplements that complement hypoglycemia diets: Start with a broad based multi-vitamin. If your hypoglycemia diet contains enough colored fruits, vegetables and berries, you might not need much more in the way of supplements. However, often we find the following additional nutrients are useful:
• Chromium 50-200 ugms a day
• Fish oil (omega-3) 1 to 3 grams a day
• Magnesium: 200-500 mg a day (start low and build up; watch out for diarrhea)
• Selenium 200 ugms daily
• N-Acetyl Cysteine 300-600 mg daily (a precursor of the antioxidant and detoxifying factor: glutathione)
Factors/Stressors that Bring Out Hypoglycemia Vulnerability
Strengthen your low blood sugar diets by identifying and treating the common physical and psychological conditions that bring out or worsen hypoglycemia diet vulnerability.
The search for physical and mental stressors is a critical part of our office evaluation. Often, these are the factors that stress the blood sugar/insulin/adrenal axis, which is what makes us vulnerable to hypoglycemia in the first place. This feeds then into a vicious cycle. The worse you feel, the worse your hypoglycemia, the worse your hypoglycemia, the worse you feel, etc, etc.
So it’s important to identify and treat any physical dysfunction, including low thyroid, unidentified infection, digestive disorders. Similarly, if you tend to feel stressed or depressed, these mental stressors also bring out hypoglycemia. Hypoglycemia, in turn, make psychological symptoms worse. Again, a vicious cycle.
A hypoglycemia diet, and treating the physical and mental stressors, is how you achieve the very best result.
Provide Holistic Support for Your Body’s Natural Healing Systems
When we see patients in the office we systematically review the function of each of the body’s major physiological systems, identify sub-par function and take steps to correct them. Again, a low blood sugar diet, plus holistic support is much more effective than a hypoglycemia diet alone. Among the most important systems to look at:
• Gastroenterology (G.I.) function: Including digestion, absorption, balance of bacterial flora, yeast, food allergies, etc.
• Liver detoxification systems: How the body processes and eliminates both foreign chemicals and metabolic waste products.
• The rhythm of breathing and breathing’s intimate relationship to the brain’s “relaxation response.”
• The immune system, and the immune system’s relationship to both the brain and the gut.
• Biomechanics – the muscle-skeletal system’s stresses and strains.
• Restorative sleep.
• Hormonal balance: thyroid, adrenal, sex hormones and others.
• Exercise – not too much or too little – the Goldilocks Principle.
Related Materials of Interest
See Dr. Podell’s articles on:
Richard Podell, MD
The Podell and King Medical Practice
105 Morris Avenue, Suite 200
Springfield, NJ 07081
Somerset, NJ office: 732-565-9224
This article is reproduced here with kind permission of Dr. Podell, from his educational website (DrPodell.org). © 2002 Podell & King Medical Practice.
Note: This information has not been evaluated by the FDA. It is for general information purposes only and is not meant to prevent, diagnose, treat, or cure any condition, illness, condition, or disease. It is very important that you make no change in your healthcare plan or regimen without researching and discussing it with your professional healthcare team.