Low blood sugar - a major problem for many people!
by Dr. Sarah Myhill
It is critically important for the body to maintain blood sugar levels within a narrow range. If the blood sugar level falls too low, energy supply to all tissues, particularly the brain, is impaired. However if blood sugar levels rise too high, this is very damaging to arteries and the long term effect of arterial disease is heart disease and strokes - this is probably caused by a local reaction in periarteriolar fat resulting in release of proinflammatory cytokines causing damage to arteries.
Normally the liver controls blood sugar levels. It makes the sugar from energy stores inside the liver and releases sugar into the blood stream minute by minute in a carefully regulated way to cope with body demands, which may fluctuate from minute to minute. This system of control works perfectly well until we upset it by eating the wrong thing. Eating excessive sugar at one meal, or excessive refined carbohydrate, which is rapidly digested into sugar, can suddenly overwhelm the liver's normal control of blood sugar levels.
We evolved over millions of years eating a diet that was very low in sugar and had no refined carbohydrate. Control of blood sugar therefore largely occurred as a result of eating this Stone Age diet and the fact that we were exercising vigorously, so any excessive sugar in the blood was quickly burned off. Nowadays the situation is different - we eat large amounts of sugar and refined carbohydrate and do not exercise enough in order to burn off this excessive sugar. The body therefore has to cope with this excessive sugar load by other mechanisms.
When food is digested, the sugars and other digestive products go straight from the gut in the portal veins to the liver, where they should all be mopped up by the liver and processed accordingly. Excessive sugar or refined carbohydrate overwhelms the liver, which simply cannot mop up the amount of sugar which is there and the sugar spills over into the systemic circulation. This results in high blood sugar, which is extremely damaging to arteries. If one were exercising hard, this would be quickly burned off. However, if one is not, then other mechanisms of control are brought into play. The key player here is insulin, a hormone excreted by the pancreas. This is very good at bringing blood sugar levels down and it does so by shunting the sugar into fat. There is then a rebound effect and blood sugars may well go too low. Low blood sugar is also dangerous to the body because the energy supplied to all tissues is impaired. It is when the blood sugar is low that this is called hypoglycaemia. Subconsciously people quickly work out that eating more sugar alleviates these symptoms, but of course they invariably overdo things, the blood sugar level then goes high and one ends up on a rollercoaster ride of blood sugar going up and down throughout the day.
Symptoms of Hypoglycaemia
The problem is that when the blood sugar is high people feel "normal", indeed, maybe slightly boosted by this high level of blood sugar. This is because they have good energy supply to their muscles and brain albeit short-term. The problem arises when blood sugar levels dive as a result of insulin being released and energy supply to the brain and the body is suddenly impaired. This results in a whole host of symptoms - the brain symptoms include difficulty thinking clearly, feeling spaced out and dizzy, poor word finding ability, foggy brain and sometimes even blurred vision or tinnitus. The body symptoms include suddenly feeling very weak and lethargic, feeling faint and slightly shaky, rumbling tummy and a craving for sweet things. The sufferer may look as if they are about to faint (and indeed often do) and have to sit down and rest. The symptoms can be quickly alleviated by eating something sweet - if nothing is done then the sufferer gradually recovers. These symptoms of hypoglycaemia can be brought upon by missing a meal (or one's usual sweet snack top up such as a sweet drink), by vigorous exercise or by alcohol. Diabetics may become hypoglycaemic if they use too much medication.
When blood glucose levels fall for any reason, glycogen stores in the liver many be mobilised to prop them up. The trouble is that these are probably already rather poor in people with increased carbohydrate intake, where insulin is relied on heavily. Another rapid and very effective way in which the body repletes the low glucose is by hepatic conversion of short chain fatty acids to glucose. In a healthy person on a good balanced diet the only time this is of importance is during the night because of the long break between food intake. Short chain fatty acids are then used to prop up circulating glucose and prevent a fall below whatever that person's usual fasting glucose level is. Short chain fatty acids are made in the gut by bacteria fermenting fibre (and such starch as escapes small intestinal digestion). Production is maximised from about 3 hours after food intake. That is to say, short chain fatty acids are highly protective against the dips we see in blood sugar.
Therefore, a key symptom of a hypoglycaemic tendency is disturbed sleep. This occurs typically at 2 - 3 am, when blood sugar levels fall and there are insufficient short chain fatty acids to maintain a blood sugar. Low blood sugar is potentially serious to the brain, which can only survive on sugar and, therefore, there is an adrenalin reaction to bring the blood sugar back, but this wakes the sleeper up at the same time.
Test for Hypoglycaemia
Measuring blood sugar levels is not a terribly useful test for hypoglycaemia, partly because they fluctuate so much and partly because by the time one gets the symptoms of hypoglycaemia, the blood sugar levels have started to correct. A much better test would be to measure short chain fatty acids in blood collected in the morning before breakfast. The test should be done as follows:
It is important to continue your usual diet - indeed, there are no special dietary instructions for the test, but the blood sample must be taken between 9 - 12 hours after a meal;
2 ml of blood taken into a fluoride oxalate tube and posted off in an envelope to Acumen.
There is a final twist to the hypoglycaemic tale which complicates the situation further. When one becomes stressed for whatever reason, one releases stress hormones in order to allow one to cope with that stress. Insulin is such a stress hormone and has the effect of shunting sugar in the blood stream into cells. This produces a drop in blood sugar levels and also causes hypoglycaemia. Therefore, hypoglycaemia can be both a cause of stress and the result of stress, indeed, another one of those vicious cycles that are so often seen in disease states.
Treatment of Hypoglycaemia
Treatment is to avoid all foods containing sugar and refined carbohydrate. The problem for the established hypoglycaemic is that it may take many weeks or indeed months for the liver to regain full control of blood sugar and therefore the symptoms of hypoglycaemia may persist for some time whilst the sufferer continues to avoid sugar and refined carbohydrate. This means that when you change your diet you will get withdrawal symptoms and it may take many weeks of a correct diet before these symptoms resolve. This type of addiction is very much like that which the smoker or the heavy drinker suffers from.
One needs to switch to a diet which concentrates on eating proteins, fats and complex (and therefore slowly digested) carbohydrates. Initially I suggest doing a high protein high fat diet, but include all vegetables (care with potato), nuts, seeds, etc. Fruit is permitted but rationed, since excessive amount of fruit juices or dried fruits contain too much fruit sugar for the liver to be able to deal with. I suggest one piece of fruit at mealtimes.
I now consider taking high dose probiotics an essential part of controlling low blood sugar. This is because probiotics ferment carbohydrates to short chain fatty acids - these have no effect on blood sugar and are the preferred fuel of mitochondria. The best and cheapest way to do this is to brew your own - see section on probiotics! Probiotics also displace yeast, which worsen the hypoglycaemia problem.
With time the regime can be relaxed, but a return to excessive sugar and refined carbohydrate means the problem starts again.
Finally, many sufferers of hypoglycaemia may need something sweet to eat immediately before and during vigorous exercise, until the body learns to fully adapt.
Hypoglycaemia is usually accompanied by micronutrient deficiencies. You should also take nutritional supplements. My experience is that chronic hypoglycaemia is a very common cause of fatigue in CFS sufferers.
To tackle hypoglycaemia one needs to do a diet based on foods of low glycaemic index. The GI is a measure of the ability of foods to raise one's blood sugar levels. Sugar (i.e. disaccharides) have arbitrarily been given a GI of 100. High GI foods are the grains (wheat, rye, oats rice etc), root vegetables (potato, sweet potato, yam, parsnip), alcohol, sugars, and fruits, dried fruits and fruit juices. But expect to see withdrawal symptoms which can persist for weeks.