by Matthew Hogg BSc (Hons) (Nutritional Health)
Hypoglycemia is the medical term for low blood sugar (glucose). Our bodies must maintain blood sugar at a certain level, just as they must maintain blood pressure, heart rate, respiratory rate and a host of other factors such as acid/alkali balance (pH). If blood sugar levels are allowed to fall too low, a large number of symptoms arise as the glucose fuel is not delivered to the cells and aerobic energy production becomes less efficient. The brain is particularly affected as it can only derive energy from glucose, unlike the rest of the body which can also generate energy from fats, and indirectly from protein. You can keep track of these levels with a blood glucose meter.
Since a stable supply of glucose is required for the efficient functioning of every cell in the body, hypoglycemia can cause a wide range of symptoms affecting the whole body. Since the brain is most sensitive to changes in blood sugar levels however, the first signs of hypoglycemia are typically nervousness, faintness, dizziness, weakness etc.
Below is a list of hypoglycemia symptoms compiled by Dr. S. Gyland, a hypoglycemia specialist and a sufferer himself. This list was produced after Dr. Gyland has treated hundreds of patients for this condition.
Experienced by over 90% of hypoglycemics:
Experienced by over 80%:
- Unexplained tiredness/Exhaustion
- Cold Sweats
- Weakness (especially noticeable as being "weak at the knees")
Experienced by over 70%:
Experienced by over 60%:
- Digestive disturbances
- Constant worrying
Experienced by over 50%:
- Confused thinking
- Muscle pain
Experienced by over 40%:
- Unsocial, asocial, or antisocial behaviour
- Crying spells
- Lack of sex drive
- Lack of coordination
- Muscle Cramps
- Poor concentration
- Blurred vision
- Twitching and jerking muscles
Experienced by over 30%:
- Itching and crawling sensations on the skin
- Gasping for breath
- Smothering spell
- Sighing and yawning
Experienced by over 20%:
- Impotency (males)
- Night terrors
- Skin conditions
- Suicidal impulses
Experienced by over 10%:
- Nervous breakdowns
Experienced by over 2%:
How does the body control blood sugar levels?
When we eat, our bodies break down carbohydrates from foods such as bread, rice, pasta, vegetables, fruit and milk products, into various sugar molecules. Ultimately these sugar molecules are broken down into glucose, the main energy source for the body. Glucose is absorbed directly into the bloodstream after food is consumed and digested, but it can't enter the cells of most of the body's tissues unless insulin is also present Insulin is a hormone secreted by the pancreas.
When blood sugar levels rise, they signal cells, called beta cells, in the pancreas to release insulin. The presence of insulin in the bloodstream allows cells to take in glucose for use in energy production, and also signals the liver to reduce glucose production (we will learn about the liver's role shortly). This action of insulin lowers the amount of glucose in the bloodstream and prevents it from reaching high levels, which also have bad effects on health (diabetes). In a healthy individual, as blood sugar levels return to normal, so does the secretion of insulin from the pancreas, ensuring that the blood sugar level doesn't dip too low and result in hypoglycemia and associated symptoms.
The liver also plays an important role in maintaining blood sugar levels. After a meal, when blood sugar and insulin levels are elevated, the liver takes up excess glucose and stores it in the form of glycogen. Along with insulin, this process helps to prevent blood sugar levels rising too high. Between meals, when blood sugar and insulin levels drop, the liver breaks down stored glycogen into glucose, and releases it back into the bloodstream, preventing blood sugar levels from dipping too low. Should the supply of glucose to the body be disrupted, the liver is also capable of producing extra glucose itself, through a process called gluconeogenesis. The liver uses various glucose precursors to manufacture glucose.
Through all the above mechanisms the healthy body is able to maintain blood sugar levels within a narrow range, ensuring smooth production of energy within the body's cells and avoiding the adverse effects of blood sugar levels straying too far from this range.
How does hypoglycemia occur?
In the medical literature, the most common cause of hypoglycemia is an incorrect dose of insulin in people with diabetes. In people who don't have diabetes, common causes of hypoglycemia include:
Mistaken Medicine Use - Accidentally taking someone else's oral diabetes medication is a common cause of hypoglycemia.
Other Medicines - Aside from diabetes medications, there are a number of other medicines that can have the effect of lowering blood sugar levels. One of the most commonly used medicines that may have this effect is quinine, which is used in the treatment of malaria and leg cramps.
Alcohol Consumption - High alcohol consumption can interfere with glucose metabolism. Excessive intake of alcohol can deplete the liver's stores of glycogen and reduce its ability to control blood sugar levels.
Illness - Hypoglycemia has long been known to be a symptom of a number of serious illnesses. Liver disease such as hepatitis and cirrhosis, as well as kidney disease, often cause hypoglycemia due to the major role these organs play in glucose production and maintenance of stable blood sugar levels. Endocrine diseases, those which affect hormone production, can also result in hypoglycemia, particularly diseases of the adrenal glands such as Addison's disease. This is because adrenal hormones such as cortisol and DHEA play a key role in glucose metabolism.
Excessive Insulin Production - Some rare disorders such as beta-cell tumors result in the overproduction of insulin (hyperinsulinemia) and cause hypoglycemia.
In recent years, it has become apparent that there is another method by which excessive insulin production and hypoglycemia can occur, called insulin resistance. With respect to hypoglycemia in environmental illness patients, it is this method that we are most interested in, for reasons that will become apparent. Insulin resistance is often referred to in popular books and the media as Metabolic Syndrome or Syndrome X.
Insulin resistance is the name given to a condition in which, for a number of reasons, the body's cells become less sensitive to the effects of insulin. The body reacts to this situation by producing more insulin with the common result being an overproduction of insulin causing blood sugar levels to drop too low. In this way, blood sugar levels swing from too high to too low. This is often referred to as a "blood sugar rollercoaster". As well as the symptoms produced by the hypoglycemic state, the high levels of insulin themselves can have serious health consequences in the long term. The underlying mechanism by which insulin resistance occurs is due to the insulin receptor cells in the liver, adipose (fat) tissue and muscles, becoming less efficient as a result of chronic exposure to high levels of insulin. This is the type of feedback mechanism that is at work in many body systems. If the levels of any chemical messenger such as hormones and neurotransmitters are chronically raised, the cells that they act on become less and less sensitive to them to avoid overstimulation. We will now look at the factors that can cause chronically elevated insulin levels and ultimately, insulin resistance and hypoglycemia.
The Causes of Insulin Resistance
Although genetics plays a role in who might develop insulin resistance, people of South Asian origin have a higher risk for example, there are a number of environmental factors that have a major influence.
High Refined Carbohydrate Diet
The types of carbohydrate we eat has a big effect on what happens to our blood sugar level and how hard our bodies have to work to maintain it within the healthy range. Most foods contain a mixture of carbohydrates, proteins and fats, but some foods are predominantly composed of carbohydrate. These include cereals, grains, starchy vegetables (mainly root vegetables), and fruits. Legumes (beans and pulses) also contain a high carbohydrate content even though they are often referred to as protein foods. The most basic carbohydrates are known as simple sugars and are found in high amounts in fruits and refined carbohydrates contained in processed foods. Simple sugars are usually identifiable by their names ending in "ose", such as fructose (fruit sugar), sucrose (table sugar), maltose (found in grains) and glucose. Simple sugars require little or no digestion and are therefore rapidly absorbed into the bloodstream causing a rapid rise in blood sugar levels. This produces a rapid and excessive insulin response which can result in hypoglycemic symptoms and eventually insulin resistance and type 2 diabetes, if simple sugars are consumed on a regular basis. This all occurs because the chronically raised insulin levels produced by constantly consuming refined foods high in simple sugars actually reduces the sensitivity of the cells to insulin. The human body was not designed to deal with a constant flow of rapidly absorbed simple sugars. The average western diet of processed foods is packed full of these simple sugars and the rapid increase in diabetes and insulin resistance tells its own story.
For this reason, to avoid this situation it is advisable to avoid eating refined carbohydrates and simple sugars as much as possible1.
Glycemic Index - To help us understand which foods raise blood sugar levels too high too fast there is a system called the Glycemic Index (GI) which tells us how fast a certain food releases simple sugars into the bloodstream. The higher the glycemic index of a food, the greater blood sugar response it will produce. A GI above 70 is considered high, 56-69 medium, and below 55 is said to be low. To maintain constant blood sugar levels and avoid hypoglycemia and insulin resistance, it is therefore advisable to limit your intake of high GI foods.
Glycemic Load - This is a relatively new system that is not widely used as yet but offers a fuller picture than the glycemic index of the impact of specific foods on blood sugar levels. The glycemic index tells us only how quickly a certain carbohydrate turns into simple sugars but does not tell us how much of that carbohydrate is in a particular food. The glycemic load on the other hand takes this into account to give us a better idea of what a particular food will do to our blood sugar level. For example, a food may contain a carbohydrate with a high glycemic index indicating it is fast releasing, but there may not be much of that carbohydrate in the food, so it would have a relatively low glycemic load (GL). A GL of more than 20 is considered high, 11-19 medium, and 10 or less is low.
It is important to consider both of these measures when deciding on which foods to eat and which to avoid. Foods with both a high GI and high GL are the ones to limit the most.
There are a number of specific vitamins and minerals that are essential for efficient blood sugar control. These include:
Vitamin B6 (pyridoxine)
Chromium - Considered to be one of the most important nutrients for controlling blood sugar levels2 , 8. Chromium, along with vitamin B3 and glutathione, make up a compound called Glucose Tolerance Factor (GTF). GTF is strongly linked with maintaining even blood sugar levels. Increased dietary GTF in normal individuals has been shown to augment the action of insulin, and in those with diabetes it reduces insulin requirements. By the same token it can alleviate symptoms of hypoglycemia. This mineral also has a direct glucose lowering effect. Chromium content of food is greatly reduced by refining and processing so it is important to make sure you are getting enough.
Magnesium - Refining and processing also greatly affects magnesium content of food and deficiencies are common. Stress also has a major impact on magnesium levels. This mineral is important for numerous biological processes including energy production and blood sugar control3.
Zinc - A highly important mineral with regard to insulin function. Zinc is necessary for the production of insulin and it also helps it to bind to receptors on the cells. Zinc is also required for stomach acid production and therefore affects how well food is digested. A deficiency of zinc affects the action of insulin directly and also interferes with proper digestion, creating deficiencies of the other important blood sugar control nutrients as well4.
Vanadium - A trace mineral required in small amounts that has similar actions to chromium5.
Calcium - Recent research suggests calcium is also important for blood sugar control. A calcium deficiency can affect the transport of essential nutrients into cells and prevent insulin from working efficiently3.
Vitamin B6 - This vitamin is essential for countless chemical processes within the body. Amongst these is its role in hormonal balance. A deficiency of vitamin B6 can result in blood sugar problems6. As with all B vitamins, it can be depleted by a number of factors such as stress, alcohol consumption, the contraceptive pill, and other medications. Food processing also destroys this vitamin.
Vitamin B3 - Works with chromium as part of glucose tolerance factor to balance blood sugar levels. Deficiency can occur due to the same factors as for vitamin B67.
Biotin - Involved in the metabolism of carbohydrates, proteins, and fats. Biotin is required to metabolize carbohydrates and control blood sugar levels through it's effects on liver glucose/glycogen metabolism8. This nutrient also acts like chromium to reduce elevated blood sugar levels.
Digestive problems are an often overlooked contributor to insulin resistance and hypoglycemia. Problems mainly arise because almost 70% of the body's immune system is located in the gut, so when this is activated by various factors, the resulting immune chemicals, such as cytokines, can cause problems. Excessive levels of cytokines are known to blunt insulin response9. Factors that can create excessive production of cytokines in the gut include food sensitivities, leaky gut syndrome, and infections with yeasts such as candida, unfriendly bacteria, and parasites. All of these can be brought about by various factors including poor diet, overuse of antibiotics and immune suppressing medications, and stress.
The role of stress in hypoglycemia and insulin resistance is a major one. The basic reason for this is that stress increases the production of adrenal hormones and these increase insulin resistance10. There is slightly more to it than that, as one adrenal hormone, DHEA, has the opposite affect, which we will get to.
The two main adrenal hormones involved in the stress response, and blood sugar control, are cortisol and DHEA. Blood sugar problems occur when cortisol is either too high or too low, and when DHEA is too low. This may sound confusing but the effects of low cortisol are high cortisol are basically the same. These hormones are produced to help our bodies cope with the demands placed upon them by stressors such as a work deadline, social conflicts, physical activity, and environmental factors such as extreme heat or cold. When we are confronted with these situations the body's natural response is to increase production of cortisol and DHEA, along with the short lived hormones adrenaline and nor-adrenaline. These hormones gives us more energy through increased glucose uptake as well as sharpening our reflexes and allowing us to make quick decisions. After the stress has passed,in a healthy person these hormone levels will return to normal once the stress has passed. Unfortunately, with our modern lifestyles we are constantly subjected to events we (and therefore our bodies) perceive as stressful. This means are bodies are constantly having to produce extra adrenal hormones in response. It has been found that over time chronic stress can produce "adrenal exhaustion" or burnout whereby the body can no longer produce the cortisol and DHEA required for us to cope with the stress. The result is depression, anxiety, insomnia, fatigue........hypoglycemia/insulin resistance.
When someone is under chronic stress, their cortisol levels will be constantly elevated. This can result in hypoglycemia and insulin resistance as cortisol directly contributes to insulin resistance by preventing insulin from doing its job of transporting glucose into cells. When adrenal exhaustion occurs due to prolonged stress, both cortisol and DHEA levels are constantly low. This has the effect of lowering your metabolic rate, making you feel tired, gain weight and crave sugary foods. All these factors alone can contribute to hypoglycemia and insulin resistance. Additionally, DHEA has a powerful effect on blood sugar control. This is because DHEA levels are inversely related to insulin levels, meaning that when DHEA levels are low, insulin levels are high, and vice versa. As such, low DHEA levels resulting from chronic stress result in high insulin levels and hypoglycemia/insulin resistance. Conversely, increasing your DHEA levels through stress reduction techniques, proper diet and lifestyle choices will effectively control hypoglycemia and reduce insulin resistance. If this isn't enough, DHEA supplements can powerfully improve your ability to deal with stress and improve your blood sugar control. It is advisable to seek professional advice if you wish to use DHEA or any other hormone, and have proper testing carried out to determine your current levels before and during treatment.
Lack of appropriate exercise can contribute in a big way to the development of hypoglycemia and insulin resistance. On the other hand taking regular exercise reduces insulin, helps balance blood sugar levels and helps you to lose fat and gain muscle. It is important to note however that too much exercise will stress the adrenal glands and have the opposite effect. Even minimal exercise such as taking a short walk can improve blood sugar control simply because getting the circulation going allows insulin to more easily due its job of delivering glucose to the cells. Regular moderate exercise can really improve blood sugar levels and insulin response however due to the fact that it increases muscle mass. Muscle is one of the major stores of glucose, so the more muscle you have the more glucose you can store, with the result that the production of insulin is minimized. The accumulation of fat tissue has the opposite effect and contributes to hypoglycemia and insulin resistance11.
Oxidative stress is a natural process that occurs in all oxygen breathing creatures. When our bodies burn glucose and oxygen to create energy, a number of unstable oxygen molecules called 'free radicals' are created in the process. These molecules are highly reactive and if left unchecked can cause damage to the body's cells. Free radicals are also generated in a number of other ways. Immune cells generate them to kill pathogens and many free radicals are produced in the detoxification of environmental toxins such as cigarette smoke, pollution and heavy metals. Normally the body is able to neutralize free radicals using antioxidants. If our antioxidant levels are low however, due to poor diet, stress, or high exposure to environmental toxins, free radicals are able to do damage to our cells and the oxidative stress on the body is increased. High oxidative stress has been found in people with a wide range of illnesses and is thought to increase the rate at which we age. With regards to hypoglycemia and insulin resistance, free radicals can damage insulin receptors, making them less sensitive to insulin's effects. Unfortunately, the more insulin receptors are damaged, the higher the levels of insulin become, which increases oxidative stress still further. In this way a vicious cycle is created12.
The Environmental Illness Connection - When we consider all these factors that can contribute to the development of hypoglycemia and insulin resistance, it is no surprise that they are common in environmental illness sufferers. It has been firmly established that patients suffering from environmental illnesses from chronic fatigue syndrome and fibromyalgia, to autism, have poor gut health, multiple nutrient deficiencies, and increased oxidative stress. Furthermore, multiple studies have demonstrated that chronic fatigue syndrome and fibromyalgia patients have poor adrenal function, typically with both cortisol and DHEA levels being low. Environmental illness patients also generally have very low exercise tolerance, so lack of exercise could certainly increase the risk of hypoglycemia and insulin resistance.
Clearly then, the treatment of environmental illnesses should include measures to tackle hypoglycemia.
Testing for Hypoglycemia
The presence of many of the symptoms listed above, particularly recurrent bouts of dizziness, faintness, weakness, and shakyness, that come and go and are relieved by eating, is a good indication of a blood sugar problem. The easiest way to confirm this is to eat only low GI/GL foods for a few weeks and see if your symptoms improve or disappear. A typical diet during this testing period would be made up of meat, fish, low carb vegetables, nuts and seeds. If there is noticeable improvement in symptoms during this period you can be pretty sure of being hypoglycemic and take measures to further improve your condition (these will be discussed below).
If you or your doctor need further verification of the presence of blood sugar problems, you may wish to have a glucose tolerance test (GTT). For this test you will need to attend a clinic or laboratory that offers this kind of testing, and remain there usually for up to 5 hours. On arriving for the test, a vial of blood is drawn and then you are given a drink containing a specific amount of glucose. Blood samples are then taken at precise intervals, usually every hour but sometimes on the half hour as well. The blood sugar levels are then measured in each sample and a graph is plotted showing how your blood sugar levels changed after you drank the glucose solution. Your graph will then be compared to a reference graph that shows a healthy blood sugar response to the glucose drink. The test gives a clear idea of how your body handles sugar. If your blood sugar level drops well below the reference level at any point this indicates hypoglycemia. Also, if your blood sugar level drops a large amount over a short period of time, this indicates reactive hypoglycemia and can produce the same symptoms as having a very low blood sugar level at any particular point.
The treatment of hypoglycemia and insulin resistance primarily involves a change in diet, particularly removing simple sugars completely and choosing foods with low to moderate glycemic index and glycemic load scores. In addition to diet, taking steps to reverse the contributing factors discussed above is important.
Overview of treatment:
1. Diet - Remove simple sugars from the diet and get majority of calories from low GI/GL foods.
2. Replenish Important Nutrients - Make sure you have a good intake of important nutrients involved in blood sugar control such as chromium, Vitamin B3, zinc, biotin, and the other nutrients we discussed. These nutrients should be supplied by both diet, and supplements if necessary.
3. Treat Gut Problems - Improving gut health is vitally important if this is an issue for you. Get tested for food sensitivities, leaky gut syndrome and infections with Candida, bacteria, and parasites. If these are a problem for you, seek appropriate treatment. See our leaky gut syndrome treatment, antifungal treatment, and antibacterial treatment pages.
4. Stress Reduction - Tackling problems of stress can make a huge difference to the severity of hypoglycemia and insulin resistance. This could mean making adjustments to your lifestyle, using stress reduction techniques like yoga, meditation, or relaxation CD's, and addressing hormonal imbalances (cortisol and DHEA).
Cortisol and DHEA levels can be tested at home with a simple saliva test (Stress Check).
5. Do More Exercise - Including regular moderate exercise in your routine is very beneficial for treating hypoglycemia. Any exercise is beneficial, no matter how little it may seem, just remember not to overdo it as this will undo the beneficial effects. For those with chronic fatigue syndrome and fibromyalgia, this is especially important and just a short walk every day or when you feel able will still help to improve insulin function and reduce hypoglycemic symptoms.
6. Tackle Oxidative Stress - Treating nutritional deficiencies, gut problems and adrenal hormone imbalances will help reduce oxidative stress. It is also advisable to supplement extra antioxidant nutrients such as vitamins A, C, and E, alpha-lipoic acid, N-Acetyl-Cysteine, and silymarin. Learn more about these on our antioxidant page. Oxidative stress can also be reduced by limiting exposure to chemicals and other environmental toxins as much as possible. See our chemical avoidance page.
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