Hypoglycemia is a general term used to describe a mixed bag of symptoms that are due to a derangement of glucose metabolism. Under the strict medical definition, hypoglycemia mainly refers to a drop in fasting blood sugar below 50mg% (normal range 70-90mg%). This drop can be associated with differing symptoms depending on the rate at which the blood sugar falls.
The causes of functional or reactive hypoglycemia (not absolute or fasting hypoglycemia) can be divided into 3 categories:
- High sugar / refined carbohydrate diet leading to hyperinsulinism
- Hypoadrenalism-stress leading to adrenal exhaustion
- Alimentary or gastric surgery leading to rapid stomach emptying or “dumping syndrome.”
A Glucose Tolerance Test (ideally lasting 5-6 hours) can confirm a diagnosis, but more alternative doctors are forgoing the inconvenience and shock to the system because symptoms alone are reliable enough. Central nervous system changes, adrenal hormone output and detoxification (what the body tries to do when it is not busy digesting food) also contribute to the overall symptom picture.
There are different interpretations given to different patterns seen on glucose tolerance testing. One such system describes three types of curves:
Type 1 (Neuroglycopenic)
This type results in a rapid rise in blood glucose within the first hour followed by a pronounced or precipitous drop in blood glucose in the second hour. Symptoms of this type of response are rapid mood swings, volatile personality, erratic behavior before and after eating. Possible cause of this response is gastric dumping, too large an insulin response (pancreatic problems) and glucose tolerance factor problems (liver problems).
Type 2 (Adrenergic Type)
After ingestion of glucose the blood sugar rises for the first three hours followed by a hypoglycemic rebound at 4 to 6 hours. Symptoms associated with this type of response are tiredness 2 hours after eating, allergic responses or food intolerances, and shakiness before meals. When blood sugar falls rapidly, the early symptoms are those brought on by a compensating secretion of adrenalin; these include sweating, weakness, hunger, racing pulse and an “inner trembling”. This response can be due to adrenal cortical insufficiency or thyroid deficiency.
Type 3 (The Flat Curve Response)
In this case the blood glucose does not deviate more than +/- 15% from fasting level through the whole test. Symptoms that may appear are fatigue, apathy or hypotonia (poor muscle tone). These symptoms are due to poor digestion and absorption of nutrients.
Patients with hypoglycemia of varying causes appear to show similar personality patterns, suggesting hypoglycemia can cause personality disorders. The term “hypoglycemia” may be better named “carbohydrate intolerance syndrome” and treated accordingly.
Signs, symptoms & indicators of Hypoglycemia
(High) intolerance of sugars
Counter Indicators
(High) tolerance of sugars
Heart racing/palpitations
Strong appetite
Hunger is a symptom of hypoglycemia.
Afternoon sugar craving
Craving but not/craving and eating wheat
Frequent fatigue/fatigue that is relieved by eating
General dizziness
Fatigue that worsens during the day
Poor bodily coordination
Dizziness when standing up
Counter Indicators
No fatigue relieved by eating
Seeing visual halos
Vision disturbances
Blurred vision and diplopia (double-vision) are possible symptoms.
Being an incoherent speaker
Adverse/moderate/mild reaction to delayed meals
Inner trembling
Difficulty losing weight
Afternoon headaches
Low stamina
Front-of-head/temple-based headaches
(Occasional) daytime sweating
Counter Indicators
No reaction to delayed meals
Depression with anxiety
Impatient/hostile disposition
Uncontrolled rage is a possible symptom.
Emotional instability
Periods of confusion/disorientation
Short-term memory failure
Trouble concentrating
Tightness across shoulders
Numb/tingling/burning extremities
Carbohydrate craving during cycle
Excess perspiration
Unsound sleep
Conditions that suggest Hypoglycemia
Addictions / Addictive Tendencies
A craving for cigarettes and/or drugs is a possible symptom of hypoglycemia.
Low DHEA Level
Insulin levels may play a significant role in determining how much DHEA is metabolized. Studies have discovered that low levels of DHEA may be related to an excess of insulin. What this suggests is that anyone suffering from hypoglycemia or excess insulin may be prone to converting nutrients to fat due to depressed DHEA levels.
Depression
Endogenous depression – depression originating from within as opposed to being due to external factors – is a known symptom.
Poor Memory
Temporary forgetfulness is a known symptom of hypoglycemia.
Headaches, Migraine/Tension
Although hypoglycemia may precipitate headache in some diabetic and nondiabetic patients, it is not a universal mechanism responsible for headache in those individuals or in normal fasting subjects.
Restless Leg Syndrome (RLS) / Periodic Limb Movement Disorder (PLMD)
Based on afternoon glucose tolerance testing, many patients with RLS – particularly if they also have spontaneous leg cramps – appear to have hyperinsulinism causing functional ‘hypoglycemia’ during testing. In fact, some patients may have an attack of muscle cramps at the same time as their lowest level of plasma glucose. In an open trial, a group of 350 patients with this type of glucose tolerance curve were placed on a sugar-free, high protein diet along with frequent nibbling and at least one night feeding. The vast majority experienced a prompt remission or, at least, a striking reduction in symptoms. [J Med Assoc 60(5): pp.29-31, 1973]
Muscle Cramps / Twitching
As hypoglycemia progresses a variety of symptoms can occur including muscle twitching. Amongst 300 patients in one study (185 female, 115 male) found to have relative hypoglycemia (a drop of 20% or more below the fasting blood sugar level during a 6-hour glucose tolerance test), 23% had muscular twitching or cramps.
Tremors
Early symptoms of hypoglycemia, such as hand tremors, are similar to those which occur as the result of experiencing a sudden and violent fear.
Night Sweats
Nighttime hypoglycemia may be without symptoms or manifest itself as night sweats, unpleasant dreams or early morning headache.
Risk factors for Hypoglycemia
Heavy Metal Toxicity
Heavy metals such as mercury, cadmium, lead and thallium poison the glucose metabolizing catalysts, thus reducing the flow of energy throughout the body. It is interesting to note that the symptoms of heavy metal poisoning are similar to symptoms associated with hypoglycemia i.e. hyperactivity, mood swings, manic depressive behavior, poor concentration and impulsive and unpredictable behavior.
Mercury Toxicity / Amalgam Illness
Heavy metals such as mercury, cadmium, lead and thallium poison the glucose metabolizing catalysts, thus reducing the flow of energy throughout the body. It is interesting to note that the symptoms of heavy metal poisoning are similar to symptoms associated with hypoglycemia i.e. hyperactivity, mood swings, manic depressive behavior, poor concentration and impulsive and unpredictable behavior.
Hypothyroidism
Patients suffering with Wilson’s Syndrome, a form of hypothyroidism, occasionally experience intense and previously unfamiliar cravings for sweets. The low body temperature patterns may affect the function of enzymes involved in glucose metabolism that could result in lower blood sugar levels which might contribute to sweet cravings.
(Slightly) elevated fasting glucose
(High) refined sugar consumption
History of tinnitus
Absence of short-term memory loss
Hypoglycemia can lead to
Schizophrenia
Numerous patients given psychiatric diagnoses have actually turned out to have hypoglycemia, including those classified with depression, bipolar disorder and schizophrenia.
Recommendations for Hypoglycemia
Glutamine
Glutamine plays a vital part in the control of blood sugar. It helps prevent hypoglycemia , since it is easily converted to glucose when blood sugar is low.
Stevia (Stevia rebaudiana)
If you must use sweeteners, stevia is an excellent natural alternative to simple sugars and unhealthy chemical alternatives.
Sugars Avoidance / Reduction
Consuming foods that contain simple sugars makes the problem worse. Avoid sweets other than fresh fruits, if tolerated. In addition, consider avoiding products that only “taste” sweet (artificially sweetened – low calorie). Even though they may contain no sugar, sending signals to your brain that something “sweet” is being consumed may have negative consequences.
Processed Foods Avoidance
Refined carbohydrates are more readily absorbed than unrefined, and should be avoided in those with any glucose intolerance.
Smaller, More Frequent Meals
Frequent small meals are more effective in stabilizing blood sugar levels than large, less frequent ones. Remember to consume something before symptoms appear. Protein snacks that keep well should be stored in locations such that you always have quick access to food. You may find it helpful to store protein bars or nuts in your car, at work, in your pockets or (for women) in your purse.
High/Increased Protein Diet
A diet consisting of higher protein and fat with less refined carbohydrates is a standard recommendation for those with hypoglycemia. Hypoglycemics may find it helpful to start with 100gm of protein or more per day. With increased protein consumption, protein digesting enzymes may need to be supplemented. Hydrochloric acid, which is usually produced by the stomach for the breakdown of food (especially protein) may be needed also.
Grams of carbohydrate can be counted, limiting them to a maximum of 100gm per day. Some persons feel better on 60-100gm of carbohydrates, adjusting up or downward depending on size and degree of physical labor (More if larger and very active). Eating less than 60gm per day may aggravate a return to undesirable symptoms.
Caffeine/Coffee Avoidance
Avoid all soft drinks, coffee, tea, artificial colors and additives.
Alcohol Avoidance
Drinking alcohol can cause blood sugar to drop in some sensitive individuals. Hypoglycemia has been well documented in chronic alcoholics and binge drinkers.
High/Increased Fiber Diet
Soluble fiber delays gastric emptying, slows glucose absorption, and minimizes blood glucose swings.
Therapeutic Fasting
In severe cases, additional methods of support besides diet may be needed and perhaps the best of these is fasting. Fasting is a useful, inexpensive and universally available treatment for hypoglycemia. The fast allows the entire system to restore its cellular integrity.
Increased Fruit/Vegetable Consumption
Fruit contains several things that are of benefit, including a sugar (fructose) that does not cause wild glucose swings, trace minerals, and fiber which slows glucose absorption. However, some people find that fruits do make their glucose intolerance worse. Vegetables, especially low starch vegetables like tomatoes, green leafy vegetables, broccoli and carrots are low in carbohydrate and high in nutrients.
Grain-free / Low Starch Diet
As a dietary priciple, simply avoiding grains and foods made from grains should go a long way toward preventing low blood sugar events in those with reactive hypoglycemia
Aerobic Exercise
Moderate exercise improves glucose metabolism. Those few individuals who find that strenuous or prolonged exercise causes hypoglycemia should take food at the earliest opportunity.
Test Glucose Tolerance
The six hour oral glucose tolerance test is normally used to determine the type and magnitude of the glucose intolerance.
Chromium
Chromium status should be optimized for its benefit in carbohydrate disorders (both hypoglycemia and adult-onset diabetes). Studies have shown that chromium supplementation is helpful with hypoglycemia and can improve glucose tolerance test results and increase the number of insulin receptors on red blood cells.
A research team, which included scientists from Georgetown University in Washington, D.C., tested chromium’s effects in humans by adding chromium chloride to the diet of 17 men and women, eight of whom had mild glucose intolerance, a condition that precedes diabetes.
During the 14-week study, all participants ate a baseline, chromium-poor diet containing less than 20 micrograms of the metal per day. This is similar to the amount consumed by 25 percent of Americans, Anderson says, noting that the recommended daily allowance ranges from 50 to 200 micrograms.
After four weeks, the researchers divided the volunteers into two groups. One group continued to eat the low-chromium diet, supplemented with daily doses of 200 micrograms of chromium; the other group stayed on the diet but received only placebo pills. Five weeks later, the groups were switched.
In seven of the eight people with glucose intolerance, tests taken an hour after they drank a sugary liquid showed that blood sugar levels rose nearly 50 percent less during chromium supplemention than at the outset of the study or during the unsupplemented baseline diet. In the 11 glucose-tolerant patients, the varying consumption of chromium had no effect on blood glucose levels
, Anderson notes. This selective reduction, he says, indicates “chromium can reverse glucose intolerance.”
Glucose-intolerant participants also showed lower circulating levels of insulin and glucagon
— a pancreas-secreted compound that opposes insulin’s action — during chromium supplementation than at any other point in the study.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Weakly counter-indicative |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Hypoglycemia
A condition characterized by an abnormally low blood glucose level. Severe hypoglycemia is rare and dangerous. It can be caused by medications such as insulin (diabetics are prone to hypoglycemia), severe physical exhaustion, and some illnesses.
Glucose
A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Fasting Blood Sugar
(FBS): Blood is drawn before breakfast (i.e., after fasting), then the glucose (sugar) in the blood is measured.
Milligram
(mg): 1/1,000 of a gram by weight.
Carbohydrates
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Adrenal Insufficiency
Also known as Adrenal Exhaustion or Low Adrenal Function, this is a condition where the adrenal gland is compromised in its production of epinephrine, norepinephrine, cortisol, corticosterone or aldosterone. Symptoms include primarily fatigue, weakness, decreased appetite with ensuing weight loss, as well as nausea, vomiting, abdominal pain, diarrhea or constipation, or increased pigmentation of the skin. Cortical insufficiency (low or no corticosteroids) produces a more serious condition called Addison’s Disease, characterized by extreme weakness, low blood pressure, pigmentation of the skin, shock or even death.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Insulin
A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.
Glucose Tolerance Factor
(GTF): A compound containing chromium that aids insulin in regulating blood sugar levels.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Hypotonia
Lessened tension; arterial relaxation.
DHEA
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Hypothyroidism
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Enzymes
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Bipolar Disorder
Also known as manic-depression, this disorder is characterized by alternating periods of extreme moods, usually swinging from being overly elated or irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal mood in between. The frequency of the swings between these two states, and the duration of the mood, varies from person to person.
Schizophrenia
Any of a group of psychotic disorders usually characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances. Schizophrenia is associated with dopamine imbalances in the brain and defects of the frontal lobe and is caused by genetic, other biological, and psychosocial factors.