by R. Paul St. Amand,
M.D.
Assistant Clinical Professor of Medicine Endocrinology--Harbor-UCLA
4560 Admiralty Way, Suite 355
Marina del Rey, CA. 90292
(310) 577-7510
October 1997
Hypoglycemia, low blood
sugar, is a name often used to denote a disease though it is only one symptom of
an illness with many complaints. It represents a syndrome better defined as
"carbohydrate intolerance." It is expressed by the inability to use
certain carbohydrate loads effectively without adverse consequences.
Sugar and complex
carbohydrates evoke a rise in blood sugar that triggers insulin release from the
pancreas. This hormone facilitates storage or utilization of these carbohydrates
in various parts of the body. It can also signal the liver to convert the excess
to fatty acids transported to fat cells where insulin induces storage as
triglycerides, our fuel reserve.
In hypoglycemics,
insulin cutoff is either inadequate, release excessive or action insufficiently
terminated by counter hormones. This creates a system-wide disturbance that
results in one of the endocrine "fatigue" syndromes we call
"hypoglycemia."
The standard for diagnosis
has been the five-hour glucose tolerance test. A certain sugar solution is
given; blood samples are drawn and tested at various intervals. Such tests were
done in 1994 by Genter and Ipp on a group of young, healthy people who had no
symptoms of hypoglycemia.1 Samples were taken every ten minutes to measure the
timing and amount of various hormones that normally prevent an excessive drop in
blood sugar by counteracting insulin. One-half of the test subjects developed
acute symptoms of hypoglycemia near the peak epinephrine (adrenaline) release,
which coincided with their lowest blood sugars. Each reacted at different
glucose levels considered normal. Obviously each person has a personal
alarm system, an individual blood sugar level at which the brain perceives
danger, and releases adrenaline (epinephrine).
The symptoms of
"hypoglycemia" (the term we will continue to use) are many. They
consist of fatigue, irritability, nervousness, depression, insomnia, flushing,
impaired memory and concentration. Anxieties are common as are frontal or
bitemporal headaches, dizziness, faintness or actual syncope [fainting]. There
are often blurring of vision, nasal congestion, ringing in the ears, numbness
and tingling of the hands, feet or face. Excessive gas, abdominal cramps, loose
stools or diarrhea are frequent. Many complain of leg or foot cramps. These are
the chronic symptoms of the condition and are experienced even in the presence
of a normal blood sugar.
The acute symptoms are
frightening and occur at very variable sugar levels usually three or four hours
after eating. They include hand or inner shaking, especially with hunger,
accompanied by sweating. Heart irregularities or pounding, and severe anxiety
complete the picture. When attacks occur during the night, they are often
preceded by nightmares and result in severe sleep disturbance that results in
daytime somnolence. Bouts of higher intensity are labeled "panic
attacks." Acute events last twenty to thirty minutes and are induced by the
sudden release of large amounts of adrenaline, more than sufficient for the
abrupt correction of the falling blood or brain sugar. In the past, we did many
glucose tolerance tests during which patients listed their symptoms. Sampling
frequently missed the lowest sugar levels that had triggered the acute attack so
rapid was the adrenaline correction. We rarely do the test now since the acute
symptoms suffice for diagnosis.
Only a perfect diet
will control hypoglycemia.
It is not the food one adds but what one removes that determines
recovery. Patients must eat no table sugar, corn syrup, honey, sucrose, glucose,
dextrose or maltose. All heavy starches must be avoided including potatoes,
rice, pasta etc. (see below). Excessive fructose is provided by the several
pieces of fruit needed to make one glass of juice. Caffeine intensifies the
action of insulin and is also forbidden. Certain carbohydrates such as
sugar-free bread are allowed but intake is limited to one slice three times per
day. Only one piece of fruit should be eaten in a four-hour period.
Improvement begins in
about seven to 10 days. Considerable relief is afforded within one month.
Symptoms totally clear within two months but only if the diet has been followed
perfectly! During the first 10 days of treatment headaches are common from
caffeine withdrawal and fatigue induced by changing the body's basic source of
fuel, and in some patients can be quite severe.
[the fatigue can be counteracted mostly by adding fat and potassium to the diet, for
some reason I have to look into. --
liz]
Consider the entire
dietary process as if one were building a checking account.
First, deposits must be made to obtain sufficient funds. Only at this
point should one begin writing checks knowing that balances are lowered with
each one written. Similarly, the
hypoglycemia diet builds energy reserves to the highest amount attainable for a
given individual. Only then can experimentation with forbidden carbohydrates
begin. Each such "cheat" draws on the account and one cannot
"overspend" without developing symptoms anew. Thus, over time, this
hunt and peck system will define the ultimate, necessary, dietary restrictions.
In the searching phase one
will slip occasionally by overindulging in carbohydrates. Close observation
should detect the first symptom that develops after such excesses. Often this
may be merely fatigue, but in other cases it will be frontal, pressure
headaches. Gradually, most hypoglycemics learn exactly what they can allow
themselves. They must often resume a perfect diet when emotional or physical
stresses occur since these place greater demands on their energy bank. The
premenstrual period is the most fragile. At such times it becomes more difficult
to maintain an adequate account. No physician or dietician can adequately
predict the final dietary restrictions. The patient must make this judgment
with judicious cheating that is individually variable.
Some hypoglycemics suffer
simultaneously from another condition, fibromyalgia, an illness that causes
chronic symptoms similar to hypoglycemia but not the acute ones listed above.
This is the subject of another paper we have written.*
Simply put, the
fibromyalgic has a deranged metabolism inducing contracted muscles, ligaments
and tendons, which constantly burn fuel. Energy deprivation occurs system-wide.
For those with a predisposition, yielding to carbohydrate craving provides the
final push to induce hypoglycemia.
These are ill patients
who suffer overlapping symptoms of combined diseases. No compromise is allowed
with the carbohydrate intolerance syndrome. One eats correctly or the illness
continues.
The reward is great,
however, since well-being is exhilarating when contrasted with the disabling
symptoms of hypoglycemia. It is yours to control.
Dietary Restrictions the
Hypoglycemic Must Follow
HAVE NONE OF THESE:
Alcohol (Most
hypoglycemics can tolerate one drink after 2 months on the diet - please use
discretion as individual tolerance levels vary)
Sugar in any form,
including soft drinks
Fruit juices and dried fruits, including dates
Baked beans
Black-eyed peas (cowpeas)
Garbanzo beans (chickpeas)
Refried beans
Lima beans
Potatoes
Corn
Bananas
Barley
Rice
Pasta of any kind
Burritos (flour tortilla)
Tamales
Caffeine
Dextrose
Maltose
Sucrose
Glucose
Honey
Corn syrup
Starch
Lentils
Reference: 1Genter, P. and
Ipp, E. Metabolism, Vol. 43, No. 1 (January) 1994, pp 98-103
"In certain people, the body is unable
to process carbohydrates without adverse consequences. Hypoglycemia, or low
blood sugar, is the name often used to denote a whole disease. But more
accurately, it is only one of a cluster of symptoms that together make up a
syndrome."
- page
103
Speeches and book signings near you
Making
an appointment with R. Paul St. Amand M.D.
Use
of uricosuric agents in fibromyalgia
Chronic
Fatigue and Fibromyalgia: One Disease, Two names
Genitourinary
syndrome and fibromyalgia