Reactive Hypoglycemia article

I found a really interesting article written by Liz Pavek. It is about reactive hypoglycemia, which is basically pre-diabetes. I am interested with it because it gives a clear and concise explanation of why carbs harm us and what to do about it. It also explains the diet nicely.

I am copying the article from a different blog. I haven't been able to find the original yet or I would have just linked to it.



Reactive Hypoglycemia
by Liz Pavek

Reactive hypoglycemia is usually the first sign that an individual has reached a dietary point of no return. It is actually the earliest stage of Type II diabetes, but diabetes can be held at bay by hypoglycemics through careful attention to the diet; so far, the only treatment that is available for hypoglycemia.

Under normal circumstances, hypoglycemia isn't much of a problem: You wait too long between meals, and you get cranky, lethargic, shaky, and confused. Eat, and you are fine. This is called "fasting" hypoglycemia.

But there is another type that doesn't behave like anything you have ever experienced. It is not, strictly speaking, the type of "hypoglycemia" that the word implies: (hypo=too little; glycemia=sugar in the blood). Strictly speaking, for this problem, the term is not a true definition. Let me list a few symptoms, just to show you that you are not immune:

* Breathlessness
* Panic Attacks
* Memory Problems
* Inability to Concentrate
* Inner Trembling and Pounding Heart 1-4 Hours after a Meal
* Palpitations/Irregular Heartbeat
* Weight Gain in Abdominal Area
* Nightmares

If you recognize any three of these symptoms in yourself over a period of time, you are probably at risk for reactive hypoglycemia.

A more complete list of symptoms:

* Fatigue
* Irritability
* Nervousness
* Depression
* Loss of libido
* Insomnia
* Flushing
* Leg or foot cramps
* Memory and concentration problems
* Anxiety
* Hypertension
* Impotence and inability to maintain an erection
* Headaches
* Dizziness, and sometimes even actual fainting
* Blurring of vision
* Nasal congestion
* Tinnitus (ringing ears)
* Numbness and tingling of the hands, feet or face
* Bloating
* Abdominal cramps
* Bowel problems

A condition similar to narcolepsy, in which the sufferer's eyes roll back in his head, his head drops forward, and he falls completely asleep for a few seconds can be very dangerous to a RHG sufferer who drives an automobile.

These chronic symptoms are bad enough and are present even when the blood sugar is in what would be considered a "normal" range. The acute symptoms (those which occur with each "episode" at widely variable blood sugar levels) can be quite frightening:

Heart arrythmias, inner trembling and sweating, During sleep, the episodes are accompanied by heavy dreaming and nightmares. During the day, these intense episodes are similar to panic attacks, and can last up to a half an hour. They are caused by the sudden release of very large amounts of adrenalin, much more than would be necessary for the restoration of the blood sugar level.

"RHG is not the same as fasting hypoglycemia, which is low blood sugar that occurs when you do not eat. For this reason, RHG is not always picked up on routine medical tests. RHG occurs within 2 to 3 hours after a meal of excess carbos, when there is a rapid release of carbos into the small intestine, followed by rapid glucose absorption, and then the production of a large amount of insulin. Adrenalin production should be measured as well as glucose, as both occur at abnormal times. RHG is also called "insulin tolerance", "postprandial hypoglycemia", "carbohydrate intolerance" and in severe forms,"idiopathic adult-onset phosphate diabetes". This condition can lead to type II diabetes.

"RHG is common in people with FMS and FMS/MPS Complex. In FMS, it is enhanced by dysfunctional neurotransmitter regulation and other systemic mechanisms. With FMS, you crave carbohydrates but cannot make efficient use of them because of an electrolytic imbalance and other biochemical imbalances in your body. We produce adrenalin even when the blood sugar doesn't fall. We crave carbos, because we need energy. Since our insulin level is high, our bodies take the carbos and store them as fat, often in the belly. We can get the body balanced by eating a balanced diet, and teach it to metabolize our fat for energy."

-- Reactive Hypoglycemia (RHG) FM/MPS Perpetuating Factor by Devin Starlanyl, MD http://www.tidalweb.com/fms/rhg.shtml

[Dr. Starlanyl goes on to recommend the "Zone Diet," but, as an "experienced" RHG sufferer, I do not for the simple reason that it contains too many grams of carbohydrate for us who must restrict carbohydrates drastically. Since carbohydrates are not essential nutrients except as a resource for fat stores, it causes no nutritional deficiency to eat without including them in your diet.]

RHG occurs frequently in individuals suffering from Fibromyalgia or Chronic Fatigue Syndrome, and explains a lot of the symptoms that people with these syndromes have experienced but never had a clear picture of. FMS and CFS are hard to diagnose and some medical systems refuse to admit that such wide-ranging symptoms could all be generated by one overarching disorder.

Thyroid problems and adrenal insufficiency can also be present with hypoglycemia, and they are both frequently found with fibromyalgia and chronic fatigue syndrome. The difficulty with testing for them is that doctors tend to look at test results rather than symptoms. If you come to a doctor with every symptom listed at the above website, but your TSH (thyroid stimulating hormone) is even 1 point inside the "normal" parameters, many times the doctor will tell you only that: "Your tests show that your TSH is within the normal range." (Loosely translated, this means, "Get out of my face with this stupid thyroid suspicion. I'm the doctor here.")

But there is nothing that will cure RHG once it gets established. The only way to deal with it is to put yourself on a STRICT low-carbohydrate diet, and STAY on it. As Dr. Starlanyl states in her article, this condition will lead to Type II diabetes if it is not carefully managed.

Hypoglycemic Episodes

A typical reactive hypoglycemic who has reached a chronic stage will have numerous episodes a day, especially if he is still eating a carbohydrate-rich diet. A couple of hours after a carb-loaded meal, he will notice his heart pounding. Lightheadedness and confusion follow, and his fingers will be cold. Suddenly, there is be a "flash;" a surge of adrenalin.

Eventually, the blood sugar will normalize (thanks to the adrenalin/cortisol, which stimulates a sudden removal of glycogen from the liver, just as if he was running) and he will regain his comfort level once more until the next episode.

This type of pressure is very hard on the body. The adrenalin surges tax the heart repeatedly every day as they stimulate all the "fight-or-flight" reflexes again and again. The body of an individual who has several flashes a day is in a state of constant and total physical stress. A combat soldier under fire might experience the same level of anxiety. (I am not minimizing combat stress. I am emphasizing the debilitating physical stresses of RHG, which at times can feel as if the heart is about to explode.) The adrenals, after years of this abuse, begin to falter. The pancreas, which has worked overtime to produce the insulin needed by the all the repeated sugar loads, fails, which results in Type II diabetes.

"What's happening to my body?"
Now, here's where it gets good: The fat cells store the molecular insulin along with the fat molecules in the fat cells. "Fat tissue is a tremendous user of insulin. An overweight diabetic must produce a great quantity of insulin to keep body cells living. His excess fat deposits divert insulin from its normal activity of supplying the vital organs, such as the liver, brain, lungs, etc. [with glycogen], and the insulin is then consumed by the body fat deposited by the eating of carbohydrate foods." -- Melvin Anchell, M.D. "The Steak Lovers' Diet" Second Opinion Publishing, Atlanta

What happens to that stored insulin?
Does it just wait there in the fat until glucagon comes to call it out for energy? I don't know, and haven't been able to find out. I'm still searching. There are low levels in the blood at all times to help stabilize blood sugar in non-diabetics. When RHG sufferers test their fasting blood sugar in the morning, they will find it elevated. (Normal blood sugar in the fasting range should be between 80 and 100 mg/dl.) Their blood sugar will frequently be between 115 and 135. Over a period of careful diet and attention to other factors, like hormone supplementation, that fasting blood sugar should fall to more normal readings.

As long as the sufferer continues to eat a carbohydrate-rich diet, his body is being covered in a constantly-growing "coat" of fat cells, but more keep coming as the body struggles to deal with the overloads of carbohydrate in the diet. (The body starts out with a certain number of fat cells. More can be stimulated as the body adds fat, but none ever go away. Once they are there, they are there forever, so the ideal situation is to have all these fat cells as empty as possible.) Our blood pressure, as well as our weight, goes up and up. Not only is insulin responsible for the storage of that fat, but it is itself being stored with the fat because the receptors on the cells have been shut down. The pancreas eventually fails from trying to pump out sufficient insulin to keep the blood sugar in the normal range. More insulin equals more fat.

Without carbohydrates to stimulate more insulin, the blood sugar will normalize very soon after this change in the diet is made. If the change continues and the sufferer is meticulous in his avoidance of starchy and sugary foods, the fat cells will begin to respond to glucagon in the blood, and will start to release the stored fat, which is either turned back into glucose and burned for energy or excreted.

If there is too much insulin in the fat and too much insulin circulating in the blood with sugar loads and no place to take them because cellular receptors are shut down, the weakened, strained, overworked, and struggling glands must compete with each other as they attempt to reach a metabolic balance. The consequence of this is a staggering list of disorders and glandular problems, and the sufferer has one disease after another in a cascade of problems and illness.

The sufferer is lethargic, cold all the time, confused and forgetful, and plagued by one adrenalin surge after another. Eventually, it reaches a chronic stage, where no insulin or fat is being used, but insulin is being secreted constantly in response to carbohydrate-containing food. This newly called-up insulin soon finds itself moved to the fat cells just like all the rest, and the cycle repeats and repeats until the pancreas fails from overwork and the sufferer is not only obese but is soon diagnosed with Type II diabetes.

The sufferer's body gets so efficient at storing every available calorie that virtually none is released from the fat for body heat or activity. In the absence of glucose being admitted to the cells, the body "perceives" a starvation situation, and immediately begins to hoard calories against famine. The energy that would have been obtained from the food is stored as fat to keep the brain and heart alive, the most essential organs in the body. Since most of what Americans eat today is composed of some form of carbohydrate, it's conceivable that virtually all the consumed food energy is going to be stored as fat.

The individual finds himself in a real dilemma: His lean-body mass is literally starving to death and shriveling away for want of glycogen for energy, with the muscles getting smaller and smaller, so that what few receptors there are are reduced even further; not to mention the physical weakness of these depleted muscles, coupled with the lethargy of hyperinsulinism. But the cells can't be repaired or replaced since they are closed to the energy available in the insulin-borne glycogen, and they are not able to extract nourishment or energy from the blood for want of receptor sites. All this time, the sufferer is getting fatter and fatter; fat which would be a rich source of glycogen if the receptors could receive the insulin/sugar loads. The sufferer becomes drowsy, cold all the time, and famished around the clock as his body gradually shuts down one function after another in order to conserve energy.

Like a lock and key, the insulin receptors on the cells only receives insulin and sugar. If the receptors are shut down (mutated and/or missing due to hyperinsulinism), there is no lock for the key to open, so there is no way to get the "door" of the cell open and the energy-producing calories in the sugar inside the cell. The more receptors that can be restored by proper diet, the more insulin will be used up.

What can be done?
Dr. Robert C. Atkins, M.D. and others have all clearly explained the sugar/insulin/fat metabolic process and thousands of people have lost tons of fat by following their prescribed programs, all of which work, to a greater or lesser degree. The Atkins Diet is a very good one for RHG.

Dr. R. Paul St. Amand, M.D., Assistant Clinical Professor of Medicine Endocrinology --Harbor-UCLA, says, in a nutshell: "Only a perfect diet will control hypoglycemia." Fasting from carbohydrate foods is a good way to get control of the oversupply of insulin.

Without the carbohydrates that would normally be in the diet, the receptor sites gradually begin to reappear, the insulin is there to take the sugar into the cell for energy. Et voila! The sufferer is suddenly carrying around his very own 24-hour, open-all-night lunch pail.

Once the switchover to the combustion of stored body fat is complete, the body will cruise easily and the "feed me!" signals will disappear. One nice thing about this fast is the fact that if it is carefully adhered to, the symptoms will disappear, and the blood sugar will move into the normal range (80-120mg/dl). The more strictly the sufferer follows the fast, the more relief he will get. The individual will immediately know if he has taken in insulin-stimulating foods because he will again feel hunger pangs, something that disappears completely when the body is utilizing its fat stores. Without insulin, the body has no "feed me!" signal.

In the first few days, the receptors on the muscle cells will begin to reappear, slowly at first, but soon in large numbers. The individual might feel some fatigue or lethargy at this time. This is normal. The body is trying to force itself to switch from consumed sugar to its own sugar, which will take a couple of days. Like your car, when the gas tank is empty, the car chugs and coughs and shuts down until you refill the tank. The same thing happens with your body. When its "sugar" tank is emptied, it struggles for several hours searching for a new source of energy. During this period, glucagon will be released once again and the switchover will be complete.

Soon, all the receptors are restored and over a period of time, if the individual is diligent, all the stored fat will be consumed, and the body will shift into a more normal sugar metabolism. When the blood sugar normalizes, energy is restored, and body temperature is back to normal.

This does not mean that the sufferer can go back to his high-carbohydrate diet, however. His sugar metabolism is broken, and will never be fixed.

This return to "normal" is only because of the stringent diet the sufferer has chosen for himself. But this is a good thing. Carbohydrates are not a part of the natural, prehistoric diet of humans, and they are very difficult for the body to handle because they demand so much from the pancreas and other glands. By removing these carbs from the daily diet and making the change permanent, the sufferer relieves that burdensome metabolic stress and is once again able to enjoy life without the worry of constantly gaining fat no matter how small his meals and portions, suffering from repeated episodes, or dealing with a somnolent metabolism and related glandular insufficiencies.

When the fat is consumed, the sufferer can return to a more normal (but still low-carb) diet, such as the Atkins diet. This process can take days, weeks, or even months, depending on the fat blanket and the amount of insulin stored, but if the sufferer is diligent, the fat will come off and the blood sugar will normalize.

For hypoglycemics, the fat loss is almost secondary to the relief from the terrifying and debilitating symptoms of this disorder. Those sufferers I have talked to all say that it is the ability to sleep through the night without frightening episodes and to be warm and alert at all times that keeps them dedicated. The fat loss is a wonderful "side effect," but is not the primary reason for the fast.

Check your blood sugar once or twice daily with a glucometer to get an idea of what is going on. For hypoglycemics, it will be highest in the morning and lowest in the evening. When it gets down around 90 mg/dl and stays there, you can call your fast a success.

Caveats:

1. Even a small sugar/starch carbohydrate feeding during this fast will shut down the process for about 24 hours and cause the carbs to be stored as fat once more. Only diligent attention to the diet will return the body to the fat-utilization stage.

2. The older you are (especially if you are a woman) the harder this will be to accomplish. Post-menopausal women have a tendency to thickened middles anyway, as a result of the secondary estrogen secretor role of their abdominal fat. If you fast for any length of time and not only don't lose, but continue to gain, the chances are very good that more than your sugar metabolism is at fault. If this happens, get an adrenal and thyroid panel from your doctor. Sometimes hidden problems like hypothyroid or cortisol disturbances can be behind your metabolic problems. Don't hesitate to ask for these tests, and follow your doctor's instructions.

3. The diet must be very strictly adhered to. Meats, poultry, fish, fats, cream, butter, lard, tallow, eggs, and cheese are the only free foods on this control diet (no vegetable oils or shortenings for reasons that are explained elsewhere on this site). Non-starchy vegetables like broccoli and cauliflower may be eaten in small amounts, as well as green beans, cabbage, and asparagus. Eat sparingly, if you wish, but don't starve. Fats are very satisfying if one is not consuming carbohydrates, so don't refrain because you are afraid you will be hungry all the time. Have no fear: This is a very comfortable time as long as no carbs are consumed. And do not be afraid of animal fats in your diet. Rather than being the heart/blood pressure villains they are claimed to be, they are nutrition-dense and highly efficient as sources of energy, besides being like "Roto-Rooters" in your arteries. Steak and butter, if you wish. Fish and cream. Meat and Cheese. Once the normal blood-sugar level is reached, you should be able to add small amounts of other foods (vegetables and small servings of fruits) back into your diet.

Many people won't even attempt this regimen because it is so restrictive. I've had people tell me "But, I can't give up my bread!" "What will I eat??" "I hate fat!" "I'll just die if I don't have my cinnamon roll every morning." Fine. Nobody is forcing anyone to eat the way I recommend. If their cinnamon rolls mean more to them than life, they should go for it. These people will probably have Type II in another couple of years. They will be the ones who will probably die in their mid-seventies, if not before.

But there are some who want to live without needles and Glucophage. They are the ones who will get serious about removing the insulin-loaded fat and untangling the metabolic knot.

4. As long as you have stored insulin in your fat cells, you will continue to have hypoglycemia. The stored insulin spells "no room" in the blood to newly secreted insulin, which means new fat cells must be stimulated for more insulin and fat, and so on ad infinitum. Only by not stimulating any new insulin can the individual begin to use up the fat/insulin stores.

I cannot emphasize enough how very important it is not to cheat on this diet. If you want to regain your health, you must, in the words of Clint Eastwood in The Outlaw Josey Wales, "...get plumb, mad-dog mean!" Get mean with yourself, and you will fool your body into using up its store of fat. Stay with it and don't let anyone distract you from your goal, because, for reactive hypoglycemics, this is a matter of life and death.

5. This condition will never go away. It is yours forever, probably as a result of a family history of defective sugar-metabolism genes, so always keep it in mind. (I even went so far as to get a medic-alert bracelet to remind myself when I am tempted that what I have is lifelong, as well as potentially life-threatening.)

RHG is actually a form of diabetes, and you are stuck with it. So stay with your diet, and avoid having to take insulin, which is what will happen if you develop Type II diabetes. You will get your hypoglycemia under control, but it will always lurk under the surface, waiting for you to slip up. If you don't like the adrenalin flashes and the other symptoms, this is what you have to do to get control of them.

6. Do not fail to eat fat with this diet. Three tablespoons of butter or so a day (more won't hurt), whipping cream in your coffee, or coconut oil two or three times a day is the bare minimum. Without it, you might even get ill. You must have some form of saturated fat on any strict fast or high-protein diet.

Saturated fats are NOT fattening, no matter what anybody tells you to the contrary. They do not stimulate the production of insulin, which must occur in order for calories to be stored as fat. They are, however, extremely nutritious, biochemically essential, and your body needs more saturated fats than almost any other nutrient, except perhaps water and protein. Do not be afraid of butter, steak fat, whipping cream, cheese, lard, cream cheese, or eggs while doing this diet. Butter and coconut oil are very good forms to use, since they are just about the only foods you can be certain are absolutely carb-free.

Coconut oil is the richest source of lauric fatty acids, an essential fatty acid. This lauric acid is so essential, in fact, that mother's milk is the next highest source of it. It is essential for the proper formation of nerve and brain cells, among other things. Coconut oil is unique in the way it is metabolized. It passes directly into the metabolic process and does not even get into the digestion. Learn more about it here.

The information provided above is strictly my opinion. Do not mistake any of this material for medical advice.