Low glycaemic index diet Treatment is to avoid all foods containing sugar and refined carbohydrate. 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.
Nutritional Supplements – what everybody should be taking all the time even if nothing is wrong
Exercise – the right sort.
The brain’s preferred fuel are ketones which the liver synthesises from medium chain fatty acids. The best source of these is coconut oil. This fuel source is much more constant than glucose and highly protective against hypoglycaemia. Coconut oil 10-20ml twice daily is often very helpful! See Brain fog – poor memory, difficulty thinking clearly etc. The brain loves fat!
If the brain runs short of fats and ketones, it can swap to short chain fatty acids (which come from the large bowel fermenting soluble fibre and can provide up to 500kcals a day) or worst, sugar. The trouble with sugar is it is a short term fuel, like running on reserve tank. The brain is constantly assessing the fullness of the tank and if the tank starts to run low, the brain stimulates the release of adrenaline – this will bring blood sugar up for the brain but one then suffers from the adrenaline effects.
Prebiotics (as soluble fibre in vegetables especially pulses, vegetables, nuts and seeds or as frucoto-oligosaccharides). Prebiotics feed bacteroides in the large bowel which ferment to produce short chain fatty acids – when blood sugar levels fall mitochondria happily swap to SCFAs as a fuel source. Indeed over 500kcals a day can be generated in this way. SCFAs help to prevent hypoglycaemia especially during sleep.
Probiotics – my view is that probiotics have not lived up to their potential. However they may be useful by displacing unfriendly bacteria or yeast. Kefir for examply produces a toxin that kills yeast in the gut. The best and cheapest way to do this is to brew your own. We should all be taking these all the time and double the dose following antibiotics and gastroenteritis.
Fermentation in the gut and CFS – a fermenting gut produces alcohol which further destabilises blood sugar levels.
Additional supplements – niacinamide and chromium are particularly helpful. I recommend taking a high dose for two months. Both these supplements have a profound effect on blood sugar levels to stabilise them but sometimes have to be given in high doses initially to kick start the necessary mechanisms. By this I mean niacinamide 500mgs, 3 daily at mealtimes and possibly double this dose. Rarely, niacinamide in these doses can upset liver enzymes but this is accompanied by nausea – so if you feel this symptom, reduce the dose to 500mgs daily. Niacinamide is a really interesting vitamin – it shares the same action as diazepam (Valium) to produce a calming effect which is not addictive. I suspect it works because so much anxiety is caused by low blood sugar and niacinamide helps prevent this.
Allergies to foods – this can certainly cause hypoglycaemia – the top three allergens are grains, dairy products and yeast. But one can be allergic to any food! See Stone Age Diet.
Hypothyroidism – see Hypothyroidism
Adrenal problems and cortisol – the job of the adrenal gland is to produce the stress hormones to allow us to move up a gear when the stress comes on. Cortisol raises blood sugar levels. It is largely excreted during mornings and declines as the day progresses – this is why we should feel at our best early in the day, and blood sugar problems get worse as the day progresses. Often people compensate for this by eating more as the day goes on and explains why many hypoglycaemics do not need or eat breakfast with supper being the largest meal of the day. Changing all of the above will help. But it may be appropriate to do an adrenal stress profile and actually measure output of the stress hormones cortisol and DHEA since a small supplement may be very helpful. See Adrenal Gland – the gear box of the car (DHEA and cortisol) – underactive
Sex hormones, The Pill and HRT. These hormones all have the effect of raising blood sugar levels. Indeed this is the mechanism which is responsible for gestational (pregnancy) diabetes. The problem is that stopping these hormones then causes hypoglycaemia and one gets withdrawal symptoms. I suspect it is part of the mechanism that makes these hormones so addictive.
Toxins and pollutants. There was a fascinating paper in the Lancet that showed that the biggest risk factor for diabetes (and this is the end product of years of hypoglycaemia as insulin resistance results) is the level of pollutants in the body (pesticides, volatile organic compounds and heavy metals). The paper showed that chemical pollutants were a greater risk factor than being overweight! It was suggested that the overweight problem reflected a larger chemical burden as the body tried to “dump” chemicals where they would be out of the way. When people who have the highest levels of POPs in the blood were compared to the people with the lowest levels of POPs in the blood, they were found to be 38 times more likely to be diabetic.
The chemicals literally get in the way of many biochemical processes and prevent the body functioning normally. So for some people doing detox regimes is very helpful – ie far infra red sweating/saunaing and improving liver detox with vitamins and minerals. We can easily test for pollutants in fat by doing a fat biopsy – this is a simple test, easier than a blood test! See Detoxification – an overview
Nickel toxicity. Nickel toxicity is a very common problem and nickel is a substance often found stuck onto DNA. See DNA adducts. Nickel biochemically looks very much like zinc and so enzymes which normally incorporate zinc into them, in the presence of zinc deficiency, will take up nickel instead. This prevents the enzyme or the hormone from functioning normally. Clinically nickel toxicity often presents with hypoglycaemia. See Nickel – a nasty toxic metal.
Fructose intolerance. Fructose is fruit sugar generally perceived to be a healthy alternative to glucose. No problem if one is tolerant of fructose or if it is taken in small amounts, but intolerance of fructose or excessive intake can result in hypoglycaemia. This is because the control mechanisms that apply to glucose are bypassed if the system is awash with fructose. In fructose intolerance (aldolase type B deficiency), fructose-1-phosphate builds up because it inhibits glycogen phosphorylase which is essential for the provision of glucose from glycogen and it also inhibits fructose-16-biphosphatase which is essential for provision of glucose from protein and fat. This combination can result in severe hypoglycaemia because it means effectively the body cannot mobilise glucose from stores in the liver for when blood sugar levels fall. This combination can lead to severe hypoglycaemia.
Even if the enzyme works perfectly well, excessive fructose intake will stress the same pathways. Sugar stores in the liver cannot be mobilised. Because liver uses up short chain fatty acids for the production of glucose to try to avoid this hypoglycaemia, this tendency can be measured by looking at short chain fatty acids in the blood and also measuring levels of fructose-6-phosphate which gets induced in this situation. These three metabolic problems i.e. levels of short chain fatty acids, levels of fructose-6-phosphate and LDH isoenzyme (indicative of liver damage), can help diagnose this problem.
I recommend people avoid tropical fruit (high fructose), and go for berries which are low fructose but rich in goodies!
Failure to tackle hypoglycaemia will result in Diabetes. Indeed diabetes is an inevitable consequence of Western diets and lifesyles. On current figures 50% of the UK population will be diabetic by the year 2030.
Initial complications. 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.
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 exercise, until the body learns to fully adapt.
Test for hypoglycaemia
Measuring blood sugar levels is not a terribly useful test for hypoglycaemia, partly because the levels 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 follow:
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.
Short chain fatty acids
LDH isoenzymes – includes Cell free DNA free of charge
Fructose investigations (F6P, SCFA, LDH-isoenzymes) – all three above tests