What Is Reactive Hypoglycemia?

"What do you mean dinner isn't ready yet?", I ask in an aggressive, irritated tone and I can feel my eyes flooding with tears. I am trying to stay calm but I am so angry.

My husband has seen this before. "When was the last time you ate?", he asks as he hands me a few slices of cheese.

I grab the food with shaky fingers and wolf it down. I close my eyes and wait for the surge of glucose through my blood stream. I am breathing steadily again. My anger, along with my pounding headache are slowly going away.

"About four hours ago.", I say.

"That's too long, sweetie." he says gently as he is leading me to the couch.

"I know, I know." I retort sadly,  "I just wish I could last without food for a couple of hours and not turn into a monster!"

Have you experienced this before? How about confusion, irritability, impatience, shakiness or the inability to compete simple tasks when you miss a meal or just haven't eaten in a couple of hours? If you or someone close to you who has, let me share what I have learned about this condition.

These symptoms are characteristic of hypoglycemia (not to be confused with hyperglycemia, i.e. high blood sugar levels - a very different medical condition we will not be exploring today).

What is Hypoglycemia?

There are two varieties of hypoglycemia in non-diabetic individuals: Fasting Hypoglycemia and Reactive Hypoglycemia.

Fasting Hypoglycemia

According to Balch (1997) Fasting Hypoglycemia is rare and is caused by pathogens or disease. Examples of causes include pancreatic tumors, liver disease, adrenal malfunction, thyroid disorders, pituitary disorders, food sensitivities, and allergies.

Reactive Hypoglycemia

Reactive Hypoglycemia (aka idiopathic postprandial hypoglycemia or functional hypoglycemia) is a condition first recognized in 1924 by doctor Seale Harris. A few years later scientists discovered that some patients who claimed to have symptoms typically associated with reactive hypoglycemia did not exhibit low blood sugar levels when they were tested. This confusion led to an attempt to re-name the condition idiopathic postprandial hypoglycemia.

In addition, hypoglycemia has become a fashionable and over diagnosed disorder in several countries, due to its popularization in the lay literature, so that a host of patients used to describe signs suggestive for hypoglycemia without any clinical evidence for low blood glucose, a situation that Cahill [5] and Yager [6] proposed to call “non-hypoglycemia”. In agreement with them, Charles [9] who found that such patients never exhibited hypoglycemia after a mixed meal concluded that this situation has no relation to glycemia and should rather be termed “post prandial idiopathic syndrome”. The number of terms applied to reactive hypoglycemia have added to the confusion: these included functional hyperinsulinism, essential hypoglycemia, functional hypoglycemia, dysinsulinism, hypoglycemic fatigue, insulinogenic hypoglycemia, and relative hypoglycemia [10-11]. Consensus conferences were held to clarify this question. Chairmen of the Third International Symposium on Hypoglycemia (22-23 September 1986) in Rome [8] published a consensus statement indicating that, although the disease was generally over-diagnosed, there was no doubt that “some patients exhibit postprandial symptoms suggesting hypoglycemia in everyday life and that, if these symptoms are accompanied by blood glucose levels between 2.8 and 2.5 mM or below (determined by a specific method on capillary or arterialized venous blood, respectively) the diagnosis of postprandial, or reactive, hypoglycemia may be correct. In these patients, every effort should be made to document hypoglycemia under their everyday-life conditions.” Source

However now we know that hypoglycemia is difficult to formally test which means that someone can truly have steady glucose levels when tested yet struggle with a severe hypoglycemic attack a few days later depending on the stress levels they experience. Source

The standard test to check for hypoglycemia is called Glucose Tolerance Test (GTT). The testing procedure requires going to a blood drawing lab in the morning after fasting over night. Blood is drawn and the fasting blood sugar levels is recorded. Afterwards glucose is being injected and then the fluctuations above and below the fasting levels are being recorded. [...]
However the GTT is not always a conclusive test. People can suffer from hypoglycemic symptoms even when the tests show normal ranges in blood sugar. The lab setting does not appropriate the stresses people may have to deal with in everyday life. As a result, sugar levels that appear to be within a normal range in the test setting might be outside the normal range if job or family stresses were part of the equation. This is because when the adrenals become stressed, they may not respond to a low blood sugar situation by starting the process of converting glycogen to glucose. (Donsbach 13)

Regardless of what the tests might say, if someone passes out, starts shaking, or becomes unusually irritated because they haven't eaten in four hours, something is going on with their blood sugar levels. I have not taken the GTT test. If you have the means to, go for it, but remember it may not be conclusive. Here is the list of symptoms for reactive hypoglycemia that maybe helpful to be aware of, if you intend to diagnose yourself.

...anorexia, anxiety, asthma, blackouts, blurred vision bruise easily, clammy skin, cold extremities  cold sweats, colitis, convulsions, craving for sweets, alcohol  coffee, sodas, chronic fatigue, chronic indigestion, constant worrying, crying spells, depression, diarrhea, difficulty concentration, digestive disorders,  dizziness, drowsiness, fatigue relieved by eating, fits of anger, forgetfulness, headaches, joint pain, nervousness, muscle twitching, sensitivities to light and noise, ravenous hunger between meals, premenstrual syndrome, shortness of breath...


The word hypoglycemia comes from the two Greek words hypo (under) and glycys (sweet).
According to McGuire (2011) the concentration of glucose - or "sweet" - in your blood fluctuates throughout the day. After several hours without eating your blood glucose decreases. Conversely, blood glucose increases after eating a meal rich in carbohydrates. Blood glucose levels are the lowest in the morning after overnight fast, returning to normal shortly after breakfast.Because our cells need energy 24 hours a day, the pancreatic hormone insulin and glucagon work vigilantly to maintain blood glucose levels within an acceptable range. 145

Source

Unfortunately in some people the pancreas "over responds" to high blood glucose levels by sending out too much insulin. Too much insulin will leave you with a low blood sugar level just a couple of hours after you ate. Insulin not only assists in blood glucose regulation but it also aids in storing glucose throughout the body as FAT.

In addition, when meals provide more glucose than we require, insulin stimulates its storage as glycogen. Once muscles and the liver reach their glycogen storage capacity excess glucose is converted to fat, which is stored in adipose tissue.
(Beerman, McGuirre 146)

A release of too much insulin ends up taking too much sugar out of the blood and into storage. Since the brain and other components of the nervous system cannot store glucose, they are dependent on the circulating glucose for energy. When there is not enough glucose circulating through the blood stream the brain begins to run out of fuel. People then begin experiencing dizziness, irritability, lethargy, and anxiety.

What are the causes of the over-production of insulin?

 1. A diet high in refined carbohydrates and sugar

I am definitely guilty of this one. During college I survived on bagels, mac n' cheese, ramen, pizza, pop, and sometimes just plain old sugar (with a little tea). I was not hypoglycemic as a child or as a teenager. But I became one in my early twenties.

Faulty metabolism can occur when someone repeatedly and excessively consumes refined foods, and or/simple sugars. When this kind of eating pattern is repeated many times a day, day after day for months or years, the constant imbalance of glucose in the system stresses the body and leads to the exhaustion of the pancreas, liver, and adrenal glands, our body's primary blood sugar regulators. (Airola, 23)

2. Skipping Breakfast

These days this is what I have for breakfast.

I hated eating breakfast in college. I would drink a cup of black tea and then at twelve I would walk to the vending machine and get a candy bar or some chips. On a good day I would eat a bagel. I always told myself that my body just doesn't like to eat in the morning. But it's actually not true. Since I began drinking a large glass of lemon water every morning as soon as I wake up, instead of a mug of appetite suppressing black tea, I began feeling hungry for protein and fats.

After fasting all night it is imperative to give your body good fuel. A cup of coffee is not enough sustenance and it will exhaust your adrenal glands. Eating a bagel or a bowl of cereal will give you instant energy and a high glucose surge but you will experience a crash a few hours later. Opt for foods that have a low glycemic index like protein, fats and complex carbohydrates.

3. Severe Emotional Stress

Coming to the US was huge challenge both emotionally and physically and it took my body quite some time to readjust. Instead of giving myself time to recover, I often survived on 5 hours of sleep  for almost four years.

The adrenals are essential to sugar metabolism. Any stress, particularly ongoing stress, taxes the adrenal glands. Constant stress can exhaust them to the point where they do not preform their job efficiently. B complex and Vitamin C in the body, necessary for proper adrenal function, are depleted by stress. (Whalen, 9)

4. Alcohol

I have never indulged in too much alcohol but the combination of eating poorly and being stressed made the beer or wine I sipped occasionally too much for my poor pancreas to handle.

It is toxic to the liver and impairs liver function. Alcohol interferes with carbohydrate metabolism and increases the secretion of insulin. This results in low blood sugar, causing a craving for foods that raise blood sugar levels quickly, as well as craving for more alcohol. (Murray, Pizzorno, 556)

5. Caffeine

I drank quite a bit of caffeine in my early twenties, never coffee but about five to six cups of strong black tea with two teaspoons of sugar. I had no idea I was exhausting my adrenal glands and wreaking havoc on my pancreas.

Caffeine also causes swings in blood sugar levels because it has a stimulating effect on the adrenal glands. When the adrenal glands are stimulated, they release hormones telling the liver to release stored sugar. This depletes the reserve of stored sugar in the liver and puts too much sugar into the blood. Excess sugar in the blood causes the pancreas to release more insulin and the cycle continues. (Airola, 60) 

6. Smoking

I did occasionally smoke in college, sorry mom. I always felt a huge surge of energy after the second time I drew the carcinogenic smoke into my lungs. The odd thing is that many of my smoker friends say smoking calms them down. I always thought it was odd that I would feel such a crazy rush of energy.

Smoking cigarettes causes a rapid rise in blood sugar, and then a quick drop not long after the cigarette is put out. These findings come from a Swedish study done on humans which nicotine in tobacco was found to be the causative agent. (Airola, 62)

This was a difficult post for me to write for several reasons. My struggle with hypoglycemia has been very hard to cope with since it affects one on such an emotional level. None of my friends, or family enjoy watching me turn irate, confused, and shaky. They have been gracious about it but I am well aware of what I sound and behave like when I am experiencing low blood sugar levels. I was aware that I did not treat my body well during my early twenties but after listing all the possible causes for hypoglycemia I realized I was guilty of all of them. Not only did I skip breakfast, eat poorly, drink too much caffeine, and sleep too little I also exacerbated the problem by smoking and drinking!

Another reason this was difficult is because there is so much literature out there talking about this condition. I have spent days and days now researching it. In my anatomy classes I have learned that the overproduction of insulin causes hypoglycemia. But once I began researching some more, there seems to be other causes I couldn't ignore.

There is various literature that seems to indicate that someone can experience bouts of dizziness, shakiness, and extreme hunger or hypoglycemic symptoms, without the pancreas overproducing insulin. It is not as common or as well researched, but there is some evidence for it.

Other Causes

1.

Another reason for a reactive hypoglycemic/idiopathic postprandial attack is increased beta andregenic sensitivity. The andrenergic receptors can stimulate the sympathetic nervous system by binding to adrenaline an noradrenaline hormones. These hormones are produced in our adrenal glands and play a role in what is often called the Flight or Fight response. When someone develops a beta andregenic sensitivity due to emotional stress or trauma they will experience the same onset of symptoms as patients suffering from an overproduction of insulin do. Source

2.

There is also the theory of fast vs slow oxidizers. Recently I took doctor Mercola's nutritional typing test, which placed me in the Protein category because I am a fast oxidizer, which means my cells burn carbohydrates and glucose too fast. This indicates that I experience low blood sugar levels not because my pancreas releases too much insulin or because my beta andregenic receptors are oversensitive  but because my body metabolizes carbohydrates and glucose too fast. Unfortunately, I have been unable to find scientific studies supporting this theory aside from proponents of metabolic typing.

Fast oxidizers tend to have low blood sugar (reactive hypoglycemia) and higher levels of blood cholesterol and triglyceride and citric acid cycle intermediates. Bilirubin is commonly found in the urine. They tend to be unable to hold their breath for a long period (one can consider the fast oxidizer functionally anemic due to low oxygen capacity in the blood and have relatively faster pulse rate. Source

Conclusion

I have found even more theories about what may cause low blood sugar levels but I tried to highlight the ones that seemed to be the most popular. The rest of them are also very fascinating, but they all suggested  similar solutions. In Part 2, I will discuss remedies and coping strategies for hypoglycemia that have been helpful for me.

Read Part Two- How I Lost Ten Pounds and Healed my Hypoglycemia here.

Bibliography:

McGuire M. & Beerman K. (2011), Nutritional Sciences ( 1st Ed.). Belmont, CA: Wadsworth Cengage Learning
Airola, Paavo. Hypoglycemia: A Better Apprroach, OR: Health Plus, 1997
Balch, James F. and Phylis A. Balch. Prescription for Nutritional Healing. Garden City, NY:Avery 1997
Whalen, Freda. The Hypoglycemia/Diabetes Cope Book. Los Angeles: Body Care, 1993.
Murray, Michael and Joseph Pizzorno. Encyclopedia of Natural Remedies. Rocklin, CA: Prima, 1998.
"Hypoglycemia", Hawthorn University Handout 2012



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