Hypoglycemia: The Forgotten Blood Sugar Disorder - Guest Column From Dr. Keith Berkowitz (Thanks to Blogger Jimmy Moore)

I'm always pleased to learn of a medical doctor who's savvy about the dangers of hypoglycemia (low blood sugar) -- which, as I point out in my book SUGAR SHOCK! -- is a much-ignored and much-maligned condition that plagues millions of Americans.

In fact, my interest in the dangers of sugar and refined carbs began with my own blood sugar nightmares and many baffling symptoms, from excessive fatigue to brain fog, as I reveal in Chapter 1 (when I tell my embarrassing sugar story).

FYI, I also delve into a discussion of low blood sugar in Chapter 13 of SUGAR SHOCK! This subject is so close to my heart that you can even find an excerpt, Hypoglycemia: A Hidden Hell, on the Web.

Anyhow, I was glad to see that my blogging buddy Jimmy Moore posted a special entry on his Livin' La Vida Low-Carb Blog entitlted, Is Hypoglycemia A Hidden Low-Carb Side Effect?, which was triggered by a conversation he had with New York-based physician Keith Berkowitz, M.D., who fold Jimmy that symptoms of hypoglycemia could by why your weight loss suddenly stops when following a low-carb diet.

Then, Jimmy took the smart move to invite the Dr. Berkowitz to write a special guest column. Because this is such an important subject, I'm reprinting the column here from Jimmy's Livin' La Vida Low-Carb Blog.

The Forgotten Blood Sugar Disorder: Hypoglycemia
by Dr. Keith Berkowitz, M.D.
Medical Director for The Center for Balanced Health

According to the American Diabetes Association, 21 million Americans have diabetes and another 54 million American are at risk with pre-diabetes or elevated blood glucose.

Because of this, our attention has been concentrated on treating high blood glucose while largely ignoring other blood sugar disorders. Poor eating habits, the addition of unhealthy ingredients, increased stress and poor sleeping habits has led to the increased incidence of this underappreciated blood sugar disorder: hypoglycemia.

Hypoglycemia has been traditionally defined as a low blood glucose level (serum levels less than 70 mg/dl either taken fasting, randomly or after a glucose challenge). Unfortunately, most individuals I see in my practice do not present with these results but instead present with normal blood glucose levels, the ability to lose some weight but not the last 10 to 20 pounds or unexplained low energy levels.

One reason for this is that most individuals only have fasting blood glucose or an HgbA1c taken by their health professional.

An HgbA1c level represents the average amount of glucose in the blood over a three-month period. A level of 4.0% is equal to an average blood glucose level of 60 mg/dl while a level of 5.0% is equal to a blood glucose level of 90 mg/dl. HgbA1c levels between 4.8% and 5.9% are considered normal. Levels below 4.8% are usually consistent with hypoglycemia.

Individuals with hypoglycemia can often have symptoms that include: headaches, increased irritability, difficulty concentrating, palpitations, light-headedness, fatigue, anxiety, excessive sweating or urination, leg cramps, dizziness and clamminess. Other symptoms can be related to eating. Patients I see with this diagnosis often feel more tired after meals, feel “sick” when they either miss a meal or if a meal is delayed.

So, if you have significantly reduced calories or carbohydrates, are you still unable to lose weight? Are you unable to lose that last 20 pounds no matter what you try? Eating a low-carbohydrate diet but still hungry and/or tired after meals? I just may have a solution for you.

Traditionally treatment for hypoglycemia has been to give sugar. Unfortunately, this treatment only provides temporary relief and in very sensitive individuals causes an even greater reaction thirty minutes to two hours later. Although, a strict low-carbohydrate diet is helpful, it does not always solve the problem by itself.

In my practice, Center for Balanced Health, I see individuals with such pronounced hypoglycemia that their blood sugar drops almost immediately after a glucose challenge. It’s the equivalent of filling an automobile with gas only to find that the gas tank has a very large leak.

At the Center for Balanced Health, we help patients manage their hypoglycemia by telling them to:

- Eat five to six small meals a day about every three hours. Think of yourself as a fuel-efficient automobile. You want constant flow of energy (glucose) throughout the day.

- Avoid meals that are too small or too large especially at night. Meals that are too small will not provide enough energy to get you through the day. Meals that are too large place a larger burden on your metabolic system to process these nutrients and thus can trigger a hypoglycemic reaction.

- DON'T skip meals especially breakfast. Breakfast is the most important meal of the day because it sets the tone.

- Balanced eating. Always have some protein and fat at each meal or snack. Avoid and limit foods high in sugar or other refined carbohydrates,especially on a empty stomach. Still utilize a controlled carbohydrate approach and get your carbohydrates from foods high in fiber (dark green leafy vegetables, non-starchy vegetables, avocado, high-fiber, low-carbohydrate crackers as examples.)

- Get a good night’s sleep. Good sleep helps replenish your system so that your body works more efficiently.

- Use of a fiber supplement (make sure you take with enough water) or eating a high-fiber food (without refined carbohydrates or sugar) before meals or snacks can help slow the absorption of carbohydrates and thus prevent rapid declines in blood sugar.

- Exercise regularly. Strength training can improve glucose metabolism

- Avoid alcohol, caffeine, tobacco use.

- Avoid the use of stimulants.

If you suspect hypoglycemia, the best diagnostic test is a glucose tolerance test with insulin levels and an HgbA1c. I usually do this test in my office because a glucose challenge can sometimes precipitate symptoms of low blood sugar.

Thanks, Jimmy, for running this informative article on your Livin' La Vida Low-Carb Blog. Guess I now to have contact Dr. Berkowitz myself. too. In fact, I have a question for him -- does he suggest the five-hour or six-hour Glucose Tolerance Test?

Comments

[Meg Gann]

Hi-- I have hypoglycemia and I've been trying to find out if these(nightmares,headaches), are connected to hypoglycemia. My Endo.and Family Doctor, say no. The more I read, the more convinced, I am that I have reactive hypoglycemia or something that is caused by carbs. I haven't had one of these spells in over a week,(since, I've been having a high protein, low-carb snack before bed), until last night [when] I had milk and a piece of pound cake. I had very vivid dreams off and on all night, plus headache. What does this sound like to you? My sincere thanks, Meg Gann Note from Connie: I'm not a doctor, but it sure sounded like you answered your own question. Didn't you pretty much say that you've found out that sugar tends to mess you up? FYI, you may need to see another doctor and perhaps get a test for reactive hypoglycemia. FYI, I'm writing to you privately, too.

[Ed]

I haven't read the book yet but I may do as finding out about Reactive Hypoglycemia has been like having a blindfold removed after 36 years of very mixed-up behaviour, moods, thoughts that go round and round with no resolution and on-and-off depression. It explains a lot of the isolation I had in my adolescence. Previously, I had put that down to "hormones" but now I know it wasn't just that. I don't crave sweet things like desserts, but I do get cravings for other carbohydrates. Another great danger is caffeine, even in small doses. If I can pass on a tip; drink Chamomile tea! It really seems to balance my mood in minutes. Kind regards, Ed. Note from Connie: Ed, great to hear from you. So glad it rang a bell for you. Yes, chamomile tea is very nice.