Hypoglycemia

Hypoglycemia is defined as low blood glucose values that are less than 50 mg/dl (2.8 mmol/l). Whipple’s triad describes the three essential aspects of hypoglycemia: low plasma glucose, symptoms associated with hypoglycemia, and symptomatic resolution when blood sugar is returned back to normal.

Signs and Symptoms

The adrenergic symptoms related to hypoglycemia are related to catecholamine levels. These symptoms include diaphoresis (sweating), palpitations, apprehension, anxiety, headache, and weakness. The lack of blood sugar supply to the brain will cause neuroglycopenic symptoms and result in confusion, irritability, abnormal behavior, ‘spaciness’, and possibly even convulsions and coma.

Kinds of Hypoglycemia

Fasting Hypoglycemia
Fasting hypoglycemia when very severe usually indicates an organic cause.

Organic Causes

• Pancreatic disorders
• Liver disease
• Pituitary-Adrenal disorders
• CNS disease
• Non-pancreatic neoplasms
• Idiopathic hypoglycemia of childhood

Exogenous Causes
Iatrogenic: insulin, oral hypoglycemic drugs, antihistamines, angiotensin converting enzyme (ACE) inhibitors, pentamidine, alcohol, salicytes, ackee nut.(1)

Postprandial Hypoglycemia

Postprandial hypoglycemia, also called reactive hypoglycemia, is a non-severe form of hypoglycemia that is not caused by a pathology, but rather by a lack of optimum function of the organs that regulate blood sugar.

Pseudohypoglycemia

Pseudohypoglycemia is a false positive laboratory reading of hypoglycemia that happens due to chronic leukemia, hemolytic anemia, or polycythemia. The mechanism for the false positive in leukemia is due to the glucose utilization by leucocytes in the blood sample after it has been drawn from the patient.

Reactive Hypoglycemia

Reactive hypoglycemia is by far the most common form of hypoglycemia. It has such a variety of symptoms that they are often misdiagnosed and overlooked. Symptoms range from feeling irritable upon missing a meal to drastic mood swings during PMS. Low blood sugar causes people to feel hungry in between meals. People will often crave foods that are both sweet and high in carbohydrates. However, after eating these foods patients still don't feel well; they become sluggish and tired.
______________________

Conventional Medical Treatment [SH]

Conventional treatment for reactive hypoglycemia as defined above is limited because often it is not considered a real condition. Conventional medicine does recognize reactive hypoglycemia by a stricter definition of serious pathologies, however:

• Alimentary hypoglycemia caused by previous gastrointestinal surgery and peptic ulcer disease.
• Hormonal causes, such early onset of diabetes Type II, hyperthyroidism, cortisol, epinephrine, thyroid hormone, glucagon, and growth hormone deficiency.
• Endocrine conditions, such as insulinoma, or insulin receptor autoantibodies.

Conventional treatment for the above conditions would be dealt with by treating the underlying cause.

Naturopathic Medical Treatment and Prevention [SH]

Before making a comprehensive treatment plan for hypoglycemia, the functions and control of blood sugar need to be considered. A holistic perspective will give much better results. By strengthening the health of the same organs involved in treating diabetes Type II, good results can be achieved.

Botanical Medicine

Gymnema sylvestre: Used in India for over 2000 years, this herb contains a compound gymnemic acid that has shown to support the beta cells of the Langerhans. It is a good herbal remedy for diabetes and hypoglycemia. Use of Gymnema sylvestre is helpful for high or low blood sugar.(2)

Siberian ginseng and Panax ginseng: Adaptogens, such as Siberian ginseng and Panax ginseng, are also very useful for sustaining healthy blood sugar levels.

Glycyrrhiza glabra: Licorice root inhibits the half-life of life of cortisol by inhibiting its peripheral breakdown.(3) Licorice is an excellent remedy for hypoglycemia due to adrenocorticoid insufficiency.

Clinical Nutrition [C]

Alpha lipoic acid: This potent antioxidant neutralizes free radicals and enhances the effectiveness of vitamin C and E, as well as sustaining blood sugar levels.(4)

Low Glycemic Diet: A low-carbohydrate, moderate-protein, and moderate-fat diet focused on natural whole foods is a solution to hypoglycemia. A diet that consists of mainly refined foods, especially sweets, combined with deficient exercise, gets people into trouble in the first place, so a program based on whole foods, not more refined food products, is the best long-term solution. In addition, more frequent meals and/or snacks through the day is helpful in keeping blood sugar stable.
      Over consumption of simple or refined carbohydrates can lead to a number of health-related concerns, including the development of hypoglycemia. This is often associated with hyperinsulinemia, which is caused by a hypersecretion of insulin by the pancreas. In other words, people can develop elevated insulin levels presumably in an effort to compensate for the spikes in blood sugar caused by consumption of these simple carbohydrates. This can lead to a subsequent drop in blood sugar (hypoglycemia) and to insulin resistance, in which the cells of the body become insensitive to insulin. Insulin resistance may eventually lead to diabetes, in which the blood sugar levels are elevated above the normal range.
     A diet to control hypoglycemia must consider the glycemic index .The glycemic index of foods is a system of classifying foods according to the degree to which they raise blood glucose levels. It compares the blood glucose level following consumption of equal portions of various foods and ranks the foods relative to a standard (usually glucose or white bread).
     The glycemic index is not a measure of the amount of carbohydrate in a particular food. For example, orange juice has a higher glycemic index than apple juice, while apple juice has higher carbohydrate levels. The body's insulin responses tend to follow the rank order of the glycemic response. Highest glycemic foods include not only sweets and deserts, but also many starchy foods, such as white bread, breakfast cereals, and potatoes. Lowest glycemic index foods include legumes, dairy products, most non-starchy fruits and vegetables, meat, fish, and poultry.
      Meals and snacks should also be balanced themselves in terms of the three macro-nutrients. A ratio of approximately 20% to 30% protein, 30% to 45% fat, and 25% to 50% complex carbohydrate will ensure that blood sugar is not raised too high at meals and therefore should not drop to the hypoglycemic range post prandially. This diet is based on human evolutionary history and physiology. It reflects what the fact that humans evolved over millions of years as hunter/gatherers, eating a diet that is low on the glycemic scale, and ‘grazing’ as opposed to having regular meals. Of note is that hypoglycemia and type II diabetes are more prevalent in people who made a rapid switch from hunter/gatherer to modern diets, such as the Native Americans.

Glycemic Index of Common Foods

For more information on a low glycemic diet and an analysis of the glycemic index of common foods, see the Clinical Handbook: Diagnostic and Therapeutic Protocols.

Side Benefits of Low Glycemic Diets

Other benefits from this diet may be seen, such as weight loss, improved lipid profile (reduction of triglycerides and high HDL levels), and blood pressure reduction. Of course, hypoglycemia symptoms should improve, and the carvings for sweets and caffeine should diminish. As the load is lessened on the adrenals, energy levels and overall mood may improve as well. As the insulin sensitivity is reestablished, the body is better able to handle small amounts of high glycemic foods (in other words, cheating is less likely to lead to symptoms).

Lifestyle

Stress: Stress plays a role in improper carbohydrate metabolism. Stress causes cortisol levels to rise, which can lead to decreased utilization of blood glucose and increased obesity and reactive hypoglycemia. If stress is persistent, the adrenals can become fatigued, which is also a major contributor to hypoglycemia. Because the adrenal response is triggered by low blood glucose, hypoglycemia exacerbates adrenal fatigue, as do simple carbohydrates (especially sweets and alcohol) and stimulant consumption. Therefore, managing stress, avoiding all stimulants, and supporting the adrenals will improve hypoglycemia symptoms.

Liver Support and Detoxification: The liver also plays a role in glucose metabolism, responsible for converting stored glycogen to glucose if blood sugar drops too low. Therefore, liver support and detoxification may improve the tendency to hypoglycemia by strengthening the ability of the liver to respond to low blood sugar. Thus, reducing toxic load on the liver by eating pesticide free foods and by avoiding chemical exposures (including over medicating) can improve the stability of blood glucose levels.

Exercise: Exercise has a number of benefits in the management of hypoglycemia. Exercise balances blood glucose by optimizing glucose uptake at the cellular level. Therefore, hyperinsulinemia is less likely to develop in a fit person. In addition, regular exercise balances the stress hormones and supports the adrenals, both of which help to maintain balanced blood sugar.

Selected Clinical Studies and Literature Reviews

For more information on the value of exercise in managing hypoglycemia, see J.K. Ojha, H.S. Bajpat, and R.M. Shettiwar, “Effect of Yogic Practices and Pterocarpus Extract on Insulin Dependent Diabetes,” in Selected Clinical Studies and Literature Reviews.

Clinical Studies

Jambul Seed, Prickly Pear Cactus, Devil’s Club, Milk Thistle, and Globe Artichoke

One clinical trial using 650 mg of herbal capsules 3 times a day consisting off jambul seed, prickly pear cactus, devil’s club, milk thistle, and globe artichoke resulted in lowered fasting blood sugar levels by 33% in the majority of adult onset diabetics, while also raising blood sugar levels in patients with reactive hypoglycemia.(5)

Hypoglycemic Score
Hypoglycemic patients were able to lower their hypoglycemic score index by 67% after 6 weeks administration of this formula. The hypoglycemic score is calculated by assigning a numerical value to the intensity and frequency of the following symptoms.

• Dizziness when standing up suddenly
•  Loss of vision when standing suddenly
•  Craving sweets
•  Headaches relieved by eating sweets
•  Feeling shaky or jittery
•  Irritability if a meal is missed
•  Heart palpitations after eating sweets
•  Need to drink coffee to get started in the morning
•  Impatient, moody, nervous
•  Feeling faint
•  Forgetfulness
•  Calmer after eating
•  Poor concentration

Results
Since hypoglycemic patients often have a hard time coping with their hunger between meals when the blood sugar drops, they are likely to eat often. Most of the hypoglycemic patients who took herbs during the study had decreased appetite between meals; thus, patients were also able to lose weight. The study showed that herbs when formulated holistically to address all the organs involved in blood sugar metabolism, not only are effective in addressing problems of high blood sugar but also in low blood sugar. Thus, it was shown that many of the herbs that were used traditionally to treat diabetes are also effective in treating low blood sugar levels, reinforcing the theory that some herbs have a regulating effect.