HYPOGLYCEMIA

HOW DO I KNOW IF I HAVE HYPOGLYCEMIA?

Do you know that shakiness, faintness, dizziness or tremor are a frequent sign of idiopathic reactive hypoglycemia (IRH), particularly when it is accompanied by nausea and fatigue. It may be caused by certain foods or food combinations. Do you get palpitations or heart irregularity which are not uncommon food in this condition? These are symptoms due to adrenaline release. Transitory gray patches in the field of vision (called scotomata) may also occur without warning, but may precede a Migraine type headache or fuzzy headedness and mental depression, even melancholia. Confusion and seizures may also occur. These are central nervous system symptoms.

Suspected postprandial (after food)  hypoglycemia is associated with beta-adrenergic (adrenaline) hypersensitivity (allergy) and emotional distress according to Berlin and others.

They state that hypoglycemia (IRH) appearing after meals rich in carbohydrates causes palpitations, headache, tremor, generalized sweating, hunger, dizziness, sweating of the palms, flush, nausea, and fatigue.  Patients develop emotional distress and significantly higher anxiety, somatization, depression, and obsessive-compulsive reactions.

Hypoglycemia causes heart irregularity. Rokas and others report of a patient in whom it was possible to document that reactive hypoglycemia was the trigger for heart irregularity and palpitations. Only when the patient was in a hypoglycemic state did heart irregularity occur.

 WHAT IS HYPOGLYCEMIA?  

Hypoglycemia is a collection of symptoms (syndrome) brought about by an abnormally low plasma glucose level.  Idipathic Reactive Hypoglycaemia (IRH) is a syndrome associated with a rapid fall in blood glucose with the release of adrenalin (causing shakiness) and may occur in those apparently non-diabetic or people predisposed to diabetes (pre-diabetic).

The brain and other tissues require glucose in order to function properly.  Brain glucose utilization fortunately is not regulated by insulin.  Deficiency of brain glucose is countered by adrenergic (adrenaline production) responses which play a part in the hypoglycemic syndrome and brings on the symptoms described above.

Idiopathic reactive hypoglycemia (IRH), occurs in individuals sensitive to some foods and produces these symptoms.

According to Leonetti and others, increased glucose use occurs in idiopathic reactive hypoglycemia after meals. In IRH, blood glucose levels drop due to increased insulin sensitivity associated with a deficiency in glucagon secretion.  Berlin and others conclude that patients with suspected postprandial hypoglycemia have normal glucose tolerance, increased beta-adrenergic sensitivity, and emotional distress.

We shall be mainly concentrating on IRH in this monograph, but we shall mention other types of hypoglycemia for completeness.  Drug induced hypoglycemia is not related to meals.

Alcoholic hypoglycemia is brought about by raised blood alcohol levels.  Inherited enzyme deficiencies bring about hypoglycemia due to genetic errors.  Liver disease and pancreatic tumors causing hypoglycemia need not concern us here.

Alimentary hypoglycemia like idiopathic reactive hypoglycemia is characterized by adrenergic (adrenaline) symptoms as mentioned above.  They occur anything from a few hours to a whole day after ingesting some foods.

There appears to be an immediate and a delayed hypoglycemic syndrome.  In the latter case there appears to be no abnormally low blood glucose level, but a delayed adrenergic response.

Postprandial (following meals) adrenergic (adrenaline) symptoms that are not corrected by taking some form of carbohydrate is common according to Merck. We suspect it is mediated by a different mechanism and is related to the delay response.

The purchase of a home glucose monitor will enable you to check your own blood glucose levels at various times. They are obtainable from most chemist or drug stores, but are not cheap.

WHY DO I HAVE HYPOGLYCEMIA?

 Leira and Rodriguez have shown that some foods in our diet can spark off migraine attacks in susceptible individuals through an allergic reaction. Citrus fruits, tea, coffee, pork, chocolate, milk, nuts, vegetables and cola drinks have been associated with Migraine. Substances in food such as tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate, aspartame) and caffeine can bring about blood vessel changes, leading to headaches. Another recognized trigger for migraine is hypoglycemia. Such foods as chocolate, cheese, citrus fruits, bananas, nuts, 'cured' meats, dairy products, cereals, beans, hot dogs, pizza, food additives (sodium nitrate, monosodium glutamate in Chinese restaurant food, aspartame as a sweetener), coffee, tea, cola drinks, alcoholic drinks such as red wine, beer or whisky distilled in copper stills, all may result in a migraine attack. Different foods affect different individuals.

HOW CAN I BE TESTED FOR HYPOGLYCEMIA?

The best way to find the cause of your hypoglycemia is to start with a simple food avoidance and challenge test.

AVOIDANCE: an avoidance test should be used to test which foods are the cause of your symptoms.  Exclude suspected foods from your diet for ten days.  Remember to read all labels carefully on all commercial foods.

CHALLENGE: If you have eliminated your hypoglycemia on the above avoidance regime, you should now challenge by reintroducing suspected foods.  The best challenge is to have that food for three meals in the one day. If you get hypoglycemia within 24 hrs (maybe 48 hrs at the outside) after adding back that food, then that food is probably a cause of your symptoms.  Exclude that food twice more and challenge to confirm that food as the cause.

If the previous avoidance did not eliminate your symptoms then you should have a more exhaustive dietary assessment which includes taking a ten-day food diary.   You will find an outline for a food diary below. With this diary, see if there is a pattern to the foods that you eat and the regular onset of symptoms. When you locate a pattern, then you can pinpoint the food producing your symptoms.  The food may be hidden in commercial products you buy at the supermarket. Once you have located the responsible food or foods, you should institute an avoidance and challenge test as described above, but involving only the suspect foods from your food diary.

If you still have not eliminated your symptoms you will need to go to a "cave-man" diet to isolate the culprit food.  This is a very primitive diet, which is designed to eliminate all allergy producing foods which are quite difficult to identify.  A copy of this diet is available from us.

Because it usually takes less than 100g to bring about a hypersensitivity reaction, it is unsafe to test foods to which an anaphylactic reaction has occurred or is likely to occur. If there is little or no reaction then increasing the quantity of the suspected food by 2, 4 or even eight times may be needed.

Exclusion Diets: If symptoms do not subside in the avoidance test then an exclusion diet should be used. These are professional diets that exclude families of foods, or types of foods. They include an additive-free diet, dairy product-free diet, egg-free diet, gluten-free diet, glutamate-free diet, low amine diet, low salicylate diet, soybean-free diet, wheat-free diet, yeast-free diet and four-day rotation diet. They are designed to diagnose what family of foods may be responsible for cause of your food intolerance or allergy.

FOOD DIARY

This diary should  include ALL food and drinks you take during this period, including nibbles! It should include the Date and Day of the Week, Symptoms and Events (These may not occur until the NEXT day)

WHAT CAN I DO ABOUT MY HYPOGLYCEMIA?

Often, mild hypoglycemia is merely a minor inconvenience and can be controlled by avoidance of responsible foods and the judicial use of over the counter medicines.

Acute adrenergic symptoms should be treated with immediate glucose or sugar such as a glass of fruit juice or water with three tablespoons of sugar added.   A delayed reaction occurred the following day should be treated by taking a less glycemic foods such as complex carbohydrates or 1/4 teaspoon of glycerin in water, to prevent the overproduction of insulin and a consequent drop in blood glucose levels leading to further hypoglycemia.

When Doctors are Needed:

However, if the symptoms are persistent, recurrent or severe then they can become an important problem to your health and lifestyle. In this case, professional diagnosis and treatment is needed by an Environmental Physician or Allergist who understands hypoglycemia.  The doctor will be able to tell you if your symptoms are due to allergy or a more sinister cause.

What to expect when you consult a professional: if you ask your doctor to help you then he or she will give you a full physical and allergy assessment which will involve a physical examination and various pathology tests.

The Environmental Physician will probably take blood for estimations of your blood insulin level and conduct a 5hr oral glucoses tolerance test to ascertain your body's  response to glucose. These tests will reveal if you have an abnormal insulin response to food and the effect on your blood glucose levels.

WHAT IS THE BEST TREATMENT FOR HYPOGLYCEMIA?

If you suffer from hypoglycemia, then there is no doubt that avoiding the responsible foods is the best treatment. Simple, uncomplicated symptoms can be treated at home with over-the-counter remedies.

If the symptoms are due to causes other than allergy, then the best treatment will be dictated by the findings after a physical examinations and testing by a doctor.

Insulin secretion and glucagon secretion are usually inversely coupled and chromium supplements may increase glucagon secretion. McCarty suggests that this coupling may explain the documented therapeutic effects of extra chromium and biguanides in reactive hypoglycemia. It might also benefit dieters.

WHAT IS THE BEST MEDICATION TO USE?

Attack Therapy including analgesics, such as soluble Aspirin, are adequate for simple, uncomplicated and occasional symptoms producing pain such as headache. These tablets may be combined with a mild tranquilizer if an anxiety state is present.

In more severe cases treatment should be under medical supervision, and may require stronger medications.  If avoidance is impossible then Cromoglycate can be quite effective in blocking food intolerance, provided it is taken prior to eating.

CAN I GET A CURE FOR MY HYPOGLYCEMIA?

There is no "cure" as such for allergy to foods. Sustained, and maybe permanent relief can be obtained by staying away from responsible foods and treating any exposure that occurs as soon as possible. Be particularly careful of the contents of bought foods, being sure to read all labels vigilantly for foods containing ingredients that cause hypoglycemia.

WHERE IS THE BEST PLACE TO SEEK TREATMENT?

If your symptoms are persistent or severe, then medical investigation and treatment by an Environmental Physician, Allergist or at a hospital is essential.

. . . more about food allergies and your immune system.

Your body has an immune system which identifies what belongs to your body (self) and what does not belong to your body (non-self). It detects and fights invading organisms (non-self) by attacking the protein of the invader. Without the immune system we would fall helpless to infection. However, for reasons largely unknown, the immune system may become sensitised to a foreign protein and create an allergy with all the resultant discomfort.

Suspected postprandial (reactive or idiopathic) hypoglycemia is characterized by

predominantly adrenergic symptoms appearing after meals rich in carbohydrates and by their rare association with low blood glucose level (< 2.77 mmol/L) according to a study from Paris, France. After glucose intake, seven of eight patients had symptoms (palpitations, headache, tremor, generalized sweating, hunger, dizziness, sweating of the palms, flush, nausea, and fatigue), whereas in the control group, one subject reported flush and another palpitations, tremor, and hunger. Patients had emotional distress and significantly higher anxiety, somatization, depression, and obsessive-compulsive scores than controls. We may conclude that patients with suspected postprandial hypoglycemia have normal glucose tolerance, increased beta-adrenergic sensitivity, and emotional distress. Berlin and others

A patient is reported in whom it was possible to document that reactive hypoglycemia was the trigger for aggravation of arrhythmia. Over a period of 6 years, a series of electrophysiological studies revealed that, when the patient was in a hypoglycemic state, initiation of tachycardia was easy and most importantly that tachycardia termination by extra-stimulus pacing always failed.  Furthermore, atrial fibrillation was inducible or spontaneously occurred only when the blood glucose level was reduced by IV insulin administration. Rokas and others.

A study from Santiago de Compstela has shown that some foods in our diet can spark off migraine attacks in susceptible individuals through an allergic reaction. A certain number such as citrus fruits, tea, coffee, pork, chocolate, milk, nuts, vegetables and cola drinks have been cited as possible allergens  associated with migraine. Substances in food may be the cause of modifications in vascular tone and bring migraine on in those so prone. Among such substances are tyramine, phenylalanine, phenolic flavonoids, alcohol, food additives (sodium nitrate, monosodium glutamate, aspartame) and caffeine. Another recognized trigger for migraine is hypoglycemia. Such foods as chocolate, cheese, citrus fruits, bananas, nuts, 'cured meats, dairy products, cereals, beans, hot dogs, pizza, food additives (sodium nitrate, monosodium glutamate in Chinese restaurant food, aspartame as a sweetener), coffee, tea, cola drinks,  alcoholic drinks such as red wine, beer or whisky distilled in copper stills, all may bring on a migraine attack. For every patient we have to assess which foodstuffs are involved in the attack (not necessarily produced by consuming the product concerned) in order to try to

avoid their consumptions as a means of prophylaxis for migraine. Leira R. Rodriguez R

Idiopathic reactive hypoglycemia (IRH) is responsible for postprandial hypoglycemia according to a study from Rome, Italy. Normal insulin secretion and reduced response of glucagon to acute hypoglycemia, but mostly increased insulin sensitivity, represent the metabolic features of this syndrome. In  IRH, increased insulin-mediated glucose disposal is due to the increase of non oxidative glucose metabolism; and glucagon secretion has been confirmed to be inadequate. The increase of insulin sensitivity associated with a deficiency in glucagon secretion can widely explain the occurrence of hypoglycemia in the late postprandial phase. Leonetti and others.

Insulin secretion and glucagon secretion are usually inversely coupled. This suggests that chromium and other insulin-sensitizing modalities, by down-regulating beta-cell activity, may increase glucagon secretion. A study from California, USA suggest that such an effect might play a role in the documented therapeutic activity of supplemental chromium and biguanides in reactive hypoglycemia, and might also be of benefit to dieters. McCarty MF .

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Courtesy of The Allergy Centre 03 9874 4144

REFERENCES

Berlin I. Grimaldi A. Landault C. Cesselin F. Puech AJ. Suspected postprandial hypoglycemia is associated with beta-adrenergic hypersensitivity and emotional distress.    Journal of Clinical Endocrinology & Metabolism. 79(5):1428-33, 1994 Nov. 95051316

Leira R. Rodriguez R.  Diet and migraine [Spanish]. Revista de Neurologia. 24(129):534-8, 1996 May.  96243443

Leonetti F. Foniciello M. Iozzo P. Riggio O. Merli M. Giovannetti P. Sbraccia P. Giaccari A. Tamburrano G.   Increased non oxidative glucose metabolism in idiopathic reactive hypoglycemia.  Metabolism: Clinical & Experimental. 45(5):606-10, 1996 May. 96202747

McEvoy R, Allergies and other Environmental Illnesses: A Practice Handbook for

Doctors, 1992.

Merck Manual, Merck Sharp & Dohme Research Laboratories, Rahway, N.J.

Middleton E, Jr, Reed CE, Ellis EF, Allergy Principles and Practice, Mosby St Louis, 1978

McCarty MF  Chromium and other insulin sensitizers may enhance glucagon secretion: Implications for hypoglycemia and weight control.  Medical Hypotheses. 46(2):77-80, 1996 Feb. 96231355

Rokas S. Mavrikakis M. Iliopoulou A. Moulopoulos S.  Proarrhythmic effects of reactive hypoglycemia. Pacing & Clinical Electrophysiology. 15(4 Pt 1):373-6, 1992 Apr.  92262301

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