low blood sugar depression and neurotransmitters Natural Treatment and Remedies
Low Blood Sugar &
Mental Health Problems
PeterSmithUK.com © 2014 (updated 11th Sep 14)
The premise of this chapter is that in people with mental health problems including depression, anxiety, addiction and bipolar syndrome fluctuations in blood sugar can exacerbate and trigger intense bouts of worse symptoms.The human brain requires a huge amount of fuel to make enough energy to function and it suffers an immediate decline in function when it runs low on fuel. The brain relies almost exclusively on glucose or sugar for energy which it draws directly from the blood, furthermore the brain does not store glucose and only stores tiny amounts of glycogen (reserve glucose) in reserve for times when our blood sugar levels fall.
The brains high demand for glucose and its lack of reserves means the brain is highly dependent on a steady supply of sugar from the blood and when blood sugar levels fall either too low or just too quickly the first part of the body to suffer is the brain and consequently our mental function.
What happens when blood sugar drops is it diminishes the brains capacity to produce neurotransmitters, transmit signals and perform essential maintenance. Almost everyone will be familiar with this effect, it’s the ‘spaced out’ shaky, irritable feeling and difficulty in concentrating we experience when we haven’t eaten anything for too long. In people without mental health problems this is just an unpleasant experience but in people with mental health problems that already have poor brain function a bout of low blood sugar that compromises brain function even further can trigger a bout of more intense symptoms of the problem, for example it could trigger a wave of increased depression, anxiety or OCD and as you may have already noticed once an intense bout of your condition starts it can persist for hours, days or longer. In these chapters we’ll look at how imbalances in blood sugar affect the brain, contribute to mental health problems and how to eradicate this problem the functional medicine.
Brain Chemistry & Blood Sugar
When we over consume carbohydrates that quickly turn into glucose it can cause a spike in blood sugar which triggers a rise in the production of serotonin and possibly dopamine. In some people the aftermath of a spike in blood sugar levels is a rapid decline in blood sugar which causes a rapid decline in serotonin and dopamine levels, the last thing you need when you’re suffering from a mental health problem and in some people their blood sugar levels don’t just drop back down to normal but they continue to fall, overshoot and go too low causing a condition of low blood sugar called hypoglycaemia. We all look at hypoglycaemia in a lot more detail later, but briefly getting frequent bouts of hypoglycaemia is very bad condition for someone with mental health problems to have because when the brain is depleted of glucose it immediately impedes the brains ability to maintain adequate neurotransmitter activity including:
serotonin and GABA involved in anxiety,
serotonin, dopamine and PEA involved in depression including bipolar depression and
acetylcholine for good memory and healthy cognitive function.
Serotonin & Blood SugarSerotonin is unique because its levels are directly affected by food intake, especially high GI carbohydrates.
The feel-good neurotransmitter serotonin is unique in that unlike other neurotransmitters the level of serotonin production in the brain is directly linked to changes in the levels of amino acids and sugar in our blood.
The production of serotonin from the amino acid tryptophan is primarily limited by the amount of tryptophan available in the brain. To get into the brain tryptophan has to cross the blood brain barrier (a special protective membrane that separates the blood from the brain), its passage across the blood brain barrier is inhibited by other amino acids that compete for the same transportation pathways across the blood brain barrier, the competing amino acids are called branched-chain amino acids or BCAA’s. In another chapter I discuss how we can use BCAA’s to inhibit tyrosine metabolism and deplete excessive levels of dopamine to curtail a bipolar manic episode.
When we eat carbohydrates and our blood sugar rises our body produces insulin to sweep excess sugar out of the blood into the muscles and liver; another effect of insulin is that it sweeps the BCAA’s out of the blood as well which paves the way for more tryptophan to enter the brain and this increases serotonin production. So technically it’s not actually the sugar in the blood that results in more tryptophan entering the brain, it’s the insulin we produce in response to elevated blood sugar clearing competing BCAA’s out of the way.
It’s the rise in serotonin levels that gives sugary and carbohydrate foods their feel-good comfort-food qualities it’s also one of the factors responsible for producing the common feeling of drowsiness we often experience after eating a high carbohydrate meal. Consistently feeling sleepy after meals is a cardinal sign of having insulin resistance, take it seriously get your blood sugar level tested and if you do have a resistance treat it aggressively. See my Insulin Resistance Treatment Proticol.
Craving carbohydrates is also not a good sign, it suggests you probably get hypoglycaemic and/or low serotonin levels, to overcome this problem follow the self-help techniques in these chapters to the stabilise your blood sugar and improve the other fundamentals of your brain health.
Technically you could boost serotonin levels by taking a tryptophan supplements and simultaneously provoking an insulin response by eating high GI carbohydrates to boost the supplemented tryptophan’s entry into the brain; however this is not a good antidepressant strategy because any benefits obtained are only going to be short lived, remember not only is insulin reducing the level of BCAA’s in the blood but it also reducing glucose levels so over the ensuing couple of hours your blood sugar levels will fall and insulin production will stop. As this happens the level of BCAA’s in the blood will raise cutting down the supply of tryptophan to the brain. The effect would most likely be a brief sugar high followed by an uncomfortable rapid decline and worsening of symptoms over the next 90 minutes or so as serotonin production in the brain rapidly declines.
Deliberately driving your blood sugar up as a way to elevate and restore serotonin levels is not only an ineffective treatment for depression or anxiety but it’s the last thing you want to do for your physical health; in the body it could lead to reactive hypoglycaemia, insulin resistance and Type II diabetes, in fact new research shows that elevated blood sugar levels damage the brain and actually increases the risk of developing depression in the long run [i] [ii]. In my opinion the manufacturers of high GI foods like soda drinks that rapidly dump glucose into the blood should be obliged to obliged to put a health warning on their products the same way that tobacco manufacturers have to.
Serotonin production will rise and fall in response to insulin production in everyone whether or not they have mental health problems, but in people with mental health problems involving impaired serotonergic activity in the brain the effects of rapidly falling serotonin levels can be far more problematic and if blood sugar continues to fall to hypoglycaemic levels now not only is the brain receiving a diminished supply of tryptophan but it is also receiving a diminished supply of glucose to make enough energy to manufacture all the neurotransmitters and function properly. Based on the observations I’ve made of my patients and the workings of my own brain it appears that a rapid rise then fall in blood sugar levels can trigger bout of depression, anxiety, OCD and ADHD.
The main take-home point I wanted to get across in the above discussion is that unstable blood sugar levels directly affect your serotonin levels and eating the wrong type or amount of carbohydrates is more likely to upset serotonin metabolism in your brain than it is to enhance it.
Okay so if eating the wrong type of carbohydrates can contribute to imbalanced and ultimately low serotonin activity how should we eat too balance and elevate it? How about eating lots of foods naturally rich in tryptophan such as turkey? Well this will not necessarily increase serotonin production in the brain in the way you might expect it to because unfortunately the along with the tryptophan in the turkey there are also significant levels of the competing BCAA’s so the tryptophan in the turkey doesn’t get a clear path into the brain, this is why when you take a tryptophan supplement you should take it on an empty stomach well away from competing protein foods. Having said that eating a high protein low carbohydrate diet is the right way to eat to stabilise blood sugar and brain chemistry; we’ll look at the optimal blood sugar stabilising diet in a later chapter.
Once you’ve stabilised your blood sugar and improved the other fundamental aspects of brain health including: reduced chronically elevated inflammation, retrained your stress responses and increased the level of brain regenerative chemicals such as BDNF’s your serotonin pathways should be working much better and with a little extra help from serotonin boosting remedies you should be feeling much improved.
Anxiety Stress Hormones and Blood Sugar:A bout of low blood sugar or hypoglycaemia a couple of hours of eating high GI foods can have a specific triggering effect on anxiety disorders. When our blood sugar falls too low our adrenal glands produce a surge of the hormones adrenaline and cortisol, the same hormones released when our mind perceives threat and danger, one of the many effects of these hormones is to quickly raise blood sugar levels. However in people suffering from anxiety the rise in these stress hormones can also create the same feelings they get when they experience a bout of anxiety or a panic attack. It seems that the brain doesn’t understand that on this occasion the stress hormones are only being released to increase blood sugar and the way their brain perceives a surge in stress hormones can trigger a another bout of anxiety or a panic attack. To compound the dysregulation in the brain caused by the surge stress hormones just prior to their release the brain was also depleted of the fuel (glucose) needed to maintain healthy function and neurotransmitter levels.
Overcoming anxiety disorders involves more than simply boosting serotonin and GABA levels, it also requires training the brain stop being overcome by stress responses; imagine how much harder it is going to be to overcome anxiety when the brain is still being frequently flooded with anxiety triggering stress hormones out of the blue due to bouts of hypoglycaemia. Once you stabilised your blood sugar you’ll be free to concentrate on resolving other triggers and causes of the problem.
Dopamine Blood Sugar
Research has shown that in some people’s brains at least a rise in blood sugar significantly increases dopamine activity, this could produce a destabilising effect in people with bipolar syndrome, addiction and some types of atypical or treatment resistant depression. This is because imbalances in the neurotransmitter dopamine seem to be at the heart of bipolar syndrome and addiction. During bouts of mania dopamine activity becomes excessive it’s similar to a cocaine high which research has shown involves heightened activity in the dopamine pathways of the brain; in the bipolar depression phase which often follows a bout of mania dopamine activity becomes diminished[iii] in a similar way to the come-down experienced after taking cocaine, it appears as that the dopaminergic pathways become overworked and burnt out during the mania (or cocaine high) resulting in a crash from hyperactivity to depression. As mentioned previously during bouts of hypoglycaemia in the brain is starved of fuel and I believe this makes it even harder for depleted dopaminergic pathways to recover.
& Mental Health
Dopamine and the dopamine pathways in the brain are now understood to be at the centre of what creates the ‘wanting’ or desire that drives addiction to drugs, gambling, sex and food; furthermore imbalances in dopamine are also involved in some cases of atypical and treatment resistant non-bipolar depression.
Therefore it follows that anyone with bipolar syndrome, treatment resistant depression or problems with addiction should completely eliminate all high GI foods and stabilise their blood sugar to rule out even the possibility that their dopamine levels are being driven up and down by fluctuating blood sugar levels, I going to explain how to do this in the chapter on how to stabilise blood sugar.
A key therapeutic goal in my techniques for treating bipolar syndrome is to take control of one’s own dopamine levels by up regulating and down regulating them with natural remedies to maintain balanced dopamine activity within the brain. As someone that lives with bipolar syndrome myself I have learned that it is essential to avoid eating high GI foods that introduce another source volatility and fluctuations in dopamine activity.
I used to have reactive hypoglycaemia in my 20’s and when I stabilised my blood sugar during my nutritional medicine training I noticed it had a tremendous stabilising effects on my bipolar syndrome, diminishing the volatility and frequency of my highs and lows. This experience is what lead me to fully appreciate the importance of blood sugar levels on mental health and develop my clinical methods in this area.
Despite having studied nutritional medicine it still took me several years of trial and error to work out the effects that specific carbohydrates and meal combinations would have on my blood sugar so that I could completely prevent fluctuations in the supply of glucose to my brain from contributing to my bipolar syndrome. Today however you have access to new tools and techniques such as the GI, GL and zone diet systems to help you stabilise your blood sugar in a fraction of the time it took me and in a following chapter I’ll tell you how you can even use a blood sugar meter to clearly reveal the effects of specific meals on your blood sugar levels and then adjust what you eat to completely eliminate meals that cause problematic fluctuations in your blood sugar; I call this the personal glycaemic response diet.
Dopamine and Sugar AddictionHigh glycaemic or sugary foods can change dopamine activity in the brain and increase addictive behaviour.
Although we may not fully understand how it works we are certain that imbalances in dopamine activity in the regions of the brain associated with seeking pleasurable rewards are in some driving force behind all forms of addictive behaviour from drugs to sex and even gambling addiction. It seems that in a healthy brain dopamine activity creates a balanced drive towards pleasurable activities but in people with so-called addictive personalities imbalanced dopamine activity literally overwhelms their brains with intense cravings and potentially destructive addictive behaviours.
The implication is if you’re struggling with addiction you don’t want to consume anything that drives up dopamine activity in the reward pathways of the brain, for example a tragic side effect of the dopamine increasing drug L-dopa used in the treatment of MS can be it turns the user into an addict. Interestingly all forms of addiction are more common amongst people with bipolar syndrome, especially during the manic (dopamine hyperactive) phases (insert reference); in fact it is the gambling, excessive spending, hyper sexuality and drug taking that have some of the most harmful effects on the lives of people living with bipolar syndrome.
Now, fairly recent research has found that at least in some people spikes in blood sugar caused by eating sugary and high glycaemic index (GI) foods activates the same dopamine pathways in the brain that are activated in the brains of drug addicts when they take cocaine and similar drugs[iv] [v] [vi] [vii]. This not only proves that sugary/high GI foods can be genuinely physically addictive but it also means that if you’re struggling with addiction you should completely avoid consuming all high GI foods because they can produce hyper-dopamine activity in the reward centres of the brain which may trigger addictive cravings.
When sugar is combined with fat the change dopamine activity is even greater which is what can make junk food (high fat and sugar) so addictive. It’s believed the strengths of the effect of food on dopamine varies considerably from person-to-person so whereas most people will simply have moderate drives towards sugary foods, a few unfortunate individuals will experience such a powerful dopaminergic effect after consuming sugary foods that for them sugary foods produce a genuinely addictive narcotic effect. Understanding that high GI foods can create food addicts or as New Scientist magazine put it “junk-food junkies” [viii] has enormous implications for how we should set about fighting the worldwide obesity and diabetes epidemic.
This little-known form of addiction may be a little hard to understand at first and deserves some clarification. Obviously sugar doesn’t make people high, stoned or intoxicated the way that cocaine, cannabis or alcohol do, but then nor does the nicotine in tobacco and yet nicotine is known to be one of the most highly addictive substances; on the other hand cannabis clearly makes people high and yet it does not cause genuine chemical addiction. So a substance can be addictive whether or not it causes intoxication and vice versa.
Furthermore although the research showed that sugar can induce similar addictive changes in the brain to cocaine I doubt sugar is likely to be as addictive as cocaine. Perhaps a useful comparison would be with alcohol addiction, literally millions of people can enjoy drinking alcohol without becoming addicted to it, however a few individuals do develop alcohol addiction and usually have their health and lives ruined by it; perhaps sugar addiction is somewhat similar in that millions of people can consume and enjoy sugar without becoming addicted to it, however those that do become addicted will probably have their health and life ruined by it through diabetes, obesity, increased risk of heart disease, cognitive decline etc. With few exceptions nobody chooses to be enormously overweight and addiction to sugar could be the driving force afflicting some of the very overweight very big eaters amongst us. Even if sugar is a lot less addictive than cocaine it’s cheap and readily available so staying on the wagon so to speak must be incredibly challenging for people hardwired to be sugar addicts. Food addiction is not currently recognised as a form of addiction by mainstream medicine however I believe there is now a sufficient body of solid scientific evidence that it should be.
I believe discovery that sugar has the potential to produce an addictive narcotic like affect should mean that foods like sugary drinks that produce a spike in blood sugar should have to carry a health warning in the same way that products containing tobacco and alcohol have to.
Perhaps it would look something like this:
Please enjoy your cola but do be advised it can produce harmful spikes in your blood sugar that can cause addiction and overconsumption leading to increased risk of cardiovascular disease, Type II diabetes, loss of sight, kidney damage, and premature death; if you believe you have a problem with sugar addiction contact your doctor or the national addiction helpline freephone XXX.
That this may seem to be found extreme or comical point of view but if the science is right and sugar spikes can be genuinely addictive and wreck lives shouldn’t it be controlled? Being a junk-food addicted obese kid is no joke, should it even be legal to give or sell sugar to minors? Would it be acceptable to add hidden nicotine to food and not worn people it contains an addictive ingredient? Obesity and type II diabetes are wrecking lives and killing people, and the financial cost of these conditions is putting an economically unsustainable drain on our national health systems.
It’s true that the causes of the rise in obesity and type II diabetes are complex and not fully understood and involve many factors not just sugar, including the overconsumption of total calories, high fructose corn syrup, excessive carbohydrates along with a sedentary lifestyle, so it may seem wrong to single out sugary food manufacturers but sugar is one of the known major players in these health problems and it’s the only food ingredient shown to cause an addictive dopaminergic effect; if we’re going to halt the march of obesity and type II diabetes reducing sugar consumption would be one straightforward thing we could do.
OK enough of the politics let’s get back to how to sugar affects mental health problems…
Having High Blood Sugar from Insulin Resistance, Type II Diabetes and Eating Sugar Increases the Risk of Developing Depression and Brain Degeneration
People with high blood sugar from insulin resistance and Type II diabetes are at a greater risk of developing depression(insert ref) and anxiety[ix]; actually the converse is also true and people with depression are at a greater risk of developing blood sugar problems including Type II diabetes[x]. The amount by which high blood sugar increases the risk of developing depression is higher in women, certain races and according to different studies. Some studies have researched whether or not it’s simply the stress of having a chronic illness like diabetes that makes people depressed, however as we’ll see below insulin resistance and Type II diabetes can disturb and downgrade physiologist the brain in several ways that promote mental health problems, they can:-
Increase BCAA levels in the blood and therefore reduce serotonin production.
Reduce the levels of a protective chemical in the brain promoting the degeneration seen in major depression and bipolar syndrome.
Be connected to chronic inflammation which also damages the brain.
Increase the harmful binding of sugars to proteins causing brain degeneration.
Insulin Resistance and Type II Diabetes Reduced Serotonin ProductionFirstly do you remember from the discussion above when the pancreas makes insulin to transport excess sugar out of the blood it also transport BCAA’s out of the blood and this facilitates more tryptophan to enter the brain and increase serotonin production. What happens in insulin resistance is the cells of the body become resistant or immune to insulin, with the result that not only does insulin no longer effectively sweep glucose out of the blood but it also no longer effectively sweep BCAA’s out of the blood so tryptophan’s entry into the brain is diminished. Several studies have confirmed that BCAA levels are elevated in people with insulin resistance[xi][xii], and rates of depression are increased[xiii].
In diabetes the problem is the pancreas no longer makes enough insulin and so yet again BCAA levels remain elevated and again tryptophan’s entry into the brain is diminished. (Insert reference)…
It has even been suggested that a blood test for elevated levels of amino acids including BCAA’s could be used as an early diagnostic test for diabetes[xiv].
High Blood Sugar and Sugar Consumption Reduces a Key Brain Protective Chemical Causing the Degeneration Seen in the Brain with Major Depression and Bipolar SyndromeA high-fat, high sugar diet has been linked to a reduction in the level of an important protein called brain derived neurotrophic factor or BDNF [xv]. This protein is needed for the brain to repair itself and make new connections a process called neuro plasticity, it’s a bit of an oversimplification but in a sense the effects of BDNF and chronic inflammation oppose each other, inflammation increases the rate at which brain cells die and neural-pathways broken, whilst BDNF protects brain cells, increases their survival and helps them make new connections and develop new neural pathways. See Brain Derived Neurotrophic Factor & Mental Health Problems.
Low levels of BDNF along with degeneration in the part of the brain associated with our emotions and feelings has been found in patients with major depression and bipolar syndrome [xvi][xvii][xviii]. It’s believed that chronic stress responses lower BDNF levels resulting in reduced protection of our brain, the resultant degeneration in key areas of the brain associated with emotions and feelings causes mental health problems; this is called the BDNF hypothesis of depression.
In addition to protecting the brain BDNF is also needed by the body to maintain healthy insulin and blood sugar control so low levels of BDNF induced by chronic stress/depression increases the risk of developing insulin resistance and Type II diabetes.
Conversely it can also work in the other direction meaning low BDNF causes a bi-directional relationship between depression and blood sugar problems i.e. stress/depression causes low BDNF levels which increases the chances of developing high blood sugar/diabetes Type II and having high blood sugar/Type II diabetes causes low BDNF levels which increase the chances of developing depression.
The combination of a mental health problem and high blood sugar can become a real downward health spiral, therefore if you have a mental health problem and high blood sugar you should aggressively treat both conditions and reverse the situation including doing everything you can to increase BDNF levels.
To raise BDNF levels there are several things you can do:-Follow a low GI/GL/zone diet combined with remedies to improve your blood sugar metabolism. See my pages on natural therapies and remedies from blood sugar problems UNDER CONSTRUCTION
Engage in regular fasting and or follow 5/2 diet.
Reprogram your stress responses to eliminate chronic unhealthy stress responses.
Do a specific form of exercise called high intensity interval training or HIIT that reduces insulin resistance/elevated blood glucose, it also directly increase the level of BDNF.
There are also supplements and drugs that increase BDNF levels including zinc, curcumin and marigold; for more information see Brain Derived Neurotrophic Factors & Mental Health Problems.
High Blood Sugar Damages Proteins within the BrainAnother consequence of having chronically high blood sugar is that the excess glucose in the blood increases the production of what are called advanced glycation end products (AGE). I talk about the harmful effects of AGE and how to reduce their formation in more detail on my website www.PeterSmithUK.com , in brief sugars can bind with proteins in a way that irreversibly damages the protein, the damaged proteins is called an advanced glycation end product. It has been shown that the formation of AGE in the brain from elevated blood sugar damages the region of the brain called the hippocampus and this causes both cognitive decline and depression[xix]. You can significantly block the formation of AGE by supplementing B6, carnosine and benfotamine a form of vitamin B1 however reducing blood sugar levels is the main priority.
Diabetes Type II, Insulin Resistance and Mental Health Problems may all have a common cause: InflammationAnother possible explanation for why depression and high blood sugar (Type II diabetes and insulin resistance) occurred together is that underlying chronic inflammation can cause both conditions. as I discuss elsewhere inflammation can cause degeneration in the brain which can cause mental health problems. Eliminating inflammation from the brain is one of the most important fundamentals of brain-health you should work on to treat mental health problems. (See inflammation and brain health UNDER CONSTRUCTION in 2015)
Holistic Treatment for High Blood Sugar and Mental Health ProblemsWhatever the connection between high blood sugar and mental health problems, whether it’s diminished tryptophan’s entry into the brain, reduced BDNF levels, increased AGE levels or a sign of underlying chronic inflammation in holistic functional medicine we apply an integrated whole-body treatment approach and try to restore health to the whole body, not just individual systems for functions. Treatment would include the combining a diet, lifestyle, exercise and supplement regime that reduces elevated blood sugar, increases insulin sensitivity, increases available tryptophan to make serotonin, increases BDNF production and decreases AGE formation; I’ll go into the specifics in chapter xxx Treating Blood Sugar.
Even Though Branched-Chain Amino Acid Supplements Can Temporarily Diminished Serotonin Production they can Still Help You Recover from DepressionAbove I explained how increased levels of BCAA’s in the blood diminishes serotonin production however used at the right time BCAA’s can be a great help to recover from depression. When taken shortly before exercise BCAA’s will not linger in the blood but be sent into the muscles whereupon they will increase your athletic endurance and encourage muscle growth, both of which lowers your blood sugar therefore helping to treat and prevent insulin resistance and Type II diabetes. Increasing your muscle mass is also an effective strategy, perhaps the most effective strategy for losing weight, which may have antidepressant effect in its own right. So BCAA’s help you exercise for longer and increase the benefits you derive from exercise they help you grow muscle, combat insulin resistance, Type II diabetes, obesity and exercise has been proven to be one of the most consistently effective antidepressant treatments; the problem with exercise of course is that when you seriously depressed you may not be able to engage in this particular beneficial activity.
For depression I only recommend supplementing BCAA’s in combination with exercise, during bipolar mania episodes you can use it any time to deplete dopamine activity. If one of the things you do when you’re hyper is manically exercise then BCAA’s could potentially be the perfect remedy as not only will they deplete your excess dopamine but they’ll assist muscle growth and therefore tone your body to boot.
Just remember to take your BCAA and tryptophan supplements at different times so they don’t compete for the same transport mechanism across the blood brain barrier, take your BCAA’s about 15 minutes or so before exercising and take your tryptophan supplements last thing at night on an empty stomach.
Please see the section on Serotonin Dependent Depression before you take tryptophan supplements, if you’re deficient in the cofactors magnesium, B6 and zinc taking tryptophan may increase the production of quinolinic acid rather than serotonin. Quinolinic acid is neurotoxic promoting cell death and depression as opposed to serotonin which is antidepressant and melatonin which is neuro-protective.
The Selfish Brain TheoryLike a foetus the human brain feeds itself and demands to be fed even at your expense, it can literally take over your behaviour and drive overeating to supply its high energy needs
The human brain requires a lot of energy to manufacture neurotransmitters and maintain proper function and it needs the supply of energy to be constantly maintained, even a brief interruption can disrupt mental function can trigger a bout of a mental health problem. Despite weighing on average only 2% of the body’s total weight it consumes is about 20% of our body’s total energy; furthermore not only does the brain require a lot of energy but it is limited in the range of substances it can use for fuel to manufacture energy. In fact the brain relies very heavily on glucose as its main source of fuel and uses the most glucose of all the organs in the body, consuming more than 50% of all the glucose in the blood. Maintaining brain function is so important to our survival that during times of hunger and low blood sugar the body will readily sacrifice other tissues, such as the muscles and break them down to produce glucose and maintain brains energy needs; this is known as the selfish brain theory implying that the brain protects its own energy needs at the cost of other systems.
The selfish brain theory is proposed as a root cause mechanism to explain the rising tide of obesity[xx]. The work of Prof Achim Peters has shown that because the brain has the overriding ability and authority to demand increased glucose when it needs it if the brain becomes imbalanced and starts demanding more glucose than the body can supply it will drive our behaviour to supply more glucose by eating more food. Unfortunately Peters research has identified at least 30 different imbalances in the brain that can cause the brain to demand increased glucose but as I understand it one of the most significant ones appears to be imbalances in stress responses. Basically when we are stressed the brain uses and needs more glucose and the initial response to stress is to release the stress hormones adrenaline and cortisol, these hormones liberate stored glucose reserves from the muscles and liver and stimulate the breakdown and conversion of the protein in our muscles into glucose, thus increasing the supply of glucose to the brain. However research has shown that in obese people their stress responses have become habituated to chronic stress and become unresponsive so that when their brain experiences stress they no longer communicate a ‘normal’ stress signal from the brain to the adrenal glands (via the HPA axis, see the chapters on stress responses) and release adrenaline and cortisol to raise glucose levels from within their own body resources, but their brain still needs the extra glucose so instead it demands that they eat more food. Let me say that again, a stressed brain needs and pulls more glucose out of the blood, some people keep responding to prolonged stress by releasing stress hormones which increase the supply of glucose to the brain and many of these people actually lose weight with prolonged stress; in other people however their body gradually stops producing stress hormones in response to prolonged stress but their brain still demands elevated glucose levels and drives increased eating. Hypothetically if the stressed brain could receive and use up the extra calories consumed it wouldn’t cause a problem however in practice the extra calories can get stuck on route in what Prof Peters calls a supply traffic jam either in the blood which is insulin resistance or deposited in the adipose tissue which is obesity.
Prof Peters research indicates that it is dysfunction in the amygdala as well as the HPA-axis that can be at the centre of the brain imbalance that demands we eat more to elevated blood glucose, which I find interesting because brain imaging has shown that these areas of the brain are consistently altered in people with anxiety, depression, bipolar syndrome and schizophrenia[xxi][xxii][xxiii] and altering the performance of these systems by amygdala and relaxation response retraining is one of the key functional medicine protocols I prescribe to improve the health of the brain and recover from mental health problems. Over the years I could clearly observe that completing an amygdala and relaxation response training programme would help normalise my patients’ blood sugar control and Prof Peters research may shed new light on the mechanism by which that improvement occurs.
From the above discussion you should have a better understanding of just how critically dependent the brain is on blood sugar levels and therefore how important it is to prevent bouts of low blood sugar when you’re trying to improve the health of the brain and recover from mental health problems.
The Brain Can Also Run on Coconut Peanut and Avocado Oils for EnergyAn interesting development is that until recently the conventional understanding was that under normal day-to-day circumstances the brain would only use glucose as a source of energy and it would only use alternative sources of fuel in extreme circumstances such as starvation. However it is now known that the brain will readily use certain specific fat molecules (medium-chain length saturated fatty acids) as an alternative source of energy to glucose, these fats are abundant in coconuts, peanuts and avocados and it has been shown that consuming these specific fats can reverse the decline in mental function caused by low blood sugar[xxiv]. So one of the helpful things that you can do to maintain a constant fuel supply to your brain is to consume some peanut butter, avocado, avocado oil and coconut fat with each meal so even if your blood sugar levels do fall the brain has an alternative source of fuel it can use to maintain the production of the energy it needs. I’ll say more about this and many other tricks you can use to stabilise your blood sugar later on.
Defining Hypoglycaemia and Its Different Types…When you eat too many carbohydrates that release glucose into the blood stream to quickly, your blood sugar rises rapidly. As far as the body is concerned, this rapidly rising blood sugar is a potentially dangerous and damaging situation, so the body produces a surge of insulin that brings the level of sugar in the blood back down. This surge of insulin however is a bit like doing an emergency stop in a car, its dramatic and lacks fine control and balance. The effect is often that our blood sugar comes down to far and ‘undershoots’, thus depleting the brain of the fuel and energy it needs to make neurotransmitters and function properly. If you already low in a particular neurotransmitter a drop in brain fuel can immediately aggravate the problem and intensify the symptoms. This is called reactive-hypoglycaemia.[Insert diagram]
In this low blood sugar state, whatever you carry emotionally is likely to come to the surface. You may experience being irritable, have difficulty concentrating, you’ll probably experience food cravings particularly for carbohydrates and sweet foods, and any depression, anxiety and addictive behaviour you have will come to the fore.
The most commonly used medical criterion to define hypoglycaemia is called the Whipple’s triad, it defines hypoglycaemia as:
1/the presence of symptoms known to be caused by hypoglycaemia (feeling shaky with poor cognitive function etc.),
2/low blood glucose (less than 70 mg/dL or 4.0 mmol/litre) at the time the symptoms occur,
3/reversal of symptoms by restoring glucose levels by eating food or injecting glucose.
I think you can work out if you have hypoglycaemia without even testing the level of glucose in your blood.
DEFINE YOU DIFFERENT TYPES OF HYPOGLYCAEMIA, DIABETIC, FASTING, REACTIVE HYPOGLYCAEMIA
Mainstream Medicine Barely Acknowledges the Existence of Reactive HypoglycaemiaThere’s extensive research in mainstream medicine into the low blood sugar that diabetics accidentally induce by a injecting themselves with too much insulin, but there is hardly any research into the bouts of low blood sugar that non-diabetic people can experience within 4 hours of eating due to an excessive production of insulin from their own pancreas.
When a non-diabetic person develops low blood sugar within 4 hours of eating it’s called reactive hypoglycaemia to distinguish it from fasting hypoglycaemia that occurs in a non-diabetic person
so called reactive hypoglycaemia. This really surprises me because I regularly see people both in my practice and personal life that experience bouts of low blood sugar, some medical references suggest that reactive hypoglycaemia is a very rare condition however others say that its prevalence is difficult to estimate and unknown.
… many of my patients complaining of fatigue and general poor health describe having typically mid-morning and mid-afternoon or sometimes even more frequently every 90 minutes or so. In addition to acting as a potential trigger for a bout of more intense mental health symptoms reactive hypoglycaemia can trigger migraines, fatigue, overeating, poor mental performance and accidents (traffic, medical etc.). It’s interesting that the research into the effects of hypoglycaemia in people with diabetes type I shows that regular bouts of hypoglycaemia caused no harm whatsoever to the brain in fact some research even suggests that it actually stimulates the brain to regenerate and improves cognitive performance; from an evolutionary point of view this would make sense if you repeatedly ended up starving with bouts of low blood sugar the body may pour resources into regenerating the brain to give us the smarts to go procure more food.
Despite the evidence that hypoglycaemia does not appear to physically harm the brain don’t underestimate the importance that maintaining a steady fuel supply to your brain has on your recovery program from mental health problems. Even if you don’t think you get bouts of low blood sugar just follow the blood sugar stabilising diet to rule out even the possibility that parts of your brain sufferer occasional bouts of lack of energy and diminished function that may trigger bouts of increased anxiety, depression, addictive cravings and instability in the bipolar brain.
Obviously I’m not saying that stabilising blood sugar on its own is ever going to be enough to completely overcome a mental health problem, but I’ve seen many patients that failed to change their diet and stabilise their blood sugar continue to have their problem triggered even if just to a lesser degree I bouts of low blood sugar, thus preventing them from making a complete recovery; …
brain and mental function can be so significantly affected by fluctuations in blood sugar failing to…….
stabilise your blood sugar that …….
if you want to effectively treat mental health problems using functional medicine methods preventing spikes in your blood sugar and bouts of low blood sugar is one of the essential fundamentals of brain health you have to get right.
Have you ever watched children become hyperactive and get the giggles from the sugar rush they get after eating too many candies and then crash when the ‘sugar high’ runs out?
The other main fundamental of brain health you must address are eliminating inflammation in the brain and retraining your stress responses.
Blood Sugar and Functional MedicineBlood sugar has such a powerful influence on brain function that stabilising it can make or break the success of your treatment for depression, anxiety and bipolar.
So as you can see eating high GI carbohydrates can increase serotonin and dopamine activity within the brain, but the lift is only short lived and as the temporary comfort fades away and the intensity of our condition begins to increase we are likely to crave comfort foods again. Unfortunately regularly over-consuming high GI carbs will eventually cause severe swings in your blood sugar levels i.e. reactive hypoglycaemia which make your neurotransmitter balance even worse; let alone cause weight gain and set you off down the path towards insulin resistance and Type II diabetes.
When you understand that surges in blood sugar/insulin directly increase the production of serotonin in the brain only to have it subsequently crash and that hypoglycaemia starves the brain of the energy it needs to function properly, and that consuming sugary foods can cause fluctuations in dopamine levels you can appreciate why stabilising blood sugar is one of the fundamentals you should get right to improve brain health to successfully treat mental health problems including depression, bipolar syndrome and anxiety.
For example during a severe reactive hypoglycaemia the natural release of the stress hormone adrenaline can independently provoke a panic or anxiety attack in people with anxiety. A person with hypoglycaemia and serotonin dependent depression may consume sweet foods for comfort which causes a blood sugar spike followed by a reactive low blood sugar crash that then significantly intensifies their cravings for comfort foods, putting them back on an unstable blood sugar and depression rollercoaster.
Instability in dopamine activity is one of the hallmarks of bipolar syndrome and eliminating anything and everything that provokes instability in dopamine levels and brain chemistry in general is fundamental to successfully managing this condition,
Imagine trying to stabilise the level of dopamine activity in a bipolar brain and periodically a shed load of glucose turns up causing a spike in dopamine activity then at other times the brain is half starved of the sugar it needs to maintain adequate dopamine levels; instability in dopamine activities is one of the hallmarks of bipolar syndrome and eliminating fluctuations in blood sugar that are and additional cause instability in dopamine levels can be enormously helpful meaning that you have less variables to have to control.
Simply boosting the neurotransmitters serotonin and GABA for someone with anxiety or serotonin and dopamine for someone with depression will not fix the contribution that imbalanced diet and blood sugar adds to their mental health problems and it’s simply not good medical practice to only try and manipulate neurotransmitters levels without also improving the health of the brain itself including balancing supply of fuel (glucose, medium-chain fatty acids and pyruvate) that the brain uses for energy.
Other fundamentals of brain health to get right to improve mental health include:Eliminating chronic inflammation in the brain from infection, brain allergies and sensitivities particularly to gluten and a diet with inadequate levels of antioxidants.
Feeding the brain enough and the right ratio of omega-3 oils.
Establishing good sleep physiology.
Exposing the eyes/brain to sufficient bright light and quality darkness.
Eliminating toxicity particularly from heavy metals.
In my practice I’ve never seen imbalances in blood sugar be the sole cause of depression, bipolar syndrome, anxiety or ADHD, what I have seen however is practically everyone I treat with mental health problems experience enormous improvements in their condition when they take their blood sugar seriously and balance the supply of fuel to their brain with diet and natural remedies. I would even go so far as to say that imbalances in blood sugar can have such a profound effect on neurotransmitter levels and therefore mental health that they can prevent full recovery and may even prevent treatments from working from the outset.
Follow a Low Glycaemic Response Diet
If you have mental health problems I recommend you use the techniques in these pages to stabilise your blood sugar.
Did you ever feel jittery, have difficulty concentrating and irritable when you hadn’t eaten for a long time and had low blood sugar? The brain also relies almost exclusively on glucose from blood sugar as a source of fuel and fluctuations in the blood sugar can quickly affect the brain’s ability to manufacture neurotransmitters and function properly.
When blood sugar levels rise after the consumption of a high carbohydrate meal it increases the rate of production of the neurotransmitter serotonin this gives sugary and carbohydrate foods their feel-good comfort food qualities and can lead people with depression to regularly crave and over consume carbohydrates with damaging health consequences.
In some people eating high GI foods stimulates dopamine activity imbalances in dopamine are associated with addiction, bipolar syndrome and some types of atypical depression.
See Blood Sugar and Mental Health for a more detailed discussion of how blood sugar affects brain and mental health.
Recap and Chapter SummarySpikes in Blood sugar can cause surges in serotonin and dopamine levels, the subsequent bout of low blood sugar can cause a sudden withdrawal of these neurotransmitters and starve the brain of energy triggering bouts of intense symptoms which can last for hours or days.
Bouts of low blood sugar can trigger the release of the stress hormones adrenalin and cortisol which can trigger an anxiety attack.
The immediate dysfunction in brain performance caused by a bout of low blood sugar may trigger a bout of symptoms but it does not cause any lasting damage to the brain, high blood sugar on the other hand diminishes euro protective BDNF levels and increased neuro damaging AGE levels which can lead to long term degeneration of key parts of the brain associated with mood causing depression and bipolar syndrome and probably also contribute to anxiety states as well.
Insulin resistance, Type II diabetes and mental health problems often exist together, when you have warned you are more likely to develop the other. Underlying chronic inflammation may be the underlying factor driving both degeneration of the brain which causes depression and bipolar syndrome on the one hand and insulin resistance and diabetes Type II on the other. Therefore reducing chronic inflammation in the body and brain is a key therapeutic target for treating these conditions.
Blood Sugar Main Menu
- Hypoglycaemia (Low Blood Sugar)
- Low Blood Sugar and Mental Health Problems
- High Blood Sugar Seriously Damages the Body
- Advanced Glycation End Products High Blood Sugars Toxic Effect
- Mainstream Medicine’s Fatal Flaw Undiagnosed High Blood Sugar
- Types of High Blood Sugar: pre-diabetes, insulin resistance, Type II diabetes etc
- How to Test Your Own Blood Sugar Responses
- Natural Treatments and Remedies To Correct Blood Sugar Problems
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