… Low blood sugar can contrbute to serotonin depression, anxiety and bipolar syndrome… Natural dietar treatment and Remedies for hypglycaemia...
 reactive hypoglycaemia or low blood sugar gives you low energy in-between meals, poor mental performance, carbohydrate cravings and worsen mental health problems

-Section I-
-Low Blood Sugar-
-Chapter 1-
Non-Diabetic (metabolic) Hypoglycaemia

PeterSmithUK.com © 2014 (updated 21st June 14)
Diabetics can get hypoglycaemia when they accidentally use too much insulin which pushes their blood sugar too low but non-diabetics can also suffer a thing called non-diabetic hypoglycaemia.

Hypoglycaemia Symptoms

The effects of low blood sugar are quite varied but nevertheless easy to recognise; when I’m out and about with people for a few hours I can easily spot the people that get hypoglycaemia, every couple of hours they get exhausted and we have to stop at a café or restaurant for them to refuel their energy.
Most people have probably experienced low blood sugar at some point in their life when food intake is delayed for a long time, especially if combined with sustained intense physical exercise blood sugar gets used up and unless the body is able to immediately mobilise adequate reserves to replenish it we become hypoglycaemic. During sports and prolonged physical exercise for example its common to experience hitting “the wall” whereby your muscles literally run out of fuel (blood sugar) so you feel physically exhausted and your mental faculties are poor, this is perfectly normal. Here we are not concerned with normal hypoglycaemia caused by fasting and overexertion or a diabetic accidently injecting too much insulin, what we are concerned with is hypoglycaemia due to imbalances in your body’s blood sugar metabolism (dysglycemia).
A healthy body should be able to go without food for several hours without developing hypoglycaemia, unless it’s engaging in sustained and intense physical exercise, actually a very fit body like that of a marathon runner should be able to maintain stable blood sugar despite sustained physical exercise and the absence of food. A healthy body should also be able to sleep through the night without developing hypoglycaemia either in the middle of the night which can wake us up or in the morning making us feel desperately groggy until we’ve had some caffeine or something to eat. 
If you regularly experience bouts of the following symptoms between meals or if meals are missed or delayed and eating or drinking something makes you feel better you could have hypoglycaemia:-
Sudden tiredness or light-headedness and brain fatigue,
Feeling irritable and short tempered,
Fine tremors in your fingers or feeling shaky or jittery,
Feel agitated, nervous, depressed, or easily becoming upset or overwhelmed,
Experience poor memory or have difficulty concentrating/learning,
Feel desperately hungry particularly craving sweets and or carbohydrates.
The defining characteristic of hypoglycaemia is that all the symptoms disappear when you eat something, especially something containing simple carbohydrates such as candies or fruit juice.
An important point I want to emphasise about hypoglycaemia is that it doesn’t just make you feel bad but it can be dangerous when combined with tasks such as driving; even moderate hypoglycaemia has been shown to impair cognitive abilities sufficiently to increase the risk of motor vehicle accidents[i].
It is typical for someone with non-reactive hypoglycaemia to skip meals, breakfast or lunch and then suddenly need a sugar fix from candies or a caffeine injection, needing a coffee and carbohydrate fix about 3 to 4 in the afternoon is a tell-tale sign of hypoglycaemia. As we’ll see later not skipping meals and eating regularly is a key dietary component of recovering from non-diabetic hypoglycaemia; the worst thing you can do is go for a long period of time without eating inducing low blood sugar and then eating candies or high GI carbohydrates which cause a surge in blood sugar levels from an already low blood sugar starting point, when you’re in a bout of low blood sugar you must resist the temptation to eat high GI carbohydrates and candies and instead eat high-protein and high-fat foods such as meat, fish or peanut butter to restore your blood sugar levels in a more sustainable way. If you do end up eating candies, pastries or white bread etc. the best thing you can do is as soon as possible eat a proper healthy protein and oil rich meal, or at least eat some protein such as eggs or cheese to provide a secondary slower source of glucose that will give you some protection against the plunging hypoglycaemic reaction the high GI carbs you just ate will produce. When you find yourself caught short with nothing to eat and having to buy a snack try and opt for the lowest carbohydrate highest protein and oil option, for example humus on oat cakes (not rice cakes), a fish or egg sandwich etc.
The classic version of non-diabetic hypoglycaemia is called is reactive hypoglycaemia, what happens is when a person eats a meal containing simple sugars and carbohydrates that quickly turn into sugar (high GI) it causes a rapid spike in blood sugar which then provokes the pancreas to produce a surge in insulin to halt the dangerously rising blood sugar levels, the surge in insulin produced by a large intake of refined high GI carbs can be so extreme that it produces a rapid over swing lowering of blood sugar levels to far into hypoglycaemia. Actually a healthy person with good blood sugar control should be able to handle an occasional high GI meal, but frequently eating and drinking foods that produce big surges in blood sugar seems to condition the body into producing big surges in insulin every time food is consumed; this develops into reactive hypoglycaemia.
[Insert diagram] 

The Rollercoaster of Reactive Hypoglycaemia

A person with reactive hypoglycaemia may wake up feeling quite groggy with low blood sugar then eat a breakfast high in carbohydrates such as cornflakes or none wholemeal toast that quickly turn into sugar with a coffee perhaps with added sugar their breakfast quickly raises their blood sugar and antidotes all the symptoms of hypoglycaemia. Unfortunately the rapid rise in glucose produced by their breakfast provokes such a strong insulin response that it lowers their blood sugar too far producing hypoglycaemia again so that a couple of hours later they’re feeling hungry with brain fatigue and have to take a quick tea/coffee/cigarette and snack break; in addition to whatever food they eat caffeine and nicotine further raise blood sugar by stimulating the release of the adrenal hormones adrenaline and cortisol which raise blood sugar levels. The mid-morning break re-raises their blood sugar and carries them through till lunchtime at which time they will re-raise their blood sugar feel good for an hour and a half to two hours, then experience another bout of hypoglycaemia in the mid-afternoon and need to take another refuelling break. They probably have another bout of hypoglycaemia on their way home from work potentially making them a bad driver and prone to road rage, they may eat and drink throughout the evening maintaining their blood sugar until they go to sleep. After a few hours of sleep they’re having another bout of hypoglycaemia but this time they don’t eat or drink anything to re-raise their blood sugar, in the absence of food and drink the body responds to hypoglycaemia by releasing the stress hormones adrenaline and cortisol which break down our body tissues (muscle and fat cells) and glycogen (stored glucose) to maintain adequate levels of blood sugar; unfortunately adrenaline and cortisol may not only raise our blood sugar but may also overstimulate us and wake us up. One of the causes of waking up around 3-4 in the morning is reactive hypoglycaemia. After a bad night sleep the person wakes up with low blood sugar starting a new day with rollercoasters blood sugar. Not every case of hypoglycaemia exhibits all of the symptoms above.
You can basically work out if you suffer from bouts of hypoglycaemia by looking for the tell-tale signs of needing to eat or drink to antidote the symptoms of hypoglycaemia and feeling a lift in your energy after eating; however by testing your blood sugar as outlined in this book you’ll be able to see exactly what’s happening with your blood sugar.
Another tell-tale sign you have non-diabetic hyperglycaemic dysglycemia is feeling groggy and experiencing the hyperglycaemic signs above upon rising first thing in the morning and observing them all disappear after eating breakfast.

Reactive Hypoglycaemia Can Also Disrupt Your Sleep and this Can Contribute to Weight Gain

If you get hypoglycaemia within a few hours of not eating during the night and you don’t eat anything to refuel yourself your blood sugar will just continue to decline until eventually your adrenal glands produce adrenaline and cortisol to prevent your blood sugar becoming seriously low. Unfortunately an unwanted side-effect of these stress hormones is they stimulate our body and brain back into a wakeful state, they may also produce anxious and stressful feelings; waking up at 3-4 in the morning especially with a stressed or anxious feeling could well be due to reactive hypoglycaemia. If you still have insomnia or poor sleep after correcting your blood sugar see my book Sleep Better with Natural Therapies for practical tips on how to correct your sleep physiology and overcome insomnia and problematic sleep cycles. 
To make matters even worse lack of sleep increases the levels of the hunger stimulating hormone ghrelin which stimulates appetite specifically cravings for high-fat and high-carbohydrate foods which causes overeating and further contributes poor blood sugar control and weight gain [ii].

Chronic Reactive Hypoglycaemia Can Cause Chronic Fatigue Syndrome and Adrenal Fatigue

Every time a blood sugar drops too low it stimulates production of adrenaline and cortisol from the adrenal glands, these hormones release any remaining glucose from storage back into the blood stream and stimulate the manufacture of new glucose from our amino acids and fats. If this occurs several times a day it can impose a significant extra workload on our adrenal glands that could after several years contribute to the adrenal glands eventually becoming exhausted, especially in someone that also tends to overproduce stress responses and overwork their adrenal glands in the first place. 
When poor sleep is also present it will tend to accelerate the development of adrenal exhaustion because when we were non-adrenaline following a bad night sleep the adrenal’s have to work that much harder.
The two-pronged solution to this problem is treating and eliminating your dysglycemia so that it stops recruiting your adrenal glands to prop you up when you have low blood sugar both during the day and night and undergoing a training programme to hardwire the ability to switch off and shorten the duration of stress responses to give your adrenal glands regular breaks and time to regenerate. Stabilising your blood sugar and eliminating the excess production of cortisol in the evening and night by learning how to switch on the relaxation response should also help you sleep better and eliminate the tax the poor sleep imposes on your adrenal glands. See the stress solution pages for the relaxation training programme on www.petersmithuk.com
If the adrenal glands become chronically fatigued it can cause or at least contribute to a state of chronic fatigue syndrome; it is absolutely possible to recover from adrenal fatigue and regenerate the adrenal glands with the right combination of natural techniques and remedies, including high doses of pantothenic acid, vitamins C, appropriate forms of ginseng, liquorice, Rhodiola, ashwaganda etc.

Hypoglycaemia can have Big Effects on Mental Health

Bouts of non-diabetic reactive hypoglycaemia are not as damaging to your physical health as high blood sugar is but they are awful for your mental wellness and energy levels, especially if you have a coexisting mental health problem such as depression, anxiety or bipolar syndrome. When blood sugar levels fall below normal you can feel physically tired but the brain can suffer terribly. 
The human brain is a unique tissue with very high energy demands to constantly manufacture neurotransmitters; it weighs only 2% of our total body weight yet it uses over 30% of all the glucose in the blood. When our brain is even partially starved of the fuel it needs during bouts of low blood sugar it is unable to maintain adequate neurotransmitter levels and we can suffer immediate short-term mental effects including difficulty with thinking clearly and concentration, depression or anxiety whichever you tend toward, intense irritability with outbursts of bad temper due to lack of serotonin in the frontal lobes, tremors or shaking in the hands. During bouts of hypoglycaemia our body responds to try quickly raise blood sugar levels and remedy our energy crisis, it makes us crave sweet foods and carbohydrates, it also produces a surge of stress hormones (adrenaline and cortisol) from the adrenal glands which mobilise stored glucose reserves. These surges of stress hormones may produce additional unwanted health complications.

What Causes Non-Diabetic Hypoglycaemia

Exactly what causes non-diabetic hypoglycaemia can be different in different people, the classic mechanism is when we eat or drink something that very quickly releases glucose into our bloodstream such as pastries, white bread, frappuccinos, sugary drinks etc. it causes such a rapid spike in our blood sugar that the body responds by producing a surge of insulin to aggressively slam the brakes on the dangerously rising blood sugar levels. Sugary foods and high GI carbohydrates can produce such rapid rises in blood sugar that it causes serious harm and if it continue to rise at that rate unchecked we could even become unconscious so as far as the body is concerned it’s a real crisis that must be aggressively checked, In response our bodies produce a huge surge of insulin to slam the brakes on so to speak and this can easily cause an over swing into low blood sugar. This is called reactive hypoglycaemia, it is caused by a an over production of insulin by our body in response to eating high GI carbohydrates, it is not the same as hypoglycaemia due to starvation or a diabetic accidentally injecting themselves with too much insulin. 
The typical version of non-diabetic hypoglycaemia is called reactive hypoglycaemia, what happens is within an hour or so of eating too many carbohydrates the person’s blood sugar becomes significantly elevated which stimulates a big discharge of insulin from the pancreas. The big discharge of insulin drives blood sugar levels down too far causing classic reactive hypoglycaemia. What seems to happen in people with reactive hypoglycaemia is the habitual overconsumption of carbohydrates conditions the pancreas to become overactive and overproduce insulin.
In some people with severe reactive hypoglycaemia the pancreas overproduces insulin almost no matter what they eat, even when they don’t eat excessive amounts of carbohydrates; it’s as if their pancreas produces a knee-jerk reaction every time they eat. [Insert flat glucose curve diagram]
Another version of non-diabetic hypoglycaemia occurs whenever a person goes more than about 2 ½-3 hours without eating their body fails to adequately maintain their blood sugar and instead of just feeling a normal healthy appetite and readiness for their next meal they experience distinct signs of low blood sugar. A healthy body should be able to quickly and readily mobilise stored reserves of glucose and manufacturer new glucose to maintain blood sugar levels for quite a few hours even though we have fully digested and absorbed all the sugar from our last meal. This is of course what happens every night in a healthy person when they sleep, in some people however once their last meal is fully digested and absorbed they get hypoglycaemia. They may experience hypoglycaemia regularly during the day before meals, especially whenever there next meal is delayed and during the night they may be woken up by release of stress hormones produced to raise blood sugar; they will also typically feel very groggy in the morning until it had something to eat. 

Non-Diabetic Low Blood Sugar May Be a Widespread Hidden Problem

I can’t find any reliable estimates of how common non-diabetic reactive hypoglycaemia is and there’s a big disparity in this regard, between mainstream medicine alternative functional medicine.
Mainstream medical view is that hypoglycaemia in non-diabetics is a rare condition apart from during extreme sports or exertion, however in my practice I frequently see people that experience bouts of hypoglycaemia on a daily basis; they typically eat too many high GI carbohydrates and sweet foods along with too little fibre and the right balance of good oil and protein giving rise to frequent crashes in their blood sugar and they quickly experience improvements in their symptoms by using diets and natural treatments to stabilise their blood sugar..
Their chronic recurrent hypoglycaemia may central to their primary health problem or just a contributing factor. In functional and holistic medicine we are so concerned with the functional relationship between different systems in the body for example both hypoglycaemia and excessive stress responses contribute to adrenal fatigue, conversely excessive stress responses may produce spikes in blood sugar that provoke the pancreas into action that treating dysglycemia is something we always address in our patients no matter what the main presenting condition; another example is disturbances in blood sugar metabolism cause disturbances in our overall metabolic function which can disturb thyroid function and balance, so in functional medicine we believe it is an essential part of treating thyroid imbalance to test for and treat even the slightest degree of dysglycemia.
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One of the reasons mainstream medicine may consider non-diabetic hypoglycaemia to be rare is that there have been too few studies about how widespread it may be, another problem is that the diagnostic definition of hypoglycaemia varies from source to source and country to country. I think the most useful definition is if you have the symptoms of hypoglycaemia and at the same time your blood sugar is below 70 mg/dL (3.88 mmol/L) and you experience relief of symptoms by eating you have hypoglycaemia.
The conventional medical view is that reactive glycaemia is uncommon in non-diabetics however in functional medicine we believe it’s very common. We believe that many of our patients
As an individual interested in improving their health what’s more important than knowing how common reactive hypoglycaemia may be in the general population is knowing whether or not you suffer from it yourself and as I will explain later you can easily work this out for yourself at home using a simple blood glucose meter.
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
[i] Cox DJ, et al. Progressive hypoglycaemia’s impact on driving simulation performance: currents, awareness and correction. Diabetes Care 2000; 23:163-70.
[ii] Shahrad Taheri et.al. Shot Sleep Duration is associated with reduced leptin, elevated ghrelin and increased body mass index. PLoS Med December 2004; 1 (3):e62.
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