Hypoglycaemia and Candidiasis
Types, Tests and Treatment
Dr George Samra and Jurriaan Plesman
We are grateful to
The Hypoglycaemic Health Assn. of Australia
and suggest this site is worthy of your further investigation.
Recommendation is from the moderator of
the Australasian FMS News Chat-Group, Eef Wylie
WHAT IS HYPOGLYCEMIAWritten by
Jurriaan Plesman BA(Psych), Post Grad Dip Clin NutrHypoglycemia means low blood sugar level. This term is used to describe a metabolic disorder, that may manifest itself in a variety of physical and 'psychological' symptoms.One must understand that glucose is a source of both physical (muscle) and mental (brain) energy. The brain, representing only 2 percent by weight of the body, has no energy stores of its own. It requires about 60 per cent percent of the all available glucose in the body and consumes about 120 grams per days regardless of whether we are asleep or awake. About one teaspoon of glucose is available in the blood at any time.Many doctors believe that hypoglycemia is due to ‘insulin resistance’, which it shares with diabetes. See Robyn Gosford, Insulin Resistance, Obesity & Diabetes: the Connection 1 As in diabetes, when a patient injects excess insulin, it causes the blood glucose concentrations to crash. This happens in non-diabetic hypoglycemia when the body produces too much insulin called hyperinsulinism. Consequently any extreme fluctuation in the supply of glucose to the brain will inevitably affect our emotions, feelings and personality. The symptoms of hypoglycemia may mimic and even cause many psychological and physical disorders some of which are shown in the following list in order of frequency and as reported by hypoglycaemic:
As will be clear later on, hypoglycemia, or low blood sugar level, is only one form of what Dr. George Samra in his book The Hypoglycaemic Connection II 2 describes as The Hypoglycaemic Syndrome. He refers to the four most important symptoms:
The blood sugar level is controlled by the pancreas by means of two hormones:
PROPER TEST FOR HYPOGLYCAEMIAThis is a special Glucose Tolerance Test (GTT) designed by Dr George Samra and described in his book The Hypoglycaemic Connection II. See The Hypoglycaemic Test
Unlike a test for diabetes, Samra’s GTT records the measurements of glucose levels after a load of glucose over time, usually over four hours taken each half hour. He is interested in the rate of variations - the rise and fall of blood glucose during the test. This enables the doctor to discern six types of hypoglycaemic reactions in a GTT as described in his book.
There are several forms that the hypoglycaemic syndrome can take and we will adopt Dr. Samra's classification;Type 1, RELATIVE HYPOGLYCAEMIAFollowing ingestion of glucose the blood sugar level rises unusually high (due to insulin resistance) and then suddenly drops. The rate of descent should be over 2.6mm/L (45 mg/100mL) in any hour, or over 1.6mm/l (30mg/100mL) in any 1/2 hour.
Type 2, ABSOLUTE HYPOGLYCAEMIAThis is any blood glucose recorded below the lower limit of 3.4mm/L (60mg/100mL).
Type 3, REACTIVED HYPOGLYCAEMIAThis is also known as ‘Combined Hypoglycemia’. Here the blood sugar level not only drops suddenly, but goes below the lower limit.
Type 4, FLAT CURVE RESPONSEWhere no blood glucose value is more than 1.3 mm/L (24mg/100mL) above the fasting level. This may be due not so much to a reaction to sugar, but a low metabolic rate.People with a Flat Curve Response should have their thyroid tested, for possible hypothyroidism. It is often indicated by low body temperature in the morning. If you measure your temperature before getting out of bed and you get a reading below 36.2 C. or 97.6 F. one should discuss this with your doctor.Vitamin B1 plays a role in the production of thyroxin, as does phenylalanine and tyrosine (the latter is the immediate forerunner of thyroxin). Thyroxin is also needed in the conversion of beta-carotene to vitamin A.
Type 5, FASTING HYPOGLYCAEMIAThis is where the fasting blood sugar level is below 3.4 mm/L (60 mg/ 100ml)
Type 6, CELLULAR LEVEL HYPOGLYCAEMIAThis is energy starvation at the level of brain cells. The person may have a normal GTT but presents the same hypoglycaemic symptoms.This may be caused by a dysfunction in enzymes involved with glucose metabolism, usually as a result of an abnormal zinc/copper ratio. Zinc is a coenzyme in the break down of glucose to simpler biochemical substances, before being used as energy inside brain cells. High copper levels depress zinc levels and vice versa.
Other coenzymes and vitamins are also involved in glucose metabolism inside the mitochondria.
SELF TEST FOR HYPOGLYCAEMIAYou can test yourself with a paper-and-pencil test for hypoglycemiawith the Nutrition-Behaviour Inventory (NBI)ALLERGIESAllergies are closely related to the hypoglycaemic syndrome. Many fibromyalgics and asthmatics have improved their condition by adopting the hypoglycaemic diet to be discussed later.
Very often, when we adopt the hypoglycaemic diet - by eating natural food - hitherto hidden allergies may emerge. Common foods, causing allergic reactions are cows milk, eggs, fish, crustaceans, legumes, grains and various seeds. These may all result in hypoglycaemic symptoms.
Food allergies often interfere with the proper absorption of nutrients in the intestines, thus causing vitamin and mineral deficiencies. Others obstruct the synthesis of neurotransmitters in the brain (such as serotonin), often resulting in 'psychiatric' disorders.
Allergic reactions can be overcome by either avoiding the offending foods and/or by supplementation with special enzymes, vitamins and minerals. Depending on the severity of allergic reactions, these should be treated in consultation with professional nutritionists. Other factors that may be responsible for allergic reactions may be the Leaky Gut Syndrome, or liver dysfunction. See: Samra, Dr G. The Allergy Connection.3
Coffee (caffeine) and cigarettes (nicotine) - and allergens - stimulate adrenaline production, which raise the blood sugar level by converting glycogen back into glucose. This provides a 'high' to hypoglycaemic, who are then often addicted to these substances. This explains why we may be addicted to our allergies.
Food, drug and allergy addiction - and even hypoglycemia - over a long period of time may cause adrenal exhaustion, as the body has relied on adrenaline production to raise the blood sugar level. Adrenaline is a defence hormone against all forms of stress. Thus often the nutritional treatment of hypoglycaemic syndrome must include nutrients to restore the exhausted adrenal glands.NUTRITIONAL TREATMENT
In brief the nutritional treatment of the hypoglycaemic condition consists of:
1) Avoidance of sugar, coffee, strong tea, nicotine if possible, refined carbohydrates, such as white bread, white rice, cakes and sugary drinks etc.
2) High protein + complex carbohydrates snacks every three hours or sooner, to provide a slow release of glucose, and to prevent the hypoglycaemic dip. A high protein breakfast must be considered the most important meal of the day. Good sources of proteins are eggs, white meat as in chicken and fish. Eat plenty of green vegetables and fruits and the more varied the diet the better it is.
3) Supplementation of diet with Anti-stress vitamin B-Complex tablets, including chromium, zinc + Vitamin C.
A rule of thumb is: "for what you are about to eat nature-made or man-made?" Nature-made food consists usually of complex carbo-hydrates and proteins, the kind of food that we were meant to eat. There are exceptions, such as sugary fruits; melons, honey, dates and bananas. These can be re-introduced into the diet after some time in moderation.
When you change your diet suddenly, you may be left with low blood sugar levels, without the highs, causing depression, fatigue and worsening the symptoms initially. These are withdrawal symptoms, that should not last longer than a week or so. Nevertheless, these unpleasant feelings can be alleviated, by taking a tablespoon of glycerine mixed in milk or diluted natural fruit juice or better still in a glass of water three times a day. When glycerine is metabolised into "energy" in the liver, it by-passes glucose, and is therefore not recognised by the pancreas as sugar.Hypoglycemia is a stress symptom. This causes potassium to be excreted in the urine and salt to be retained. Adelle Davis suggests that the unpleasant feelings of hypoglycemia may be relieved by taking potassium chloride tablets. Avocado contains an odd sugar called mannoheptulose, which may actually depress insulin production. Apart from avocado there are many other herbs that can help regulate blood sugar levels. See Research Evidence.
WHAT'S IN A NAME?As described previously, hypoglycemia means low blood sugar level. This is the common term used by people who suffer from the hypoglycaemic symptoms. Unfortunately, this term causes immediate confusion for conventional doctors who understand hypoglycemia to be low blood sugar occurring in diabetic patients who have accidentally overdosed with their insulin injections.
However, if we consider the condition in terms of ‘insulin resistance’ the difference between diabetes and hypoglycemia is one of degree. In diabetes we have high blood sugar concentrations, whereas in hypoglycemia we see wildly fluctuating sugar levels, depending on the severity of insulin resistance.
If you want to research hypoglycemia in the medical scientific literature, you have to look for terms like hyperinsulinism, hyperglycaemia, insulin resistance, Syndrome X, diabetes and so on. Many nutritional doctors use the term Dysglycemia. It is possible that in the near future the medical fraternity may agree on a term.
There is no doubt that the impact of hypoglycemia is underestimated by the community. There are studies to show that hypoglycemia is associated with a vast array of modern degenerative diseases, from atherosclerosis, arthritis, various bone diseases, heart diseases, in fact every organ found in the body. And there is much evidence that hypoglycemia is a factor in mental illnesses, not generally recognised by conventional medicine or psychology. See Research Evidence.
CANDIDIASISThis condition is one of sensitivity to yeast in the diet occurring in foods such as bread, alcohol, mushroom and malt, as well as to yeast germs which normally live in the intestines, particularly Candida albicans.
Approximately 25 percent of hypoglycaemic patients suffer with candidiasis. The symptoms are almost identical and are mainly tiredness, vagueness, poor concentration, poor memory and depression.
People with candidiasis need to follow the rules recommended for hypoglycaemic but must also avoid yeast foods and in most cases do better with antifungal agents such as Nystatin prescribed by the doctor as well as Acidophilus capsules obtainable from health food stores.
CHRONIC FATIGUE SYNDROMEOther names include ME or Myalgic encephalomyelitis or the yuppie flu. Severe fatigue is a common feature of CFS. This disease is becoming more common and many doctors regard it as predominantly a psychological condition. Some of the sufferers do have hypoglycemia and candidiasis and these can be treated mainly with diet and supplements.
Dr Samra and other doctors regard this condition as a weakness of the immune system which has developed as a consequence of modern medicine as well as environmental pollution. Defying Darwin's laws of nature, these days even people with weak constitutions live to become adults and do reproduce.
This is one theory; others include the development of CFS as a result of exposure to antibiotics over some years. Again others believe the disorder has resulted from pollutants in the environment, including petrochemicals, lead, mercury and even fluoride in our drinking water.
THE SEROTONIN CONDITIONOne obvious reason for the development of hypoglycemia and diabetes is our modern lifestyle with easy access to manufactured foods laden with sugar. Our sugar consumption has increased exponentially over the last sixty years. Much of it is promoted by the fast food industry. Sugar is addictive and helps to boost the sale of food products.
But there is another mechanism that may have contributed to excess sugar consumption. Studies have shown that psychological stress produces stress hormones, such as cortisol and adrenaline, that may interfere with the synthesis of a neurotransmitter, serotonin. This is why we have included a self-help Psychotherapy course, that will help people deal with stress in a more effective way.Serotonin is the main ‘feel-good’ neurotransmitter in the brain. An imbalance of serotonin in the brain can cause endogenous depression. Doctors usually prescribe Selective Serotonin Reuptake Inhibitors (SSRIs) for endogenous depression. These drugs increase serotonin by blocking its reabsorption in the brain and so may reduce depression. The body produces serotonin from tryptophan, an essential amino acid (protein unit) found in food, such as soya protein, cottage cheese milk and many others. See: Rich Sources Of Nutrients
The absorption of tryptophan from food has to compete with the absorption and digestion of other amino acids - such as phenylalanine. Most amino acids (including glucose) - but not tryptophan - are transported into cells for utilisation via the action of insulin! The absorption of tryptophan for conversion to serotonin can be sped up by consuming refined carbohydrates, such as sugar.
Increased sugar consumption has the effect of triggering the release of insulin from the pancreas. This helps to absorb all the amino acids (including glucose) - but not tryptophan - leaving tryptophan free for absorption.
Unfortunately, people who are depressed may be inclined to increase their sugar consumption. This will speed up absorption of tryptophan for conversion to serotonin with the help of vitamin B6 and magnesium and presto they feel happy!!! But this may precisely lead to ‘sugar addiction’ and hypoglycemia!
Many depressed people, including those with an addiction problem have been found to have a history of sugar-addiction.A high sugar diet, however, will cause the body to ‘down-regulate’ receptors for insulin in the membranes of cells. This means the cells will fail to respond to normal levels of insulin and eventually show “insulin resistance”. The body will try to compensate for this through what is called the hypothalamic-pituitary-adrenal axis (the HPA axis). This means in response to the perceived energy starvation by the hypothalamus in the brain, a message is sent to the adrenal glands to secrete adrenaline into the blood stream. This hormone functions to convert glycogen stores in the liver and muscles into glucose, so as to quickly raise blood glucose levels.
But adrenaline is also the fight/flight hormone readying the body to face the dangers of life by pumping energy into muscles and the brain. This panic hormone is also responsible for the myriad of hypoglycaemic symptoms, such as tremble, shakes, mood swings, depression and confusion. Some people have learned that taking sedating drugs such as alcohol, marijuana or benzodiazepines will temporarily give relief to these symptoms. But these can lead to addiction. See: The Serotonin Connection
So we see that there is more to hypoglycemia than meets the eye.
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TESTING FOR HYPOGLYCEMIAAND HOW YOUR DOCTOR CAN HELP
Written byDr George Samra, M.B.,B.S. (Sydney), F.A.C.N.E.M.
The correct test for Reactive Hypoglycemia is a G.T.T. The test should be ordered by the doctor as follows: G.T.T. – 4 hours. All 1/2 hourly readings. No special diet prior.
THE GLUCOSE TOLERANCE TEST (G.T.T.)
The Glucose Tolerance Test is the classical test used in diagnosing Diabetes. The Diabetic test is a 2 hour G.T.T. with just 3 readings, the fasting, the 1 hour and the 2 hour. This test is not correct for testing Functional or Reactive Hypoglycemia.
With Hypoglycemia one is interested in the full reactions to a sugar load. In both cases a 75gram load of glucose is given to the patient after having collected blood for the fasting level. With Reactive Hypoglycemia the emphasis in on the word “Reactive”- one is looking for the sugar reactive phenomenon in which the blood sugar either drops suddenly or falls very low. Part of diagnostic criteria for Hypoglycemia is the rate of fall of blood sugars, hence the relationship between consecutive readings is very important. Sudden drops in blood glucose will usually trigger an adrenaline response and subsequently adrenaline symptoms such as nervousness, shakiness, dry mouth, irritability, agitation, neck stiffness and sometimes palpitations or a racy heart.
With Reactive Hypoglycemia one is also seeking to ascertain how low the blood sugar may go as this in fact is one of the measures of severity. The brain is dependent on blood glucose as it’s only fuel supply under normal circumstances. When the blood glucose falls below a certain level, usually 3.6mm/L, there is a lack of available fuel to the brain and symptoms of brain starvation will occur - these include tiredness, moodiness, depression, forgetfulness, poor concentration and cloudy headedness.
The purpose of the G.T.T is to clarify how well one tolerates glucose and by doing it properly one is able to see if the blood sugars drop too rapidly or fall too low. It is important that the glucose tolerance test is done accurately and properly. The following rules apply:
DOES INSULIN NEED TO BE MEASURED?Usually Insulin levels do not need to be measured. However, when the doctor suspects an Insulinoma (Cancer of the head of the Pancreas) and also in the case of an obese patient insulin levels may prove very useful in clarifying the diagnosis.
DETERMINATION OF THE GLUCOSE TOLERANCE TEST RESULTS
The different types of Hypoglycemia have been classified based on the Glucose Tolerance Test. If the blood glucose levels falls below 3.6mm/L (65mg per 100ml) then Absolute Hypoglycemia is present. If the blood glucose level drops rapidly i.e., greater than 1.6mm/L (30mg per 100ml) in 1/2 an hour or greater than 2.6mm/L (50mg per 100ml) in 1 hour, then Relative Hypoglycemia exists. If the curve has a sharp gradient and numbers below 3.6mm/L together, then it is regarded as the classical Reactive Hypoglycemia. The lower the blood sugar readings and the larger the gradient the blood glucose falls, the more severe is the diagnosis. A fasting Hypoglycemia alerts the doctor to the possible diagnosis of Insulinoma. The flat curve response and its implications have also been described elsewhere on this web site.
WHAT TO SAY TO YOUR DOCTOR
& HOW TO APPROACH YOUR DOCTORMost doctors have a problem understanding Reactive Hypoglycemia and this frustrates them. For this reason I’m including a letter to the doctor that you should download and which should help you get a satisfactory response from your doctor.
SAMPLE LETTER
HYPOGLYCAEMIC HEALTH ASSOCIATION
P.O. BOX 830 KOGARAH NSW 1485
www.hypoglycemia.asn.auDear Doctor,
Your patient has identified with the many symptoms suffered by patients with Reactive or Functional Hypoglycemia. As you well know, Hypoglycemia is low blood sugar. However Reactive Hypoglycemia is a sugar reactive phenomenon (and is not Diabetes.) After a sugar load such as a soft drink or cake, patients with this condition often suffer symptoms due to a sudden drop in their blood sugars, which typically occurs between 1 1/2 hours and 2 1/2 hours after the sugar consumption. Typical symptoms of Hypoglycemia include tiredness, poor concentration, moodiness, depression, forgetfulness, nervousness and irritability.
The brain relies on glucose as its only fuel under normal circumstances. The symptoms of Hypoglycemia relate to the fact that the brain is not being fueled properly at some point in time. In order to investigate this condition and help your patient please order a Glucose Tolerance Test as follows:
GTT 4 Hours. All 1/2 Hourly Readings. No Special Diet Prior.This is the correct way to order a test for Reactive Hypoglycemia. The patient is usually given a 75gm load of glucose soon after the fasting level has been collected. With the prolonged GTT and with the 1/2 hourly readings one is able to ascertain both the rate of fall of blood sugars as well as whether they in fact fall below the Hypoglycemia line that is usually 3.6 mm/L (65mg per 100ml). Guidelines for interpretation of the Glucose Tolerance Test are available on the web site or directly from the Hypoglycemic Health Association.
Thank you sincerely for your co-operation. This test may help to clarify many troublesome symptoms that your patient has been experiencing.
Yours sincerely,
The Hypoglycemic Health Association.Please feel free to use the flyer: What is Hypoglycaemia?
Send it to your doctor, counsellor, or other health care worker or to friends.
Perhaps you may wish to use it for your local Discussion Group Meetings and/or Community Health Centre.----------O---------
BIBLIOGRAPHY
1 ) Cosford, Robyn, Insulin Resistance, Obesity & Diabetes: the Connection JACNEM Vol.18 No.1, April 1999: 3-10
2 ) Samra, Dr George (2003), The Hypoglycemic Connection II One Stop Allergies, Fax (612) 9588-5290, PO Box 394, KOGARAH NSW 2217, Australia
3 ) Samra, Dr George (2003), The Allergy Connection: Food and Disease Paradigm One Stop Allergies, Fax (612) 9588-5290, PO Box 394, KOGARAH NSW 2217, Australia
See also:
Treatment of Drug Addiction
Rich Sources of Nutrients
Research Evidence for Hypoglycemia
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We are grateful to The Hypoglycaemic Health Assn. of Australia and suggest this site is worthy of your further investigation.
The Australian website above is recommended by the moderator of the Australasian FMS News Chat-GroupEef Wylie, <everdina@tpg.com.au>To join you may write to Eef or click on the graphic to the right to make contact with the group and to participate.
