Low Energy? Chronic Fatigue?
It Could Be “Reactive Hypoglycemia” Caused by Excessive Carbohydrate Intake
The American diet averages over 300 grams of carbohydrate per day. A hundred years ago that number was less than a third of that amount. The explosion in carbohydrate intake has led to an epidemic of obesity and diabetes (and their complications) . . . but it is also likely the reason for another common condition: the excessive fatigue and low energy many people experience on almost a daily basis.
“Reactive Hypoglycemia”, is also called “postprandial hypoglycemia”. (The word postprandial means “after a meal”.) Reactive hypoglycemia is a condition which occurs when blood glucose (blood glucose is the same as blood sugar) rises rapidly after a carbohydrate meal. The meal may include simple carbohydrates (sugars) or complex carbohydrates like breads, potatoes, or other starchy foods. These foods cause blood sugar to rise rapidly. However, this rapid rise is then followed by a significant drop in blood sugar and the associated symptoms of low energy and fatigue.
And the blood glucose does not need to be at a markedly low level to experience these symptoms. This is because “relative hypoglycemia” can cause symptoms of low energy as well. True hypoglycemia is generally considered a blood glucose below 70 mg/dl. However, relative hypoglycemia occurs whenever a significant and/or rapid drop in blood sugar occurs, even if the blood glucose does not drop to be technically in the “low” range. A spike in blood glucose form a baseline of 120mg/dl up to 160mg/dl, followed by a “reactive” drop to 85 mg/dl produces similar symptoms. The result of this relative reactive hypoglycemia is the same – low energy and fatigue.
When we eat a high carbohydrate meal, the carbohydrates are digested by our intestines to be released as blood glucose into the blood stream. The pancreas then releases insulin. Insulin is the hormone which allows our tissues and organs (for example our muscles) to absorb blood glucose to use as an energy source. This allows the organs and tissues to function properly. However, often the amount of insulin released overshoots the mark, resulting in an excessive amount of blood glucose being absorbed by the tissues. When this occurs, the amount of blood glucose in the blood rapidly drops, causing hypoglycemia. The below image demonstrates this process:
Reactive hypoglycemia usually occurs within an hour or two after a meal, and can last for four hours or more. However, if frequent carbohydrate rich meals or snacks are consumed, this process can repeat itself over and over during the course of a day, resulting in recurrence periods of hypoglycemia and fatigue. It may seem to the person ingesting these high carbohydrate meals and snacks that they always have low energy.
Reactive hypoglycemia is compounded by a couple other physiological processes that prevent the hypoglycemia from revering rapidly. One is the presence of “insulin resistance”.
Adults who have been ingesting high carbohydrate meals for years, often have a condition called “insulin resistance”. Insulin resistance is the process that eventually leads to prediabetes and diabetes. (Many American adults are already prediabetic and do not know it. Just because your fasting blood glucose is below 100 mg/dl or your A1C is below 5.7% does not mean that a person is not prediabetic, or that insulin resistance is not present. Most people have some degree of insulin resistance present for more than five years before they are diagnosed as prediabetic or diabetic.) When insulin resistance is present, it means that the body’s organs don’t absorb inulin as readily. This results in higher inulin levels, and more rapid and enhanced spikes and drops in blood sugar.
The other process that compounds the issue of reactive hypoglycemia is “adrenal fatigue”. When blood sugar drops low, the adrenal glands normally will release adrenalin and another hormone called cortisol, which is a natural steroid. These hormones work together to restore blood sugar to a higher level. However, if a person experiences reactive hypoglycemia many times in a day, then the adrenal glands stores of adrenalin and cortisol run low. The reduced amount of these hormones cannot reverse the presence of the low blood glucose. So the low blood glucose persists for many hours.
The result of all these processes – reactive hypoglycemia, insulin resistance, and adrenal fatigue – is low energy and chronic fatigue.
How can reactive hypoglycemia, low energy and chronic fatigue be reversed? First and foremost, a person needs to have an understanding of their blood glucose levels over the course of a typical day. This can be achieved by a physician prescribing a Continuous Glucose Monitor, or CGM. A CGM is a temporary wearable device with a tiny probe that measures blood glucose continuously. The device’s sensor transmits blood glucose levels to a smart phone (and remotely to the prescribing physician). A CGM (after being prescribed by the physician) is placed at home by the patient in a 5-minute painless procedure. It is then worn for a two week period and replaced. With a CGM a person can see how their diet affects blood glucose on a continuous basis, including spikes and drops. A person can if they have episodes of hypoglycemia or relative hypoglycemia after a meal. It can be determined if the reason for low energy is reactive hypoglycemia of relative reactive hypoglycemia.
CGMs also provide constant reminders to those wearing them of how their dietary habits affect their blood sugar. This is why CGMs are also remarkable tools in assisting people in losing weight. Eating behavior is significantly changed when a person is reminded in real-time of the impact of their diet on their blood sugar. When eating behavior is altered with these constant reminders, most people lose weight in addition to improving energy levels.
To reverse the symptoms of low energy and chronic fatigue, a properly constructed low carbohydrate diet is often the answer. This diet may involve both limiting overall carbohydrates and eating the right types of carbohydrates. (In particular “low glycemic” carbohydrates can help avoid blood glucose spikes and plunges.)
The improvement in sense of well-being can be dramatic for many patients. Energy is improved, fatigue is reduced or eliminated, and often weight loss is also achieved. With a CGM and the right diet patients often feel more energized and vibrant than they have in many years.