Fibromyalgia Information & Local Support
©Devin Starlanyl, MD 1995-1998
There are three basic types of nutrients. Beef, fish, poultry, cottage cheese and tofu are foods that are largely protein. Butter, cream, and vegetable oils are fats. Vegetables, fruits, grains, pastas, and cereals are carbohydrates (carbos), and so are many so-called "junk" foods, such as candy. These junk foods have little if any nutritional value, and may carry fat as well as carbo. People with reactive hypoglycemia(RHG) are often (but not always) overweight, and unable to lose the extra weight. A fat pad develops on the belly, and won't go away.
The often-overlooked factor is that carbos stimulate insulin production. Insulin enables blood sugar to move into our biochemical "factories" in the cells, where it is burned as fuel. If there is an excess of insulin as well as an excess of carbos, the excess carbos are stored as fatty acids in fat cells. The excess insulin also prevents the carbos from being used. You not only gain fat, but you are also prevented from losing this fat because of the availability of excess carbos.
RHG is not the same as fasting hypoglycemia, which is low blood sugar that occurs when you do not eat. For this reason, RHG is not always picked up on routine medical tests. RHG occurs within 2 to 3 hours after a meal of excess carbos, when there is a rapid release of carbos into the small intestine, followed by rapid glucose absorption, and then the production of a large amount of insulin. Adrenalin production should be measured as well as glucose, but this can occur in brief spurts and can be difficult to "catch". If the symptoms are there, such testing is unnecessary, as there is no harm in trying a "balanced" diet like the Zone (see Books and Tapes). RHG is also called "insulin tolerance", "postprandial hypoglycemia", "carbohydrate intolerance" and in severe forms,"idiopathic adult-onset phosphate diabetes". This condition can lead to type II diabetes.
RHG is common in people with FMS and FMS&MPS Complex. In FMS, it is enhanced by dysfunctional neurotransmitter regulation and other systemic mechanisms. With FMS, you crave carbohydrates but cannot make efficient use of them because of an electrolytic imbalance and other biochemical imbalances in your body. We produce adrenalin even when the blood sugar doesn't fall. We crave carbos, because we need energy. Since our insulin level is high, our bodies take the carbos and store them as fat, often in the belly. We can get the body balanced by eating a balanced diet, and teach it to metabolize our fat for energy.
When you consume carbos, your insulin production increases. If you have RHG, your body overcompensates. This results in low blood sugar. RHG can range from very mild to severe. Symptoms include headaches (usually in the front or top of the head), dizziness, irritability, chronic fatigue, depression, nervousness, difficulty with memory and concentration, nasal congestion, heavy dreaming, palpitations or heart pounding, tremor of the hands (especially if a long time elapses between meals), day or night sweats, anxiety in the pit of the stomach, anxiety, leg cramps, numbness and tingling in the hands and/or feet, flushing, and craving for carbos (especially sweets). The hunger pangs experienced in reactive hypoglycemia can come in the form of acute stomach pain and nausea. Severe RHG can cause hypoxic symptoms such as visual disturbances, restlessness, impaired speech and thinking, and blackouts. You can expect excess body fat, high triglycerides/cholesterol, fluid retention, dry skin, brittle hair/nails, dry small stools, decreased memory and ability to concentrate, fatigue or dips in energy, grogginess when waking, mood swings/irritability, and sleep disturbances. In cases of chronic MPS, the process of eliminating TrPs is hampered or even thwarted by the presence of hypoglycemia. TrP activity is aggravated and specific therapy response is reduced by hypoglycemia. Recurrent hypoglycemia attacks perpetuate TrPs. MAny of these symptoms are caused largely by circulating adrenalin, which is also increased by anxiety.
Hormones in a given system usually work in a set, called an "axis". The most important in RHG is the insulin-glucagon axis. Insulin drives down blood-sugar levels, while glucagon raises it. If insulin is too high or glucagon is too low, the result is hypoglycemia. Insulin resistance means that the insulin levels are elevated but blood sugar levels remain high, because the target cells no longer respond normally to insulin. This can eventually promote diabetes.
Insulin is a storage hormone. It takes excess glucose from carbos in your food and stores them as fat. Then it locks the fat in place. Insulin drives down blood sugar. Glucagon, on the other hand, is a mobilizing hormone. It releases stored carbos as glucose. Glucagon restores blood sugar levels.
The release of insulin is stimulated by carbos, especially heavy starches like bread and pastas. Glucagon is stimulated by dietary protein. If you eat a big carbo meal for lunch, by 3 pm you are ready for a nap. Excess carbos have generated overproduction of insulin. As your blood sugar drops, your brain begins to fall asleep. Because the massive amount of carbos you ate drove your insulin level up and your glucagon down, the fats stored in your body can't be released. But you feel fatigues, so you crave energy and more carbos. This happens in 50% of all people. In 25%, the normal fat response is blunted, so they can get away with eating a lot of excess carbos. Yet 25% of us have an extremely elevated insulin response to carbos. Many of these people have FMS or FMS&MPS Complex. Hypoglycemic tendency is inherited, and often comes with a family history of diabetes.
Remember, insulin triggers an adrenalin response. Coffee, tea and colas stimulate the release of adrenalin, as does nicotine. All carbos stimulate the secretion of insulin. Fatty acids are actually the preferred fuel for building new muscles and for energy. A high-carbo diet means fat is deposited and it stays. Dietary fats decrease the flow of carbos into the bloodstream and dampen the insulin response. Dietary proteins enhance the mobilization of fatty acids from fat cells and fat loss. We need a balance.
Weight loss on a high carbo diet is mostly water and muscle loss. Any subsequent weight gain is fat gain. Also, the more carbos you eat, the earlier adrenalin is produced as the blood sugar goes down. Blood sugar swings are more extreme and faster the more carbos you eat, and your mood and energy swings go right along for company. Studies show that high carbo intake and resultant hyperinsulinism can contribute to every known disease process.
The hormonal response from a balanced meal lasts 4 to 6 hours. Serotonin regulates the appetite for carbo-rich foods, and this neurotransmitter is often out of balance in FMS. Serotonin is also influenced by photoperiodism -- the dark/light cycle. (Often carbo cravers overeat only at certain times of the day). The rate of conversion of tryptophan to serotonin is also affected by the proportion of carbos in a person's diet.
Dr. Barry Sears wrote a book with Bill Lawren, called Enter "The Zone", (Harper Collins N.Y.N.Y. 1995) It explains in detail why a ratio of 30/40/30 (protein to carbohydrate to fat) is the healthiest balance for a majority of people. You are eating 30 percent of fewer calories as fat, and that fat is being used for energy. Every meal and snack must be balanced because there is a hormonal response very time you eat. 30/40/30 is an adequate protein, moderate carbo, low fat diet. At the same time, you will need to adjust your caloric intake and exercise to meet the needs of your body. In this diet, it is helpful to have minimal alcohol, sugar (in any form), fruit juice, dried fruit, baked beans, black-eyed peas, lima beans, potatoes, corn/popcorn, bananas, barley, rice, pasta, caffeine, or other heavy starches. Avoid caffeine, as its breakdown products tend to increase insulin levels.
This is one tough diet, because if you need it, you REALLY crave carbohydrates. You only have to try it for a few days and your body informs you, "Yes, this is what you must do," because you are attacked by whopping headaches and extreme fatigue as soon as your body begins its struggle for balance. Your excess fat will start to break down and release large amounts of toxic substances and waste material. It is not fun. As Dr.St.Amand says, it is not for the faint of heart. But "diet alone" is a treatment that works.
When you start each meal, it is wise to eat some protein first. That allows its products reach your brain first. Exercise regularly to decrease the amount of insulin in your blood. Drink at least 8 ounces of water or a sugar-free decaf beverage with each meal or snack. If you are hungry and craving sugar 2-3 hours after a meal, you probably ate too many carbos.
Now that you are aware that sugar can ease your "carbo "withdrawal" symptoms in the short term, you may be tempted to cheat. If you do, you cheat yourself. If you don't cheat, in one month you will see considerable improvement. Within two months, the RHG symptoms should be gone. When all is in harmony, your body is your best doctor. Once you are in balance, it will tell you a great deal, if you listen.
Learn to eat like a gourmet. Eat slowly, chew thoughtfully, and enjoy each bite. Eat less, but eat mindfully, and you will be satisfied. You may have the bad habits of a lifetime to break, but if you succeed , you will have a better chance to live a longer and healthier life.
Thanks to Drs. Lynne August, Barry Sears, Paul St.Amand, Janet Travell and David Simons and the Wurtmans for the basic research.