Hypoglycemia
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Overview
Hypoglycemia is a disorder in which the body is unable to maintain an adequate level of blood glucose (blood sugar).Etiology
Paradoxically, one cause of hypoglycemia is over-consumption of sugar and other simple carbohydrates without balancing fats and proteins. When simple carbohydrates are eaten in the absence of protein or fat, the stomach dumps the entire meal into the blood within an hour. This spikes insulin production to reduce excess blood sugar by storing it in the cells of the body. The problem is that, as quickly as the sugar has surged into the blood and been stored, the sugar falls back off as the stomach empties. However, the insulin remains in the blood for a while, driving blood sugar to below normal values - causing hypoglycemia - and the patient "'crashes." On the other hand, if the meal eaten contains a significant proportion of protein, the stomach spreads out emptying into the blood for up to 2 hours to allow for digestion of the protein. If the meal eaten contains a significant proportion of fat, the stomach spreads out emptying into the blood for up to 4 hours in order to digest the fat. The slower the rate of dumping of sugar into the blood, the better insulin production can track the blood sugar level, resulting in a more stable blood sugar - lower peaks and shallower troughs.Elevated urinary levels of tartaric acid and other markers of dysbiotic overgrowth with yeasts and fungi are associated with some cases of hypoglycemia. This may be due to inhibition of gluconeogenesis by tartaric acid [Shaw2008].
Hypothyroidism, iodine deficiency, and adrenal insufficiency are also common in hypoglycemia, and in most cases, treating these underlying causes results in remission of hypoglycemia [Barnes; Starr2005, pg 140].
In some cases, hypoglycemic patients may show a hightened sensitivity to insulin, as demonstrated by the insulin tolerance test [Barnes1999; Escamilla1954; Starr2005, pg 141].
Diagnosis
- Basal body temperature below 97.8 degrees F, elevated TSH, or depressed T3 (suggests hypothyroidism).
- Organic Acid Test (elevated markers for gut dysbiosis).
- Glucose tolerance test.
Differential Diagnosis
- Hyperinsulinemia
- Reactive hyperglycemia
Treatment
- Dietary modifications (restrict simple carbohydrates, add fat and protein to each meal and snack).
- Treat dysbiosis if present.
- Treat hypothyroidism if present.
Pathophysiology
Elevated levels of tartaric acid (3-hydroxymalic acid or 2,3-hydroxy-succinic acid) are associated with some cases of hypoglycemia, and may be attributed to a gut yeast overgrowth or dysbiosis. Tartaric acid is an analog of the Krebs cycle intermediate malic acid that inhibits the Krebs cycle enzyme fumarase that converts fumaric acid to malic acid [Shaw2008] [Russell1995]. Malic acid is the Krebs cycle precursor of oxaloacetic acid, which is normally drained out of the Krebs cycle to form phosphoenolpyruvate, which is a starting material for gluconeogenesis.Note that excessive consumption of carbohydrates may exacerbate hypoglycemia if a yeast dysbiosis is present - the excess carbohydrates will feed the yeast, promoting the formation of still more tartaric acid, which further inhibits gluconeogenesis.
ICD-9 Codes
| ICD9-Code | Description | Comments |
|---|---|---|
References
Unless specifically noted above, references used in the construction of this web page include the following:[FDM] Lecture notes from Functional Medicine University.
[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.
[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.
[Barnes] Broda O. Barnes M.D. Research Foundation at http://www.brodaobarnes.org. Cited by [Starr2005].
[Barnes1999] B.O. Barnes & C.W. Barnes. Hope for Hypoglycemia, Revised Edition. America Book Company (1999). Cited by [Starr2005].
[Escamilla1954] Escamilla RF. Laboratory Aids in Endocrine Diagnosis. Charles C. Thomas (1954).
[Russell1995] Russell IJ, Michalek JE, Flechas JD, Abraham GE. Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995 May;22(5):953-8.
[Shaw2008] Shaw W. Biological Treatments for Autism & PDD, Third Edition. (2008).
[Starr2005] Mark Starr. Hypothyroidism Type 2: The Epidemic. Columbia, MO: Mark Starr Trust (2005).
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