Control Your Blood Sugar With…Coffee?

My blood sugar tanked yesterday for no good reason at all. I micro-studied my diet for the last few days to try and identify the culprit. I failed and thought it was just a “blip”–one of those blood sugar moments that has no cause. I was wrong: I found my solution, this morning, in my (decaf) coffee cup.
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Celiac Disease and Reactive Hypoglycemia

As part of my journey with discovering what exactly was causing my reactive hypoglycemia, I received a comment from Erica Douglas who suggested that my symptoms might be caused by celiac disease. Celiac disease is a fairly common autoimmune disease where the small intestine’s lining is damaged from gluten and other proteins in wheat, barley, and rye.
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Reactive Hypoglycemia Caused by…Yeast!

It’s been a rough few months. I thought I had my reactive hypoglycemia under control, and then things suddenly went downhill. The list of foods I was able to eat with experiencing a hypoglycemic episode dwindled to apples and walnuts by July. I was so ill I was unable to walk up a flight of stairs and all of the regular doctors said there was nothing they could do for me.
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Hereditary Fructose Intolerance

I have no definitive answers yet as to why my son and I both have reactive hypoglycemia. However, a spate of recent tests gave us some clues, including lab work that may indicate Hereditary Fructose Intolerance.
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Vacation causes low blood sugar!

At a beautiful restaurant 8,000 feet in the Rocky Mountains, the dreaded symptoms returned last week with a vengeance: a sense of unpleasant, dizzy anxiety accompanied by shaking hands, sweating, and nausea. I broke out in a cold sweat and excused myself to the bathroom.
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Fibromyalgia can Cause Reactive Hypoglycemia

I was doing a little research last night on another ailment I have, called Tietze’s Syndrome. Tietze’s syndrome is a benign inflammation of the ribs which causes pain that sometimes mimics a heart attack. I found a blog post from a girl who had Tietze’s; she said her symptoms were caused by fibromyalgia. That led me to discover that up to half of fibromyalgia patients also report problems with reactive hypoglycemia.
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Reactive Hypoglycemia in Highly Gifted Children

About Gifted Children

I don’t usually tell people that Leo is academically gifted, for risk of sounding boorish. My close friends and family know, but it isn’t the kind of thing I’ll bring up in general conversation, let alone post in a blog. However, it looks like Leo’s giftedness may be the reason he’s reactive hypoglycemic.

Our Bipolar Child

For years we thought Leo (now ten years old) had cyclothymia (a mild form of bipolar disorder). He would have mood swings and highs reminiscent of my mother’s menopause: doors would slam, dishes would break, and then an hour later, Leo would (puzzlingly) make tea for me, give me a hug, and apologize in the sweetest way you could imagine for being a “toad.” At the time, I didn’t notice that his mood improved after a snack.

Sometimes he would come home from school and go to bed for a two hour nap. We knew better than to disturb him–it was either let him sleep or put up with a miserable, grumpy Leo.

Leo’s schoolwork was haphazard–sometimes brilliant, other times nothing but scrawl and misspellings. His teachers were as puzzled as I was. Another thing that didn’t make sense: Leo would crave sweets and carbs so much that he would often raid the kitchen late at night for cookies, chips, and crackers (we no longer keep those items in the house!)

An Unquiet Mind

An Unquiet Mind

While Leo seemed to fit the definition of bipolar, his puzzling seizures (two Grand mals) didn’t quite fit the profile. Neither did his spells of feeling nauseous and looking pasty-faced before he passed out.
After he was diagnosed with reactive hypoglycemia (for more on that see my post How to Get Diagnosed), the pieces of the puzzle fell into place. However, we wanted to know the cause. Wouldn’t any parent?

I may have found my answer in a book by James Webb, called Misdiagnosis and Dual Diagnosis of Gifted Children

About six percent of highly-gifted children, says Webb, suffer from reactive hypoglycemia. The children who fall into this category are usually slender and exhibit intense behavior. Leo is definitely intense, and very slim. Why is reactive hypoglycemia seen in these children? As the brain runs on glucose alone, it’s thought that highly gifted, energetic children simply use up available brain fuel quickly.
If your child is a good student but exhibits puzzling mood swings, especially in the late morning or late afternoon, reactive hypoglycemia could be the cause.

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What Causes Reactive Hypoglycemia?

Reactive Hypoglycemia is a condition, not a disease. Often, the underlying disorder can’t be determined, but that’s not because a real cause doesn’t exist. According to F. John Service, M.D., reactive hypoglycemics fall into three categories, Alimentary Hypoglycemia (this is a consequence of dumping syndrome; it occurs in about 15% of people who have had stomach surgery), early diabetes mellitus or prediabetes (if you have risk factors for diabetes, this could be worth further consideration), and “Other,” sometimes referred to as “Idiopathic.”

If you are reading this article, you most likely fall into the “other” category, as I’m going to assume you know if you’ve had stomach surgery (and have spoken to your doctor about your symptoms), and you have already had a diabetes talk with your physician (always a good idea if you are at risk).

Tracking down why you might have reactive hypoglycemia could be a long process, because there are many different causes for reactive hypoglycemia. Some tests (like a breath test for Helicobacter Pylori Infection) are remarkably easy. Others, like testing for a hereditary fructose disorder are neither easy nor inexpensive.  Here are some causes which you may want to consider when trying to figure out what is causing your reactive hypoglycemia:

• Being Gifted

  Around six percent of highly gifted children have reactive hypoglycemia. This is usually seen in very active, lean children with IQs above 160. The thought is that these children use up the available glucose quickly, crashing mid-morning or mid-afternoon.* For more on this topic see my post Reactive Hypoglycemia in Highly Gifted Children.

• Helicobacter Pylori Infection

  A common stomach bacteria can lead to reactive hypoglycemia, according to current research. If you have other symptoms such as bloating or nausea, a breath test from your doctor can rule of the presence of this bacteria.

• Epinephrine Sensitivity and Insulinemia

  When a reactive hypoglycemic eats a meal high in carbs, the body responds by producing a large shot of insulin, resulting in insulinemia, an abnormal concentration of insulin in the blood. This high concentration of insulin results in the unpleasant side effects of hypoglycemia, and will often subside within a short time period until enough epinephrine is released to balance the insulin. The body’s natural reaction to this influx of insulin is to balance the insulin with compensatory epinephrine. This is where it gets complicated: individuals with a sensitivity to epinephrine will have symptoms of hypoglycemia–shakes, anxiety, sweats etc. Additionally, stress causes more epinephrine to be released, so being anxious about the pounding heart, palpitations and other unpleasant side effects of epinephrine in epinephrine sensitive individuals will lead to more epinephrine being released, and more anxiety. How to decide if epinephrine sensitivity or insulinemia might apply to you? I discovered I was sensitive to epinephrine in the dentist chair (some anesthetics contain epinephrine), but monitoring my blood sugar helped me to determine that epinephrine alone was not the culprit. As of time of writing, Leo and I are still searching for the cause of our reactive hypoglycemia, and we haven’t ruled out some type of hereditary insulinemia.

• Glucagen and Epinephrine Deficiency

  Glucagen works alongside epinephrine in regulating insulin levels.
  According to authors Ellenberg & Rifkin in the book Diabetes Mellitis, glucagen deficiency alone isn’t enough to cause hypoglycemia, although a epinephrine and glucagen deficiency working together will. The only way to determine whether you have an epinephrine and glucagen deficiency is to see a physician and undergo further testing (i.e. blood tests and a Glucose Tolerance Test).

• Hereditary fructose intolerance

  As suggested by the title, this condition is caused by the transmittal of a faulty gene, resulting in a fructose-1-phosphate aldolase. If you have this condition, you are likely to already know about it, but a dietary history can help with a diagnosis: if your symptoms occur after eating fructose or sucrose heavy foods instead of the usual culprit, carbohydrates, this may be worth a second look.

  

  A fructose tolerance test can help with the diagnosis.

• Galactosemia

  Hypoglycemia isn’t very common in this rare genetic disorder, but it can be a problem. Galactosemia affects how an individual processes galactose, a simple sugar found in many foods. Symptoms can range from severe (a failure to gain weight and grow in infants, jaundice, sepsis, and shock) to moderate (cataracts, delayed development). This is usually diagnosed at birth and is one of the rarer causes of reactive hypoglycemia.

• Pharmaceuticals / Drugs

  Many different pharmaceuticals and prescribed drugs can make hypoglycemia worse. If you are taking any of the drugs listed as “potentially causing hypoglycemia” in this document, you should suspect them as a possible cause for at least some of your symptoms.

• Leucine sensitivity

  This is also a rare disorder. Leucine sensitivity causes too much insulin to be released in the body (and thus causing the body to respond the same as in insulinemia, see above for explanation). An L-Leucine Sensitivity Test can diagnose this, but it is a rare disorder. This is usually only seen in adults with other factors (i.e. if you have had a partial pancreatectomy).

• Fibromyalgia

  Reactive hypoglycemia is a common occurrence in people afflicted with fibromyalgia. According to Dr. Devin Starlanyl, reactive hypoglycemia in people with fibromyalgia “is enhanced by dysfunctional neurotransmitter regulation and other systemic mechanisms.”

Celiac Disease

According to the National Institutes of Health, Celiac disease can cause a myriad of symptoms, including low blood sugar. If you have reactive hypoglycemia with an undiagnosed cause, it may be worth a look, especially if you have other symptoms, like stomach ailments or lactose intolerance.

*Webb, James et. al. Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, bipolar, OCD, Asperger’s, depression, and other disorders. (2004) Scottsdale: Great Potential Press. Available from the publisher

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