Comments on: Why Test for Reactive Hypoglycemia?

By: Steph Kenrose

Steph Kenrose — Thu, 13 Aug 2009 11:35:15 +0000

Jo…wow, what a story! Glad you found the site. I can only exercise for 20 mins at a time without my blood sugar crashing. About 1/2 hour before I swim, I eat a Luna bar and immediately after, I eat a snack size Luna bar. That’s as good as I’ve gotten it Steph

By: jo hardy

jo hardy — Tue, 11 Aug 2009 10:54:00 +0000

I have had this condition all my life. call it whatever you like and tell me it is not life threatening but 61 years of disfunction has wrought havoc with my relationships, family, lifestyle. As an alcoholic who is now 25 years sober and still fit [thanks to AA and a Higher Power of my own unstanding] I survived this illness which I know now was caused by addictionand sensitivity to sugar. It was there way before the alcohol [eg.I remember events as early as 10 and 11 interfering with my playtimes with friends and my mum saying I was too hungry [greedy] – as was post meal hypoglycemia [my 1st husband was an insulin dependent diabetic[mellitus] he recognised it when I was courting him and thought I was a diabetic too]. I went on to destroy our life together and the children we made through alcoholism. For many years I have contacted various uk professionals -including the diabetic association – to be told that there was no such condition and it was all in my head etc.
Well despite their erudite responses I went on iand taught myself how to deal with it. I learned when to eat and what to eat, when to exercise and when not to exercise etc etc. I have self diagnosed and self treated it. I am interested in the lefevbre stance and will research it as I do have the heart fibrillation and sleep disturbances. I wouldn’t rule out anything now, I have spent my life being sensitive/allergic to so many things I would not be surprised to find it is more than a sensitivity to sugar. I found this site when I was looking for advice of when to exercise [yoga and aerobics] as I can’t seem to get that right with my husband who wants to walk after dinner. If I go out for the day I have to take protein snacks-apple juice would just cause symptoms as does anything with a sweet taste.[including some artificial sweeteners]
anyway thank you for your site it is nice to know there are others like me in the world. thanks, jo hardy[mrs]

By: Steph Kenrose

Steph Kenrose — Wed, 27 May 2009 13:05:05 +0000

John,
I wholeheartedly agree that the terms used for this condition (call it what you will–reactive hypo, postpranidal hypo or any other name we’ve come up with) are plagued with problems, historically. However, I chose to continue using those terms for one reason: I started this blog to help others like me. Most people find their docs call this disorder “RH” so that’s just the name I chose. It would be nice to completely rename it (like they did with “dementia” and “Alzheimers”?) to get rid of the old baggage, but I’m not in a position to do that.
As for there being no “specialists” in this area…I think that’s an unfortunate aspect of the way our medical system is set up. There’s no money to be had in researching dietary solutions for illnesses….only pharmaceutical ones. Additionally, RH isn’t deadly…so there are more pressing needs out there that need research.
Thanks for the link…I’m going to read it and see what else I can learn
Best,
Stephanie

By: John Smith

John Smith — Wed, 27 May 2009 02:54:04 +0000

Notice that Dr Bruns said that his test distinguishes between prediabetes and reactive hypoglycemia, not between reactive hypoglycemia and the normal population. But as you say, there is little relationship between prediabetes and reactive hypoglycemia and they are easily distinguished on many pieces of evidence. But re-read both of his articles and he admits that neither the ordinary OGTT nor the hyperglucid breakfast does very well at separating those with reactive hypoglycemia from the normal population. While I agree that a diagnosis can be made of this condition based on signs and symptoms, non-abnormality of key tests, and response to diet, the tests you list don’t seem to do a very good job of confirming a diagnosis: the OGTT separates normals and “reactive hypoglycemia” from prediabetes, and the Whipple criteria or diagnostic fasts separates normals and “reactive hypoglycemia” from measurable hypoglycemia due to insulinoma, genetic defects, etc, but no one has yet come up with a test that distinguishes “reactive hypoglycemia” from normals and both Dr Bruns and the hypoglycemia chapter in the Clinical Biochemistry text you posted clearly make this point. I suspect Dr Bruns was trying to politely avoid making a dishonest claim, but if your description of his email is accurate he dodged the key question — whether any version of a GTT can reliably distinguish normal people from those with whatever “reactive hypoglycemia” is. As you say, anyone has a right to seek any test they wish, or to call their symptoms any name they see fit, but don’t you think that you would avoid having to defend the “realness” of this “real disorder” if you didnt use a term already associated with very different problems? That confusion of terminology has always seemed to me the heart of the enormously frustrating miscommunication that arises over this so often between patients and doctors (which you document here as well). I found your website from the wikipedia link, and was pleasantly surprised at the quality of your authorities (I have no quarrel with anything in Dr Bruns’ articles, the Clinical Biochemistry chapter or Fred Hofelt’s book), but I am not so sure they support some of your assertions as well as you seem to think they do. Your banner implies that you are aware of the unfortunate paradox that most of the doctors with the most experience and interest with the many serious types of blood sugar derangements see little evidence that viewing “reactive hypoglycemia” as a form of hypoglycemia is useful– which is why so many patients accuse them of not believing the condition is “real”. For a brand new, vividly explicit example, see page 9 of the new Clinical Guidelines for Evaluation of Adult Hypoglycemia just published by the Endocrine Society at http://www.endo-society.org/guidelines/final/upload/FINAL-Standalone-Hypo-Guideline.pdf .

I am convinced the condition is real, that “it” is diagnosable by symptoms and some exclusions, and that it responds to a change of eating pattern, sometimes with much benefit for quality of life. Current medical science does spectacularly well conceptualizing certain kinds of problems and poorly with others: no one has trouble with the concept of a gene defect in an enzyme involved in regulating insulin secretion, but we — both patients and doctors– have a great deal of trouble understanding and describing a disorder of mental functioning arising from a suboptimal diet. No respectable subspecialty claims and investigates this type of disorder, and we lack the tools and concepts to even talk about it without seeming to turn it into something else– a blood sugar disorder, a mental illness, a chronic infection, a delusion, a problem of “bad foods”, etc, with all sorts of ranked “respectability” values attached to each category. Confucius taught that using the right words for things was the first step toward restoring right relationships between people, and this seems highly applicable to improving the chronic misunderstandings that surround this condition. I am not sure how invested you are in viewing “reactive hypoglycemia” as a disorder of blood sugar level, but doesn’t it give you pause that it is a view has proven remarkably unproductive of deeper understanding after 70 years? Compare how different our understanding of all forms of diabetes and other hypoglycemia is compared to the 1930s and recognize that not one piece– not a single fact— of new information or understanding about “reactive hypoglycemia” has been contributed by our hundred-fold deeper understanding of the complexities of carbohydrate metabolism. Perhaps it is time for another paradigm for this type of disorder?

However, if this makes no sense to you, I’ll not disturb you further.

By: Steph Kenrose

Steph Kenrose — Tue, 26 May 2009 23:36:24 +0000

John,

I’m going to have to respectfully disagree with your statement that Dr. Brun’s research “simply shows no ability to distinguish people with reactive hypoglycemia from those without.” This is an excerpt from an email I received today from Dr. Brun, who says that regarding the hyperglucidic breakfast test, “With this test it is very easy to discriminate between the two causes [prediabetes and reactive hypoglycemia].”

The same argument for EEGs and CAT scans cannot be made for the OGTT, as you suggest, because I requested the test for my son, suspecting that his seizures (and many other symptoms) were being caused by RH. I wonder, have you read the article on what led to the OGTT for my son? You may find it explains some of your points.

Some of my comments come from the horse’s mouth, other statements are from personal experience. I think what it boils down to in the end is the choice to get tested or not is a personal one, but a diagnosis can be made.

Thanks for your comments,
Stephanie

By: John Smith

John Smith — Tue, 26 May 2009 23:22:48 +0000

At the risk of nitpicking, none of your 3 arguments seem valid according to the info you have posted here. Unless a test is a medically pointless ritual that is part of earning the social right to claim a diagnosis, it needs to be a procedure that gives different results for people who have the condition and those who dont. The Bruns reference as well as many studies cited in it, as well as the OGTT curves you have posted, simply show no ability to distinguish people with reactive hypoglycemia from those without. Even the “hyperglucid breakfast”, a load of carbs far in excess of the breakfasts of most american hypoglycemia sufferers did not allow objective separation. The OGTT certainly does not tell a person with hypoglycemia how often to eat, and the strictness of the diet has no measure except personal results, which are highly variable. Your second reason is equally invalid: the OGTT is a poor test to detect insulinomas, other forms of hyperinsulinism, hormone deficiencies, ketotic hypoglycemia, etc. These are more reliably detected by adhering to Whipple criteria for a diagnosis of hypoglycemia: typical hypoglycemic symptoms at the time of a measured low glucose promptly relieved by the raising the sugar, or by a visit to an endocrinologist. In fact it is quite rare for those who think they have reactive hypoglycemia to have any of the more serious types. Third, since the OGTT tests do not exclude all the other conditions with similar symptoms, they do not reduce the need for other tests. By this argument you could say that a positive “yeast test” (said to produce virtually identical symptoms) would make testing for reactive hypoglycemia unnecessary. It is certainly possible that there was no reason to do EEGs or CAT scans on a particular patient, but the same argument could have been made about the OGTT, since you know nothing different about the person after doing the test than you knew before, except that they dont have diabetes.