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- Low blood sugar (hypoglycemia)
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Low Blood Sugar (Hypoglycemia) 

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Low blood sugar (hypoglycemia) is a major cause of chronic fatigue and some experts believe up to 20 percent of adults in the western world suffer from the condition. It is possible that chronic fatigue syndrome is actually a severe case of hypoglycemia, although that might to too simplistic an explanation. In any case, the treatment for hypoglycemia is essentially the same as that for chronic fatigue syndrome - correct diet and the avoidance of heavy exercise. 

Hypoglycemia results in rapid rises and falls in the level of glucose in the blood - due to a malfunctioning of the pancreas and liver, predominantly. Exhaustion of the adrenal glands is also a factor. 

I don't intend to get into a detailed medical explanation of hypoglycemia because it is complicated and somewhat controversial. However, in simple terms it is caused by overactivity of the pancreas which produces too much insulin when sugar or sweet foods are eaten. 

In a healthy person, the pancreas produces just enough insulin to neutralise any sugar eaten, to bring the blood sugar back to normal. But in those with hypoglycemia, the pancreas overreacts and produces too much insulin in response to the sugar eaten. This over-abundance of insulin metabolises not only the sugar which has been eaten but also some of the glucose which was already present in the bloodstream. 

The result is a state of low blood sugar which can cause an alarming number of distressing symptoms -fatigue being only one of them. Other symptoms include headaches, dizziness and feeling faint, irritability, depression, difficulty in remembering, blurred vision and in most cases an overwhelming craving for something sweet or a stimulant such as tea or coffee. 

If any of those symptoms sound familiar, particularly if they are accompanied by a craving for sweet food, then it is very likely you are suffering from hypoglycemia. Strenuous exercise also lowers the blood sugar, which is why those with chronic fatigue syndrome should be careful not to over-do any physical activity. After heavy physical work, a healthy person feels tired, his energy has been drained. However, if he rests, his strength will return reasonably quickly. 

What has happened? The exercise has burned up part of the glucose in the blood. Stored glycogen in the liver is then used to bring the blood sugar level back to normal - even if the person doesn't eat anything immediately. The adrenal glands help raise the blood sugar level by releasing catecholamines which convert glycogen into blood sugar.

Thus, the healthy body has a system of checks and balances, involving mainly the liver, pancreas and adrenal glands, to ensure the blood sugar level stays stable. But in a person suffering from hypoglycemia (and chronic fatigue syndrome) the system doesn't work properly. After strenuous exercise, the person's blood glucose is depleted and the adrenal glands react by releasing catecholamines to convert stored glycogen into glucose. But unlike the process in a healthy person, in the hypoglycemic the new glucose stimulates the pancreas to produce more insulin - which once again lowers the blood sugar level. 

The pancreas of a hypoglycemic person is extremely sensitive to extra glucose, whatever the source. It over-reacts to glucose with a secretion of insulin too large to maintain an equilibrium in the body - and the person suffers the symptoms of hypoglycemia. 

The cure for hypoglycemia is to prevent large swings in the blood sugar level, by eating little or no sugar and by avoiding excessive physical exercise. But it is much more difficult than it sounds. Sugar is found in so many foods these days, particularly packaged foods, which almost always have sugar added. Some people are also sensitive to "natural" sugars such-as those in fruit and even milk. 

Diet for Hypoglycemia 

Various diets have been proposed for hypoglycemia over the years The earliest treatment was a high-protein, high-fat diet with a minimum of carbohydrates, in the belief that all carbohydrates stimulated the pancreas to produce insulin. Such diets had mixed results and are certainly not healthy in the long run. They have largely been abandoned but variations still exist, such as the Atkins diet and more recently Barry Sears' "zone" diet which involves a 30/30/40 ratio between protein, fat and carbohydrate. 

The prominent American nutritionist Paavo Aerola started a change in thinking about hypoglycemia  treatment in the 1970s when he advocated a largely vegetarian diet with an emphasis on complex carbohydrates. Aerola's diet was popular for many years and very successful. However, it relies heavily on dairy products for protein - which doesn't suit everyone. 

More recently, a concept known as the "glycemic index" of foods has been developed. The glycemic index represents the amount by which a food raises the blood sugar level, with glucose having an index of 100. It is interesting that foods such as white bread can raise the blood sugar almost as much as ordinary white sugar, whereas as whole-grain breads cause a much slower rise in blood sugar.

I have proved this myself - before I knew anything about glycemic indexes. When I was experimenting with the high-carbohydrate, low-fat diets I often had a white bread roll with a small amount of low-fat cheese (no butter) and salad for lunch. I would always get a headache during the afternoon following such lunches but I persisted because I thought it was a "healthy" low-fat meal and it had no-sugar. 

Occasionally, I would have a thick cheese sandwich on wholemeal bread (with butter) and a glass of milk - supposedly a very bad meal from the low-fat viewpoint. But I felt great during the afternoon after such a lunch. Fats such as butter and cheese can be useful in controlling low blood sugar because they slow down the absorption of carbohydrate. Of course, that is not a licence to eat a lot of fat - nor a lot of anything, for that matter.  

A huge meal, even if it contains no sugar, can raise the blood sugar more than a candy bar. Getting back to the glycemic index, it can be confusing sometimes because different studies give different indexes for the same foods. For example, some studies have found potatoes to have a high glycemic index (making them unadvisable for people with hypoglycemia) while others recommended potatoes as one of the best foods for keeping blood sugar stable! 

Fruit is another controversial food in relation to hypoglycemia. Some experts advocate eating fruit because its sugars (mainly fructose) are "natural" and thus don't affect the hypoglycemic like refined sugar does. Others find better results by avoiding fruit, at least in the initial stages of treatment. I found fruit often affected me adversely, particularly sweet fruit likes bananas, grapes or water melon. 

I believe the best diet for controlling low blood sugar and chronic fatigue syndrome - is the good old-fashioned "balanced diet" with three meals a day. You need to avoid sugar for the first few weeks and then have sweet things occasionally in small amounts as you start feeling better. 

I have experimented with different diets to see which has the most beneficial effects on my blood sugar levels. I have found the best results with a diet based on complex carbohydrates and adequate protein, with a certain amount of fat to slow down the impact of the carbohydrates on my blood sugar. Fat is usually regarded as the main villain by modern diet writers but a certain amount of fat is essential, particularly if you suffer from low blood sugar. 

In fact, many people develop low blood sugar by following the popular high-carbohydrate, low-fat diet theories to extreme. They think fruit is a "good" food and eat lots of it while avoiding foods like eggs, cheese and whole milk. But they could be better off avoiding fruit if they are hypgolycemic and eating eggs for breakfast.

Eggs are a particularly valuable food. They help build up the adrenal glands - a vital factor in recovery from hypoglycemia. Of course, they contain cholesterol and should be eaten in moderation. But one or two eggs a day will not harm most people's cholesterol levels and, in fact, there is growing evidence that sugar is much more harmful in raising cholesterol than foods such as eggs, dairy products or meat. 

Many experts on hypoglycemia advocate six small meals a day rather than three meals. It used to be almost universally accepted that frequent, small meals  was best. But some writers on the subject have recently challenged this belief. The problem with eating six or more meals a day is that it can easily lead to over-eating something that can adversely affect hypoglycemics because the body is flooded with extra sugar which it doesn't need. 

In the early stages, you might find you need a snack between meals to alleviate extreme symptoms of low blood sugar. However, I believe it is best to establish the habit of eating three balanced meals a day and keep snacks to a minimum. Having said that, you shouldn't allow more than five or six hours between meals or you will start to experience hypoglycemic symptoms. Eating breakfast at about 7.30am, lunch about 12.30pm and dinner about 6pm should be fine for most people, without the need for regular snacks. But if a meal is late, for some reason, then it's best to have a snack (but not a sweet snack!).

Eating snacks can also be detrimental if you have a problem with addictive eating or a tendency to binge on sweet foods which many people with hypoglycemia do, in a desperate attempt to make themselves feel better. If you find you can't stop yourself bingeing on sweet or starchy foods, it's virtually certain you are suffering from hypoglycemia. By eating three balanced meals a day, you have the best chance to keep your blood sugar stable and avoid destructive sweet snacks. 

A balanced meal should contain some protein and complex carbohydrate plus a moderate amount of fat. A good breakfast is one or two eggs on one or two slices of buttered wholegrain toast; or unsweetened porridge or cereal plus one or two pieces of buttered toast. 

Lunch could be sandwiches with wholegrain bread and butter plus a filling of salad vegetables and a small amount of cheese, meat, chicken or fish; or it could be a more substantial meal of meat or fish with cooked vegetables, potatoes, pasta or rice. Forget dessert and, until you feel better, avoid even fruit at the end of the meal initially. 

If dinner is the main meal of the day, there is an endless variety of suitable foods, according to your taste. The main principle is to eat protein, complex carbohydrates and vegetables, and avoid refined sugar in any form.

If you really need to finish with something sweet, try a small home-made muffin, biscuit or piece of cake, made with just a small amount of sugar and have only a small helping! You'll need to experiment to see how much sugar you can tolerate.  

Eating sugar as part of a meal has less effect on blood sugar levels than eating a sweet snack on its own. That's another good reason for eating just three meals a day. It is important not to over-eat because that overworks the liver, which plays a vital role in keeping blood sugar stable. An overworked liver is the cause of much chronic fatigue and it takes time for a damaged liver to restore itself.  

So don't set back your progress by over-eating. Listen to your body and stop when you feel comfortably full. If you are not eating sugar, you are less likely to overeat because most over-eating tends to be of sugary, fatty foods. 

It usually takes at least a month to recover from hypoglycemia by following a balanced diet. Some people start feeling better after a week or two, while others who have been sick a long time might find they need three months or more to really start feeling the benefits. Initially, you will almost certainly feel intense cravings for something sweet and may be tempted to lapse. 

If you are hypoglycemic, you are essentially addicted to sugar and you are fighting something which can be as difficult as an addiction to cigarettes or alcohol. If you do slip, pick yourself up and start again. The first week or two is the hardest in starting a low-sugar diet that's when the cravings will be at their most intense. Eating even a small amount of something sweet can actually trigger a full-blown binge because of the way your body reacts to sugar. 

Don't despair. You may have to pick yourself up many times before you can stick to a balanced diet. It just proves that you have been over-dependent on sugar for too long and that you must break the addiction before you can ever expect to enjoy good health again. 

Keep that as your motivation when the sugar cravings come. Tell yourself: "I might feel bad now but I'll be ten times worse if I binge".

 

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