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Need to Know
For fast reading, scan through the topic headings in BOLD BLACK, important conclusions in BOLD BLUE, and "Must Know" in BOLD RED. To jump to specific sections in this article, click on the respective in the Table of Contents.
Information presented here is for general educational purposes only. Each one of us is biochemically and metabolically different. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.
Adrenal Fatigue and Hypoglycemia
One of the classic signs of Adrenal Fatigue is hypoglycemia. Traditionally hypoglycemia is a medical term for a state produced by a lower than normal level of blood sugar.
Unfortunately, no single glucose value alone satisfactorily gauges all people because many variables are involved. While there are no disagreements as to the normal range of blood sugar (90-110 mg/dl), debate continues as to what degree of hypoglycemia warrants medical evaluation and treatment, or can cause harm.
Throughout the 24-hour cycle of a day, blood plasma glucose levels of healthy people are generally maintained between 72 and 144 mg/dL (4-8 mmol/L) while 60 or 70 mg/dL (3.3 or 3.9 mmol/L) is commonly cited as the lower limit of normal glucose.
Many healthy people can occasionally have glucose levels in the hypoglycemic range without symptoms of disease. This makes hypoglycemia a difficult clinical state to establish in the first place. The problem is further compounded in those with Adrenal Fatigue.
In adrenal fatigue, the hypoglycemia experience is more often than not sub-clinical. This means that the person has clinical signs of hypoglycemia even though the blood plasma level is invariably above 60-70 mg/dl. Their fasting serum blood sugar and glucose tolerance tests are usually normal. Conventional doctors not aware of the adrenal influence will miss this.
The diagram below shows how Adrenal Fatigue affects hypoglycemia. Compared to a normal person or even one with compromised insulin control, those with Adrenal Fatigue tend to have symptoms of hypoglycemia even though the serum blood sugar may be within the normal range. This is clinically evident. After a meal, those with advanced Adrenal Fatigue tend to have a faster dip in serum blood sugar below the Hypoglycemic Symptoms Threshold (HSL) level compared to normal. This triggers symptoms of hypoglycemia such as irritability and fatigue. The more advanced the Adrenal Fatigue, the more the blood sugar curve is shifted towards the left. As a result, the time between completion of a meal to the onset of hypoglycemic symptoms is shortened.
For this reason, it is common for those with Stage 3 and beyond Adrenal Fatigue to require sugar replenishment every 2-3 hours. A small snack usually suffices. In fact, as Adrenal Fatigue recovers, this period lengthens. Those with Stage 2 Adrenal Fatigue can go 4-6 hours without food and not have symptoms of hypoglycemia and hunger. Many in Stage 1 can skip a meal and have no symptoms at all.
Our body needs a continuous supply of energy to maintain homeostasis throughout the day. Cellular energy demand is met by intake of food, which is then converted into sugar. When this demand is not being met, as in Adrenal Fatigue, the body will turn to existing protein and fat as resources of energy. This pathway is not as efficient but, nevertheless is put on overdrive in order to provide the energy required. Without adequate cortisol levels to elevate blood sugar levels by facilitating the conversion of glycogen, fats, and proteins to new glucose supplies, this increased demand is difficult or impossible to meet. Irregular blood sugar patterns with hypoglycemia are common as the body tries to kick start the process whenever it detects a low blood sugar level. This leads to a variety of symptoms.
Symptoms of hypoglycemia include hunger, nausea, headache, rage, lethargy, daydreams, confusion, amnesia, dizziness, fatigue, irritability, anxiety, jittery feelings, adrenaline rush, elevated heart rate, memory loss, and in severe cases, fainting, coma, and seizures.
Key hormones regulating blood sugar in the body include insulin, cortisol, and growth hormone. Conditions associated with Adrenal Fatigue that might also play a part in sugar regulation include PCOS, metabolic syndrome, drug effects, adrenal insufficiency, and diabetes. In the absence of other medical reasons, one must consider Adrenal Fatigue as a cause.
Acute hypoglycemia can easily be temporarily reversed by taking 10-20 grams of carbohydrate (3-4 ounces of orange, apple or grape juice). While this can be overcome with a sugar fix consisting of an instant load of sugary drink or food such as coffee or soda, this is a quick solution emergency remedy only. Usually symptoms go away immediately, but return after 1-2 hours. Reactivation and restoration of normal cell function require extra amounts of energy beyond what is normally required for maintenance of normal energy burn. With each hypoglycemic episode, more cells are damaged. Thus, the body reaches a new low with each insult of hypoglycemia. If this happens at the same time as demand for glucose increases, the stage becomes set for an adrenal crisis. With each plunge, the Adrenal Fatigue increases and hypoglycemia worsens. By the end of the day, the person may feel nearly exhausted without having done anything. Low blood sugar times are most likely to occur at around 10:00 a.m., 2:00 p.m., and from 3-4:00 p.m.
Sub-clinical hypoglycemia secondary to Adrenal Fatigue requires a systematic and comprehensive approach to be prevented and reversed due to its chronic nature.
Here are important things to do:
- Take protein (such as nuts, meat, beans, cottage cheese, whole milk yogurt) and fat (nut, extra virgin olive oil, coconut, whole milk yogurt, avocado) with each meal or snack. This will lead to slower release of sugar in the body and thus extend the time you become hypoglycemic between meals.
- Take frequent meals and snacks. Avoid taking only 3 set meals a day. Take breakfast, lunch, and dinner. Equally important is to have a mid-morning snack, mid-afternoon snack, and bedtime snack. Do not skip meals or snacks to prevent the low dip of blood sugar.
- Avoid alcoholic beverages, especially on an empty stomach.
- Avoid foods made with sugar and flour-pies, cakes, cookies, candies, sweets, and desserts.
- Make sure you consume at least 1200 calories per day, even if you are planning to lose weight.
- Take recommended supplements that have direct adrenal and metabolic support. This will help cortisol and insulin balance.
- Snacks: nuts and fruits; cottage cheese and fruits; whole milk yogurt and berries; apple with almond butter; celery stick with cream cheese; celery stick with nut butter; refried beans; cream cheese and salmon/tuna on rye crisp.
- Breakfast samples: muesli with whole milk yogurt, nuts and green apples; poached egg on Ezekiel bread; smoothie-add avocado, coconut, whole milk yogurt, nuts and raw egg; vegetable omelet; cream cheese and salmon on whole grain bagel; cooked oatmeal with nuts and fruits.
- Listen to your body. Sometimes you may need to eat something every two hours, especially if you are doing mental activity or heavy physical work.
- Make sure you carry a water bottle around and keep well hydrated throughout the day.
- Always carry a snack such as nuts with you wherever you go.
- Avoid all food with a glycemic index of 60 or higher. Refined sugar and simple carbohydrates such as candies, dessert, white bread or soda only make you feel good for a short period. It is usually followed by a rebound and a low that is stressful on the body. Please check out the Glycemic Index chart below.
Glycemic Index Table
|Here is a list of common food products and their actual GI values. These numbers use Glucose as a baseline, which is given a GI of 100. All the other values are relative to glucose.|
|Recommended for adrenal: GI <60 ; Avoid food with GI >60||
|All Green Vegetables||0 - 30||Apple||39|
|All Bran||43||Bean Sprouts||OK||Apple Juice||41|
|Baked Beans, canned||68||Barley, pearled||25||Angel Hair||45||Bagel||72||Bran Chex||59||Beets||64||Apricots, dried||35|
|Black Beans||30||Buckwheat (kasha)||54||Bean Threads||26||French Bread||96||Cheerios||75||Carrots||71 - 92||Bananas, ripe||60|
|Black Eyed Peas||42||Bulgar||47||Gnocchi||67||Kaiser Roll||73||Corn Bran||75||Cauliflower||OK||Cantaloupe||65|
|Butter Beans||31||Couscous||65||Pastas, brown rice||92||Melba Toast||71||Corn Chex||83||Corn||58||Cherries||23|
|Chick Peas||33||Cornmeal||68||Pastas, refined||65||Pita Bread||58||Cornflakes||84||Eggplant||OK||Grapefruit||25|
|Chick Peas, canned||42||Millet||71||Pastas, whole grain||45||Pumpernickel Bread||49||Cream of Wheat||71||All onions||OK||Grapefruit Juice||49|
|Fava Beans||80||Rice, brown||56||Star Pastina||38||Rye Bread||64||Grapenuts||68||Parsnips||97||Grapes||46|
|Kidney Beans||30||Rice, instant||85 - 91||Vermicelli||35||Rye Bread, whole||50||Life||66||Peppers||OK||Kiwi||52|
|Kidney Beans, canned||52||Rice, white||70||
|Stuffing||75||Muesli||60||Potato, russet (baked)||90||Mango||56|
|Corn Chips||70||Tortilla, corn||70||Nutri Grain||66||Potato, instant mashed||83||Orange||42|
|Lentils, red||25||Graham Crackers||74||Fried Pork Rinds||OK||Waffles||76||Oat Bran||55||Potato, fresh mashed||73||Orange Juice||51|
|Lima, baby, frozen||32||Rice Cakes||77||Olives||OK||White Bread||95||Oatmeal, regular||53||Potato, new, boiled||57||Papaya||58|
|Pinto Beans||39||Rye Crispbread||67||Peanuts||10||Whole Wheat Bread||75||Oatmeal, quick||66||Potato, french fried||75||Peach||35|
|Soy Beans||18||Stoned Wheat Thins||68||Peanut M&M's||32||
|Split Peas||32||Water Crackers||72||Popcorn||56||Ice Cream, regular||61||Puffed Rice||90||Sauerkraut||OK||Pineapple||66|
|Potato Chips||55||Ice Cream, low-fat||50||Rice Chex||89||Sweet Potato||54||Pineapple Juice||43|
|Pretzels||82||Milk, regular||27||Rice Krispies||82||Tomato||38||Plum||29|
|Rice Cakes||77||Milk, skim||32||Shredded Wheat||69||Water Chestnuts||OK||Raisins||64|
|Rich Tea Cookies||56||Yogurt, sugar||33||Special K||54||Yams||51||Strawberries||32|
|Vanilla Wafers||77||Yogurt, aspartame||14||Total||76||Yellow Squash||OK||Watermelon||74|
Ref: AFANDHYPOGLYCEMIA (Rev 131008)
About The Authors
Michael Lam, M.D., M.P.H., A.B.A.A.M., is a western trained physician specializing in nutritional and anti-aging medicine. Dr. Lam received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from the Loma Linda University School of Medicine in California. He also holds a Master’s degree in Public Health. He is board certified by the American Board of Anti-Aging Medicine where he has also served as a board examiner. Dr. Lam is a pioneer in using nontoxic, natural compounds to promote the healing of many age-related degenerative conditions. He utilizes optimum blends of nutritional supplementation that manipulate food, vitamins, natural hormones, herbs, enzymes, and minerals into specific protocols to rejuvenate cellular function.
Dr. Lam was first to coin the term, ovarian-adrenal-thyroid (OAT) hormone axis, and to describe its imbalances. He was first to scientifically tie in Adrenal Fatigue Syndrome (AFS) as part of the overall neuroendocrine stress response continuum of the body. He systematized the clinical significance and coined the various phases of Adrenal Exhaustion. He has written five books: Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, The Five Proven Secrets to Longevity, Beating Cancer with Natural Medicine (Free PDF version), How to Stay Young and Live Longer, and Estrogen Dominance. In 2001, Dr. Lam established www.DrLam.com as a free, educational website on evidence-based alternative medicine for the public and for health professionals. It featured the world’s most comprehensive library on AFS. Provided free as a public service, he has answered countless questions through the website on alternative health and AFS. His personal, telephone-based nutritional coaching services have enabled many around the world to regain control of their health using natural therapies.
Dorine Lam, R.D., M.S., M.P.H., is a registered dietitian and holistic clinical nutritionist specializing in Adrenal Fatigue Syndrome and natural hormonal balancing. She received her Bachelor of Science degree in Dietetics, holds a Master’s Degree in Public Health in Nutrition, and a Master of Science degree in Nutrition from Loma Linda University, in Loma Linda, California. She is also a board-certified, Anti-Aging Health Practitioner by the American Academy of Anti-Aging Medicine. She coauthored with Michael Lam, M.D., the books Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs and Estrogen Dominance and numerous articles on Adrenal Fatigue Syndrome. Her personal research and writing focuses on the metabolic aspect of Adrenal Fatigue Syndrome. She is married to Michael Lam and is an integral part of the telephone-based nutritional coaching team helping people overcome Adrenal Fatigue Syndrome.
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