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Adrenal Fatigue and Hypoglycemia
By: Dr. Michael Lam, MD, MPH; Dr. Justin Lam; Dorine Lam, RD, MS, MPH


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.

Graph showing the difference between normal blood glucose and blood gluose in adrenal fatigue

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
Bread Products
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
Snacks, Misc
Stuffing 75 Muesli 60 Potato, russet (baked) 90 Mango 56
Lentils, green 30
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
Dairy Products
Puffed Wheat 74 Radishes OK Pear 35
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

I hope you have enjoyed reading this article. If you have areas you don't understand, feel free to write to me by clicking here.

About The Authors

For more information about the authors, click here.

For More Information

For the latest Anti-Aging and Adrenal Fatigue related health issues, visit Dr. Lam at www.DrLam.com.
Feel free to email Dr. Lam by clicking here if you have any questions.

© 2010  Michael Lam, M.D. All Rights Reserved.

5 stars - "This is not a question" This is not a question but a long overdue thank you for my Christmas present you sent me -2 bottles of Allergone- remember? Well I was on Zyrtec at the time and you said I had to be off of Zyrtec for one month and then start on the Allergone. You said take 4 at night. I did this for 4 days and felt not-so-good, more anxiety, less sleep, etc. So, I stopped it for 2 or 3 days and then decided to try 2 in the morn. (on an empty stomach) just like I did the Zyrtec and guess what? Oh, my gosh - it works! I cannot believe it! My mind is so much clearer - even the trees outside look clearer - that may sound a little strange but it's true. My concentration and thought processes are so much improved also. I feel like my creative juices are starting to flow again and I don't seem to have the horrible afternoon (2:00 p.m. to 5:00 p.m.) lows as bad. I think this so strange - I have spent thousands of dollars and taken 2 or 3 anti-depressants, etc, etc., without any of it helping me. And, this anti-histamine / anti-inflammatory supplement helps me so much! Why do you feel this is helping me so much? Do you feel I am allergic to everything I am eating? Have you ever seen this before? I have none of the traditional allergenic symptoms that most people have with allergies. You didn't give me lots of hope of feeling better before 2 years and this is a wonderful feeling! I pray to God it continues to keep working. I couldn't wait till our next appt. to tell you! Thank you so much for all of the time you are spending on me and for taking my sisters as patients - we are a strange lot, don't you think!! And, you are an extremely rare concerned doctor that I can't quite figure out!

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