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Insulin Resistance, Hypoglycemia, & Thyroid Health – Part 2

In the last post I spoke about some of the main causes of insulin resistance.  In this post I am going to focus more on hypoglycemia.  I will then discuss seven factors which can help to balance blood sugar levels.  These will be important regardless of whether you have insulin resistance or hypoglycemia.

Hypoglycemia refers to low blood sugar levels, typically less than 70 mg/dL.  What happens is that either the body’s glucose is used up too quickly, is released into the bloodstream too slowly, or too much insulin is released into the bloodstream (1) [1].  Some of the causes of hypoglycemia include alcohol consumption, an infection, hypothyroidism or hypoadrenalism, and severe heart, kidney, or liver failure (1) [1].  I’ll talk more about these causes shortly.  Some of the common symptoms associated with low blood sugar levels include weakness, fatigue, sweating, disorientation, and shakiness (2) [2].

Reactive hypoglycemia is an exaggerated fall in the blood glucose levels, and is due to excessive insulin secretion in response to a meal.  Dr. Alan Gaby has dedicated a chapter to reactive hypoglycemia in his excellent book “Nutritional Medicine”, and he discusses how if the blood glucose levels fall too rapidly then the body compensates by releasing adrenaline, as well as other compounds which raise the blood glucose levels.  This in turn results in “fight or flight” symptoms such as anxiety, panic attacks, hunger, palpitations, tachycardia, tremors, sweating, and even abdominal pain.  Dr. Gaby also talks about the symptoms presented when the blood glucose levels fall slowly over a period of hours, as this can lead to symptoms such as headaches, fatigue, blurred vision, mental confusion, impaired memory, and even seizures.  These symptoms usually are worse before meals, and frequently are relieved by eating.

Keep in mind that not everyone who has hypoglycemic symptoms will have low blood glucose levels or an abnormal glucose tolerance test.  And so this can be a challenging condition to diagnose.  I briefly mentioned some of the causes of hypoglycemia earlier, but there are other factors which might play a role in this condition, such as food allergies or sensitivities.

The following are some of the potential causes of hypoglycemia:

1) Eating refined foods and sugars.  Most people reading this know that eating a lot of refined foods and sugars will affect the blood sugar levels.  Eating a lot of refined sugars over a period of time will usually lead to hyperglycemia/insulin resistance, and eventually can set the stage for a condition such as type 2 diabetes.  However, in some people it can also lead to hypoglycemia.  Skipping meals frequently also can have a negative effect on the blood sugar levels and lead to hypoglycemic episodes.

2) Alcohol consumption.  Alcohol has a hypoglycemic effect, which is probably caused by the inhibition of gluconeogenesis in the liver (3) [3] (4) [4].  Gluconeogenesis involves the production of sugars (primarily glucose).  While having an occasional alcoholic beverage usually won’t lead to hypoglycemia, frequent consumption of alcoholic beverages can cause blood sugar imbalances.  And if anyone currently has blood sugar imbalances it probably would be a good idea to completely eliminate any alcohol consumption.

3) Thyroid hormone imbalance.  There is evidence that hypothyroidism can be a factor in hypoglycemia (5) [5].  However, it is also possible that having hypoglycemia can inhibit the pituitary-thyroid axis (6) [6].  And while hyperthyroidism isn’t usually associated with hypoglycemia, hyperthyroidism with congestive heart failure or liver dysfunction can induce hypoglycemia, although this is very rare (7) [7].

4) Adrenal Insufficiency.  Hypoglycemia is one of the clinical manifestations of chronic primary adrenal insufficiency (8) [8] (9) [9].  Most cases of primary adrenal insufficiency are considered to be Addison’s disease, which is an autoimmune condition involving the adrenals.  However, secondary causes of adrenal insufficiency can also cause hypoglycemia (10) [10] (11) [11].  And so if someone has low cortisol levels, a low serum ACTH, and/or low DHEA levels, then this can be responsible for the hypoglycemic symptoms.

5) Acute infections.  Most cases of hypoglycemia aren’t caused by infections.  However, in some cases hypoglycemia can occur in bacterial sepsis (12) [12] (13) [13], or in bacteremic pneumococcal infections (14) [14].

6) Food allergies or sensitivities.  Earlier I mentioned the book “Nutritional Medicine” by Dr. Alan Gaby.  In this book he mentions that “the ingestion of allergenic foods can trigger a hypoglycemic response in some people”.  Sometimes this can be challenging to determine, and in people with Hashimoto’s Thyroiditis and Graves’ Disease food sensitivities are common, although many times they are the result of a leaky gut, and don’t cause hypoglycemia.  However, if someone notices hypoglycemic symptoms upon eating a certain food, and if this pattern occurs every time after eating this food then one obviously should suspect that this food is responsible for the hypoglycemic effect.

How Can Blood Sugar Imbalances Be Corrected?

Diet.  Regardless of whether someone has hyperglycemia/insulin resistance, or hypoglycemia, eating well is very important.  Obviously you want to eat whole foods, and minimize the refined foods and sugars.  You also want to minimize your overall carbohydrate intake, and this is especially true if you’re suffering from insulin resistance, as when this is the case you will usually want to consume less than 150 grams of carbohydrates per day, and eating less than 100 grams of carbohydrates per day is sometimes necessary.  Keep in mind that I’m not suggesting that everyone should eat a low carbohydrate diet, but a big problem is that many people eat too many carbohydrates, which is one of the main reasons for the high incidence of insulin resistance and type 2 diabetes.

Although I love eating fruit, eating a lot of servings of fruit per day can cause problems in some people, and this is especially true in those with blood sugar issues.  If you are dealing with blood sugar imbalances it probably is a good idea to limit your consumption of fruit to one or two servings per day.  Even though fruit is high in phytonutrients and consists of natural sugars, you can still overdo it by eating too much fruit.

You also want to eat regularly throughout the day.  This is especially important for those who have hypoglycemia, although I think it’s important for most people to eat breakfast within one hour of waking up, and then every two to three hours after this.  Some people reading this might bring up the benefits of caloric restriction and intermittent fasting, which I wrote about in an article entitled “Intermittent Fasting and Thyroid Health [15]“.  I agree that intermittent fasting can be beneficial, although it probably isn’t a good idea in someone who has hypoglycemia.

Address food sensitivities.  This seems to be more of a trigger with regards to hypoglycemic conditions, but of course even if someone doesn’t have any blood sugar imbalances they want to try to avoid any foods they are reacting to.  It can be very difficult to determine which foods you are sensitive to.  There is testing available such as IgE testing for food allergies, an IgG panel for delayed food sensitivities, and other types of testing such as the ALCAT.  These all can be valuable, but they also all have limitations.  And testing for food sensitivities can be very expensive, yet still provide false results.  I usually recommend an elimination diet for 3 to 4 weeks, followed by reintroducing the “suspicious” foods one at a time over a three day period.  This also has certain limitations, and of course takes more time than conducting a test for food sensitivities.

Improve insulin sensitivity.  It is also important to do things to improve insulin sensitivity.  This is especially important with insulin resistance, although it also can benefit those who have hypoglycemia as well.  Some of the best nutrients which can help to increase insulin sensitivity include chromium (15) [16] (16) [17] (17) [18], magnesium (18) [19] (19) [20], and alpha lipoic acid (20) [21] (21) [22].  Vanadium (22) [23] (23) [24] and bitter melon (24) [25] can also increase insulin sensitivity.  Berberine can benefit those with insulin resistance and type 2 diabetes by lowering blood glucose levels, and it might do this by modulating the microbiota (25) [26].  The herb gymnema sylvestre can help to balance the blood sugar levels (26) (27) [27].  You can also improve insulin sensitivity through exercise, which I’ll discuss next.

Exercise.  We all know that regular exercise is beneficial.  Although there are many nutrients which can increase insulin sensitivity, there is plenty of evidence which shows that exercise can also help to increase insulin sensitivity (28) [28] (29) [29] (30) [30].  A big problem is that many people who exercise regularly also spend a good part of their day sitting.  So for example, someone might have a job that involves sitting behind a desk for most of the day, and then they expect three or four sessions of exercise each week to offset all of this inactivity.  Unfortunately this isn’t the way this works, as regular movement is very important.

Decrease inflammation.  Earlier I discussed how inflammation is a big factor in insulin resistance, and so one needs to do things to reduce the inflammatory process.  Obviously eating a healthy diet can help to reduce inflammation.  But it frequently is necessary to take nutrients to help break the inflammatory process.  I spoke about this in my blog post entitled “The Role of Cytokines In Autoimmune Thyroid Conditions [31]“, as there is a transcription factor called Nuclear Factor Kappa B (NF-kB), and this needs to be downregulated.  Certain nutrients which can help with this include vitamin D, fish oils, turmeric, resveratrol, gamma-linolenic acid, ginger, and green tea.

Reduce oxidative stress. I also discussed how oxidative stress and mitochondrial dysfunction can play a role in insulin resistance.  And so doing things to reduce oxidative stress and improve the health of the mitochondria can be beneficial.  Some nutrients which can help with this include vitamin C, lipoic acid, acetyl-l-carnitine, CoQ10, resveratrol, and omega 3 fatty acids.

Correct dysbiosis.  Since intestinal dysbiosis can play a role in inflammation and insulin resistance, it is necessary to address this problem.  As I mentioned earlier, I have written a separate article on this topic, and so I would refer to this when you get the chance.

So hopefully you have a better understanding of the different factors which can cause insulin resistance and hypoglycemia, as well as some of the things you can do to address these health conditions.  Insulin resistance is when the body no longer is responsive to the effects of insulin, and some of the factors which play a role in the development of insulin resistance include inflammation, mitochondrial dysfunction, lipotoxicity, gut dysbiosis, circadian disruption, and genetics.  Hypoglycemia involves low blood sugar levels, and some of the potential causes of this condition include alcohol consumption, an infection, hypothyroidism, hypoadrenalism, as well as food allergies or intolerances.  Eating well and exercising regularly are both important factors when trying to regulate blood sugar imbalances, but some of these other factors I discussed in this post also need to be considered.