Medical authorities balked. Reactive hypoglycemia is rare, they protested, and rarely if ever does it cause such a multitude of ills.

The debate over reactive hypoglycemia has died down; the diagnosis is no longer trendy. Yet it is still a diagnosis every depressive would do well to consider.

On some things, orthodox physicians and proponents of the liberal, alternative view of reactive hypoglycemia—we'll call the latter hypoglycemia doctors—agree.

Hypoglycemia means pathologically low (hypo) blood (emia) sugar (glyc). Blood sugar is our major fuel source. It consists entirely of glucose, the most basic carbohydrate in most of the sugars and starches (complex carbohydrates) we eat. Reactive hypoglycemia typically happens like this: After eating or drinking something that sharply raises blood sugar—refined sugar or starch, alcohol, or caffeine (these pull stored sugar from the liver)—the body overreacts. The pancreas secretes so much insulin (the hormone that lowers high blood sugar by helping it get into the cells) that, within a few hours, the blood sugar is too low for comfort.

The brain, especially, feels the pinch, for it depends exclusively on a steady supply of blood sugar for its extraordinary energy needs. Mental confusion, faintness, fatigue, dizziness, headache, spasms, yawning,
blurred vision, cold spells, and other symptoms can occur. To compensate, the adrenal glands may pour sugar-mobilizing stress hormones into the blood to release more glucose from the liver. But that can
mean trouble of its own, for these hormones can trigger nervousness, trembling, palpitations, and other symptoms—especially hunger. Ironically, that hunger can drive the sufferer right back to the cookie jar.

Traditionally, reactive hypoglycemia has been diagnosed with the help of the oral glucose tolerance test (OGTT). On an empty stomach, a patient downs a few ounces of glucose dissolved in water. Over the next four, five, or six hours, her blood sugar is periodically measured. If it drops abnormally low (below 50 or 60 milligrams per deciliter), and if her symptoms flare up at that time, reactive hypoglycemia may be diagnosed. Increasingly, however, experts are refusing to make the diagnosis unless they can measure low blood sugar levels during a real-life symptomatic flare-up—and if a stiff dose of sugar brings prompt relief.

Hypoglycemia doctors (among whom are numbered most orthomolecular psychiatrists) use and interpret the OGTT much more flexibly. Even if the glucose nadir (the lowest blood sugar reading) is in the normal range, doctors like Harvey Ross and Herbert Newbold will still diagnose reactive hypoglycemia if any of several other conditions are met:

• The blood sugar fails to rise substantially above the fasting level during the test.
• It falls sharply (i.e., by 50 milligrams per deciliter or more per hour)at any time during the test.
• The nadir is appreciably lower than the fasting blood sugar level was.
• The patient has symptoms at any time during the test.

Other research has supported some of the hypoglycemia doctors' liberal quirks of interpreting the OGTT. Careful investigations have led endocrinologists like Fred Hofeldt to concede that "normal" blood sugar nadirs—as high as 75 milligrams per deciliter—do provoke symptoms in some sensitive hypoglycemics.

The hypoglycemic index (HI) is a measure of how sharply blood sugar falls during the ninety minutes preceding the nadir. Several research groups have shown that the HI is high in most people with symptoms of reactive hypoglycemia, whether or not their glucose
nadirs are low, and that it's low in most people without symptoms. In a study by psychologists Lori Taylor and S. J. Rachman, subjects with high His experienced up to five times the psychological symptomatology before, during, and after their nadir as subjects with low HIs.

Other research supports, albeit in a left-handed way, the hypoglycemia doctors' willingness to diagnose reactive hypoglycemia no matter when symptoms occur during the OGTT. Researchers at MIT and other centers have shown that people—especially women—tend to become lethargic and drowsy thirty minutes to two or three hours after eating a very sweet or starchy, low-protein meal (Spring et aL). Ironically, these reactions have occurred while blood sugar is still rising. So the culprit must be something other than reactive hypoglycemia. The researchers believe it's soporifically high brain levels of serotonin, because insulin, which rises sharply after a carbohydrate meal, indirectly promotes the passage of serotonin's precursor, tryptophan, into the brain. 

Whatever the explanation, these findings confirm that hyperglycemic foods—sweets and starches that rapidly raise blood sugar—are a problem for some people. Even a typically skeptical authority like Jonathan B. Jaspan of the Pritzker School of Medicine in Chicago maintains that people who think they have reactive hypoglycemia, but don't ("reactive nonhypoglycemia"), do have some kind of problem handling refined carbohydrates and are better off without them.

Yet depressives are more likely to see refined carbohydrates as a solution. Research from MIT, NIMH, and many other centers has established that many depressives—particularly winter, premenstrual, atypical, and alcoholic depressives—compulsively snack on hyperglycemic foods to feel better, less fatigued, less tense, less confused—and
less depressed. G. E. Abraham found that women with PMS ate nearly three times as much sugar as healthy controls. To MIT's Richard and Judith Wurtman, these carbohydrate fixes are benign "self-medication"—an instinctive attempt to raise depressingly low brain levels of serotonin. But to the hypoglycemia doctors, the sweet fix's rewards are fleeting. It
perpetuates in the long run what it medicates for the moment.

The bottom line is that carbohydrate-craving depressives remain depressed. And their habit promotes obesity, tooth decay, heart disease,
malnutrition, and other health problems. But if they give up their drug of choice, hypoglycemia doctors claim, their symptoms gradually fade. "My research," writes Larry Christensen, chair of the psychology department at the University of South Alabama, "has revealed that eliminating added sugar and caffeine from your diet will not only help you control your depression in the short term, but also that these beneficial effects will last over time."

One of those effects could be a normalization of serotonin metabolism. High in unrefined, complex carbohydrates, the most popular diet
for reactive hypoglycemia is conducive to a steady, stable supply of tryptophan (serotonin's precursor) to the brain. In contrast, the typical high-protein, refined-carbohydrate-rich diet of modern Westerners may provoke an unstable, feast-and-famine serotonin situation above the neck.

In recent years, more and more academic, mainstream psychiatrists and behavioral scientists have joined the hypoglycemia doctors' club. Internist Richard Podell reports: "About 40 percent of my patients whose history suggests a sugar-related problem improve after adopting an antihypoglycemia diet. Most continue to benefit for months or years. Thus I don't believe they are fooling themselves with a placebo effect."

Columbia University psychiatrist Richard Brown and Baylor University neuropharmacologist Teodoro Bottiglieri write: "Although it's never been studied [actually it has—see below], we believe that a high-sugar diet may contribute to depression by creating sugar 'highs and lows' that can result in sagging spirits. Sticking to complex carbohydrates—and avoiding junk food—can help keep you off the sugar roller coaster."

Those studies? The leader in the field is Larry Christensen. 1mpressed by the passionate literature of the hypoglycemia doctors, Christensen decided to investigate.

In a study published in the Journal of Abnormal Psychology in 1985, Christensen and his associates prescribed a euglycemic (good for your blood sugar) diet to four psychologically distressed people with symptoms suggestive of reactive hypoglycemia and/or caffeine intolerance. All improved markedly. When they returned to their previous junky diets two weeks later, they all relapsed. Back on the euglycemic diet
they improved again. At least three had suffered from depression, including one fairly severe case that was turned off and on by each dietary switch. Later, three of the subjects were deliberately deceived:
Sugar and caffeine, they were told, weren't their problem after all. Greatly relieved, they returned to their old diets—and relapsed again.

This was the first of several such studies Christensen's group would publish. All have demonstrated, as the researchers wrote in 1991 in Biological Psychiatry, that "a refined sucrose- and caffeine-free diet ameliorates depression and other symptoms such as anxiety and fatigue in selected individuals."

Dealing with Depression Naturally 
Complementary and Alternative Therapies for Restoring Emotional Health
Amazon.com | Chapters.ca

Other Books by Syd Baumel

	Serotonin: How to Naturally Harness the Power Behind Prozac and Phen/Fen
	Natural Antidepressants: Tried and True Remedies from Nature's Pharmacy

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