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reactive hypoglycemia -- causes and treatments?

Discussion in 'Gastrointestinal and Urinary' started by sensing progress, May 31, 2010.

  1. Athene

    Athene Never give up

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    Hi Adam,
    I totally understand where you're comig from and I do agree, what I want is a magic pill specific for this illness.
    Sadly, I reckon even if they find a treatment for XMRV there will also be AFTERMATH to deal with. I think that, like borreliosis, XMRV probably sets up a domino effect and killing the virus isn't enough to get everything up and running again. You'll need to mend the methylation cycle and get the hormones up and running again and deal with al the nutritional deficiencies etc.
    Uurgh.
    Hope I'm wrong!
  2. richvank

    richvank Senior Member

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    Cause of reactive hypogycemia according to the GD-MCB hypothesis for CFS

    Hi, all.

    For what it's worth, here is an explanation for reactive hypoglycemia in CFS based on the Glutathione Depletion--Methylation Cycle Block pathogenesis hypothesis for CFS:

    1. Because glutathione is depleted in the mitochondrial of the skeletal muscle cells (and also some other types of cells), a partial block occurs at aconitase in the Krebs cycle, caused by oxidizing free radicals. Note that oxidative stress is probably the best documented biochemical abnormality in CFS, and glutathione depletion has also been found in many PWCs. For example, see the treatment study at www.cfsresearch.org Glutathione depletion is intimately tied to oxidative stress, which means an increase in the concentrations of oxidizing free radicals. These are known to inactivate aconitase by oxidizing one of its iron ions.

    2. Because carbohydrates must enter the Krebs cycle at its "beginning" (as acetyl Co-A, produced from pyruvate, which in turn is produced from glucose in the glycolysis pathway), they (together with fatty acids, which must also enter here) are partially blocked from being utilized as fuel by the cells in CFS.

    3. If a PWC consumes carbohydrates at a rate higher than they can be processed by the partially blocked Krebs cycle, the initial result is buildup of glucose in the blood. The pancreas responds by increasing its secretion of insulin, and because the skeletal muscle cells do not respond by accepting glucose at a higher rate, insulin goes high enough to push the glucose into the liver and fat cells, to be converted to fat and stored.

    4. The results of this are an increase in weight (which is later very stubborn, because fats cannot be burned well as fuel by the cells either) and an overcorrection that causes a drop in blood sugar level below normal, which constitutes hypoglycemia.

    5. Because glucose is normally the main source of fuel for the brain, hypoglycemia causes brain-related symptoms, such as tremor, irritability, and even seizure in some cases.

    6. The above process is compounded in CFS cases in which the HPA axis is very dysfunctional, so that cortisol is not able to rise and promote an increase in glucose in the blood from stored glycogen in the liver and from processing of amino acids through the gluconeogenesis pathway in the liver.

    7. According to the GD-MCB hypothesis, the dysfunction of the HPA axis in CFS is also caused by glutathione depletion, in this case occurring in the hypothalamus and pituitary, inhibiting the properly regulated secretion of CRH and ACTH, which control the secretion of cortisol.

    8. This scenario explains why a low carb, high protein diet is favorable for PWCs, as reported by several people on this thread. The low-carb aspect prevents reactive hypogycemia from occurring, because there is no high compensatory secretion of insulin by the pancreas, and it also prevents weight gain. The protein supplies energy for the skeletal muscle cells, because it is broken down into amino acids. Amino acids can be interconverted by transamination reactions, and some of the resulting types of amino acids can enter the Krebs cycle beyond the partial block and thereby be used as fuels in this cycle.

    9. In the longer term, this explanation indicates that restoring the glutathione levels to normal is the way to correct this tendency toward reactive hypoglycemia when carbohydrates are consumed. And we have found in recent years that it is necessary to lift the partial block in the methylation cycle to enable glutathione to come back up to normal on a permanent basis.

    10. In fact, lifting this partial block, according to the GD-MCB hypothesis, will correct essentially all the other features of CFS as well.

    11. There are several treatment protocols that various people are using to lift the methylation cycle block. These include the Vinitsky protocol, the DAN! approaches used in autism, the full Yasko treatment approach, the protocol advocated by freddd on this forum, and the Simplified Treatment Approach, which I extracted from the full Yasko treatment program a little over three years ago, with the help of a person on the full Yasko approach. It isn't clear at this point which approach is the best, but I think it is clear that lifting the methylation cycle block is the right goal.

    Best regards,

    Rich
  3. BEG

    BEG Senior Member

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  4. alex3619

    alex3619 Senior Member

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    Hi HopingSince88

    I agree with you on sleep side. In my sleep study I only had 50% sleep efficiency (whatever that means), and it has long been known that shift workers are at increased risk of insulin resistance. Insulin resistance is thought to spiral into type 2 diabetes over time, but there are many many causes of insulin resistance. Trans fats found in hydrogenated food, a staple of the industrial food industry for many decades due to cost and longevity, can induce insulin resistance according to some. So apparently does premature birth, which appears to have epigenetic effects and rewires the body.

    In CFS the single most likely cause is mitochondrial dysfunction, but other things interact. I am going to have another look at burning fat for fuel, as I know much of the fat in the body is NOT burnt in the mitochondria but by other intracellular organelle complexes. What I don't recall is that if this uses oxygen. We know from studies on arctic and antarctic explorers the way to make the body burn more fat is to eat more fat, so you have to restrict carbs to prevent weight gain. Hence the Atkins diet and its successors, although it is now claimed that eating lots of protein induces appetite suppression.

    The arguement behind mitochondrial dysfunction is something like: if you can't burn the sugar (an aspect of insulin resistance) then sugar levels rise. Elevated sugar leads to more insulin resistance, as the cells try to defend themselves from toxic levels of sugar. More insulin resistance causes sugar levels to rise. Repeat until diabetes. The point is that anything that causes sugar levels to rise can trigger this cycle, and not being able to burn sugar for fuel due to mitochondrial dysfunction is a good place for this to start. Its not just about obesity as many claim. I know of many thin type 2 diabetics, for example.

    When I was tracking insulin resistance research (I haven't in recent years) it became apparent that this area is like CFS: every year saw one or two claims to have found answers, going back decade after decade. Every study I looked at had problems however, and proponents would claim more than they could prove. No surprise there, in CFS research every psychobabble paper I read in detail had claims in their conclusion and discussion sections that could not be supported by their data. One piece of advice I often give on research is: never believe abstracts, read the paper and compare results with conclusions.

    I am still betting on XMRV like many others, but there may be a lot more news in a week or three, and only the science will give us definitive answers here.

    On supplements, my approach is to introduce them one at a time, increasing the dose one at a time until either I reach what I consider to be a safe limit (this takes research), I get results, or I get adverse reactions. Then I usually decrease the dose one step. You can check this result by withdrawing the supplement - do you get worse kind of thing, as well as noting if any new symptoms disappear. Be very sure to check out toxic reactions, several B vitamins and all minerals are toxic in only moderate doses.

    Bye
    Alex


  5. Adam

    Adam *****

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    Hi Athene

    I hope you are wrong too, but my reading of it (which is not that informed) is you are probably right.

    Wish it wasn't so.
  6. xchocoholic

    xchocoholic Senior Member

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    Thanks for all the GREAT info here ...

    From Rich ...

    This may explain why taking Solgar essential aminos every few hours gives me energy ... normally all of my energy comes from food.

    I noticed that I had a bigger problem with hypoglycemia that I'd originally thought I had a couple of years ago. I realized that if I was out running errands or walking my dogs that if I ate something with sugar in it prior I felt better the whole time. Otherwise, my vision would get fuzzy and I'd start feeling weak and winded.

    So, I tried going on the Atkins diet. I seem to be feeling better at first but as soon as I increased my activity level, I'd feel horrible again. Fuzzy vision, weak and winded. I stayed on this diet for a few weeks. I was monitoring my blood glucose and noticed that it was below 70 most of the time and when it was this low I felt horrible. And I realized that I felt much better when it was in the 80 - 90 range. I never saw it go over 104 while I was monitoring it.

    About that time, while attending a home show (aka really over exerting myself) with a friend who is a diabetic, she got scared because I was hardly able to speak and was pale as a sheet. I tried eating more of my Atkins food to recover but my glucose stayed below 70. At her request, I finally gave in and ate a pear. Within a few minutes, I felt great ... So there was my answer. I had to have some sort of sugar in order to function.

    My GTT showed hypoglycemia both times in 2006 - 2008 but my last fasting blood glucose in 2010 showed 97 ... an all time high fasting blood glucose for me ... I still need a sugar source to function though. Typically, I'll eat a low carb meal followed by a piece of fruit. I attribute this to the Paleo / low carb diet because I feel better if I eat this way. Oh but healthy fats help me here too ...

    My latest trick if I'm running errands or walking the dogs is to eat 2 Ginger Chews just as I start out. For some reason, maybe it's all that saliva, these work great. Fruit or honey don't work for this.

    Anyone else here with petite mals or other seizures ? I wonder if there's a glucose connection to these. I read that the Paleo / low carb diet + plenty of healthy fats is good for this but I'm still having these. This recommendation was based on the Ketogenic diet and now the modified Atkins diet. FWIW. I've had these my whole live though ...

    Oh, BTW, it's very common for anyone with celiac disease or anyone with a gluten intolerance to have diabetes. What they see many times is that the diabetes in celiacs is resolved after they eliminate gluten. There are actually pancreatic antibodies that disappear in some celiacs.

    TC ... X

    Ps .. count me in on the majic pill cure !!! I'm sooo ready ...
  7. alex3619

    alex3619 Senior Member

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    Hi Athena

    I doubt many scientists or doctors would disagree, but removing the initial causes has to be a good place to start. I suspect recovery from CFS will take one or several months for every year of illness once the cause is eliminated - fast but not instant.

    Bye
    Alex

  8. alex3619

    alex3619 Senior Member

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    Hi Rich,

    Excellent as always. Although I still assert that it is more complex than this, I don't disagree that eliminating every cause or contributing factor you can is a good way to go, and may have the desired effect.

    Bye
    Alex

  9. alex3619

    alex3619 Senior Member

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    Hi

    I wanted to elaborate a little on fat burning and mitochondria. Mitochondria burn fuel. Processed carbs and things that can be converted to other relevant substances are burnt in the Krebs (citric acid) cycle, and then pass to the electron transport chain which creates energy (ATP) and consumes oxygen.

    Short fats are burnt in the mitochondria in the usual way, or via preprocessing in the peroxisomes and then the mitochondria for longer fats. About 18% of parts of long chain fats (by energy or ATP equivalents) bypasses the Krebs cycle and feeds the electron transport chain (another part of the mitochondria), although this still requires normal fuel burning to work. I could easily be misinterpreting this however, i will have to go back and check the equations again, and look at other interactions.

    Fats use more oxygen than carbs or protein, and generate even more free radicals and nitric oxide if they are long chain fats. So the benefits come with problems, particularly in CFS.

    The non Krebs cycle energy input from fats is small, but could be important if you have Krebs cycle problems. Most fats that do this are animal fats however, and so have other problems. This implies that while the Atkins approach can supply more energy, it might also produce more problems. We simply don't know.

    What will happen on high protein similar diets is, as Rich has stated, the decreased reliance on sugar means that insulin resistance can be alleviated. I do worry about supplying energy to the brain using this approach, we don't know the molecular impact of over-relying on ketones in CFS.

    Bye
    Alex
  10. HopingSince88

    HopingSince88 Senior Member

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    In 1997 for an 18 month period I was on a liquid protein diet under a doctor's supervision. It allowed 70g of carbs a day, which was contained in the protein shakes. Total calories per day was about 800. I lost 70 lbs while on this diet. It took me about 3 months to transition back to regular food, and when I did I did not eat any starchy foods at all ( no bread, potatoes, corn, peas...etc). I did eat non-starchy vegetables and fruit. In order to keep my weight off I had to keep my calories between 1000 and 1100 per day...otherwise I gained weight. I was able to do this until the year 2000. I suffered a pulmonary embolism and as a result of a problem stabilizing my blood clotting factor while on warfarin, I had to stop eating greens, so my docs had me eating starchy foods. In 3 months I gained back 50 lbs, although I was still only eating about 1100 calories a day.

    I felt wonderful, had lots of energy and my cognitive problems were greatly improved while I was on the starch-free diets.

    It was theorized that taking birth control pills caused my PE, but it appears that hypercoagulation is a problem with ME/CFS...so maybe the diet was affecting this too.

    So now I am afraid to go back to a no-starch diet because I am afraid of another PE.

    I appreciate all the information and explanations from all!
  11. xchocoholic

    xchocoholic Senior Member

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    FWIW ... I think it's important to remember that we're not dealing with healthy livers, brains, kidneys, digestive tracts, etc etc. And even though many of our labs may come back normal, many of us know that taking digestive enzymes, liver support supplements, fish oil, etc etc ... or watching our diets has proven irreplaceable ...

    I don't understand how if lab tests can't pick up these problems then how is any medical scientist is going to speak intelligently about how the body works or doesn't work ? Not to mention the fact that many chemicals in the body aren't measurable in the ways that labs have insisted that they have been for years. Just look at the B12 thread ..

    I'm fortunate enough to have a great GI who keeps running tests on me to see if he can help me in any way. The problem is that they keep coming back negative. He's great though and assures me that his tests just aren't sensitive enough. It's nice to have someone who trusts you like this.

    FWIW .. when I went on the Atkins diet, I was told by a well meaning friend that there was no way my body / brain couldn't just function off of ketones. Well, if not eating sugars of some sort was causing me to look pale and feel weak, then obviously my body wasn't happy with ketones. It wasn't for lack of trying .. My urine tests showed that I was in ketosis so that appeared to be working ok.

    My doc later told me that my liver simply wasn't well enough to convert glucose from ketones at the time I tried it. My constant low glucose levels at the time proved that. It's gotten better in the last year because my fasting glucose level is now within normal range ... but it's still a problem when I exert myself.

    BTW ... I have a friend who's blood glucose levels will drop into the 40 range if she has eaten any dairy. She figured this out the hard way ...
  12. Athene

    Athene Never give up

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    Thank you everyone for all this really interesting and useful info.

    Does anyone know a good web page that would give me a very basic introduction to the Krebs cycle? I think it is about time I started to learn what that's all about. I am looking for something along the lines of "The Ladybird Book of Krebs".
  13. sensing progress

    sensing progress Senior Member

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    Here's something I have noticed that happens occasionally when I eat a lot of carbs. My body will start to heat up and skin will feel very warm. It's almost as if my body is using the carbohydrates to make heat. Has anyone else experienced this? It does not happen every time, but it is very distinct when it does. I have always wondered about it. Also, I'm not sure, but I think when this happens I do NOT get a hypoglycemic response (will have to pay closer att'n in the future).
  14. alex3619

    alex3619 Senior Member

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    Krebs cycle texts

    Hi Athene

    The Wikipedia has many entries on this and similar threads, and is reasonably detailed. Just be sure to open a medical or biochemistry dictionary on another tab so you can look things up. Several books on CFS I think discuss this briefly, from my memory books by David Bell and Charles Sheffield. For a first read, I suspect you would be better off looking for a nursing textbook with a discussion of metabolism. This kind of text tends to make less assumptions about prior knowledge. If you have a university library near you, and you can travel, this might be a good place to start. The worst place to start would probably be a five inch thick biochemistry testbook. The second best choice would be a general biology textbook. Biology texts always have a section on metabolism, and are often written with minimal background assumptions.

    It took me several years to get a grip on this stuff, then I went to uni and studied it, and I have since forgotten most of it; but if you plug away at it little by little you can learn almost anything you want to.

    On the other hand, decent accessible books on mitochondria are difficult to find. When I was looking some years ago, even university libraries had few, and they were ALL checked out on six months loans by researchers.

    Bye
    Alex
  15. alex3619

    alex3619 Senior Member

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    heat after eating

    Hi datregy,

    I have noticed this too. There are some theories of CFS that claim we burn a lot of energy in futile cycles that just make heat, but I suspect this has more to do with metabolic rate and blood flow. I could be wrong of course. Are there any other ideas about this out there?

    Bye
    Alex

  16. ahimsa

    ahimsa Senior Member

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    Hi HopingSince88,

    I know nothing about hypoglycemia or insulin issues so I'm not able to comment on the original post. And I agree with you about ME/CFS patients having cardiac problems and low blood volume!

    I just thought I should mention that the study listed about is about reduced Heart Rate Variability (HRV) not reduced heart rate. They found that having reduced HRV seems to predict poor sleep quality and frequent awakening.

    I hope this does not seem like nit-picking or a thread derail. Okay, back to the discussion of hypoglycemia!

    Marjorie
  17. alex3619

    alex3619 Senior Member

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    another link between CFS and insulin resistance?

    Hi

    I have run across some interesting information regarding insulin resistance and CFS. I don't know if this is accurate or relevant, but I do know that it worth looking into.

    Hi Paula

    This has implications far beyond what you posted. Remember the study from de
    Meirleir on very long term patients? They all had very high levels of
    bacterial lipopolysacharide in their blood, which correlated with severity.
    This implies, via a similar argument to the gum disease one, that ME and CFS
    patients could develop insulin resistance from their immune response alone.
    Protecting the gut would be the primary method to fix this, at least until
    we understand more of the mechanisms.

    (I have Paula's permission to repost this:)


    ----- Original Message -----
    From: "Paula Carnes" <pj7@cox.net>
    To: "Paula Carnes" <pj7@cox.net>
    Sent: Friday, June 04, 2010 2:08 AM
    Subject: [CPAR] Gum disease and inflammation

    Dr. Mirkin writes a nice summary of the issues with gum disease. What he
    doesn't cover is how to effectively treat it. I would be interested in
    further ideas on this. Paula Carnes

    Dear Dr. Mirkin: Do bleeding gums increase risk for diabetes as well as for
    heart attacks?

    After reviewing 690 papers, doctors at the University of Edinburgh, UK,
    report that treatment of gum disease in type 2 diabetes (not type 1) can
    lower blood sugar levels and HBA1C, a test for cell damage (Cochrane
    Database of Systematic Reviews, May 2010). Patients with gum infections are
    at high risk for developing Type 2 diabetes (Journal of Public Health
    Dentistry. December 2009).

    Bleeding gums are usually caused by infections. Chewing drives bacterial
    endotoxins from the gums into the bloodstream (Journal of Periodontolology,
    January 2002). Your body responds to this invasion of bacteria with
    inflammation: producing huge amounts of cells and proteins to kill the
    germs, but they also block insulin receptors to raise blood sugar levels.
    Adults who brush their teeth less than once a day have increased risk for
    gum disease, a 70 percent increased risk for heart disease, and higher CRP
    and fibrinogen blood tests signifying inflammation (British Medica Journal,
    May 2010).

    People with bleeding gums should seek treatment because they are at
    increased risk for heart attacks, strokes and diabetes.

    Sometimes treatment is just a short course of antibiotics, or you may need
    extensive dental repair. For more information and journal references see
    <http://www.drmirkin.com/heart/8333.html>
    http://www.drmirkin.com/heart/8333.html

    Paula Carnes
    Las Vegas, NV


    Hi Alex,
    YES, certainly post the whole thing. Also add that one patient in the
    Incline Village outbreak said the early cfs cases had onset of gum disease
    as an early sign of illness. It looks like some infection found in cfs also
    infects the gums????

    Paula


    I hope this opens up some new considerations in the CFS diabetes debate.

    Bye
    Alex
  18. sensing progress

    sensing progress Senior Member

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    so the consensus seems to be only treatment for hypoglycemia is diet?
  19. Mithriel

    Mithriel Senior Member

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    Diet modification didn't help me at all, except that if I ate before the hypoglycaemia set in I was OK.

    A local consultant believed that taking prozac improved REM sleep which led to the body healing so I started to take it. (No one ever suggested I was depressed)

    It made absolutely no difference to my mood, or anything else really except the hypoglycaemia changed. It was delayed

    The Prozac didn't take it away but it masked it somehow. Where before I would start to feel bad about 11.45 I was now able to go till 12.15 and eat my dinner with everyone else :victory:

    But I knew it was only masked because if I did start to feel bad I went to collapse in minutes - so I was as bad at that point as I would have been if I had started to feel hypoglycaemic at the usual time.

    Regardless, it made life much easier. I don't take it any more. Being worse in general, now, I don't do very much so it is not the problem it was. (I really resented the hypoglycaemia because it struck when I was feeling better and doing a bit more. It took the fun out of life. )

    I didn't have any problems stopping the prozac but other people have. The only down side to me was doctors then assumed I had depression which was annoying.

    This is a classic example of the way we have to be our own medical adviser and it is very difficult when no research has been done.

    Mithriel
  20. Forbin

    Forbin Forbin

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    Well, my extreme reaction to high fructose corn syrup - heart pounding, rapid pulse, sweating, flushing, generally feeling awful - certainly seems to be consistent with "reactive hypoglycemia." If true, this is quite a revelation for me since I have thought of this as a kind of corn allergy for 27 years.

    If I understand this right, when you eat something that raises your blood sugar up high, the body then over-reacts and lowers your blood sugar levels down into hypoglycemia; then your body tries to seesaw back in the other direction by releasing adrenalin to raise your blood sugar back to normal. It would then be the adrenalin release, and not hypoglycemia itself, that produces the symptoms above. [Please correct me if I’ve got this wrong.]

    This makes a lot of sense. I could see my reaction being caused by a release of adrenalin. The odd thing is that I’ve read that this reaction usually occurs about 2.5 hours after eating. In my case it happens within 45 minutes of eating anything with high fructose corn syrup. I don’t get this reaction with any other sweetener (or to other things containing fructose for that matter). Like everything with this illness – a mystery.

    Have there been any studies linking CFS/ME and reactive hypoglycemia?

    Or, for that matter, is reactive hypoglycemia a known response to an infection or other stress?

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