What does low blood sugar feel like?

[Sushi]

So does this mean that I should try to eat more frequently or I shouldn't? I always feel better when I do not eat (or so I thought?) and am so confused now what to do!!!

The usual recommendation for hypoglycemia is to eat small snacks of protein or complex carbs frequently. I guess the only way you would be able to figure out would be better for you is to experiment and/or test your glucose levels regularly--it is very easy to test.

Sushi

 

[Sherlock]

@Sherlock and @xjhuez So does this mean that I should try to eat more frequently or I shouldn't? I always feel better when I do not eat (or so I thought?) and am so confused now what to do!!!

Since you very much seem to be having hypoglycemic spells (the fasting kind), you do need to eat more often. My father (non-CFS) had such spells, and they completely went away when he ate more often. They came back when he ate less often.

Low GI carbs/meals are best. Beans would be a good example. Also dairy.

There is a LOT of misinformation from pseudo-experts about what makes for low GI - such as saying that typical whole wheat bread is low GI because it has fiber, which is false-false-false. Also false is the ever-present claim that refined carbs are automatically high GI. (White pasta is low/medium GI, because of the type of starch in it).

http://www.glycemicindex.com/ is from Jenny Brand-Miller who is an actual expert. The GI numbers are derived by experiments.

Some proteins convert readily to glucose. They have glucogenic amino acids.

Some proteins readily provoke insulin release. They are insulinogenic or aka insulinotropic.

Is this [hypoglycemia being a sign of impending diabetes ] in PWC's too or only in normal people?

I don't know. But just because a person has CFS doesn't mean that everything they have is only due to CFS. Also, a person's bodyfat percentage would factor in.

A weight loss diet is probably the best treatment for most people, while being careful to avoid hypoglycemic spells.

I recently had a urine test (for another reason) and it showed high ketones in my urine. I asked my cardio and cfs doctors but they said not to worry about it and it wasn't significant. Is this something to be concerned about or is it normal in PWC's?

Depends on how high, I'd suppose. It might be the beginning of diabetic ketoacidosis, which is a worry. It's also found in low-carbers, and is not a worry there. I don't know about levels for PWCs.

 

[Sherlock]

The usual recommendation for hypoglycemia is to eat small snacks of protein or complex carbs frequently. I guess the only way you would be able to figure out would be better for you is to experiment and/or test your glucose levels regularly--it is very easy to test.

Sushi

Sushi, not to be contentious but I must disagree with referring to complex carbs. Starch, being chains of thousands of glucose molecules, is complex (as opposed to e.g disaccharides). Yet amylase is very capable of instantly cleaving some starch into thousands of glucose molecules.

Amylopectin is the high GI starch.
Amylose (like durum semolina) is the low GI starch. Pasta is made from amylose, that's why it is low/medium GI. Brown whole-wheat pasta is not very different in GI from white pasta.

Yes, testing your glucose levels regularly is very wise advice, because people might react differently.

There are counter-intuitive aspects to all of this: e.g. raisins are high, but prunes are low (prunes have the viscous soluble fiber).

But insoluble fiber like wheat bran or rice bran has not much effect, especially once pulverized into fine dust in modern high speed grain milling. But coarse stone ground bread tends to be lower GI.

 

[Sushi]

not to be contentious but I must disagree with referring to complex carbs.

I don't know the science around this so I am happy to accept your correction. Maybe the main point would be not to regularly eat pure sugar as a preventative strategy?

Sushi

 

[Sherlock]

I don't know the science around this so I am happy to accept your correction. Maybe the main point would be not to regularly eat pure sugar as a preventative strategy?

Sushi

Actually, table sugar (sucrose) is not high GI, it's usually around 55-60 out of 100. That makes sense because it's 1 glucose plus 1 fructose molecule, and glucose is 100 and fructose is close to zero GI so that averages in the middle.

But then comes insulin. For most carbs, the Insulin Index correlates with the GI - but not so with sucrose sugar. Sucrose scores much higher on the Insulin Index than its GI would predict. That's a special property of sucrose.
http://ajcn.nutrition.org/content/66/5/1264.full.pdf html
An insulinindex of foods:the insulin demand generated by
1000-kJ portions of common foods

(with Jellybeans being almost pure sucrose)

 

[Sherlock]

http://www.health.harvard.edu/newsweek/Glycemic_index_and_glycemic_load_for_100_foods.htm

White wheat flour bread 71
Wonder™ bread, average 73
Whole wheat bread, average 71

Eve so, every pseudo-expert on tv has been saying to avoid "blood sugar spikes" by avoiding white bread and having whole wheat bread.


Next, different grain breads:
Coarse barley bread average 34
Pumpernickel bread 56
50% cracked wheat kernel bread 58 (because it's coarse)

How about ice cream?
Ice cream, regular 57
Ice cream, premium 38 (premium has more fat)

 

[Sherlock]

Rice varies a lot according to the variety, notice that long grain white rice usually measures as lower GI than brown rice:
http://www.lowglycemicdiet.com/ricegi.html

Food GI Value

Converted, White 38
Long grain, White 44

Brown 55

Short grain, White 72
Instant, White 87

Glutinous (Sticky) 98

 

[xjhuez]

@Sherlock and @xjhuez So does this mean that I should try to eat more frequently or I shouldn't?

I went this route for years - eating snacks every few hours. It's effective, but only if you stay on top of your game. I like what I'm doing now much better.

 

[jimells]

We typically exhibit a phase lag in endocrine response which causes the cortisol release that lowers blood sugar to appear in exaggerated form well after it is appropriate.

Welcome back anciendaze. It's good to see your posts again. My very thin understanding is that cortisol is released when the fight or flight mechanism is triggered, in order to increase blood sugar, in preparation for anaerobic metabolism, etc. Could you clarify this?

 

[anciendaze]

Welcome back anciendaze. It's good to see your posts again. My very thin understanding is that cortisol is released when the fight or flight mechanism is triggered, in order to increase blood sugar, in preparation for anaerobic metabolism, etc. Could you clarify this?

Short-term and with narrow focus you are quite right. In a hurry, I used a shorthand version which was easier to misunderstand than to interpret correctly.

But, cortisol merely accelerates the breakdown of stored energy reserves like glycogen into a form, glucose, which you can metabolize immediately. This is quite different than the process of building stored energy reserves from digested food. The stress response based on cortisol actually shuts down digestive processes in order to deal with more immediate survival concerns. Prolonged excess production of cortisol will ultimately result in a state where these ready reserves are exhausted. The hormone then goes on to break down proteins, proteolysis, which can have very serious consequences. This is one of the dangers of prolonged physiological stress.

There are problems in talking about any of these processes where there is feedback, and biology is all about feedback loops. When things start running open-loop you are dying.

In the case where there is a phase lag in cortisol secretion you get into a situation where the body makes a biochemical response to a challenge which then produces no immediate effect, this causes an even stronger biochemical response. ("Didn't you hear me? We need to do something, RIGHT NOW!") By the time all the biochemical consequences develop, the original context in which the stressor was present is long gone. The body now has to do something with these inappropriate chemicals, and they get dumped in a number of places where they don't do much good. The end result is that the energy stores produced by digesting food have been wasted, and you still feel short of energy, after a giddy rush in which you were agitated and anxious for reasons that had little to do with your immediate environment. It should not be surprising to anyone that people also suffer from indigestion in these circumstances.

One aspect of inappropriate cortisol secretion is suppression of the parasympathetic part of the autonomic nervous system and increased activation of the sympathetic part. I believe most people here suffer from over-activation of the sympathetic nervous system, (possibly because of diffuse nerve damage.) Cortisol also suppresses inflammation, which is part of a normal response to infection. This gets us into impaired immune function, though the problem I'm describing is episodic impairment. Measurements over a full daily cycle will not show that part of the time activity is too low, and part too high. The general picture is one of misdirection of available resources.

I suspect many people on this forum would show exaggerated responses to steroids. In my own case I once went 48 hours without sleeping after a shot of Prednisone.

 

[Gingergrrl]

Thank you to everyone for all the additional feedback which has made me realize that this entire topic (blood sugar, low glycemic foods, etc) is yet another whole area that I know nothing about.

My former naturopath put me on a strict diet back in June (based on my lab results of a food sensitivity test from US Biotek Labs.) I was having severe GI issues at that time with constant nausea and diarrhea 5-6x a day (sorry to be graphic TMI ) and I was desperate to try anything. She literally cured me of all my GI issues along with some supplements I got from an integrative GI doctor. At the moment I am having a slight return of the symptoms but on a minor scale and part is b/c I ran out of the supplements which I was finally able to re-order today.

Her diet for me was no gluten, dairy, casein, whey, eggs, cane sugar, corn, yeast, or soy. After about four months she said I could add eggs and corn back in. I had already been gluten free b/c of Hashimoto's disease so that part was easy. The hardest part for me was (and still is) no dairy b/c I used to drink milk, eat yogurt and cottage cheese, frozen yogurt, ice cream, and most kinds of cheese. I could grab a piece of string cheese or a greek yogurt so she eliminated most of my snacks.

What I am supposed to eat now is protein, fruits and veg, rice, potatoes, beans & legumes, nuts, eggs, and non-dairy alternatives like from coconut milks, etc. I have minimally added back in yeast so I can eat gluten free bread again, and minimally added back in sugar. I remain gluten and dairy free.

My husband thought we should order glucose tablets (I guess for diabetes) that I could have in an emergency but that in general I need to eat every few hours even if it is a handful of nuts or a rice cake with peanut butter. I need to figure this out and wish there was a nutritionist or dietician who understood ME/CFS who could make me a personal food plan. This all feels like so much work and there really is no joy for me in eating like there was when I was healthy .

 

[Sherlock]

rice cake

from http://www.glycemicindex.com/foodSearch.php
Rice cakes, Calrose rice (low-amylose) GI =91
Rice cakes, Doongara rice (high-amylose) GI = 61

I'd go with the latter, if available.

 

[Gingergrrl]

@Sherlock

Since you very much seem to be having hypoglycemic spells (the fasting kind), you do need to eat more often. My father (non-CFS) had such spells, and they completely went away when he ate more often. They came back when he ate less often.

That is what I suspected and I have done much better with eating today and have not had an episode or felt shaky so it definitely helps.

Low GI carbs/meals are best. Beans would be a good example. Also dairy.

Sadly I am not supposed to eat dairy but am reconsidering this.

http://www.glycemicindex.com/ is from Jenny Brand-Miller who is an actual expert. The GI numbers are derived by experiments.

Some proteins convert readily to glucose. They have glucogenic amino acids.

Some proteins readily provoke insulin release. They are insulinogenic or aka insulinotropic.

Thank you and I am going to look at the index and really appreciate all the resources. I don't understand though, do I want proteins that convert to glucose (the first category you mentioned) or do I want the second one (insulinogenic) or both? I probably should look at the index and then ask my questions and am doing it backwards.

I don't know. But just because a person has CFS doesn't mean that everything they have is only due to CFS. Also, a person's bodyfat percentage would factor in. A weight loss diet is probably the best treatment for most people, while being careful to avoid hypoglycemic spells.

I've lost a lot of weight since getting ill and weigh around 106-108 lbs depending on the day. My body fat percentage is around 20-22% although I have absolutely no muscle and am very weak.

Depends on how high, I'd suppose. It might be the beginning of diabetic ketoacidosis, which is a worry. It's also found in low-carbers, and is not a worry there. I don't know about levels for PWCs.

My test result said 2+ but am not sure what this means. I am not sure if I would be considered low carb b/c I am eating gluten free bread again as well as rice cakes, and sometimes potatoes, beans, rice, etc.

 

[Sherlock]

Here are a couple things to muddy the waters

Very Lo Carbers will typically fail an Oral Glucose Tolerance Test because they get what they call physiologic insulin resistance. So they've learned to eat carbs in the few days before taking an OGTT.

Taking Vit C post-exercise kills the typically increased PWO insulin sensitivity.

Let's throw in a third: some people get insulin secretion in response to consuming some artificial sweeteners.

And a fourth: bake a potato and you make the GI go way up. Cool it and the GI goes way down.

 

[Sherlock]

I'm replying throughout in red.

@Sherlock

That is what I suspected and I have done much better with eating today and have not had an episode or felt shaky so it definitely helps.

Congratulations! That's a nice, fast improvement


Sadly I am not supposed to eat dairy but am reconsidering this.

It's maybe worth a try.


Thank you and I am going to look at the index and really appreciate all the resources. I don't understand though, do I want proteins that convert to glucose (the first category you mentioned) or do I want the second one (insulinogenic) or both? I probably should look at the index and then ask my questions and am doing it backwards.

If you want to avoid hypoglycemia, then pure fats or non-glucogenic (converting-to-carbs) proteins probably won't help. You'd want low GI carbs, also called slow carbs because they get into the bloodstream slowly. Some nuts are only pure fat.


I've lost a lot of weight since getting ill and weigh around 106-108 lbs depending on the day. My body fat percentage is around 20-22% although I have absolutely no muscle and am very weak.

Congratulations on the weight loss, You are probably much healthier now, artery-wise. You must have a lot of willpower.


My test result said 2+ but am not sure what this means. I am not sure if I would be considered low carb b/c I am eating gluten free bread again as well as rice cakes, and sometimes potatoes, beans, rice, etc.

I don't know the ranges, sorry.

 

[Gingergrrl]

Congratulations on the weight loss, You are probably much healthier now, artery-wise. You must have a lot of willpower.

All my life since high school I had tried to lose weight without much success until I got ill. Ironically, since ME/CFS, I never tried to lose weight and it just happened b/c I had no appetite and for a long time I had constant nausea. I also had severe shortness of breath and chest pain when I tried to eat so there was no pay off and I could breathe better when I did not eat. It had nothing to do with willpower in any way. When I was younger and healthy, if there was a bag of chips or candy I would eat the entire thing and now I have no interest in it whatsoever. It is very strange. I would honestly return to a higher weight if I could have my health back.

 

[Comet]

@Comet How did you determine that was the problem? Did you do a test for low blood sugar? No doctor has ever mentioned this issue to me and every single one has told me to eat salt (but not sugar!). I literally cannot fathom eating every few hours and it is enough trying to force myself to drink fluids!

Didn't have a chance to check this thread for a while, but it looks like every one has given you better answers than I could!

 

[halcyon]

Is there something with CFS or dysautonomia that makes you no longer feel hunger or thirst? I eat twice a day now b/c I know I am supposed to but if I lived alone, I really don't think I would remember to do this. That must sound so weird.

As an aside, it just came to me. The lack of hunger could be due to elevated leptin levels, as we heard about earlier this year at the IACFS/ME conference.

 

[AndyPandy]

Hi there @Gingergrrl. It is hard work at first to establish a suitable eating plan which takes into account dietary restrictions, but it is possible. I have managed to do this and have regained 6 kilos after losing 10 kilos. Not much fun, but worthwhile.

I had some advice from a standard dietician, but mostly worked it out myself. There are references available which tell you the calorie/kilojoule components of various foods and you also need to become a good food label reader. You may want to google for these. They might be aimed at people who want to lose weight, but once you have the basic info about certain foods, you can use this to increase your weight too. There is also information on the Internet about how many calories/kilojoules a day you need to maintain or increase your weight. Given what you have said about your food intake and weight loss, it is possible that you are not meeting these targets.

I suspect you will ask me , but sorry I just don't have the references from the Internet anymore.

I lost weight (which I didn't need to lose) and felt awful on a strict elimination diet until I realised that I simply wasn't taking in enough calories/kilojoules and nutrients to sustain myself. I had to do a lot of research to improve my situation but it was worth it.

This wasn't easy as I have had to balance lots of food allergies and intolerances, IBS, elevated cholesterol (genetic) and diabetes (skinny type 2) with a tendency to lose weight.

Adequate nutrition is very important to me. I think it is crucial to underpin my chance of long term healing.

Best wishes Andy xxx

 

[taniaaust1]

For a while I was just eating once a day and am forcing myself to eat twice. I can't imagine eating every few hours and everything tastes like cardboard to me. I actually think I might be sick right now on top of ME/CFS but am not sure.

Im supposed to eat every 2-3 hours due to the hypoglycemia I used to get (I dont know if Im still getting it at times now as Im now at times in diabetic range for high sugar). I felt like crap with my hypoglycemia.. it made me far more tired and weak when I had it. Severe hypoglycemia showed up twice on my standard blood test results which was how I first found out I had this. (I was mostly bedridden at the time that first showed up on the doctors general blood test panels.

My specialist has me monitor for both high sugar and for low sugar using a normal diabetes monitor which I was told to get.