There are a lot of people who, like me, are perfectly fine except that every now and then they get shaky, headachy, maybe just a little bit frantic or even cranky because they're starving, damn it... people who are lovely, even-keeled souls unless they crash, and then they're not on the floor, they're well below it.
A decade or so ago, there was a popular diagnosis for this kind of behavior. According to a number of books and self-help groups, hypoglycemia (a fancy term for abnormally low blood sugar) was to blame for premeal jitters and postmeal stupor, not to mention forgetfulness, depression, yelling at your spouse, and cuddling up with sweets. It was the diagnosis your doctor refused to make, advocates claimed, even though the syndrome was rampant.
Except that it wasn't. Careful studies proved that, aside from diabetics, very few people have blood sugar that gets seriously out of whack. Good thing, too, because persistent hypoglycemia is a signal that something is very wrong. "The diseases that cause hypoglycemia are serious, with major health implications," says Mayo Clinic endocrinologist F. John Service, MD, a longtime expert in the field. Which doesn't necessarily mean that your mood and energy swings are unrelated to blood sugar. If the hormones that regulate it are just a little overeager, you may be prone to a host of unpleasant symptoms that have nothing to do with being ill or abnormal, and everything to do with the way you eat.
Forget the sensory pleasures of digging into a garlicky bowl of pasta or licking a dripping chocolate ice cream cone. All your body really wants of a culinary creation is to mash it, dissolve it into a slurry, and break the carbs down into simple sugar that can float in your blood to each and every cell. Blood sugar, aka glucose, provides the energy that keeps your brain buzzing and your heart ticking, and all your other muscles and organs functioning nicely. So it's no wonder there's a complicated hormonal system to nip and nudge at blood sugar to keep it in normal range. Insulin ushers glucose into needy cells or into the liver for storage; glucagon and other hormones prompt the liver to release stored glucose if blood levels get low. These hormones keep your blood sugar where it should be even if you miss meals or work out strenuously.
But you can mess with the system by overdoing foods that are high in simple carbohydrates—obvious sugary items like candy, cake, nondiet soda, and syrupy waffles, as well as white bread, bagels, and orange juice. Inhale a big load of pure simple carbs at one sitting (a box of fudge, a big stack of pancakes), and your blood sugar will shoot up. To deal with the jump, insulin will shoot up, too, according to Roland G. Hiss, MD, a hematologist who has been an investigator at the Michigan Diabetes Research and Training Center for more than 20 years. And the higher the sugar intake, the more likely it is that your body will produce excess insulin for the job.
An overenthusiastic insulin response sweeps too much sugar from the blood, dropping it below your normal set point. That triggers a release of other chemicals bent on raising blood sugar, among them adrenaline, one of the stress hormones that produces the fight-or-flight response in a panic situation. All you did was pour a little too much syrup on your pancakes a couple of hours ago, and here you are with the sirens blaring, red lights flashing, and then come the jitters, racing heartbeat, cold sweats, that I-could-kill-someone feeling.
"The body hates low blood sugar," Hiss says, "and that's because of the brain. It must have a constant blood sugar level to function—and if it doesn't, all hell breaks loose." Once the body senses a blood sugar dive and goes into panic mode, the repercussions can last a half hour or longer. It won't matter if you throw food into your mouth by the fistful; you're going to have to wait out the aftershocks until the level of stress hormones falls.
The 5 rules you need to keep a balanced diet
1. Start with breakfast. If you frequently find yourself in a midmorning slump or agitated state, steer clear of the fast-burning simple-carb breakfast that may cause your blood sugar to surge and then nose-dive an hour or two later, pushing your body's alarm buttons. Instead, begin the day with a meal that includes protein and a little fat, both of which delay the absorption of sugar into the blood and take longer to digest. Try pairing your juice with an egg white omelet or a slower-burning complex carbohydrate (think carb with fiber, like a dense bread with lots of whole grains and nuts) and peanut butter. Take the same mix-and-match approach to lunch, dinner, and snacks. "You want a meal to have a combination of foods so there's a slow, steady release of sugar into the bloodstream," says dietitian Tammy Baker, a spokeswoman for the American Dietetic Association. "This will signal a slow, steady release of insulin and keep you on an even keel."
2. Don't let yourself get too hungry. Going hours without food sets you up for a sugar-heavy snackfest (anyone have chocolate?). And if you resist, you're more likely to overeat at your next meal because your brain takes about 20 minutes to get the message that you've had enough—and that could be 20 minutes of continuous stuffing. To process all that food, your body shunts blood to the digestive tract, slowing down functions that are unrelated to the business at hand. Blood pressure drops. Your heart rate slows. So does your mental activity. Result: postmeal stupor.
You may feel much better with smaller meals and bigger snacks. Registered dietitian Roxanne Moore suggests that if you're having a sandwich for lunch, eat half of it as a midmorning snack and the rest at 1 P.M. with a small salad or some yogurt. Parcel out your day's food so that you never go longer than three or four hours without a mini meal that includes a mix of nutrients.
3. Fuel your workouts. Exercise is great for both health and mood, but it can drag your blood sugar down if you don't compensate for some of the calories your body is using up. To keep your energy high, you may want to eat something like a banana before you start, take swigs of a sports drink during the workout, or schedule a snack just after the sweat dries.
4. Find out if caffeine is a culprit. There is some evidence that caffeine can increase sensitivity to low blood sugar, at least in diabetics—although other studies suggest that it can raise blood sugar. Either way, caffeine consumption is known to exacerbate jitters, irritability, and anxiety, so you might try cutting back to see if it's making matters worse.
5. Pay attention. As you experiment with changes in diet and exercise, keeping a diary may help make clear what works and what doesn't. In particular, note how long after eating you feel crummy. One or two hours? Look at what you ate. Simple carbs are probably the culprit.
Finally, don't forget your doctor. If you have repeated bouts of what feels like low blood sugar—especially if your symptoms are coming more frequently and getting worse—it's worth investigating. You may be pregnant or suffering from unusual anxiety. Or you may have one of the potentially serious diseases that announce themselves with hypoglycemia: insulin-secreting tumors, for instance, or adrenal cancer.
These diseases, however, are rare. Most likely you're perfectly healthy and the best medicine you can take to relieve your symptoms is a dose of awareness. Once you fine-tune how you're fueling your body, it should run smoother. And then you can pay attention to more important things.
Lisa Davis is a writer in Oakland whose work has appeared in Health and Vogue.
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