In every minute taken to read this blog post, someone is dying from preventable diet-related disease.

More people have died from metabolic disease since 1980 than the [i]sum of all the world’s military conflicts combined. This is more than a burgeoning health issue – it is a [ii]national security issue with profound economic implications. The HSF seeks funding, support and partnership to develop much needed educational content and programs for medical professionals and their patients that focuses on metabolic health and nutrition – preventing, treating, and resolving diet-related issues. The urgency of this work has never been greater.

The HSF is a 39-year old nonprofit organization, founded by a patient advocate, dedicated to forging a healthier world empowered by science-based nutrition and the prevention, early detection, and management of metabolic disease. Hypoglycemia, also known as low blood sugar, is one of the earliest and most frequently experienced indicators of metabolic dysfunction by the general population. For decades, the HSF has been filling a critical gap in educating the public about a health issue recognized as a “canary in the coal mine” of metabolic disease. The HSF has forged a compelling new strategic vision and is poised to expand its impact at a critical moment in U.S. public health history.

Dr. Seale Harris, the [iii]pioneer researcher of hyperinsulinism, viewed hypoglycemia as a harbinger of more complex metabolic disease as early as 1924: “The low blood sugar of today is the diabetes of tomorrow.” Today, low blood sugar is an issue that affects the majority of the population in some form or another, and is a key indicator that metabolic dysfunction is at play. Patients, adequately informed by their doctors, can take action to address diet and lifestyle factors that are driving the condition before more advanced diet-related disorders progress. Unfortunately, many doctors are poorly prepared to diagnose and treat the condition within the context of metabolic (systemic) dysfunction.

In 1958, the year after Dr. Seale died, slightly more than 1.5 million people were diagnosed with diabetes each year. In 2015, the [iv]rate had increased to over 23 million per year. Since 1980, [v]rates of type 2 diabetes have quadrupled. [vi]More than half of Americans are now either pre-diabetic or diabetic. [vii]Nearly half of adult Americans are obese, a rate that has nearly doubled since 1980, while [viii]childhood obesity and diabetes diagnoses have tripled. [ix]One in two adults in the U.S. has a chronic disease. [x]One out three children born in 2000 will have diabetes.

Chronic disease rates have escalated, and now exceed communicable disease. While 80% of the obese population suffer from metabolic disease, it is important to know that 40% of the non-obese also suffer from metabolic disorders. Conditions such as non-alcoholic fatty liver disease (NAFLD) are not easy to detect and are [xi]increasing at alarming rates in adults and children. Metabolic disease erodes our health care system both directly (hypoglycemia, type 2 diabetes, NAFLD) and indirectly (heart attacks, strokes, cancer, dementia), while prevention programs are lacking funding and support.  

National [xii]health care expenditures are currently $3.2 trillion – 75% of this results from chronic disease, and 75% of this is preventable and diet-related. An estimated $1.8 trillion is being wasted. One study showed that a 10% reduction in mortality from heart disease would have a value of $5.5 trillion to current and future generations, while a 10% reduction in mortality from cancer would be worth $4.4 trillion. [xiii]Research suggests that a modest reduction in avoidable risk factors could lead to a gain of more than $1 trillion annually in labor supply and efficiency by 2023.

Wellness programs generally report high returns of investment (ROI), and preventive and early intervention measures targeted to those already identified to be at risk, result in significant ROIs. [xiv]Data show that public health interventions generate anywhere from four to twenty-seven dollars for every dollar invested. The good news is that we are resilient, and [xv]research shows that simple interventions, such as reducing consumption of added sugar within limits recommended by the World Health Organization (WHO), can result in dramatic improvements in child metabolic health, including a 22% reduction in liver fat, in as little as 10 days.

Defying the statistics on diet-related disease, and the ROI of preventive measures, less than 30% of medical schools require courses in nutrition, despite repeated calls from the U.S. government and medical authorities to do so. Research shows that most primary care doctors are unprepared to diagnose and advise patients with diet-related disorders, lacking the time, training, and tools to help patients, and, by default, focusing on management of disease versus actually addressing the root causes of metabolic dysfunction. Doctors have little confidence that patients can make the necessary lifestyle changes, and rely on drugs like Metformin and procedures like gastric bypass surgery.

One of the leading ways to provide training to doctors and health care professionals is a system called Continuing Medical Education (CME). CME education is supported by the national Accreditation Council for Continuing Medical Education, and consists of educational activities designed to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. CME content is widely respected and validated by respected institutions such as the American Medical Association, and provides a body of knowledge and skills recognized and accepted by medical professionals. CME keeps health care providers up to date with the most current knowledge needed to help their patients.

In contrast, patient medical education is unregulated, and health literacy among the patient population is hobbled by a lack of quality education, and inconsistent information that lacks standards aligned with current evidence-based medicine. Information about diet-related disorders is particularly inadequate, and many doctors prefer to avoid providing education about nutrition and diet and focus on treating patients with drugs or devices. Prevention of diet-related disease has little support within the mainstream health care system, and the protocols for sustaining optimal metabolic health and nutrition are woefully lacking.  While dietary interventions have been developed that can reverse type 2 diabetes and non-alcoholic fatty liver disease – few doctors are aware of the most current science.

HSF leadership have been involved in the development of the nation’s first Metabolic Health and Nutrition CME summits at Swedish Hospital in Seattle. The second summit is took place June 15-16, 2018.  The first summit focused on [xvi]Pediatric Metabolic Health & Nutrition and the second summit expands the focus to Metabolic Health & Nutrition for the Whole Life Span. HSF would like to foster the development of similar CME summits at other leading health care institutions in the U.S.

The HSF would also like to offer smaller CME programs focusing on specific sets of topics featured at the comprehensive metabolic health and nutrition summits. The development of these CME modules will build on the impressive network of contacts in the field that leadership of the HSF has assembled over decades of work. There is a distinguished and very impactful group of leaders in the metabolic health and nutrition field – but there is a lack of awareness about their work. HSF will tap their considerable expertise and knowledge (critical to developing high quality CME content featuring the most current research and practice) and bring their work to national audiences.

In conjunction with the development of the CME programs, HSF also proposes to develop Patient Medical Education (PME) programs that translate the content developed for professional health care providers into education that is relevant and applicable to the patient population acutely affected by metabolic health disorders. It is not unusual for patients visiting diabetes clinics to be handed one-size-fits-all diet guidelines like the “Food Pyramid” or “My Plate.” These diet plans, high in carbohydrates, are typically not what the patients need, but Registered Dietitians feel compelled to follow Academy of Nutrition and Dietetics (AND) guidelines that are woefully out of date. Drugs like Metformin (Glucophage) are routinely prescribed, designed to managed disease, not eliminate the causes of it.

If any of this sounds like something you might want to get involved with, please contact Wolfram Alderson, CEO, Hypoglycemia Support Foundation by email.

FOOTNOTES

[i] U.S. deaths since 1980 caused by: terrorism = < 4,000; warfare = <9,000; gun violence = <1,500,000; diet-related diseases = >45,000,000.

[ii] The Impact of Obesity on National and Homeland Security

[iii] https://en.wikipedia.org/wiki/Seale_Harris

[iv] https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

[v] Type 2 Diabetes Rates Quadruple Worldwide Since 1980.

[vi] Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012

[vii] Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults Aged 20 and Over: United States, 1960–1962 Through 2013–2014

[viii] Childhood Obesity Facts

[ix] As of 2012, about half of all adults—117 million people—had one or more chronic health conditions

[x] One in Three US Children Born in 2000 Will Develop Diabetes

[xi] Nonalcoholic fatty liver disease: A comprehensive review of a growing epidemic

[xii] National Health Expenditure Data, Centers for Medicaid and Medicare Services

[xiii] An Unhealthy America: The Economic Burden of Chronic Disease — Charting a New Course to Save Lives and Increase Productivity and Economic Growth

[xiv] Return on investment of public health interventions: a systematic review.

[xv] Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome

[xvi] Pediatric Metabolic Health and Nutrition Summit, Swedish Hospital, Seattle.

“The low blood sugar of today is the diabetes of tomorrow.” -Dr. Seale Harris

It is rare that I have a conversation about hypoglycemia that the subject of diabetes doesn’t come up. The thousands of letters and e-mails I’ve received over the past 38 plus years confirm that this is a major concern. One such email message gives you an indication of what I mean. “Darren,” a full-time college student at Tulane University in New Orleans writes, “I feel like I’m going to die from this thing that grossly interferes with my life…I want to know everything…I don’t understand much. Should I just eat everything when I have an attack? Tell me what to eat when I’m freaking…I also want to know how this affects my metabolism? How does it differ from diabetes? Is it the predecessor? What are the long-term effects? Can this kill me? Because sometimes I want to die or just be able to stick insulin needle in my arm and feel better. Perhaps it is because I am uneducated on the issues, but it seems to me that diabetics have it easier. They can just “get a fix” so to speak. I don’t really like needles but I could get used to them if it would make me feel better, feel normal.”

Another e-mail arrived shortly after the one from Darren.” “I was just diagnosed with hypoglycemia. Can you explain in plain language that I can understand how hypoglycemia is prediabetic? Please tell me this isn’t true and if so how could I become diabetic?”

It was difficult to respond to these two emails. What do you say to someone who sounds so desperate and helpless? Is information enough? In both these cases however, information is the ONLY answer. When fear and panic set in because of the unknown, every physical symptom becomes magnified. If only they read Lick The Sugar Habit by Dr. Nancy Appleton, Sugar Shock by Connie Bennett, Hypoglycemia: The Other Sugar Disease by Anita Flegg, or Hypoglycemia for Dummies by Cheryl Chow and Dr. James Chow. Each of these books would have answered all the above questions!

It saddens me that this information isn’t readily available through the medical community. Maybe it is because hypoglycemia and diabetes are often separated as health conditions—one is accepted while one is virtually ignored. Hypoglycemia is often only spoken of in the context of insulin and blood sugar level management for people with diabetes. Just scan your local newspaper and magazines. Diabetes (high blood sugar) definitely takes center stage in medical headlines. According to the American  Diabetes Association, “In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Of the 30.3 million adults with diabetes, 23.1 million were diagnosed, and 7.2 million were undiagnosed.”

Type 2 diabetes, like obesity, is at epidemic proportions in the United States and throughout the world. Twenty-five million Americans have diabetes, with 800,000 new cases each year. Is it any wonder why this disease is the seventh leading cause of death? Diabetes increases the risk of heart disease, gangrene and limb amputation, kidney failure, and blindness. A leading killer, it also decreases your life expectancy.

The saddest part is that 50 percent of those affected may not be aware that they have this deadly disease. Hypoglycemia (low blood sugar), an important sign that you may be at risk for type 2 diabetes, is typically ignored and treated symptomatically. There may be an article here, a book there, but seldom do you see informative statistics. Too bad, for maybe if we had better numbers, more Americans would stand up and take notice of blood sugar issues. One book I read estimates that 100 million Americans are experiencing hypoglycemia.

Unfortunately, there are few formalized studies on hypoglycemia as a stand-alone condition. Therefore, it is very difficult to substantiate these numbers. Often, the only research to be found on hypoglycemia is within the context of studies on related medical conditions. Because of this, however, we may never know how many Americans are suffering, needlessly, from hypoglycemia. We need to study and document that there is a connection between low blood sugar (hypoglycemia) and high blood sugar (diabetes) – the blood sugar roller coaster described in our infographic. Or do we just need to read more of the e-mails that the HSF receives?

“I was just diagnosed with borderline hypoglycemia. My doctor told me not to worry and handed me a single sheet of paper with some diet instructions. Since he didn’t seem concerned, I left with the feeling like my condition was ‘no big deal.’ I kept eating all my chocolate chip cookies and gave in to all my cravings. I am now dealing with the consequences. I feel terrible. My symptoms are worse and I was just diagnosed (2002) with diabetes. Both my mother and grandmother had diabetes. Why didn’t I take this more seriously? What can I do now?”

“I desperately need to find a doctor that knows how to treat my hypoglycemia. My present one told me all I had to do was carry a candy bar with me. My Dad is severely diabetic and I don’t want to end up with that disease. I live in the Cincinnati, Ohio area. Please help me.” “Can uncontrolled hypoglycemia result in diabetes?”

I asked Dr. Lorna Walker, nutritionist and advisor to the HSF, to answer the last question. This was her response. “Hypoglycemia is a blood management disorder in which the pancreas reacts to a rapid rise in blood glucose levels by secreting too much insulin while in diabetes, when blood sugar gets abnormally high, the damaged pancreas is unable to bring it down by secreting too little. In some cases, this hyperinsulinism is the precursor to adult onset diabetes (type 2 diabetes). The hypothesis is that the overactive pancreas, when predisposed by genetics, diet, and lifestyle, finally begins to wear down and the end result is diabetes.”

Dr. Linda Peterson, who wrote the groundbreaking work, “Brain Neurophysiology in Persons with Reactive Hypoglycemia,” states that “More information is needed regarding the brain neurophysiology of persons with reactive hypoglycemia. Although it is possible to diagnose the condition when several simultaneous blood tests are conducted, few practicing physicians have used any procedure except the inconclusive glucose tolerance test. Because brain changes have not been documented, clinicians vary in their belief about the seriousness of the condition. As a result, treatment modalities for clients depend on the bias of the professional. Sometimes treatment will adequate and at other times miss the needs of the client entirely.”

No letter, e-mail or explanation can be as profound as the simple black-and-white facts. So in 1998, I added a hypoglycemia/diabetes questionnaire to our website. Due to the increase of questions and concerns about a possible connection between hypoglycemia and diabetes, I wanted to find out if this association could be observed. The goal was to determine whether untreated hypoglycemia is a precursor to diabetes. The survey was also designed to gather information on how and by whom hypoglycemia had been diagnosed and what type of treatments, if any, were found to be beneficial. The HSF received over 5500 responses (3752 respondents with hypoglycemia) from 25 countries.

Below is a brief synopsis of what we discovered. Sixty-four percent of those confirmed with hypoglycemia (diagnosed by a physician with a glucose tolerance test) indicated that one or more family members had been diagnosed with diabetes. With this information, we can alert people who experience hypoglycemia to the seriousness of this condition, as diabetes will almost certainly be the next stage if left untreated. It is also critical for people with diabetes to share this information with other family members as a preventative measure. When we asked those surveyed what kind of symptoms they experienced, the most common were:

• Heart Palpitations 80%
• Dizziness 79%
• Mood Swings 77%
• Headaches 74%
• Depression 67%
• Addiction to Sweets 62%
• Extreme Fatigue 52%

When diagnosed with hypoglycemia, only 59% changed their diet. That number is high considering that only 48% of physicians who diagnosed hypoglycemia through a glucose tolerance test recommended treatment. A little more than 50% of the participants incorporated vitamins and exercise, while only 25% changed their mental attitude towards the illness. Unfortunately, 23% considered candy the cure-all for their low blood sugar problems.

Check out the current questionnaire on our website, https://hypoglycemia.org/questionnaire. It will give you an idea of what we are looking for and how this information will help future treatment of these conditions. This questionnaire isn’t the answer of course, as it cannot take the place of well-structured medical research. However, it is actually giving us the answers we need to encourage more scientific research into this condition that is so often not taken seriously. In the meantime, we are working on publishing Dr. Linda Peterson’s work, which was ignored by the medical profession when presented in 1978.

Do you know of significant research on hypoglycemia? If so, please let us know. We are gathering all that we know and will be listing studies about hypoglycemia on this site.

Before the future, let’s look one more time at the present. Diagnosing and managing hypoglycemia is one of the key determining factors in the subsequent development of adult onset type 2 diabetes in later life. Diet, lifestyle, age, predisposition, and insulin and tissue resistance are all variables that need to be addressed concerning this issue. To date, there is nothing we are able to do to counteract the effects of either aging or genetic predisposition. The remaining elements, however, can be managed. If one is successful, there is a good chance that Type 2 diabetes can be prevented or delayed.

Here’s to your health,

Roberta

*Yes, Gift. Why?

“Because long before you get diabetes or heart disease, low blood sugar, also called Hypoglycemia, sends you insistent warnings, like a “canary in the coal mine,” while you still have time to spare yourself. The gift messages take many forms: anxiety, depression, physical and mental fatigue, brain fog and cravings  — all with the same greeting: ‘Change while there’s still time.’ Assuming you listen and act, it could save you a lifetime of unnecessary suffering.”
– Dorothy Mullen, Founder, The Suppers Programs

The food-mood connection is a vital one – listening to what blood sugar is telling you and taking appropriate actions can dramatically improve your metabolic and mental health. Mental health conditions are increasingly being evaluated within the context of metabolic health. Blood sugar dysregulation (high and low), often associated with insulin resistance and hypersecretion, is one of the “canaries in the coal mine” for many metabolic and mental health disorders, and is associated with many medical conditions.

“The low blood sugar of today is the diabetes of tomorrow.” – Dr. Seale Harris

Hypoglycemia is one of the most confusing, complicated, misunderstood, and too often misdiagnosed or undiagnosed conditions of modern medical history. A growing need/emphasis on patient self-advocacy and education is emerging, since, unfortunately, many healthcare professionals are poorly equipped to diagnose the issue, and often lack the training in nutrition science to prescribe a proper dietary response. Nutrition education in medical schools has actually declined in the last three decades. How do you listen to what blood sugar is telling you, and what actions can you take as a patient?

Background

Hypoglycemia is associated with a wide variety of diet-related disorders (metabolic syndrome, type 2 diabetes, fatty liver disease, etc.) and medical conditions (critical illness, drug side effects, organ failure, gastric bypass surgery, etc.). The most common form, functional / reactive hypoglycemia is diet-related and preventable. There are tools available to you that can help pinpoint why and where you might be on a blood sugar roller coaster, and simple solutions involving diet, stress, and lifestyle are accessible and affordable. New and old diagnostic tests and technology can help you pinpoint what the issues might be, and provide helpful data to your healthcare provider.

Resources

Some conventional methods such as keeping a diet/symptom diary and a variety of tests have been in place for decades. Now, new bio-monitoring devices have the potential to empower consumers to optimize their metabolic and mental health – matched with personalized nutrition built on the foundation of real food.

• Hypoglycemia – Blood Sugar Roller Coaster (Comprehensive Infographic)
• Hypoglycemia – Do’s and Don’ts (Book by Patient Advocate, Roberta Ruggiero)
• Sweet Revenge – Turning the Table on Processed Foods (Public Television Program – get a discount code here)
• https://hypoglycemia.org (Informational Website)

According to leading experts some 80 million or more Americans have hypoglycemia and most don’t even know it!  Are you one of them? Let’s take a look at some of the symptoms of this most confusing, complicated and too often misdiagnosed condition.

Fatigue, insomnia, mental confusion, nervousness, mood swings, headaches, depression, phobias, heart palpitations, craving for sweets, cold hands and feet, forgetfulness, blurred vision, inner trembling, outbursts of temper, sudden hunger, allergies and crying spells.  

This list contains just a few…the entire list by Dr. Nancy Appleton, author of Suicide by Sugar; includes over 100 symptoms!

How about we look at this from another point of view?

You try to sleep but you’re restless all night long.  So when you finally do get up, you need at least three cups of coffee to function.  You struggle to get to work, already feeling tense because you’re late; and when you do arrive, you snap at your co-workers for some minor guidelines they forgot to follow. You reach for another cup of coffee both before noon and at 3 o’clock when you feel that afternoon slump  about to overcome you.

Or you got up late, too busy to eat breakfast, run off to your first meeting of the day.  Great, they’re serving coffee and donuts! Lunch, I’ll just have a yogurt with fruit…that should be healthy.

It’s five o’clock and you’re running to get the kids from school but your pounding headache makes it a difficult drive.  Then you’re too rush to cook a healthy dinner because you either have to run out for a late night meeting, your children have to do a school project and you still didn’t buy the necessary supplies needed. So dinner is a quick macaroni dish, chicken you picked up at Publix or as a last resort, canned soup and sandwiches.

Do you realize that though all this scenario, your blood sugar is going up and down like a yo, yo?

Your coffee, donuts, sugar laden yogurt, skipping meals and stress can lead to hypoglycemia symptoms that just keep getting worse if left untreated!

Do you believe that if you just make some small changes you can see a difference in your attitude, behavior and thinking process that can lead to better personal and professional relationship?

Here are some quick and easy changes to stabilize your blood sugar and avoid the highs and lows of hypoglycemia…a condition most of you don’t realize affects you on an everyday basis:

1. Start and end the day with protein.  That means breakfast is a must, even if it is a good protein drink, hard boiled egg, apple slices with almond butter. Check out my list of suggested snacks on our ….If you have dinner early, make sure you have a protein snack an hour or so before going to bed. Otherwise you will be going 12 to 14 hours without food, a reason some find very difficult to get out of bed in the morning!
2. If you have yogurt, make sure it is plain Greek yogurt and add your own fresh fruit and nuts.  Too many name brands are full of sugar which will drop your blood sugar in just a few hours leaving you fatigued and hungrier.
3. Watch you consumption of orange juice…most believe it is the perfect drink of juice, especially since it is advertised as “natural!”  Each 8 ounce glass of orange juice e contains 8 teaspoons of sugar!!!
4. Preparation is the key!  Make some meals ahead of time, preferable over the weekend. You can freeze some and serve them on a night when you have literally no time to cook.
5. Always carry a protein snack with you, especially if you are driving.  Feel weak, it is easy to grab a few almonds or string cheese.
6. If your place of work has coffee available just as soon as you arrive, ask to add herbal teas, nuts and allowable fruits.
7. Exercising strenuously, especially without eating before or after, will definitely lower your blood sugar…sometimes to extreme.  Instead of worrying so much about how you look, listen to your body’s reaction. If symptoms persist, you may have to slow down your exercise program or change your routine entirely.   

The purpose for this particular blog is to let you know that how you think, feel and act can be a result of what you are or are not eating!  Before you take the pain pill for your headache, it could be from the three cups of coffee you had to start the day. The tranquilizer you feel you need for your anxiety could simply be that you skipped breakfast and lunch and your body is running without fuel…won’t and can’t function!  And finally the sleeping pill you crave at night could be that the candy, ice cream and soda you had before going to bed is keeping you wired and unable to have those forty winks your body needs, craves and deserves.

Please, take stock, evaluate your dietary habits, keep a diet/symptom diary and assess those foods and habits you think or know need adjusting. In doubt, reach out for more information or assistance.  You don’t have to do it alone!

Here’s to your health…make it count!

Roberta   

By Dr. Keith Berkowitz, M.D. Medical Director for The Center For Balanced Health and Medical Advisor for the Hypoglycemia Support Foundation

According to the American Diabetes Association, 21 million Americans have diabetes and another 54 million American are at risk with pre-diabetes or elevated blood glucose.

Because of this, our attention has been concentrated on treating high blood glucose while largely ignoring other blood sugar disorders. Poor eating habits, the addition of unhealthy ingredients, increased stress and poor sleeping habits has led to the increased incidence of this under-appreciated blood sugar disorder: hypoglycemia.

Hypoglycemia has been traditionally defined as a low blood glucose level (serum levels less than 70 mg/dl either taken fasting, randomly or after a glucose challenge). Unfortunately, most individuals I see in my practice do not present with these results but instead present with normal blood glucose levels, the ability to lose some weight but not the last 10 to 20 pounds or unexplained low energy levels.

One reason for this is that most individuals only have fasting blood glucose or an HgbA1c taken by their health professional. An HgbA1c level represents the average amount of glucose in the blood over a three month period. A level of 4.0% is equal to an average blood glucose level of 60 mg/dl while a level of 5.0% is equal to a blood glucose level of 90 mg/dl. HgbA1c levels between 4.8% and 5.9% are considered normal. Levels below 4.8% are usually consistent with hypoglycemia.

Individuals with hypoglycemia can often have symptoms that include: headaches, increased irritability, difficulty concentrating, palpitations, light-headedness, fatigue, anxiety, excessive sweating or urination, leg cramps, dizziness and clamminess. Other symptoms can be related to eating. Patients I see with this diagnosis often feel more tired after meals, feel “sick” when they either miss a meal or if a meal is delayed.

So, if you have significantly reduced calories or carbohydrates, are you still unable to lose weight?

Are you unable to lose that last 20 pounds no matter what you try?

Eating a low carbohydrate diet but still hungry and/or tired after meals?

I just may have a solution for you.

Traditionally treatment for hypoglycemia has been to give sugar. Unfortunately, this treatment only provides temporary relief and in very sensitive individuals causes an even greater reaction thirty minutes to two hours later. Although, a strict low carbohydrate diet is helpful, it does not always solve the problem by itself.

In my practice, the Center for Balanced Health, I see individuals with such pronounced hypoglycemia that their blood sugar drops almost immediately after a glucose challenge. It’s the equivalent of filling an automobile with gas only to find that the gas tank has a very large leak.

At the Center for Balanced Health, we help patients manage their hypoglycemia by telling them to:

• Eat five to six small meals a day about every three hours. Think of yourself as a fuel-efficient automobile. You want constant flow of energy (glucose) throughout the day.
• Avoid meals that are too small or too large especially at night. Meals that are too small will not provide enough energy to get you through the day. Meals that are too large place a larger burden on your metabolic system to process these nutrients and thus can trigger a hypoglycemic reaction.
• DON’T skip meals especially breakfast. Breakfast is the most important meal of the day because it sets the tone.
• Balanced eating. Always have some protein and fat at each meal or snack. Avoid and limit foods high in sugar or other refined carbohydrates especially on a empty stomach. Still utilize a controlled carbohydrate approach and get your carbohydrates from foods high in fiber (dark green leafy vegetables, non starchy vegetables, avocado, high fiber low carbohydrate crackers as examples)
• Get a good night’s sleep. Good sleep helps replenish your system so that your body works more efficiently.
• Use of a fiber supplement (make sure you take with enough water) or eating a high fiber food (without refined carbohydrates or sugar) before meals or snacks can help slow the absorption of carbohydrates and thus prevent rapid declines in blood sugar.
• Exercise regularly. Strength training can improve glucose metabolism
• Avoid alcohol, caffeine, tobacco use
• Avoid the use of stimulants

If you suspect hypoglycemia, the best diagnostic test is a glucose tolerance test with insulin levels and an HgbA1c. I usually do this test in my office because a glucose challenge can sometimes precipitate symptoms of low blood sugar. 

Below you will find an excerpt about treatment for depression from the Faculty of Harvard Medical School. First, however, I’d like to convey my strong, immediate reaction to the report.

As I was reading this article, I thought about “The List”…the list of medications I took from 1961 to 1972…Valium being the first of my introductions to mind-altering drugs. I had no idea what they were or the damage they could do…I simply obeyed orders. In those days, you never questioned a doctor’s instructions!

When 10 milligrams of Valium didn’t help my headaches, fatigue or crying spells, the dosage was increased …repeatedly, in fact, over a six-month period. And as other symptoms manifested — depression, insomnia, inner trembling, blurred vision and dizziness — additional medications were added to the mix. Before long I was introduced to Mellaril, Tofranil and then Thorazine.

After years of trying these medications and my symptoms not improving, psychotherapy was suggested. Two of the therapists just changed my medications, but the third suggested a series of treatments that he thought would combat my depression. By 1969, I was so severely depressed that I welcomed any suggested treatment…I was torn between wanting to live and wanting to die.

I did not know that the treatments were electroconvulsive shock therapy! However, once in the hospital, I was not allowed to leave. I was told that I had signed papers for a series of treatment, and that’s what I was going to get. Needless to say, I came home in worse shape than when I went into the hospital. The whole experience was something I kept to myself and didn’t share for years. The shame, embarrassment and humiliation of being labeled a “mental patient” were too heavy a burden to bear.

Fast forward to 1972. My symptoms were stabilizing… or so I thought. I was in church on a Sunday morning when I suddenly passed out while standing. After several of these episodes, I reluctantly went to a doctor in Hollywood, Florida. After looking over my medical history, he said… “With all the tests and treatments you have had over all these years, you never had a Glucose Tolerance Test” (GTT)… so he ordered one. It was only then, ten years after being undiagnosed, misdiagnosed and labeled “crazy” (mostly by me), that I finally had a name for my condition…I had a severe case of functional hypoglycemia, also known as low blood sugar! The cure…a simple diet!

You can read all about this story in detail in my book, The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar. My purpose here today is to caution anyone with depression – especially severe depression that doesn’t go away – before years of medication, psychotherapy or the ECT treatment (that is once again popular) are prescribed…evaluate your dietary habits! What you are (or are not) eating can contribute to how you think, act and feel! Ask your healthcare practitioner to check your blood sugar, thyroid, hormone and insulin levels. Look into allergies and food sensitivities. Leave no stone unturned. The life you save may be your own!

What If My Depression Doesn’t Go Away?

 Content provided by the Faculty of Harvard Medical School

 Excerpted from a Harvard Special Report.

Until doctors have a way to test people ahead of time to see which treatment will work for each individual, finding the right approach is a matter of trial and error. Depending on the severity of the depression and other factors, including your preference, you may start with either psychotherapy or medication, or a combination of the two.

If the first drug you try doesn’t work after four to eight weeks of treatment, your doctor may increase your dosage. If that doesn’t work, he or she may suggest that you switch to another drug in the same class or a drug in a different class. You can try several different antidepressants in sequence until you find one that is most helpful. Your doctor may also recommend adding psychotherapy if that hasn’t been part of your treatment plan.

If you still don’t respond to these therapies, your doctor may prescribe an additional medication, such as lithium or an antipsychotic medication, to be taken with the antidepressant. Depending on the type of symptoms and their severity, the next step may be trying electroconvulsive therapy or light therapy. Newer therapies, such as vagus nerve stimulation or repetitive transcranial magnetic stimulation, are other options for you and your doctor to discuss. Your doctor or mental health professional is also likely to address life circumstances or losses that may be putting pressure on you or a problem with substance abuse that may be getting in the way of your progress.

Having to go through all of these steps may sound discouraging, but finding the treatment that works for you will be worth the effort.

One major study, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, took a close look at how people respond to “real world” treatment, where they try a series of treatments until they find one that works. More than half of the people who participated in the study went into remission after two treatment levels. Overall, 70% of all the people who didn’t withdraw from the study got relief from all their symptoms of depression.

You can improve your chances for successful treatment by taking steps to help yourself, including understanding how to take your medication, discussing your plan in detail with your doctor and abiding by it, and keeping up with therapy appointments

Here’s to your health,

Roberta Ruggiero