Before I get back to my review of Mindless Eating, I want to share a personal experience.
In one of the Protein Power books (I forget which), Michael and Mary Dan Eades describe how primitive humans would’ve had only one source of concentrated carbohydrate - the occasional lucky find of a honey tree. They hypothesize that a hunter-gatherer stumbling on a honey tree would have sent signals to all the other members of the band, and pretty soon there’d be a honey party until every last bit of sticky, sweet, gooey honey was gone.
In honor of our human heritage, they suggest that we modern humans might allow ourselves to indulge in sugary goodness, occasionally. Occasionally here is key. Think about how often our hunter-gatherer ancestors might have run across honey. Hint: it’s not “daily.”
Well, all I can tell you is, if you’re going to raid the honey tree, be careful, because it can sting you.
I don’t know what got into me last night, but on my way out of the office I passed a candy dish full of Hershey’s Nuggets. I have walked by that candy dish with complete disinterest every day for months, but yesterday was different. I ate one, went back to my office to turn off my computer, went back for another, put on my coat and gloves, went back for another … you get the picture. I think the total was five.
On the subway, I thought, “I really should not have done that.” On the other hand, since my doctor refuses to order a glucose tolerance test, I thought that I could turn this moment to my advantage by actually testing my blood sugar (I bought a glucometer a while ago) to see just how high a little carb binge could drive my blood sugar. It takes me about 45 minutes to 1 hour to get home, depending on the condition of the winter sidewalks, so I figured I’d be getting home at my blood sugar peak.
One hour later I stuck my finger and waited. Blood sugar reading: 57. (For comparison, a healthy fasting blood sugar is around 85.) This was not what I was expecting - I figured the reading would be sky high, not low. Clearly, though, it was time to eat something.
I immediately went to the kitchen and started heating up leftovers (my husband was eating dinner at the office, poor guy). Ten minutes later, I broke out into a cold sweat and started shaking. Back in the bathroom, the glucometer read 41.
If you are not familiar with diabetes - a blood glucose of 41 constitutes a medical emergency. I was in danger of passing out, alone in my house. The only treatment for this is to consume some fast-acting carbohydrates, fast.
I made a beeline back to the kitchen and started consuming whatever sugar I could find. And folks, I’m low-carb woman, so it’s not much. I had a few swigs of my husband’s Coke (yuck! it’s been at least a decade since I drank regular Coke), a few sips of his milk, and two low-sugar cookies I made last week from a recipe on Anna’s blog. I was about to start eating sugar straight from the jar when I noticed that the cold sweat was dissipating and the shakes were going away. I then ate a normal, low-carb dinner - leftover slow-cooked turkey in chipotle pepper sauce, with plenty of Monterey jack and Greek yogurt (in place of sour cream).
The good news is, apparently I am not diabetic yet - clearly my pancreas knows how to produce insulin, and lots of it! But I have to wonder, just how high did those 5 chocolate candies initially drive my blood sugar? It must have been pretty high to cause my pancreas to pump out enough insulin to drive my blood sugar down to 41 in a matter of 1 hour and 10 minutes.
The other thing is, I felt terrible for the rest of the evening, nauseated and sort of foggy. I am surprised that, Inderal notwithstanding, I didn’t come down with a migraine, too - skipping meals, with the resulting low blood sugar, was one of only two reliable migraine triggers I uncovered before Inderal set me straight. (The other was lack of sleep.)
The whole experience confirmed, quantitatively, what I’ve known qualitatively for years. My glucose tolerance is terribly impaired. I may not be diabetic yet, but if I had continued to eat the carb-laden diet recommended by most authorities, I guarantee you my poor pancreas would’ve worn itself out, and by now I’d be jabbing myself with insulin several times a day. This is why I do not think it is an exaggeration to say that Gary Taubes’s landmark article in the New York Times magazine saved my life.
Migraine aura picture from 
Glad to hear you didn’t pass out. It doesn’t feel good that low, does it? And sometimes these experiences are far more instructive to us than reading about what happens. Once you recongnized the signs, it’s easier to avoid the situations that trigger them. I’ll bet you think twice about having even the first chocolate if you are considering a “honey day” again. I figured those Honey days didn’t apply to those of us who already have impaired glucose metabolisms. Or I will go for a couple of my homemade dark chocolate truffles, which are far less dangerous or likely to trigger a reactive hypo. I try to make sure anything that I might have as a sugary indulgence, is consumed after a full meal or with enough fat and/or protein, because high sugar on its own is quicksand.
Check out What They Don’t Tell You About Diabetes website for more on these kinds of hypos and reactive hypos.
People look at me like I have two heads when I say something about how dangerous a lot of sugar is, especially on an empty stomach, but from this perspective, how can we not see it as a trigger to avoid?
Those glucose meters are very instructive, aren’t they? I had a similar experience when I was 8-9 months pregnant. Went out for a long circular walk after dinner with my husband to return a video. It’s only slightly uphill on the way back (not even noticable in a car), but I was starting to feel awful. I thought my poor husband would have to carry me. I made it home but was trembling, dizzy, and rubbery. I asked my husband to take a glucose reading first and it was really low, somewhere around 50. I drank an 8 oz glass of orange juice and not long after that I had a very high glucose level, close to 200. So you don’t need many fast acting carbs to get your glucose back up. What you don’t want to do is overconsume and go on a glucose roller coaster, which I think you’ve figured out now.
Jenny at Diabetes Update and Dr. Bernstein indicated that those little Smarties and SweetTarts candies have about 5 gm of dextrose (glucose) in each tablet, and if I rememer right, they will raise BG about 10 mg on average. So just 3-4 of those tablets would have had you in good shape very quickly. They are convenient to keep in a purse, glovebox, etc. But a bite or two of something sweet or starchy would work, too. Just not a whole bowl or serving. I saved some Smarties & SweetTarts that came in my son’s Halloween “loot”. Btw, Jenny’s diabetes site also has info about doing your own informal GTT at home with a meter. I used TJ’s version of Cheerios and milk, to equal 75 gms of sugar. I got a peak of 275 and then went too low. Worst readings from any food I have tested, so far.
I had a 51 hypo about 4.5 hours after the start of my 3hrGTT. I was home from the lab by then, making lunch (a ribeye and a big salad) when I started to get jittery and strange feeling. I wanted to last 5 hours before eating so I could keep testing for glucose data, but I also was a bit worried I would pass out and I was alone. So I ate my ribeye and salad and that was enough to come out of it, but not go too high with the glucose. It was fast enough. But I think the tendency is to look for a bagel or a sugary item and that is overdoing it.
Comment by Anna — December 20, 2007 @ 12:12 pm
The lesson is eat protein with (before) your small dietary indiscretion to slow the BG rise. The faster it rises the faster it will drop and it is probably the speed of the drop that makes you feel so bad. People diagnosed with type 2 diabetes may be making as much as 5 times the normal amount of insulin with half the normal number of ß-cells, it just isn’t enough to overcome the insulin resistance. Hyperinsulinemia just exacerbates the resistance.
If you are on insulin or a ß-cell stimulator, amaryl, glipizide, etc. you could pass out and die from a low. If you aren’t, even if you black out you will not die. Your liver will make enough glucose to bring your BG back up, even if it has to break down muscle to get the protein for that. You will still feel like shit, though.
I find 2 grams dextrose (5 Smarties) and a few minutes rest is usually enough to make me feel better.
Even people on insulin (and the high carb exchange diet) are supposed to eat 15g carb and wait 15 minutes, retest and then decide if they need more. If they are back to normal they are instructed to eat a small amount of protein and some slower carb to prevent another drop.
Reactive hypoglycemia like you experienced is often a precursor of diabetes. It can still happen after a diabetes diagnosis because the criteria is high BG levels, not low insulin levels.
Comment by nonegiven — December 20, 2007 @ 6:57 pm
Beta-blockers (Inderal) can mess with your blood sugar. They also mask or delay the symptoms of hypoglycemia, and impair the body’s normal corrective response to low blood sugar. You were very wise to treat the hypo.
Comment by Jen — December 20, 2007 @ 10:37 pm
Thank you all - everything you’ve said has been most informative. Now that I know how little carb is required to treat a reactive hypo incident, I’m glad I didn’t actually have much in the house in the way of carbs. I probably would’ve overdone it. When I tested my BG at bedtime last night, it was 122. Higher than I like, but it could’ve been a lot worse if I’d overindulged in carbs.
I won’t be doing this again for a very long time. Like, hopefully, never. I feel nauseated just thinking about it.
Jen - I’d forgotten that Inderal can mask hypo. That raises an interesting philosophical question. Since skipping meals is a migraine trigger, and Inderal has my migraines under control, I wonder if migraine could be considerd a symptom of hypoglycemia. I know that many migraine sufferers are too nauseated to eat, but I often found that eating actually made me feel a bit better. (Skipping breakfast was the worst.) Also, it seems Larry McCleary says in The Brain Trust that the way a ketogenic diet works is by giving your brain an alternate source of fuel so it doesn’t need to be affected by changes in the blood sugar level. I really hate taking this drug, but my migraines were so disabling I’m afraid to stop, too.
And I would hate to become one of those people whose hypo is asymptomatic. My mother was one of those - my siblings who lived across town from her would call her several times a day, because she had passed out several times from hypo.
Comment by psipsina — December 21, 2007 @ 12:07 am
I’m lucky that I don’t get hypo reactions. But I do get unbelievable cravings! I drop low enough to trigger cravings, but not enough to be otherwise symptomatic.
The longer I stay on plan the easier it is to stay on plan….but a trip to the honey tree is a dangerous thing if I’m not in a “good place”.
Comment by Cindy Moore — December 21, 2007 @ 1:31 am
I’m postmenopausal and have prediabetes and migraine. I generally follow a low-carb diet, but struggle to stick to it. Luckily my migraines are infrequent and mild, though usually heralded by spectacular auras. On several occasions I measured my blood sugar at the first hint of an aura. The first time I thought to do this, it was 67. Aha, I thought — these pesky migraines are triggered by a sudden drop in blood sugar. However, every other time it was 90-100, as it usually is. And, of course, other dips in blood sugar have *not* been followed by migraines.
The McCleary book is most interesting. Once or twice it has appeared that I was able to abort a migraine by eating sugar, which makes sense in light of his “brownout” idea — but then that quit working. My attempts to follow a ketogenic diet seem to provoke more frequent migraines — or maybe it’s the new plasma TV, or MSG in the ranch dressing. Migraine remains a huge mystery to me. Just when I think I’ve discerned a pattern, it changes.
Inderal is a reasonably safe drug with a long track record, and it’s obviously helped you enormously. If I had disabling migraines that were largely prevented by Inderal I’d be extremely reluctant to stop it, but I’d keep in mind that long-term use of beta blockers and thiazide diuretics appears to be associated with a slight increase in risk of developing diabetes. This association was noted in prospective studies of people taking different types of medication for high blood pressure.
http://www.medscape.com/viewarticle/531877
Comment by Jen — December 21, 2007 @ 12:37 pm
Sheesh, my husband IS diabetic and he doesn’t EVER react like that! Even after ice cream… he just gets a little sleepy!
Comment by Queen B — December 21, 2007 @ 6:11 pm
Thank you for linking to that cookie recipe. Holy Mother, that recipe is dangerous for me to know! I replaced the sugar in it with splenda and they were still golden, brown, and delicious.
It’s going to be hard not to eat them all before Christmas.
If it helps, know that almost going into a diabetic coma had the side effect of making one coconut-loving family in Indiana extremely happy. I’ve been trying to find a decent low-carb cookie recipe for two months and have failed every time. Hope your family has a great holiday.
And stay away from that nasty sugar. The world needs your articulate and fiery voice sticking it to the dietary status-quo, not in a diabetic coma.
Comment by nightwitch — December 24, 2007 @ 12:04 am
Jen - migraine is a bitch. I personally subscribe to the “whole complex of diseases with similar symptoms” theory, because after 6 months of following many, many migraine blogs, it’s clear to me that what works for one person fails miserably for another.
Nightwitch - glad you liked the cookie recipe. I hope you commented on it on Anna’s blog, too, since it’s her recipe. Like you, I think most low-carb cookies are dreadful, but these are practically indistinguishable from the “real” thing.
Comment by psipsina — December 24, 2007 @ 9:59 am
[...] there was anything good about my little incident with the Hershey’s Nuggets, it’s that I am finding it almost ridiculously easy to pass on the sugary Christmas treats. [...]
Pingback by Happy Holidays! « The Migraineur — December 24, 2007 @ 10:24 am
Well, at least you didn’t catch a bad cold like I did the last time I ate too much sugar
You may have read on Barry Groves’ web site that sugar depresses your immune system - 100 g ingested causes a 40% decrease in white blood cell functioning. About two years ago I started changing my diet. I attribute not getting any colds the winter of 2006-2007 to adding high vitamin cod liver oil and kefir. But in late April 2007, after my daughter’s team won their soccer game, we decided to go to Dairy Queen for a treat. We hadn’t done this in quite a while. I ordered a Chocolate Extreme blizzard, figuring that wouldn’t be too terribly bad. But I didn’t count on my daughter’s friend accidentally taking a bite out of my wife’s sundae. My wife wouldn’t eat it, so good old me, not liking to waste food, ate that too. And then my daughter didn’t eat much of her sundae - so garbage disposal me to the rescue! Needless to say the rest of the evening I didn’t feel the greatest and regretted my indiscretion. I looked up the amount of sugar that I had just eaten - about 150 grams! Maybe it was just coincidence, but about three days later I came down with a bad cold that lasted two weeks! Not even CLO and kefir could save me. Since then I have come to the conclusion that refined sugar is truly a toxin
Comment by Bryan-oz4caster — January 15, 2008 @ 7:20 pm
Brian - well, how about that? I did catch a contagious disease not long after writing this. I wonder how long the immunosuppressant effect lasts. Do you know? I had my little sugar binge on December 19; on December 26 I came down with stomach flu. On December 28, my husband came down with it, suggesting an incubation period of about 48 hours, which means I would’ve been exposed to the flu around December 24, or 5 days after consuming a lot of sugar.
Then again, my husband read some research that suggested that stomach flu is so incredibly virulent that if you’re exposed to it, you’re almost guaranteed to get it, regardless of how strong your immune system is. (Unless, of course, you’ve already had it.) I don’t know if this is true.
Comment by psipsina — January 16, 2008 @ 12:27 pm
I’m a low-carb diabetic.
You should consider yourself a diabetic. I don’t mean this in any way to be harsh, it’s not. This advice could save your life. Whatever you do, don’t follow the ADA dietary guidelines, just keep on doing low-carb. I have amazing control from low-carb: HgbA1c = 4.5.
If you start to treat yourself as a diabetic now you will be healthier for it later on. I don’t know if you’ve read Bernstein’s Diabetes Solution or not but if not, I strongly encourage you to read it now.
I developed reactive hypoglycemia about three or four years before I was diagnosed as a diabetic. Some people develop it much longer before becoming diabetic. Whatever the case, take it as a fortunate warning sign. Say to yourself “I am a diabetic.”
I encourage you to perform your own Glucose Tolerance Test (GTT) as one of the other posters suggested. That way you will be able to refer to it in the future to see how your diabetes is progressing.
Here are my tips. They have some adaptation because of your reactive hypoglycemia(RH).
1) Make sure that you have another person present during the test. Instruct them what to do if your blood sugar goes low, or if you become unresponsive, irrational, etc.
2) Prepare your glucose solution. Although you could use a substitute, don’t. You’re going to all this trouble, why not have something that you can show to your doctor, etc. Use glucose tablets(usually in the form of dextrose). You can purchase a good sized bottle of glucose tables at WalMart for just a few bucks. Dissolve about 75 grams of glucose in a glass of water. It would require 19 of the walmart tablets. I actually used 20 tables and then filtered the water through a coffee filter. The tablets are flavored so drinking it will be no problem. Make sure you have at least 15 of the tablets on hand for when your sugar goes low. Note that you won’t use all 15 tablets when you go low, just have them on hand.
3) Make sure that you have enough strips on hand. I don’t know what brand meter you use, but the walmart brand costs about half the cost of the other strips. I pay around $44.00 for 100 strips. I use more strips than would be done in a doctor’s office. The reason for that is that your blood sugar can really change quickly and it’s easy to miss the peak if you aren’t testing often.
4) You will take a baseline reading. It’s best to start exactly at the beginning of an hour to make timekeeping easier. Suppose you start at 9:00 AM. Take your blood sugar reading at exactly 9:00 AM then drink your glucose solution. Note that for the first reading you will want to wash your hands three or four times since you’ve been handling glucose. Note also that Bernstein suggests that you don’t need to change your lancet every time you test. I used to change for every test, but since reading this I only change it once per month and it works fine. Bernstein says he’s never had a case of anyone getting an infection from not changing the lancet after every test. Of course if anyone else will use your lancing device then you need to change the lancet after each use.
5) For the first two hours I suggest that you test every 10 minutes. I know it seems like a lot, but if you don’t you can miss the peak by a lot. If you just can’t bring yourself to test every 10 minutes then you really need to test at least every 15 minutes, but 10 minutes is much better.
If you haven’t reached your glucose peak by two hours, continue testing every 10 minutes until you reach your peak. You’ll know when you’ve reached your peak because your blood sugar should start coming down fairly rapidly once you’ve hit your peak.
6) For hours two through four you can test every 20 minutes. If you choose to go beyond four hours then you can test every 30 minutes.
7) You can stop the test before you go low, or continue it and let yourself go low. If you decide to continue the test and let yourself go low, then once you start going low (either by your symptoms or by the indication on your meter) then you should start to test every 10 minutes once you start going low.
9) You should eat a normal (low-carb) meal as soon as practical.
You will be considered to have impaired glucose tolerance if your highest reading is above 140 mg/dL. You are considered a diabetic if your highest reading is above 200 mg/dL. In reality, you are probably a diabetic at some number below 200mg/dL.
Remember that the levels of FASTING glucose levels that are considered to be diagnostic for diabetes are different from one country to another. In the US, you are a diabetic if your fasting glucose > 126 mg/dL. In Europe the number is > 110 mg/dL, and in Autralia the number is > 99 mg/DL. Your good health dictates that you use the lowest number.
This is just a technical note, but Glucose Tolerance Tests don’t work exactly right on people who are on low-carb diets. The results you get from this will be close enough for your purposes however.
Comment by itsme — February 9, 2008 @ 12:18 am