“Dr. F.” was a well-respected, prominent psychiatrist who had a serious medical problem which almost ended his medical career. I’m guessing that you, my dear reader, also are threatened by this disease and, therefore, I encourage you to read on with great care to understand the information that follows.
Dr. F. would start his day with two cups of coffee – cream and sugar (three spoonfuls) – with a sweet bun or two, after which he would appear the picture of confidence and robust good health as he headed off to the University to practice his craft. Colleagues who had studied with him and observed his practice over the years held him in the highest regard and his medical students also appreciated the wisdom and insights, which he shared with them during clinical rotations and Grand Rounds. In short, Dr. F. was a great psychiatrist.
Except that a certain small subset of his patients had grown increasingly angry with him and quit requesting his care over the past few months. Some, to the horror of the Department Chairman and the hospital administration, had even talked of suing Dr. F. and the University with which he was associated. What had happened to offend these patients? Sexual impropriety, perhaps, behind closed doors? No. That was not the alleged offense. Had there been repeated violation of doctor patient confidentiality? Not that either. What had so stirred that ire and indignation of this small subset of patients?
The answer has to do with timing. On closer examination, the offended patients all shared one characteristic. They were scheduled to see Dr. F. between 2 and 4 p.m. – the very time the good doctor could not stay awake. His offense: It seems Dr. F. would fall asleep repeatedly sometime around 2:00p.m. and rather than offering brilliant insights and compassion to his suffering patients, his only utterances were gentle snores. In shock, his rightfully insulted patients simply walked out (leaving the good doctor sleeping at his desk) and refused to schedule again. This disease, which may have tugged at your eyelids, too, in afternoons past, is called hypoglycemia or low blood sugar.
What causes hypoglycemia? The answer is hyperinsulinemia (too much insulin for too long) and hypoglucagonemia (too little glucagons). A definition of terms is perhaps in order here: Insulin is the hormone that pulls glucose (blood sugar) out of the blood in order to store it for future energh needs. Glucagon is the antagonistic hormone that mobilizes glycogen (tissue sugar) out of tissues and converts it to the immediate energy source: glucose. So insulin saves up for a rainy day and glucagons spends the stored reserves.
Why does hypoglycemia cause us to sleep? Is the old wisdom true that after a big meal our blood rushes to the stomach to help digestion thereby leaving the brain deprived? Yes, partly true; but, since so much more is known now, let’s look at the events in more detail.
It won’t surprise you to know that the brain, like all other tissues in the body, needs glucose ( a sugar derived from all edible carbohydrates) to survive. What may surprise you is that, whereas other body organs and tissues can store glucose for their own emergency use, the brain cannot.
The heart, for example, can release glucose into its local blood supply to meet sudden changes in metabolic needs. Nifty feature. The brain, though, the crowning feature of our evolution (and our organ for staying awake at appropriate times), lacks this critical ability. It depends upon an appropriate dance of the hormones insulin and glucagons to stay awake. In summary: hyperinsulinemia (high insulin) from a big meal which causes hypoglycemia (low blood sugar) whose resultant hypoxemia (lack of oxygen) puts the brain to sleep.
How does one “catch” hyperinsulinemia and hypoglucagonemia? What has gone amok that, like Dr. F., so many people are pulled under the wings of the Greek god of sleep (Hypnos) after a big meal? What causes the dreaded hyperinsulinemia? Well, that amount of insulin in the blood depends upon three critical variables: the glycemic index of the carbohydrates we eat, the amount of protein/fat we eat, and the degree to which we have worn out our endocrinological system through past dietary indiscretions.
So hypoglycemia puts you to sleep. Is that such a big deal? Is that itself worthy of an entire column? The answers are: “yes” and “yes” because hypoglycemia, itself seemingly benign, presages a calamity of serious illnesses resulting from hyperinsulinemia. These include
Eicosanoid Trouble Again?
So, while Dr. F. sleeps at his desk, let’s see who else is in “eicosanoid trouble”. What other clinical manifestations of hypoglycemia caused by hyperinsulinemia can we spotlight?
Let’s take “kids nowadays”. How would you feel if you were one of the following school-age kids who, because of hyperinsulinemia causing hypoglycemia, were trying to make it through the day with a brain that was suffocating and starved for glucose? If you were a preschooler, would you patiently play and share with other kids? Or would you act out, thrashing in a hyperactive way, preoccupied with the feeling of biological threat in your brain? If the latter is the case, get in line for Ritalin because most people mistake symptoms of hyperinsulinemia’s hypoglycemia for attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). Whereas Ritalin suppresses the symptoms, reducing insulin levels treats the source of the problem.
Now imagine yourself as a junior high scholar whose brain was starving and suffocating. Would you behave well in class, let alone be able to concentrate? Not likely. How about your hypoglycemic hyperinsulinemic high school brain? Would you have indefinite patience to face life’s challenges or would you seek out stimulants and recreational drugs in a misguided effort to jump-start your brain metabolism? How about Mr. H.’s morning cup of coffee, which he needs to start his day? (His wife confided in me that she drinks the rest of the pot after he leaves for work!) How are we to understand the classic American institution of the coffee break and Ms. K.’s three mid-morning doughnuts, without which she can’t make it ‘til lunch. Again, think hyperinsulinemia-causing hypoglycemia.
How to control insulin levels while reducing problems with hypoglycemia? Modify your food intake and alter therefore your body’s myriad hormonal responses to food.
Everyone knows that actions have reactions but we are oblivious to the consequences of our food intake as we are to the fate of the tons of plastic and other waste we fail to recycle each day. Research now shows that the hormonal consequence of our meals are more critical than the medications and supplements we take every day.
Granted, we eat for two primary reasons: pleasure and health. Now, while I won’t belittle the former, let’s look at the latter. What is a meal? It is probably the most significant health-modifying behavior you engage in each day. Probably more important than your vitamins and mineral pills and more important than your medicines. Why is a meal so important? Come with me to
Part of the answer came to me years ago when I was living with the Tibetans in exile in Dharamsala,
Since spiritual appreciation of a meal is beyond the scope of my writing, let’s look, in good old American style, at the mechanics of a meal. What happens to the food we eat? Well, the food is consumed in order to provide nutrients in the form of proteins (for tissue repair and enzyme production), carbohydrates (for energy), and fats (for energy and for physical protection – padding). In the stomach, assuming good digestion (no antacids or dairy and sparse fluids), the food is churned up and digested to the point where nutrients are primed for absorption as they travel through the 22 feet of the small intestine.
As Barry Sears, PhD, points out in his new book, Enter the Zone, the secret of maximal health and longevity is to orchestrate the dance of the eicosanoids. (Hmmm. There’s that strange word again – eicosanoids. Well, don’t bother asking you doctor about it because even though the research on these super hormones began in 1937 and earned the Nobel Prize for Medicine in 1982, most doctors can’t define an eicosanoid. If you don’t believe me, ask yours…. And, yes, 1982 was 20 years ago!)
Eicosanoids are a form of super hormone that, when wisely regulated, can offer long life and health, but, if disregulated, can contribute literally to all forms of serious illness. They are, if you will, the sine qua non of health. They might equate to the Chinese concept of chi or vital energy.
How to optimize our eicosanoid ratio? By controlling insulin levels. How to control insulin levels? We modulate insulin levels through altering the amount and rate of glucose entering our blood stream (blood sugar). The only reliable way to achieve this physiologic goal is to mediate between the two antagonistic endocrine hormones – insulin and glucagons – and the only way to reliably achieve this balance is through the food we eat. Bingo.
Rather than attempt to elucidate the biochemistry of eicosanoids and related paracrine, autocrine, and endocrine hormones here, let me share the principles of eating a balanced meal, which will control your blood sugar levels and facilitate health and weight loss as well as maximizing your brain function. (Imagine staying awake after lunch!) Once you understand these principles, you will appreciate Hippocrates’ oft-quoted dictum: “Let food be your medicine and let medicine be your food.” Indeed, a wise use of food will have more powerful ramifications than any drug for health, fitness, and longevity.
All carbohydrates enter the bloodstream as glucose at different rates, which is termed that particular food’s glycemic index. The physiologic goal is a slow and steady combustion or metabolism of food into glucose, thereby allowing an even level of this critical sugar for bodily functions. Now, if the glycemic index of a consumed carbohydrate is high (meaning rapidly absorbed into the blood) or if too much carbohydrate is eaten, an excessive amount of insulin is secreted by the pancreas and the result is depletion of glucose or low-blood sugar.
This is how the brain starves, and this is why so many kids are hyperactive. What happens to them when they grow up? As adults, they complain of mental fatigue. Making a habit of high-carbohydrate meals without adequate protein and fat will create excess insulin and get you in trouble.
How to mute the response of insulin to carbohydrates? Eat carbohydrates rich in fiber (i.e. the whole carrot, not the juice alone) but, more importantly, eat other foods that lower the rate of absorption of glucose into the bloodstream. These include most proteins (which stimulate glucagons) and mono-unsaturated oils (which lower insulin levels).
To illustrate this problem and a reasonable solution, let’s look at a horrible illness – adult-onset diabetes. With this illness, the patient needs to take insulin shots in order to avoid small-vessel damage, necrosis, gangrene, and amputations. How did this terrible illness occur? Can we assume that since the patient needs to take extra insulin that he is low in insulin? Well, you could, but that would be incorrect. Paradoxically, the opposite is true. The patient has had too much insulin (hyperinsulinemia) for too long. Consequently, the receptor cells for insulin have been overwhelmed and have shut down becoming “insulin resistant”.
At this point of insulin resistant/dependent diabetes mellitus, we have a particularly lethal state of hyperinsulinemia, which disregulates eicosanoids and accelerates our risk of suffering from many degenerative diseases including cardiovascular and auto-immune problems to say nothing of obesity and the embarrassment of falling asleep after meals.
The Long Haul
How to live long and prosper? Learn to maximize your eicosanoid balance by blunting your insulin activity and enhancing your glucagons performance. Insulin and glucagons are your keys to health. If you plan on living a healthy and long life, you had better learn how to manage these antagonistic hormones. “But how?” you ask. My answer is to avoid the current fad in dieting: high carbohydrate and low protein meals. See in the light of hyperinsulinemia (from high carbos) and hypoglucagonemia (from low protein) you now understand how this diet imparts a double whammy since the excess carbohydrates release excess insulin, but the low protein amount is inadequate to stimulate glucagons release.
Who among us mismanages the dance of the hormones? Those who crave sweets and suffer the rollercoaster of high glycemic carbohydrate craving (bread, pasta, rice, chips). You know who you are….
In summary, if you fall asleep after meals, feel groggy, or crave carbohydrates, if you have a compelling sweet tooth or have trouble losing weight, then you are suffering to some degree from hyperinsulinemia induced hypoglycemia. If so, the worst of your problems is not falling asleep on the job. Fear more the ravages of myriad prematurely debilitating illnesses and accelerated aging.
Time to despair? No! The control is in you hands. To be precise, the control is in what your hands put into you mouth every day. Your food is your medicine. It is the only means you have to effect your eicosanoid performance, which is your key to health. So what’s for lunch? Shun starches in the form of grains (pastas, breads), eat lots of fresh veggies and fruits, and take lean protein and unsaturated oils in amounts adequate to lower the glycemic index of the foods you eat. Try it. You’ll like it!