During my second appointment with my metabolic doctor, we reviewed the results of my blood work. Every three months, she has me do a 0-30-60-90 blood test: I come in fasting, they draw blood, I eat a balanced meal, and then they draw my blood every 30 minutes thereafter, up to the 90 minute mark (or sometimes up to 120). A few weeks later I go in for a follow up where she shows you an analysis of the bloodwork data, often accompanied by charts and graphs so I can see my progress over time.
She measures a variety of things, including cholesterol, TSH (thyroid stimulating hormone), ACTH, MSH, cortisol (a stress hormone), glucose, and insulin in the first blood draw. Each subsequent blood draw just monitors glucose and insulin. Here’s what some of my glucose numbers looked like over time during one lab:
0 minutes – 85
30 minutes – 56 LOW
60 minutes – 66
90 minutes – 85
Whoa, wait a second. What’s happening here? The 0 minute mark was before I ate, and that looks normal enough. But after I ate my breakfast, my blood sugar dropped to 56, and didn’t recover to its original levels until 90 minutes later. But… after eating, isn’t my blood sugar supposed to go up? That’s the point, right, to digest food and send the energy, in the form of glucose, to the brain and muscles?
I didn’t even know it was possible for your blood sugar to go down after eating. I thought that only happened if you waited too long in between meals – you know, when people claim they’re hangry because they have low blood sugar. Yet, in another blood test, my blood sugar got as low as 45. This is very dangerous. As you dip below the 40 mark, low blood sugar can cause fainting, seizures, coma, and even death.
Thus, it was during my first consultation that I learned that in addition to my leptin, MSH, and ACTH all being out of whack, I also had a blood sugar problem, and that, yes, this was also most likely the result of over-dieting, over-exercising, and under-fueling my workouts – particularly by eating low-carb. In medical contexts, this would be referred to as “reactive hypoglycemia“. The medical literature discusses this as a symptom of eating high carbohydrate meals, yet I was just eating a balanced meal, with a mixture of healthy protein, fat, and carbohydrates. For example, as a meal during my blood draw days I’d bring in Greek yogurt with almonds and fruit, or have oatmeal and scrambled eggs. You know, normal food – even healthy food!
Yet, instead of doing the right thing and releasing sugar into my bloodstream when I ate, my body was essentially overreacting and suppressing the sugar from ever getting out in high enough levels to do things like help me feel sated or energized after eating. It did this by releasing too much insulin, which in turn can cause insulin resistance, which in turn can lead to diabetes. A low carb diet is what led me down this path, and yet, ironically enough, there are sites out there that claim “reactive hypoglycemia” is cured by low-carb diets. Yikes! Though, to be fair, I’d be skeptical of trusting a website like “why-low-carb-diets-work.com” compared to, well, a doctor.
In any case, the result was that after nearly any meal, I would feel more hungry than before, like there was a bottomless pit in my stomach that couldn’t be filled, no matter how much I ate. I frequently got headaches or felt sick after eating. I might even feel tired, distracted, or anxious. On top of all this, I was gaining weight pretty much uncontrollably. All of these, as it so happens, are side effects of hypoglycemia.
I went on medication to slowly but surely try to reverse the damage. Specifically, for hypoglycemia I inject a medication 30 minutes before eating, which prevents my blood sugar from dropping and slows the progress of food through my digestive tract. One of the most drastic, immediate differences was the change in satiety after eating. Before, I’d never quite felt satisfied at the end of a meal. At best, I never really felt full; at worst, I’d have massive sugar cravings, especially while on the low carb diet. Sometimes I even had the weird parallel sensation of being both full and hungry at the same time – I could feel that my stomach was full, yet it somehow also felt like a void, a gaping chasm that could never be filled, yet eating more just made me feel worse than before.
After I began taking medication, everything changed. I got full quite quickly, and when I was full, I was completely satisfied. No sugar cravings, no intense feelings of “something missing” at the end of a meal. In fact, after eating a small meal I was absolutely disinterested in food until I got hungry again. If I wanted dessert, I often had to wait at least an hour after eating, because it also took much longer to become hungry again. Sweets could sit right next to me and I wouldn’t be interested in taking a single bite until an hour or two after dinner. I no longer felt compelled to eat everything on my plate (and then some), because the feeling of fullness was so complete (and could be so uncomfortable) that I could simply push the plate away and be done with it.
If you’ve ever gone on medication for something like depression or anxiety, you might know the feeling of emerging from a mental fog, suddenly understanding that you don’t have to feel that way all the time, and that it doesn’t have to be your status quo. Much like this, I discovered that it isn’t normal to feel tired, sick, or hungry after eating. I realized what true hunger signals and fullness actually feel like. Hypoglycemia and my body’s “starvation mode” response to dieting had obfuscated those signals, to the extent where my brain and my stomach couldn’t agree on whether I was hungry or full.
Ultimately, the goal is that through balanced eating and medication, my body will ultimately be able to regulate its blood sugar on its own again. Fixing my diet-induced metabolic issues is like peeling back the layers of an onion. First we have to fix my blood sugar, then my MSH/ACTH/Leptin issues, and after that there will most likely be some sort of other hormonal imbalance to fix. Fixing each level reveals a new problem underneath that requires correction.
And, yet, I feel a sense of peace now that I didn’t before, not since I was controlling my diet and exercise regimen with an iron fist. I understand what’s going on, I’m getting treatment, and I’m not spiraling out of control.