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ARTICLES

Blood Sugar Problems & The Metabolism: Is it the Thyroid?

Tobias McGowan

       The foundation for optimizing and controlling our blood sugar is not always as simple as it seems. Most individuals are simply addressing the symptoms of blood sugar fluctuations, assuming that cutting carbohydrates or choosing low glycemic foods will solve everything. However, if you have metabolic issues, you may be merely treating the symptoms and not getting to the root cause. Complications with any part of the thyroid cascade can alter the body’s ability to metabolize, transport and manage blood sugar effectively. Thyroid function is highly correlated with the blood sugar and your capacity to optimize health. Therefore, if the metabolism is not functioning properly, blood sugar complications will likely arise.   

 

 

THYROID FUNCTION & THE METABOLISM

       The primary glands and organs that are responsible for blood sugar regulation can easily be altered by the thyroid system. If the thyroid system and the cascade are working properly, there should be adequate hormonal production, hormone conversion (T4 to T3), and cellular activation. With this criteria, the thyroid system will allow the body to: consume and utilize oxygen, produce energy and regulate the metabolic rate in the body’s trillions of cells. The thyroid’s global impact on almost every cell in our body has major implications for blood sugar management. Therefore, hypothyroidism  or hypo-metabolic conditions can inhibit each component and essential organ related to balancing blood sugar. The major organs that will be affected are the liver, the digestive tract, the pancreas, and the adrenals.

 

A SLUGGISH LIVER

       Remember, the liver serves to store and manufacture glucose, which regulates energy and blood sugar levels. The regulation of sugar is a delicate process that can be easily thrown off balance if the liver is overloaded and sluggish. During hypothyroidism, “There is considerable congestion of the liver, the hepatic (liver) cells secrete badly, while the canaliculi (tubular canals running between the liver cells) are compressed.” [1]. When the liver is sluggish, glycogen (stored glucose) liberation into free glucose is slowed. Thus, the body does not get glucose for energy in a timely manner. This can lead to a state of low blood sugar, also known as hypoglycemia. The body will interpret this as a major stressor and believe that energy is needed for survival, especially for the brain and central nervous system. In response to this hypoglycemia the body will secrete cortisol and adrenaline (stress hormones) to mobilize blood sugar from the liver and glycogen reserves.

       Oppositely, glucose storage to form and replenish glycogen is also slowed down. This decrease in glycogen formation will decrease glucose uptake, and also slows the insulin response. This will lead to high blood glucose in the circulation, also known as hyperglycemia. This cascade can alter the feedback to the pancreas, causing an overcompensation of insulin secretion in an attempt to rapidly bring blood sugar back down, but this can also lead to hyperinsulinemia. Unfortunately, insulin clearance in the circulation is also slowed, which can drop blood sugar levels too low and can throw the body in the opposite direction into hypoglycemia. Hypo/hyper states are problematic in so many different ways, and should be addressed immediately.

       These blood sugar fluctuations will place more pressure on the already sluggish liver, which will down regulate its capacity to perform other functions. The liver is the major site for thyroid hormone conversion. Therefore, the liver will decrease T4 to T3 (T3 being the more active hormone) conversion, and also increase T4 conversion into reverse T3 (the inactive hormone). These complications will slow down the thyroid function, decrease the metabolism, and further slow down the liver. Not a cycle our body wants any part of. The liver is usually slow due to hypothyroidism. 

 

DECREASED DIGESTIVE FUNCTION

       If the metabolic rate slows due to thyroid complications the digestive system will also slow, which will lead to multiple problems for blood sugar regulation. To keep things simple, I will only touch on a few digestive concepts and will keep the emphasis on blood sugar. The main issues that arise include a decrease in stomach acid (HCL) and digestive enzymes at large. When hydrochloric acid is lacking, the stomach will struggle to properly digest and denature certain nutrients, especially proteins. Low stomach acid will also down regulate chemical messengers necessary for signaling other crucial organs that are involved in the digestive process. Digestive enzymes facilitate the breakdown of nutrients to a single molecular level, which is required for nutrients to be absorbed into the intestinal wall. Therefore, decreased levels of enzymes can inhibit nutrient absorption and eventually impact energy production. If we do not have sufficient stomach acid and enzymes the system will suffer greatly. It should be noted that excessive stress can also decrease digestive function, and it is a major contributing factor to hypothyroidism. 

       Digestive complications will decrease glucose absorption in the gastrointestinal (GI) tract, slow insulin secretion and clearance, and slow glucose uptake into the cell. These problems will lead to altered blood glucose levels. The possible high glucose in the bloodstream will create cross-linking with proteins, and if this persists, will lead to Advanced Glycation End-products (AGEs). The hyperglycemic state will force the pancreas to compensate by secreting more insulin, and remember insulin clearance is already slow, which will lead to hyperinsulinemia. Since glucose absorption is slow the body can also shift the other way into low circulating blood glucose, and the body can experience hypoglycemia. As mentioned above, this will create a stress response, which requires cortisol, adrenaline, and glucagon for the mobilization of blood sugar.

 

THE PANCREAS & PANCREATITIS

       A low metabolic state will change carbohydrate/sugar metabolism and can easily overload the pancreas and lead to pancreatitis. First off, enzyme levels will be altered, due to digestive dysfunction (as mentioned above) and low body temperature (from the low metabolic state). Most enzymes are temperature sensitive, and thus hypothyroidism can change enzyme levels. The pancreas will strive to compensate, which can lead to altered serum amylase (the major carbohydrate enzyme) levels, which usually marks pancreatitis. The enzymatic changes will slow carbohydrate metabolism. Glucose absorption into the GI tract is also slowed. Furthermore, insulin and glucagon levels will be on high demand due to the sluggish liver and digestive function. All these compounding factors will cause inflammation, pancreatitis, and then lead to pancreatic insufficiency.

       Pancreatic insufficiency will decrease necessary sodium bicarbonate, proteolytic enzymes, and insulin. The decreased sodium bicarbonate will not properly neutralize the acidic food matter entering the duodenum, which will contribute to metabolic acidosis. The lack of proteolytic enzymes will decrease amino acid break down and lead to amino acid deficiencies, which is what insulin is manufactured from. Finally, the decrease in insulin will wreak havoc on the blood sugar [3].

 

OVERLOADED ADRENALS

       The body is not designed to go through extreme highs and lows when regulating blood sugar. These conditions have serious repercussions, and place a serious demand on the adrenal glands and the body. If the body is constantly undergoing hypoglycemic states the adrenal glands will have to secrete progressively more cortisol and adrenaline, to mobilize blood sugar for energy demands. When a low metabolic state is causing altered blood sugar levels and increased stress hormones, the adrenals will become over-stimulated and can atrophy. Excessive demand on the adrenals can lower cortisol levels, which can create a whole new set of problems. Interestingly, the adrenal cascade (HPA axis) and the thyroid cascade (HPT axis) both involve the hypothalamus and the pituitary, which explains how one system can affect the other and vise versa. The excessive stress will also increase estrogen, while decreasing progesterone. Progesterone assists in stimulating TPO (thyroid peroxidase), which is necessary for hormone production and activating the metabolism. Therefore, the burden that is placed on the adrenal glands and the hormonal system can make matters much worse.

 

HYPOTHYROIDISM & THE BLOOD SUGAR

       Below is a chart outlining the possible complications that can arise. In the case of hypothyroidism or a low metabolism, the liver, the pancreas, and GI tract will be affected. 

 

       It is important to remember that each person is metabolically different and my chart above clearly doesn’t encompass every case. If anyone is dealing with these issues, identifying and changing specific nutrition and lifestyle factors can usually be of great benefit.     

 

REFERENCE

1. Hetoreghe, E. Thyroid Deficiency. Lecture presented to the International Surgical Congress at the New York Polyclinic School and Hospital, New York, NY. International Clinic Week. April 1914 (Brodabarnes.org)

2. Starr, M. (2005). Hypothyroidism Type 2. Columbia, MO: Mark Starr Trust.

3. Langer, S. & Scheer, J. F. (2006). Solved: The Riddle of Illness. New York, NY: McGraw-Hill.

4. Widmaier, E. P., Hershel, R., Strang, K. T. (2008). Vander’s Human Physiology: The Mechanishms of the Body Function (11th Ed.). New York, NY: McGraw Hill


Water: A Refreshing School of Thought

Somya Sahay

Water is a highly undervalued nutrient. In a world of powerful pharmaceutical drugs, workout-enhancing supplements, miracle herbs, and super foods, water gets the cold shoulder. After all, there aren’t many who would financially benefit from you spending a few cents on a glass of water—it just isn’t that profitable. Unfortunately, this is why it isn’t marketed very well or studied for that matter. 

So, why is water THAT important? What happens when you don’t drink enough? To start off, our bodies are made up of ~75% water! Even more impressive, our brain tissues are estimated to be ~85% water!1 It is a major life-giving and sustaining molecule and should never be under-looked. 

Primary Roles of Water:

-Aids in the regulation of body temperature

-Lubricates joints (i.e. synovial fluid, articular cartilage)

-Provides structural support (Cells, intervertebral discs, etc.)

-Water is a transport medium to send chemical messages.

-Acts as a shock absorber (i.e. Intervertebral discs, synovial fluid)

-Creates hydroelectric energy through energy-generating pumps

-Plays an essential role in metabolism

Water plays a role in every system of our body, whether directly or indirectly. A lack of water, therefore, can lead to anything from weight gain, to alzheimer’s, to arthritis, to hypertension, to hormone imbalances, etc.

While discussing all the possible diseases in detail is equally important, I will only mention the most common ones that need to be addressed, with a fresher school of thought. The three I will be discussing are: Rheumatoid Arthritis, Dyspepsia, and Hypertension. 

**Note: All examples are discussed from a dehydration standpoint only—conditions can be caused from a combination of other health & lifestyle factors.** 

RHEUMATOID ARTHRITIS/JOINT PAIN

According to Dr. Batmanghelidj, in his book, Your Body’s Many Cries for Water, “50 million Americans suffer from some form of arthritis, 30 million people suffer from low back pain,…and 200,000 children are affected by the juvenile form of arthritis.”

Rheumatoid Arthritis is a chronic inflammatory disease of the joints. In order to understand the role of water in joint health, we must have a basic understanding of joint structure first. 

All Synovial (highly moveable) Joints have the following components:

  • Articular capsule
  • Articular cartilage
  • Synovial membrane
  • Joint cavity (which contains Synovial Fluid)
  • Sensory nerves and blood vessels
  • Accessory structures

Articular (Joint) Capsule-Made up of dense fibrous connective tissue, the articular capsule surrounds the joint cavity, providing a protective seal. It also functions as an active/passive stability mechanism.

Articular Cartilage-Articular cartilage is a matrix of cartilage cells that covers the bony surfaces of joints, protecting it from damage.

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Synovial Membrane-Lining the inside of the joint (except for the articular cartilage), the synovial membrane produces synovial fluid, which fills the joint cavity.

Synovial Fluid-Synovial fluid provides lubrication for joint movement, acts as a shock absorber, and is a medium for both nourishing the cartilage cells (Chondrocytes) and disposing of waste. The circulation of synovial fluid in and out of the articular cartilage is driven by joint movement. 

Accessory Structures-Structures that support the integrity and function of the joint. These include, but are not limited to, ligaments, tendons, and bursae. (Will not be discussed in this article)

When in a dehydrated state, your body triggers a rationing system because it cannot keep all systems functioning optimally. To compensate for a reduction in fluids, the body closes capillaries that supply blood/nutrients to various tissues based on a priority system. This redirects water to the more vital organs (i.e. brain, heart, liver, etc.). Unfortunately for joints, the rationing system puts them low on the priority list. People can survive with a frozen shoulder or an inflamed knee, but good luck trying to survive without your brain!

Without adequate nutrition and hydration, the articular cartilage deteriorates to the point where the bony surfaces of the joint are exposed. The grinding of these surfaces are too much for the body to handle. The rate at which bone cells are being sandpapered away is much greater than the body’s ability to replace them. As a result, the joint becomes chronically inflamed, also known as Rheumatoid Arthritis. 

DYSPEPSIA (Abdominal Pain)

Dyspeptic pain is all too common these days—to the point where antacids have become a common household item. Dyspeptic pain is related to the upper abdominal area, typically occurring after eating. It is generally known to be caused by gastritis or other similar diagnoses. It can be extremely painful and last for hours. It may come about once in a while, or every time you eat a meal. How many of you currently have, have had, or know people who have had dyspeptic pain (stomach pain)? Before you run off to the doctor’s office and come back with a prescription of antacids, let’s take a look at this from a dehydration standpoint. 

 Let’s start off with a simplified overview of the stomach. The inner lining of the stomach is covered with what are called mucous cells. This is known as the mucosal layer. These cells secrete a protective mucus to guard the deeper layers of the stomach from gastric juices. This cover of mucus is made up of ~98% water.1

In a well hydrated state, the mucus protects the stomach lining by neutralizing gastric juices with the help of sodium bicarbonate (which is released from the cells below). In order to prevent a build up of too much salt (the reaction of stomach acid—HCL—and sodium bicarbonate creates salt), the stomach relies on a constant supply of water to wash out the salt. A buildup of salt compromises the structural integrity of the mucus.

You can imagine that with a lack of hydration, the production of mucus is reduced, thinning the stomach’s primary and strongest defense mechanism. Without water to drive out excess salt, the mucous composition becomes less sticky, allowing stomach acid to tear through the protective layer and come into direct contact with the mucosal layer (cell lining). This is why pain occurs. The corrosive quality of HCL damages the stomach lining, causing pain, inflammation, and potentially ulcers. 

While antacids also neutralize HCL, it merely acts as a bandaid. It does not heal the stomach lining. The best solution is giving the body what it needs, WATER!

HYPERTENSION

I feel pretty bad for salt these days. Salt has gotten a bad reputation—especially from those with high blood pressure (not their fault though). Of course, it doesn’t help that most of the population buys cheap, bleached, and highly processed salt (white table salt) rather than naturally occurring and minimally processed salt (i.e. Celtic Sea Salt or Himalayan Pink Salt), but that’s an article for a different day. We’ll look at sodium’s role in hypertension shortly.

The question is: how does water (or rather a lack thereof) affect high blood pressure? 

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When talking about Rheumatoid Arthritis, I mentioned a rationing system your body activates when it does not have enough water supply. This is essentially you body saying “What systems  do I NEED to survive, and what can I live without?” Much like you would question if you were financially broke. “Well, I have to pay rent and I have to eat food, but I can skip the movies for the week and not go out to the bars to save some money.” Your body has a very intricate version of this.

When you are dehydrated, the blood volume will decrease and gas pockets will start to open up in the blood vessels, unless the volume of blood is adjusted. This is extremely dangerous! In order to prevent that from happening, the lumen (inner gap of blood vessel) shrinks. This feature adjusts the blood vessel for the available amount of fluid. Your body also starts to close capillaries to areas of less importance (i.e. joints, muscle, etc.) in order to adequately supply the more vital organs (i.e. brain, heart, liver, lungs, etc.). In areas of low circulation due to closing of the lumen/capillaries, increased blood pressure is needed to push the blood into the capillaries, causing high blood pressure. 

Now, the body has a shortage of water and therefore needs to get it from somewhere. If not the diet, where can it get if from? “In water shortage and body drought, 66 percent is taken from the water volume normally held inside the cells, 26 percent is taken from the volume held outside the cells, and 8 percent is taken from blood volume”1. It is for this reason our bodies retain sodium and hold on to it for dear life. Sodium is the main mechanism to attract water, indirectly supplying it to cells. Therefore, if you are dehydrated and have high blood pressure—trying to rid yourself of salt is a poor idea, because it is your body’s last resort for trying to retain water. 

HOW MUCH WATER SHOULD I DRINK?

We generally recommend 1/2 your bodyweight in oz of water, consumed gradually throughout the day. For those that live in hot conditions and/or are very active, 60% is more ideal. Juices and other drinks like tea and coffee do NOT count! 

It is easy to get lost in all the advertisements and ‘miracle supplements’ out there. However, sometimes the simplest solution is the most effective, no matter how complicated the problem. While water is not the most exciting beverage to drink, the depth at which it affects us is nothing short of marveling. 

References

1. Batmanghelidj, Fereydoon. Your Body’s Many Cries for Water: You’re Not Sick; You’re Thirsty Don’t Treat Thirst With Medication. 3rd ed. United States of America: Global Health Solutions, 2008

2. Martini, Frederic H., et al. Human Anatomy. 5th ed. San Francisco: Benjamin Cummings—Pearson Education, 2006

Blood Sugar Basics

Tobias McGowan

       If we are truly looking to maximize our health and metabolic function we need to master the crucial concept of balancing our blood sugar. In order to do that, we must understand how our organs, glands and hormones tightly regulate this process. Your blood sugar is deeply connected to a multitude of physiological processes that regulate the transportation and utilization of energy. Normal fasting glucose levels are usually in the range of 70 - 100 mg/dL. In the presence of health, the body should control blood sugar levels in a steady range. However, when complications are presented, drastic fluctuation will occur that can be highly problematic. Optimizing and controlling our blood sugar is not always as simple as it seems, and most individuals are simply addressing the symptoms of blood sugar fluctuations and not addressing the root issue.

 

HOW IS THE BLOOD SUGAR REGULATED?

       As you consume a meal and digestion takes place, blood glucose (sugar) levels will naturally rise within the circulation. Carbohydrates and protein will elevate the blood glucose levels. In response to elevated blood glucose levels, your pancreas will secrete insulin (along with other hormones) to bring levels back down to baseline. Insulin will deliver glucose to various cells, such as, the muscles, fat, and other tissues in need of energy. Insulin will act to shuttle and transport glucose into the target cells of the body. Glucose is the cells primary source of energy, but the efficiency of that glucose utilization will be dependent of the presence of oxygen and T3. If glucose does not enter the cell properly and is elevated in the circulation it can become toxic to many organs including the kidney. Oppositely, in between meals and while sleeping the body will shift into a semi-fasted state, which will cause the blood sugar to go down. When levels drop the pancreas will respond by secreting glucagon (along with other hormones) to stimulate the liver to liberate glycogen for glucose production, which will be released into the circulation and delivered systemically to the cells in need of energy. This intricate balancing act of blood glucose going up after a meal, coming down during a fasted state, and being tightly regulated by the body's hormones is the essence of controlling your blood sugar.

 

A DEEPER LOOK AT WHAT’S INVOLVED

       Most individuals stop after this basic information is established, but the real foundation for understanding is in the details. Therefore, it is necessary to look deeper at the primary organs and hormones that play the largest role in blood sugar regulation. Each organ that will be covered will pertain specifically to the concept of blood sugar.  All of these systems tightly regulate blood sugar within the circulation (blood stream) and in the cell.

 

THE PANCREAS: HELLO HORMONES

       As mentioned earlier, the pancreas is directly involved in how the body regulates the blood sugar. It is composed of two types of cells, exocrine and endocrine cells. The exocrine cells are responsible for secreting bicarbonate and digestive enzymes, and the endocrine cells are responsible for secreting several hormones. These hormones are the key determinants to whether levels will rise or fall in the circulation. The pancreas produces these crucial hormones through clusters of cells called the Islets of Langerhan. Within these clusters are three primary cell types; each responsible for secreting specific hormones that affect levels differently.

ALPHA CELLS

Glucagon: When the blood sugar goes down glucagon will be secreted and will signal the liver to liberate glycogen to produce glucose. Depending on glycogen levels (and other factors), glucagon will also elevate glucose levels by converting amino acids and other by-products into glucose, and dietary fats into ketones for energy. This hormone is responsible for preventing hypoglycemia (low blood sugar). Glucagon is catabolic and lipolytic in nature and will liberate storage forms of glucose, amino acids, and fatty acids. Glucagon is considered to be the antagonist to insulin.

In other words: Glucagon is responsible for the release of stored energy. Glucagon stimulates glycogenolysis, gluconeogenesis, ketogenesis, proteolysis, and lipolysis.

BETA CELLS

Insulin: When blood glucose levels are elevated in the circulation insulin will be secreted to bring levels down. Insulin does this by transporting glucose from the circulation into major target cells such as the muscle, fat and red blood cells. Along with glucose, Insulin will drive amino acid uptake and protein synthesis. Insulin is known as an anabolic hormone, or tissue building hormone. Thus, it is also a storage hormone; storing additional glucose into glycogen, and excess glucose and amino acids into triacylglycerols and into fat, and excess fatty acids into fat.

In other words: Insulin is responsible for transporting and storing energy. Insulin stimulates glycogenesis, protein synthesis, and lipid synthesis.  

Amylin: Amylin is secreted along with insulin and assists in lowering the blood sugar levels when they are elevated. This peptide hormone also slows down gastric (stomach) emptying, thus slowing down blood glucose spikes. This hormone also triggers satiety, which makes you feel full.  

DELTA CELLS

Somatostatin: This hormone regulates the action of the alpha and beta cells. Somatostatin acts as an inhibitory hormone, capable of suppressing the release of insulin and glucagon.

 

THE LIVER: I GUESS YOU ARE IMPORTANT

      The liver must not be overlooked when considering the regulation of blood sugar. This organ is the primary site for macronutrient metabolism, which in turn acts like a control center for blood sugar management. It converts glucose into glycogen and produces glucose from glycogen and other by-products, which is the basis for blood sugar regulation. Many of the hormones related to blood sugar act on and are metabolized by the liver. The liver is intricately involved with the pancreas and if it is functioning less than optimal the pancreas will suffer and can become overloaded.

       The liver functions like an energy reservoir, and will control glucose production and storage depending on the body’s energy requirements. The primary substance for this control is glycogen, which is a storage form of glucose. Liver glycogen is the body’s go to for restoring blood sugar levels during the semi-fasted state, supporting the system for a several hours to a day (depending on levels). During this state, or anytime the body requires glucose, glucagon will stimulate the liver to tap into the glycogen reserves and break it down into glucose. This breakdown of glycogen for needed energy is called glycogenolysis.

     After a meal or when glucose levels are elevated, insulin will signal the liver to store additional glucose in the form of glycogen, which serves as a semi-immediate energy reserve for later times. This formation of glycogen from additional glucose is called glycogenoesis. Thus, liver glycogen is vital for maintaining an energy balance without utilizing non-glucose substances for energy. The consumption and metabolism of fructose is crucial for replenishing liver glycogen reserves and therefore liver health.

       During a fasted state and in the absence of glycogen, the liver will transition into the metabolic process of gluconeogenesis, which is when the body must convert non-glucose by-products into glucose or ketones. The body will break down and convert amino acids, lactic acid, and other by-products into glucose, and fatty acids into ketones for energy. However, this is a more costly process and will require the activation of the sympathetic nervous system. Gluconeogenesis is predominantly stimulated by glucocorticoids and will set off the stress response.  

 

THE ADRENALS & THE STRESS RESPONSE

       When our physiology shifts into a stress state our blood sugar will rise to meet the energy demands of the survival situation that is being interpreted. Unfortunately, many of the stressors in today's lifestyle stimulates this response even when we do not need additional glucose for energy. Furthermore, blood sugar fluctuations, especially low blood sugar (hypoglycemia), place another major stressor onto the system. Regardless of the type of stress(es), the sympathetic nervous system will be stimulated, which will signal the adrenal glands to secrete hydrocortisone (cortisol), cortisone, epinephrine (adrenaline) and nor-epinephrine. Cortisol and adrenaline are the major contributors in raising the blood sugar, and are released to produce glucose from the liver and other tissues, thus elevating circulatory levels of glucose.   

EPINEPHRINE (ADRENALINE): Epinephrine is classified as a catecholamine, which is a hormone and a neurotransmitter, and is secreted from the core of the adrenal gland known as the medulla. It liberates glucose from glycogen in the liver and peripheral tissue through glycogenolysis and gluconeogenesis. Epinephrine also increases glucose levels indirectly by stimulating glucagon and adrenocorticotropic hormone (ACTH), which stimulates cortisol. This contribution to increasing ACTH and thus cortisol, indirectly implies that epinephrine in excess can inhibit insulin sensitivity.

CORTISOL: This hormone is a glucocorticoid, named for one of it’s primary functions, which is to increase glucose levels when the body is in immediate need. This is a survival mechanism for when the blood sugar gets too low (a hypoglycemic state). In this state cortisol will be released from the cortex of the adrenal glands, and will convert non-glucose by-products into glucose through gluconeogenesis. However, this process occurs at the expense of breaking down tissue in the body such as muscle, thymus and skin tissue. Excessive cortisol also suppresses the uptake of glucose into the muscle and fat cells.

Excessive adrenaline, cortisol and overall stress can cause insulin resistance and lead to metabolic complications.

       The stress response intensity is highly dependent on liver glycogen levels for proper stabilization. If liver glycogen is depleted and energy levels are in demand; the body will rely heavily on these two hormones, especially cortisol, to stimulate gluconeogenesis. This metabolic pathway results in tissue wasting, and excessive production will increase insulin resistance. The constant utilization and reliance on gluconeogenesis can result in a constant alarm response and lead to complications. The health of the liver, proper glycogen replenishment, and controlling stress levels is imperative for handling the blood sugar. Without controlling our stress response our blood sugar levels can be all over the map, not to mention it can also interfere with other physiological systems such as the thyroid.

       Both epinephrine and cortisol stimulates hormone sensitive lipase (HSL), which is an enzyme that liberates fat from adipose (fat) tissue. This releases free fatty acids and glycerol, which contributes to the utilization of gluconeogenesis to produce energy. However, fat liberation can release excessive amounts of stored polyunsaturated fats, estrogen and other pro-inflammatory by-products, which could be damaging to several systems. Proper nutrition should always be implemented to support the proper detoxification necessary for fat liberation, increased metabolic rate and body fat loss.

 

THE SMALL INTESTINE: MORE HORMONES

       The small intestine is the site for lots of action, including digestion and absorption, but we will only analyze the endocrine functions and just look at the hormones of relevance. The two hormones of importance are peptide hormones known as incretins, which are gastrointestinal secreted hormones that decreases blood glucose levels. These are secreted by various sections of the small intestinal lumen in response to glucose in the circulation.

GLP-1 (Glucagon-Like Peptide 1) GLP-1 contributes by stimulating the beta cells of the pancreas to secrete insulin while suppressing the alpha cells from secreting glucagon. This hormone works synergistically with insulin to decrease the blood sugar. GLP-1 brings levels down immediately after a blood sugar spike, but has a relatively short half-life, which helps control potential hypoglycemia several hours after. GLP-1 works similarly to amylin, by slowing down the rate of gastric emptying and controlling appetite by signaling the brain that the system is full.  

GIP (Glucose-dependent Insulinotropic Polypeptide) GIP functions in the same way as GLP-1, stimulating the pancreas to produce insulin and inhibits glucagon. The stimulation of GIP is triggered by high levels of glucose in the small intestine, hence the name glucose-dependent.  GIP is also correlated with fat storing enzymes and lipid metabolism.

 

WHAT NUTRIENTS AFFECT THE BLOOD SUGAR?

      This is a question in which the answer should be more widely known. Based off the topic and the question, most minds will jump to the obvious nutrient of carbohydrates. Yes, carbohydrates do increase the blood sugar levels, for healthy digestion will break down carbohydrates into simple sugars. However, not all carbohydrates are metabolized the same, and not all affect the blood sugar levels that same. In general, glucose is the main monosaccharide (simple sugar) that contributes to elevated levels, and starch is composed of multiple glucose units. Therefore, starch products such as wheat, potatoes, rice, etc., will certainly elevate blood sugar levels. When it comes to the digestion of starches and grains, the processing, viscosity, fiber, type, and more will affect the degree of the blood sugar response. Now, sugar or sucrose (glucose + fructose) impacts the blood sugar differently. Fructose will slow down the process because there is a concentration gradient during absorption, which slows the transportation process. Thus, the consumption of fruits, honey, syrups and others will have less impact on blood sugar.

       When consuming protein the body’s blood sugar will also rise, and in if not balanced with other macronutrients, will cause a dramatic increase. Last but not least, fat is the one nutrient that actually slows down the digestive process and minimizes blood sugar spikes. The rate at which the stomach empties fat into the intestines is naturally slower and requires more time. Simply incorporating fat into a meal can dramatically decrease the blood sugar and insulin spike. So you ask, why aren’t more people utilizing fat consumption to regulate blood sugar? That’s another great question.

 

COMMON PROBLEMS

      As illustrated above, our blood sugar levels are influenced by multiple physiological systems. The health of each organ and the hormones related, will dictate our capacity to optimize energy utilization. It’s important to understand that if issues arise they are dependent on the individual's current health, nutritional habits, lifestyle factors, and more. Highlighted below are some of the most common problems related to the concept of blood sugar.

HYPOGLYCEMIA: A condition in which blood glucose levels go too low and result in a myriad of symptoms. The primary concern is generally a lack of glucose to the brain, which can cause major dysfunctions neurologically. When levels get into the low, below 70 mg/dL (completely dependent on the individual) hypoglycemia is usually presented, and glucose is needed to bring levels up. Now, if insulin levels are high or not controlled (elevated for extended periods) then glucose levels will commonly fall below the norm, setting off this cascade.

REACTIVE HYPOGLYCEMIA: A pattern or consistent occurrence of hypoglycemia within several hours after eating a high carbohydrate meal. Again excessive insulin or prolonged insulin release will drive level down. There is no diagnosis of diabetes while individuals are going through this.  

HYPERGLYCEMIA: Excessively high levels of blood glucose in the circulation. The presence of glucose and insulin in high levels in the circulation are toxic and dangerous. The glucose will connect with proteins in the circulation, creating glycation reactions and cross-linking. This will slow down the circulation and decrease optimal blood and cellular flow. Excessive cross-linking will lead to Advance Glycation End-Products (AGEs), which lead to a whole host of problems.

DYSGLYCEMIA: Abnormal blood glucose levels or fluctuations of hyperglycemia and hypoglycemia.  

HYPERINSULINEMIA: Excessive insulin levels in the blood circulation in relationship to glucose. This condition is generally seen in individuals that have cellular / receptor problems, usually present during insulin resistance. The pancreas and its beta cells are still performing or even over performing, but the connection at the cell level is disrupted. Insulin is a storage hormone and excessively high levels lead to lipid complications, dyslipidemia, obesity, and metabolic syndrome (which is a collection of symptoms). Insulin will also create several other complications such as: mineral imbalances that can lead to hypertension, increased levels of aromatase that converts testosterone to estrogen, and other far reaching issues.

INSULIN RESISTANCE: Insulin receptors located on target cells become defective, leading to an inability to uptake glucose. This condition is a major factor in most if not all of these problems highlighted. This complication can develop from any number of issues, from insulin overload to excessive cortisol.

DIABETES: A metabolic illness related to the above problems and diagnosed by hyperglycemic conditions. From a medical perspective, a fasting glucose level of 126 mg/dL and above, or an oral glucose tolerance level of 200 mg/dL and above, is considered diabetic. Diabetes can present any of the symptoms above. It is also related to neuropathy, nephropathy, increased risk of cardiovascular problems, increased infection, and more.   

    

With this foundation set, we can explore the root causes and real solutions to these troubling issues.

 

Reference

Pottenger, F.M. (1919). Symptoms of visceral disease: a study of the vegetative nervous system

             in its relationship to clinical medicine. St. Louis, MO: Mosby Company / Forgotten

             Books

Widmaier, E. P., Hershel, R., Strang, K. T. (2008). Vander’s Human Physiology: The

              Mechanishms of the Body Function (11th Ed.). New York, NY: McGraw Hill