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The Five Must-Knows for Treating SIBO
that have helped every person I've worked with.

It’s amazing to me how often I identify hypoglycemia in a patient. I see fasting blood glucose readings of 58, 62 or 70 that’s called ‘normal’ on the blood tests. I see non-fasting glucose readings at these levels, which are also called normal. I see a lot of patients on restrictive diets, losing too much weight and as a result, they have disrupted sleep. This is especially true with people trying to follow a SIBO diet and spacing their meals out (you definitely do not need to do this to treat and heal from SIBO).

It’s not normal to…

…wake up multiple times throughout the night.

…wake up in the middle of the night and stay away for 30+ minutes.

…wake up feeling like you are having a panic attack (with a racing heart and/ or overactive thoughts) in the middle of the night.

These are all symptoms of hypoglycemia. In this article, we will discuss the role of cortisol in hypoglycemia and how hypoglycemia can further disrupt glucose regulation and lead to disrupted sleep.

The brain is particularly sensitive to changes in glucose levels and requires a constant supply of glucose for proper functioning. In fact, your brain runs on glucose. Cortisol is a hormone that is released in response to stress. It also is involved in the normal everyday regulation of glucose levels in your body.

Hypoglycemia is a condition that occurs when the glucose level in the blood falls below normal levels.

Role of Cortisol in Hypoglycemia

Cortisol is a steroid hormone that’s released by your adrenal gland in response to stress. It’s also involved in regulating various metabolic processes in the body, including glucose metabolism. Let me first explain how this happens:

Say you eat breakfast around 8 AM and have lunch around 2 PM. 3 to 4 hours after you eat breakfast, your blood sugar will naturally dip. The brain will signal for a small release of cortisol, and this cortisol will signal your liver to release glucose stores to bring your blood sugar back up into balance.

This is a normal every day process that occurs and this does not drive adrenal dysregulation.

With hypoglycemia, after the 3 to 4 hours, your blood sugar will continue to drop because cortisol is not cycling properly. This further drop in blood sugar is very concerning to your brain, and it will send up a red flag – signaling your adrenal glands to release adrenalin. This adrenalin hit brings with it a quick surge in blood sugar and insulin and is no different than the adrenalin hit that you would get if say, a car came into your lane while you were driving. The sugar will help reinstate your blood sugar levels, however, this process is inflammatory, and it also will drive adrenal dysregulation.

This is a no-win cycle of blood sugar dysregulation driving adrenalin hits and vice versa.

Disrupted Sleep and Hypoglycemia

During sleep, your body undergoes various physiological processes, including the regulation of glucose metabolism. The release of growth hormone and cortisol during sleep helps to maintain normal glucose levels in the body.

During sleep your body will go through around two rounds of blood sugar dips (approximately every 3-4 hours). The first is around 1-2am and the second is around 4-5am.

When cortisol levels are low due to hypoglycemia, it can disrupt the sleep-wake cycle, leading to insomnia, frequent awakenings during the night, and poor quality of sleep. This can cause further stress on the body and exacerbate the effects of hypoglycemia.

If you waking during these timeframes and you have a hard time going back to sleep, it is likely that you are suffering from dysregulated blood sugar and cortisol patterns.

Maintaining stable blood sugar levels through proper nutrition, supplementation and physical activity is key in preventing and managing hypoglycemia.

There are three key steps to healing hypoglycemia:

  1. To manage hypoglycemia, it is important to maintain stable blood sugar levels throughout the day. Eating small frequent meals at routine times (literally set timers to eat at consistent times each day), with protein at every meal, can stabilize blood sugar.
  2. Physical activity is also beneficial for regulating blood sugar levels, as it increases insulin sensitivity and improves glucose uptake by cells.
  3. Address stress with the use of adaptogens, walking, meditating, getting into nature and bringing joy back to your life.

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  1. Cryer, P. E. (2002). Hypoglycemia: pathophysiology, diagnosis, and treatment. New England Journal of Medicine, 346(12), 957-966.
  2. De Castro, J. M. (2004). The time of day of food intake influences overall intake in humans. The Journal of nutrition, 134(1), 104-111.
  3. Kalsbeek, A., la Fleur, S., Van Heijningen, C., & Buijs, R. M. (2004). Suprachiasmatic GABAergic inputs to the paraventricular nucleus control plasma glucose concentrations in the rat via sympathetic innervation of the liver. Journal of Neuroscience, 24(35), 7604-7613.
  4. Spiegel, K., Leproult, R., Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. The Lancet, 354(9188), 1435-1439.
  5. Weyer, C., Pratley, R. E., & Tataranni, P. A. (2000). Insulin action and insulinemia are closely related to the fasting complement of plasma cortisol in healthy humans. Journal of Clinical Endocrinology & Metabolism, 85(11), 4030-4034.

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