Relapse and Blood Sugar Dysregulation
By Christina Veselak, LMFT
Preliminary research has already clearly shown that low or dropping blood sugar levels lead to cravings (and ultimately, to relapse) in clients with both process and chemical addictions.
Symptoms of low blood sugar, caused by a combination of adrenaline release and a hungry brain, include anxiety, shaking, sweating, heart pounding, and emotional reactivity such as irritability, anger and tears, “brain fog,” fatigue and insomnia. When these symptoms are found in people with “dry drunk syndrome” and premenstrual syndrome (PMS), restoring blood sugar levels through appropriate food, or the use of LGlutamine may completely eliminate these symptoms.
In fact, clinical experience leads us to suspect that women addicts are much more likely to relapse during the last phase of their monthly menstrual cycle. As estrogen drops toward day one of the cycle, blood sugar becomes more dysregulated, leading to all the above symptoms. A drop in serotonin levels, also due to dropping estrogen may need to be addressed as well.
The brain absolutely requires glucose to function. Although the brain’s mass constitutes only 2% of an average body’s weight, the cerebrum utilizes 20% of the carbohydrates that are consumed in any 24 hour period. Moreover, the brain does not have the capacity to metabolize its own source of energy, and can store very limited amounts of sugar. Therefore, the brain requires a steady supply of fuel.
Blood sugar level is a metabolic process that is tightly controlled in the body. When we eat food, carbohydrates are broken down into glucose, which passes into the blood stream and raises blood sugar levels, in the length of time shown in the glycemic index. The glycemic index lists how long it takes for the carbohydrates in a particular food to be absorbed into the bloodstream, compared to the amount of time necessary to absorb white, refined table sugar. Thus, sugar is 100 (the highest rank) on the glycemic index, a cup of cornflakes is 84, and apples are 35. Foods with lower scores are absorbed more slowly, and produce smoother changes in blood sugar levels. Protein, fiber and fats generally slow down digestion, and reduce the rate of glucose absorption. Refined sugars and starches typically rank high on the glycemic chart. They raise blood sugar levels rapidly, as does tobacco. Surprisingly, pure alcohol is 0 on the glycemic index, and actually lowers blood sugar levels, through a variety of mechanisms. (Lehninger, pg 762)
When blood sugar levels dip close to baseline, the brain signals us that it is again time to eat, and people find a source of food by which to raise blood sugar levels. This cycle usually takes about 4 hours, and blood sugar concentration is supposed to rise and fall in a gentle wave, throughout the day.
However, at least 80% (if not more) of all alcoholics, (Milam ) premenstrual women, those who habitually eat large amounts of sugar/refined carbohydrates, and patients from alcoholic families, have dysregulated blood sugar metabolism,
Adrenal gland attempts to slow down blood sugar metabolism and as blood sugar continues to drop, the now starving and unbalanced brain sends out urgent signals for the body to do whatever it takes, to bring blood sugar level back into balance.
This message can easily translate into a powerful craving for quick energy sources such as alcohol or sugar, but this signal just as easily could lead to a craving for the drug or addictive behavior of choice, since an addict’s brain has previously been conditioned to look to its drug of choice to restore equilibrium. Thus, the alcoholic craves alcohol, the sugar addict craves sugar, the smoker craves a cigarette, and the sex addict craves sex!
This relapse-inducing craving especially occurs if a meal is missed, and simply too much time has passed since the brain has last been fed.
This situation causes a double problem. Coping skills are blocked by adrenaline, while self-control is diminished by a lack of energy and blood flow to the brain. So, a stressor that a well-fed addict could successfully cope with, without relapse, instead leads to a “slip” or relapse, in a person with low or dropping blood sugar. Even more disturbing is the reality that an external stressor is not even needed, for low or dropping blood sugar to lead to cravings, relapse and addictive use.
Moreover, sugar itself is an addictive and dangerous substance. Craving and physical withdrawal symptoms are common when people swear off sweets. Sugar has been shown to fire and deplete the same neurochemicals as do cocaine, heroin, and ecstasy. As we have seen above, a major problem with this “quick fix” approach is the fact that the blood sugar is likely to rise too high and too fast, leading to dramatic swings (the “yo-yo effect”), all day. These unpredictable mood and behavior swings can be literally crazymaking, and strongly induce relapse.
Therefore, our recommendation is to teach clients how to manage their own blood sugar on a daily basis. Such management is actually quite simple to do, although it might require focus and periodic troubleshooting. We recommend that the day start with a breakfast of high protein, moderate complex carbohydrate foods, with high protein snacks or meals, every four hours. There are many excellent books and articles available, which discuss how to make these dietary changes in a healthy and enjoyable way.
It is often very hard for people in general, and especially those in early recovery, to change their unhealthy ways of eating.
Tools that we have found to be useful in building motivation and awareness include:
1. A food/mood/craving diary;
2. A list of hypoglycemic symptoms which clients check off;
3. A 6 hour glucose tolerance test;
4. Using the Glycemic Index as a food ranking guide;
5. Asking clients who have had a slip into addictive behavior to recall the last time they ate, and what they ate, before the slip occurred;
6. Taking time in each session, to find out what a patient is doing to keep his or her blood sugar in balance.
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