By Barbara Leonhard | Featured Contributor
Depression is a complex weave, and I have explored it in various articles on Phoebe, MD. The grief of watching my mom decline with Alzheimer’s and the grief of infertility. However, did you know that some symptoms of depression can also result from a diet high in sugar and simple carbohydrates, which in some people can lead to postprandial hypoglycemia (extremely low blood sugar after a meal)? This has been another life challenge for me.
When Mom was diagnosed with Type 2 Diabetes, her doctor encouraged her to attend a training on how to manage her diet choices, and I was her taxi driver. At the first session, I noticed a list of symptoms that can be caused by hypoglycemia (low blood sugar). A particular type of hypoglycemia, called reactive hypoglycemia, occurs when the blood sugar spikes and then drops to dangerous levels (usually after a high-carb meal), causing a variety of symptoms and effects if not treated.
The symptoms I recognized included depression, shakiness, blurred vision, headaches, panic attacks, anxiety, irritability, fatigue, and dizziness. The anxiety promoted fear and dread, possibly contributing to the panic attack I experienced one day out of the blue. A panic attack feels like a heart attack. All in all, I felt miserable.
In order to be properly diagnosed, I had to undergo a test at my doctor’s office. I arrived having not eaten breakfast and was given a solution to drink. Periodically, my blood sugar levels were tested. By the end of the 6-hour session, I had practically passed out. He told me I had the worst case of reactive hypoglycemia he had ever seen.
Ideal blood sugar levels before eating breakfast may read 100mg/dL. After eating, they are normally 140mg/dL or less. But during that test, my blood sugar levels dropped into the 20s!
How did I develop this condition? It is possible I inherited a problem with blood sugar regulation because Mom developed Type 2 Diabetes, and two brothers had pancreatitis later in life. My life style, food choices, and dietary habits contributed.
Optimizing My Diet
I am from a large family, and we were raised on lots of simple carbs (“bad carbs”), such as white pasta, homemade white breads and sweets, white rice, potatoes, sugary cereals, and the like. Mom was able to feed us on a budget of $100 a month back in the 50s and 60s, and simple carbs were affordable. I don’t recall us eating a lot of fresh fruit and vegetables, but we ate canned corn and peas, both of which are carbohydrates. She was able to can her own tomatoes and corn when friends shared garden bounty. We ate fresh fruit mainly when we were sick. Mom would make a huge fruit salad in her roasting pan for dinners at those times. Because fruit was the only thing on the menu, my blood sugar definitely crashed.
Because simple carbohydrates digest quickly, they can cause the blood sugar to spike and then suddenly drop to low levels. I learned to substitute the simple carbohydrates with complex carbohydrates (“good carbs”) in my diet. Complex carbohydrates digest more slowly, which prevents the rapid swings in blood sugar level typically seen with simple carbs.
Now I eat whole grains (e.g. rye, oats, wheat), brown rice, pasta made with super greens or whole wheat, hearty whole grain bread or sour dough breads, sweet potatoes, beans, nuts, and other complex carbohydrates which are high in fiber. When baking, I use a flour blend of whole wheat and white unbleached flour, and I reduce the sugar. I add walnuts to baked sweets to add fiber.
I also avoid fruit juice and other sugary drinks. Some varieties of fruit, such as melons, apples and oranges, help my blood sugar levels. But I always make sure I eat fruit with a meal rather than as a snack unless I eat some protein along with it, such as nuts or cheese. Some experts say not to eat bananas because they are high in sugar, but because they are also high in fiber, bananas don’t bother me. Pears are recommended, but they actually make my blood sugar drop almost immediately. Everyone has to experiment and find what their body requires.
Hypoglycemia & the Brain
To control my weight, I used to skip meals. In fact, in graduate school, in the morning, I would eat one boiled egg, skip lunch, and for dinner, I would eat a huge salad followed by an ice cream cone! My weight dropped to 110 pounds, but I became anxious and depressed because I was starving not only my body but also my brain.
The only food our brain gets is glucose (the body’s main energy source). Glucose is produced when the body breaks down the carbohydrates from food. Insulin distributes the glucose to cells, and the liver stores extra glucose. Fasting causes the pancreas to trigger the liver to break down the stored glucose (glycogen), releasing it into the bloodstream to maintain blood sugar levels.
Imbalances in blood sugar levels can harm the brain. As this article notes, “The key role of glucose in the body is fuel for energy, and the brain depends completely on glucose to operate normally” In fact, the brain uses up 50% of the total sugar energy in the body to feed its brain cells.
A starved brain exhibits these symptoms: memory loss, learning problems, depression, anxiety, and other mental/emotional problems. As a result, when I start to feel down or lack focus, I look at my diet. Is it time to eat? Have I “carbed out” (eaten a big load of simple carbs)? Have I skipped a meal?
Caffeine can also contribute to hypoglycemia in some people. I used to drink coffee all day, which heightened my symptoms. A stimulant, caffeine speeds up the metabolism and actually acts like insulin, causing the blood sugar levels to spike and to drop quickly. Imagine how I felt when I was skipping meals and drinking gallons of coffee! I was weepy, irritable, and “hangry” (so hungry I was angry, impatient, and irritable).
Feeling “hangry” made me hard to live with. I would practically stab my husband with a fork to make sure he didn’t take more peas on his plate than I did! If we were out and about and my blood sugar suddenly dropped, I became demanding for food. Today I make sure to grab a high protein, low carb bar on the way out the door in the event my blood sugar drops.
Another factor that can lead to hypoglycemia is alcohol. If we drink alcohol without eating, the liver is unable to release the emergency stash of stored glucose into the bloodstream. If the alcoholic drink contains sugar, the effect can be even more pronounced as the alcohol triggers a spike of blood sugar and release of insulin, which causes the blood sugar levels to drop. One night, after I had fasted all day, I met friends for a huge meal at a local Greek restaurant because I was so “hangry”. After one sip of Ouzo while waiting for my order, I passed out and woke up on my couch.
Once I started to make changes in diet and dietary habits, I noticed a huge difference in the way I felt.
As I said, I switched to a diet rich in good carbs, fiber, and protein, and stopped skipping meals. I reduced caffeine intake to mornings with breakfast, and I controlled alcohol intake by limiting amounts and combining it with food. Hard liquor was out.
Over time, I have been able to add in small amounts of refined sugars on a full stomach. For example, I like ice cream, but I make sure I have had a good meal before I eat it. White potatoes, rice, and pasta are fine if I limit the amounts and have protein and fat in the meal. Proteins and fats take longer to digest than simple carbs do.
I eat regularly to avoid sugar lows and uncontrollable hunger, which causes me to binge on simple carbs. I found I have to eat small meals throughout the day to balance the blood sugar levels. Thus, snacks are okay as long as they include a combination of protein with carbohydrates, such as dark chocolate with nuts, pita with hummus, cheese with whole grain crackers, popcorn with a cheese stick. I avoid overeating, but holiday dinners are difficult to resist!
Having to eat more often can cause weight gain, which is an issue because too much weight can contribute to the development of diabetes. Portion control and exercise help with weight control, but finding the best balance is a challenge. Too much aerobic exercise at one time can also cause lows in my blood sugar.
Insomnia results if my blood sugar drops in the middle of the night. In that case, I eat a few nuts or drink some milk. My dietitian was adamant about addressing a hypoglycemic reaction at night. She said this condition could easily revert to type 2 diabetes.
Now that I am feeding my brain and avoiding sugar highs and lows, I feel more emotionally balanced. I am so grateful I learned of this condition, especially at a very hard time in life as I was a caregiver to my mother and had two cancer scares to navigate. I was fully invested in my career, which was stressful. I also injured my back on an emergency trip to help my parents, and the ongoing bulging disk pain contributed to the depression as well.
Indeed, depression is a complicated condition with many contributing factors. But food choices and frequency of meals definitely affect mental health and wellness. Now my average blood sugar level is around 90 mg/dL, which is considered normal—as are my moods!
Recovery and healing can occur if we listen to our body and seek help. Most importantly, we are the ones in charge of our care and healing. We are our own healers.
“Hangry” no more!
Barbara Leonhard is a writer, poet, and blogger at Extraordinary Sunshine Weaver. Her podcast Poetry: The Memoir of the Soul explores universal themes such as Grief, Kindness, and Presence. She taught writing for many years at the University of Missouri and is the author of Discoveries in Academic Writing. She is also a regular contributor to Free Verse Revolution, PhoebeMD.com, and Go Dog Go Café.
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