Discussion in 'Ages 30-39' started by Fry2, Dec 5, 2016.
It might be time to check into rehab or get to a meeting.
Addiction Relapse and Blood Sugar Dysregulation
Christina Veselak, LMFT, CN
Missing a meal or consuming a high sugar diet are primary relapse triggers for all recovering addicts.
Research has clearly shown that low or dropping blood sugar levels lead to cravings, and ultimately, to relapse, in clients with both process and chemical addictions. This blunt fact is substantiated by many years of clinical experience, in my practice and in those of many other chemical dependency clinicians around the world.
Symptoms of low blood sugar, caused by a combination of adrenalin release and a glucose-starved brain, include anxiety, shaking, sweating, heart pounding, and emotional reactivity such as irritability, anger and tears, “brain fog,” fatigue, and insomnia. These symptoms are also in people with “dry drunk syndrome” and premenstrual syndrome (PMS). Fortunately, restoring blood sugar levels through appropriate food and the use of the amino acid l-glutamine often completely eliminates these symptoms.
Clinical experience also confirms that women addicts are much more likely to relapse during the last phase of their monthly menstrual cycle. As estrogen (and progesterone) levels drop towards day one of the cycle, blood sugar becomes more dysregulated, exaggerating all the above symptoms (a drop in serotonin levels, also due to dropping estrogen, often needs to be addressed as well).
How could sugar and low blood glucose exert such strong, negative effects on addiction recovery efforts? The brain absolutely requires glucose to function. Although the brain’s mass constitutes only 2 percent of an average body’s weight, the cerebrum utilizes 20 percent 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 balancing 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 varying amounts of time, as noted on 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. 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.
When we eat, sugar is released into the blood stream and the pancreas releases small amounts of insulin. Insulin attaches to the sugar molecules, escorts them to nearby tissue cells, and metabolically “asks” the cells to store the sugar. In non-diabetic people, the cells readily accept the sugar molecule, and store it for future need. In normal circumstances circulating blood sugar levels then drift downward, and insulin goes away.
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 four 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, premenstrual women, those who habitually eat large amounts of sugar/refined carbohydrates, and those from alcoholic families, have dysregulated blood sugar metabolism, termed reactive hypoglycemia. In these cases, the pancreas appears to release excessive amounts of insulin, leading to a precipitous drop in blood sugar which then may fall below normal baseline.
Two very significant metabolic changes happen when blood sugar is below baseline. First, the adrenal glands release adrenalin in an attempt to slow down this precipitous drop by stimulating the release of some stored sugar back into the bloodstream. Second, as the drop in blood sugar continues, the now starving and unbalanced brain sends out urgent signals for the body to do whatever it takes to bring blood sugar levels 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 any drug or addictive behavior of choice, since an addict’s brain has previously been conditioned to look to its drug of choice to restore comfort and 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.
What, one may ask, does sex for the sex-addict have to do with low blood sugar, other than a conditioned attempt to restore equilibrium? There are several answers. The first answer has to do with access to the brain’s problem-solving skills. When adrenalin is released, the sympathetic nervous system is activated. One result of this activation is less blood flow to the prefrontal cortex, the cognitive center where plans are made, skills accessed, consequences assessed, and instinctive fight/flight reactions are triggered.
Thus, with low blood sugar, a powerful physiologic trigger for use and relapse is encountered. An addict may be working a strong recovery program, and has learned new and helpful skills. However, at that “hypoglycemic moment,” access to those skills is physiologically blocked, and the conditioned response of reaching for the drug behavior of choice is activated to force a release of stress-managing neurotransmitters.
Furthermore, researchers Matthew Gailliot and Roy Baumeister have determined that “self-control relies on some sort of limited energy source.” Their research
“…suggests that blood glucose is one important part of the energy source of self-control. Acts of self-control deplete relatively large amounts of glucose. Self-control failures are more likely when glucose is low, or cannot be mobilized effectively to the brain (i.e., when insulin is low or cells are insensitive). Restoring glucose to a sufficient level typically improves self-control. Numerous self-control behaviors fit this pattern, including controlling attention, regulating emotions, quitting smoking, coping with stress, resisting impulsivity, and refraining from criminal and aggressive behavior. Alcohol reduces glucose throughout the brain and body, and likewise impairs many forms of self-control. Furthermore, self-control failure is most likely during times of the day when glucose is used least effectively. Self-control thus appears highly susceptible to glucose.” (emphasis added)
This situation causes more problems. Coping skills are blocked by adrenalin, 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 relapsing, 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.
Traditionally, in treatment and Twelve Step circles, sugar is touted as the cure for cravings. Candy, chocolate and sweetened coffee abound at recovery meetings. Most residential programs make no effort to limit the amount of coffee, sugar, and refined carbohydrates that are served to their clients. It is common for many people to gain weight after quitting their drug of choice. We all know, for example, that for people who are quitting nicotine their greatest fear is gaining weight. What is actually happening in these situations? Is sugar truly useful for the recovering addict or is the real case just the opposite?
How do we evaluate the AA sponsor’s recommendation that his sponsee should carry a bag of candy for relapse prevention? We believe that this approach actually encourages the switching of addiction from the drug/behavior of choice to sugar. But, researchers have created alcoholic rats by feeding normal rats high amounts of sugar!
Sugar itself is an addictive and dangerous substance. Increased cravings and other 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 after eating sugar blood glucose levels are 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 crazy-making and strongly induce relapse.
Furthermore, recent research strongly implicates sugar as a major suspect in the etiology of many cancers. Sugar obviously contributes to obesity and diabetes. Finally, switching addictions may support abstinence from the primary substance, but does not lead to true recovery. People who become “sugarholics” are still addicts.
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 high in protein and moderate in complex carbohydrates, with protein snacks between 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.
Most women who relapse do so within the ten days before bleeding starts. In general, premenstrual women should eat food high in protein every three hours to maintain blood sugar stability. For people who just forget to eat, seem to be too busy to eat, or have trouble finding access to appropriate food (and potato chips definitely falls into the “inappropriate” category!) we recommend carrying better quality protein bars (whose sugar content is no higher than their protein content).
It is advisable to eat protein and complex carbohydrates every three or four hours (and again if you become wide awake in the middle of the night) and limit caffeine to no more than two cups per day. For snacks: a cup of Greek yogurt, half an apple and a stick of string cheese, unsweetened peanut butter on celery or carrots, a handful of walnuts or almonds, half a meat sandwich with lettuce and tomato on whole grain bread, or a higher-quality protein bar (where the grams of sugar listed are no more than the grams of protein).
Placing 1,000 mg of l-glutamine under the tongue for fast absorption can be utilized by the brain as fuel. L-glutamine can eliminate a craving in seconds. It is also a GABA (gamma amino butyric acid) precursor, so l-glutamine also reduces anxiety-both by raising GABA and by stopping the adrenalin response to hypoglycemia. Also, people with unstable blood sugar tend to abruptly wake up in the middle of the night due to an adrenalin surge, and find it impossible to go back to sleep because they feel so alert. Eating a small snack, or using l-glutamine at this time helps to decrease circulating adrenalin and puts people back to sleep easily.
It is often very hard for people, especially those in recovery, to change their unhealthy ways of eating. Tools that we have found to be useful in building motivation and awareness include:
A food/mood/craving diary
A list of hypoglycemia symptoms which clients check off (link)
A 6-hour glucose tolerance test
Using the glycemic index as a food ranking guide
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
Taking time in each session to find out what a patient is doing to keep his or her blood sugar in balance.
Feeding oneself in a healthy, pro-recovery way, is an act of self-care that is recovery- and life-sustaining. We encourage clinicians to try these approaches themselves and with their clients and track the outcomes.
Interesting on the hypoglycemia theory. I will attest that when I binge on porn, I don't get hungry at all. Seriously, I could begin a binge at 5pm, watch videos for hours into the night, and by 6 am the next morning I wont have eaten anything and I'm not hungry at all. Why is this? I think it's because my adrenaline and sympathetic response ramps up and I'm totally out of the rest and digest mode. I get adrenal fatigue real bad when I binge too much, and I think this is why. Interesting stuff.
Hey Fry. That's great news about the diagnosis. I mean, it's a shitty thing to have, but now you know you can start addressing teh problem and it may make a real difference in your life.
There is something nice about a normal life. A basic life. I've found it a bit in travel to poorer countries. Friends and family are always #1. There is no greater feeling than love. I don't know if anyone ever truly finds their purpose, or the perfect purpose..I mean being a father and husband is pretty huge. Your bills will get paid..it is nice to travel and have some toys but not totally essential. I think if you get a grip on sobriety most, if not all, of your dreams can come true.
Im sorry..sometimes in life we must keep fighting. I think you can get sober and stay sober. I would see a doctor about non addictive sleep meds
Firts, I must say, in regards to the long text about the blood sugar that you pasted, that I 100% have noticid it to be true. A drop in blod sugar is dangerous territory for me. It is like I lose at least 50% of my selfcontrol. But damn it, it's so much to think about when rebooting that I foter forget this part as well.
Don't give up on your hopes that starting with the hypothyroidism treatment will make you function better. It might take a little while before you notice improvemtns, just as with most things in life.
Congrats on the good sleep tonight!
I'm so happy for you dude! After binging two nights ago, I had to spend all of yesterday awake with no sleep the night before. Being awake for 48 hours is one of the worst feelings I know. The fact that you had to stay awake until 5am the other morning without even succumbing to your addiction just doesn't seem fair. I hate insomnia, it doesn't get me very often but when it does my frustration goes through the roof.
On the other hand, maybe you feel this way too like I do. I recall reading somewhere on the causes of ups and downs of dopamine. One of the things that will actually INCREASE dopamine is lack of sleep, like if you were to stay awake an entire night, you'll actually have more dopamine production on that given day. I've actually experienced this, as my anxiety will completely abate on days where I didnt sleep the night before. I even got a haircut one day after not sleeping and had great conversation with the stylist with no anxiety (I have panic disorder so getting a haircut is really difficult for me).
I see today is your day 1 as well. The challenge is on my friend! Get a black bottom at the bakery for your hypoglycemia and have a wonderful time with your family. You deserve it.
You're going to have to fill your time with activities outside the house if you can help it. Whenever my wife works the night shifts is always when I relapse. Being alone is always one of the biggest drivers of my addiction. How many days will you be sequestered to yourself? You've experienced the benefit of staying clean, so try and use those past experiences to pull you through. I know each and every time I get done with a binge, i always always tell myself it wasn't as good as having a clear head with no anxiety. I also know about over exercising, it puts me right back into adrenal fatigue and makes my withdrawal worse. Take it easy over these coming days and you'll get by clean if you're diligent. Good luck man!
Your wife sounds really supportive That's great to see.
This completely. My wife has no suspicion whatsoever about my addiction. I feel like that would make things infinitely easier, but I know coming out to her about my problem would result in some intense fighting. You're lucky, Fry!
I'm sorry you're still dealing with the insomnia. Have you tried deep breathing or progressive muscle relaxation? A lot of times when I can't fall asleep I'll do 4-2-6 breathing. 4 in, 2 hold and 6 seconds out. After 20 min. Of that ill typically fall asleep. I know it's hard to turn your brain off when it's most critical, have you tried valerian? That stuff puts me out like no other. Also, I mentioned in my recent posts that I'm taking CBD oil now. That might do wonders for your insomnia.
I'm back to day 1 today as well. I found a loophole in the settings of my launcher app that has it's own web browser. The locks don't even touch it. I should've taken your advice. I need a new approach. I might be running from something as well, like you've said. Keep your head up and stay diligent. You'll find the answer if you're dedicated enough. The question remains, are you dedicated enough? Disciplined enough to stay away long enough to find what's missing/not working? Stay well friend
thats an interesting observation you made about yourself "running away from things"
in your opinion, what do you think you are running away from?
good point about total honesty
Oftenen times, when I read your journal posts it is like I see myself writing. Think we must be pretty similar, except you have a wife and baby and I'm a single dude.
Interesting, the research about sugar spikes, adrenaline and the connection to addictive behaviour.
How are you doing with all that at this time?
How are you doing Fry? It's been a while since you made an update here
Hey Marston, actually I wanted to start a new journal as I'm not so much into my old one anymore
Not much to report though. Still going through 1-2 week cycles and trying to figure it out.
Oh, have I missed something here? Have you already started a new journal? If so, what's it called?
Separate names with a comma.