Did you know that low blood sugar is a powerful trigger for both anxiety and mood issues?
I don’t think this gets talked about nearly enough…
Today we will look at why keeping your blood sugar levels stable is SO important for reducing anxiety, and a couple strategies on how to prevent hypoglycemia-induced anxiety and panic attacks!
What is Blood Sugar?
Glucose, a simple sugar, is the body’s main energy source.
And your blood sugar levels, or blood glucose, is simply a measurement of much glucose you have in your blood!
If you are eating a balanced diet, most of the glucose floating around in your bloodstream comes from eating carbohydrate-rich food such as potatoes, rice, fruits, and so on:
Your blood then delivers the glucose to your muscles, brain, liver, kidneys, etc, so they can burn it as fuel and produce energy.
The body likes to keep blood glucose levels it in a relatively tight range; not too high and not too low.
We’re not going to go too deep into the mechanisms of blood sugar regulation today, but it is managed by different hormones such as insulin (= lowers blood glucose), and glucagon and adrenaline and cortisol (= elevate blood glucose).
You can study this picture for a more detailed explanation:
What Causes Low Blood Sugar?
Hypoglycemia is the fancy-pants word for low blood sugar; essentially it’s a failure of the body to keep blood sugar levels steady.
Hypoglycemia is where your blood glucose drops below 70 mg/dL (3.9 mmol/L) and you may start feeling irritable, anxious and shaky.
This can occur due to a variety of different reasons…
Perhaps the most common cause of low blood sugar is when diabetes patients are taking medicine, e.g insulin, to manage their blood sugar levels.
Accidentally taking too much insulin can cause blood sugar level to tank = you get hypoglycemia!
However you don’t need to have diabetes to get hypoglycemic episodes.
Here are a few other causes of hypoglycemia:
- Poor nutrition/diet which messes up your body’s ability to keep blood sugars stable.
- Reactive hypoglycemia a.k.a sugar crash = low blood sugar that occurs after meals.
- Good liver function is really important for maintaining stable blood sugar levels; you can think of the liver as a battery that recharges with glucose after every meal. If you have a “sluggish liver” or liver issues or fatty liver you may experience issues with maintaining good, stable blood sugar levels.
- Long-term restrictive dieting, or starvation, or overexercising.
- Too much coffee, especially on an empty stomach.
- Drinking a ton of alcohol prevents your liver from releasing stored glucose into your bloodstream. (I think this explains a lot of crazy drunken behaviour + of course the effects of alcohol).
- Acute liver disease such as hepatitis or cirrhosis can cause hypoglycemia.
- Kind of rare but a tumor of the pancreas (insulinoma) can cause overproduction of insulin and cause hypoglycemia.
How Hypoglycemia Can Cause Anxiety, Panic Attacks and Depression
Hypoglycemia – or low blood sugar – can act as a powerful trigger for anxiety.
The brain relies on glucose as a fuel source.
If your blood sugar drops too low, the brain isn’t going to get enough fuel which can have severe consequences.
This is an emergency situation for the body!
Thus, in a hypoglycemic state the body QUICKLY needs to bring blood sugar levels back up again so your brain doesn’t run out of energy.
(The same way I QUICKLY need coffee in the morning!)
In order to get glucose to the brain as fast as possible, the body starts pumping out adrenaline and cortisol from the adrenal glands to help liberate energy from storage sites (muscles and liver) and increase blood sugar levels.
And you know what happens when you have high levels of adrenaline – you get a “fight-or-flight” stress response with increased anxiety, sweating, shakiness, feeling jittery and wired!
Case in point:
When you take a bunch of people in a laboratory setting and make them acutely hypoglycemic, they get a worsened mood and energy levels, and remain in a state of “tense tiredness” for 30 minutes even after restoring blood glucose to normal levels.
This is why low blood sugar, or unstable blood sugar that goes and up down like a Yo-Yo, can make you feel truly awful… especially with a pre-existing tendency towards anxiety.
Symptoms of Low Blood Sugar
A hypoglycemic state can make you feel really bad, here are some common symptoms:
- anxiety and panic.
- feeling terribly depressed.
- feeling moody.
- feeling weak.
- having no energy.
- trembling and shakiness.
- racing heart.
- feeling like you’re about to faint.
And remember, the brain NEEDS glucose to function and if the low blood sugar isn’t treated you can start experiencing:
- weakness, blurred vision, difficulty concentrating, feeling drunk, slurred speech, even collapsing or passing out.
Low blood sugar can also happen when you sleep – often this causes you to wake up at around 2-3 AM from adrenaline flowing in your blood!
So as you can see, the symptoms of hypoglycemia are kind of hard to separate from anxiety and even panic attacks (sudden onset of intense fear and anxiety).
Both low blood sugar and anxiety causes you to go into a fight-or-flight mode with all the associated horrible symptoms!
How Stabilizing Your Blood Sugar Relieves Anxiety
I found this case report where a 15 year old girl was eating a poor diet of mostly refined carbohydrate that was causing her blood sugars to go up and down like a rollercoaster, causing severe ‘hypoglycemia anxiety’.
Switching to a diet that balanced her blood sugar levels significantly improved anxiety symptoms!
From the article:
“AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of protein, fat, and fiber to her diet resulted in a substantial decrease in anxiety symptoms as well as a decrease in the frequency and severity of hypoglycemia symptoms. A brief return to her previous diet caused a return of her anxiety symptoms, followed by improvement when she restarted the prescribed diet. This case strengthens the hypothesis that dietary glycemic index may play a role in the pathogenesis or progression of mental illnesses such as generalized anxiety disorder and subsequently that dietary modification as a therapeutic intervention in the treatment of mental illness warrants further study.”
If you are suffering from anxiety, it is super important that you make sure your blood sugar levels are nice and stable and DO NOT ever dip into dangerously low levels.
I can’t stress this enough!
As we have talked about, low blood glucose can both trigger and mimic anxiety symptoms, so avoid it all costs.
Practical Recommendations for Keeping Blood Sugar Stable
How do you manage your blood sugar to avoid unpleasant hypoglycemic episodes?
The best solution is to prevent hypoglycemia from occurring in the first place.
And in my experience, the best way to do that is being proactive by fixing your diet and eating properly!
There are lots of ideas on what diet is the best for stabilizing your blood sugar, e.g low-carb, intermittent fasting, carnivore, high-carb vegan, fruitarian (hmm… maybe don’t do that).
Different people will likely respond better to different approaches!
However there are some general guidelines for improving blood sugar stability which I think apply to the majority of individuals:
1. Eat Enough
Fasting, time-restricted eating, caloric restriction, cutting out carbs, etc, may have some benefits for some specific conditions… but in my opinion, more often than not it just messes with your hormones and makes you MORE anxious.
It’s been shown that long-term calorie restriction reduces active thyroid hormone T3.
And intermittent fasting (16:8), vs a regular eating schedule, has been shown to reduce both testosterone and T3!
I believe that fasting and under-eating can be especially harmful for people that are vulnerable to anxiety and depression.
Actually, my own issues with panic attacks started during a period where I was doing 16:8 intermittent fasting (only eating during a 8 hour window) and drinking a bunch of black coffee during my fasting window.
Not eating enough and being in a chronic calorie deficit is a huge stressor.
By reducing food (fuel) intake, the body increases stress hormones to break itself apart and provide the fuel.
This is not something you want happening when you are already stressed out and dealing with anxiety and panic attacks.
I’ve found that I feel MUCH better on a regular eating schedule (3-5 meals per day) with a good chunk of calories; better stress resilience, better mood, no anxiety.
How Much Should You Eat?
If you have no idea how much you should be eating you can calculate your basal metabolic rate (BMR) here.
Your BMR (x activity levels) should be a good starting point.
Again if you have no idea how many calories you consume on a daily basis, an easy way to track calories is by using cronometer.com where you input the foods you eat and it calculates the total daily caloric intake.
2. Eat ALL The Macronutrients – Fat, Protein, Carbohydrate
Not only do you want to get enough calories, but you also need adequate amounts of protein, fat and carbohydrates.
Yes, all of them!
We’re not going to restrict any macronutrient.
I generally recommend that you diet consists of balanced nutritious meals, and that you avoid eating large doses of refined sugar/carbohydrate in isolation to avoid reactive hypoglycemia.
The combination of protein, fat, carbohydrate and fiber (from whole foods) in a meal is ideal for reducing blood sugar spikes, and helps to reduce stress and anxiety.
By eating balanced meals you’ll greatly reduce the risk of getting reactive hypoglycemia a.k.a low blood sugar after meals.
And it should allow you to go 3-5 hours between meals with no energy dips and without becoming hangry (hungry + angry) or anxious.
An exception to this “rule” is that eating WHOLE fruits on their own – in reasonable quantities – is fine as the fructose (and fiber) helps reduces insulin secretion and risk of crashing blood sugars.
(In fact, adding some fruit/fructose to starchy meals can be a great way to improve blood sugar stability!)
Here’s an example meal that would satisfy these criteria:
- Meat (fat and protein)
- Basmati rice (easy to digest carbohydrate)
- Zucchini (fiber)
- Glass of pomegranate juice (more carbs + fructose to balance blood sugar)
Simple and effective and tasty!
Here’s another example:
- 1 cup oatmeal (slow digesting carbs)
- 3 egg omelette cooked in butter (fat and protein)
- 1 glass of juice (fructose)
Or you could do something like:
- Greek yoghurt (fat and protein)
- Fruits/berries/honey (carbs and fiber)
3. Eat 3-4 Times Per Day
For good blood sugar regulation, I usually recommend spacing out your calories over 3-4 meals.
This means you’ll be eating something every couple of hours and re-filling your liver glycogen (glycogen = storage form of glucose) frequently so it doesn’t run too low.
Kind of like how a normal person eats:
- Breakfast at 7 AM
- Lunch 12 PM
- Snack 3 PM
- Dinner 6-7 PM.
Some individuals do fine on 2 meals per day, and some on 5 meals per day, but most do best on the standard 3 meals per day + 1 or 2 snacks.
When you start spacing out your meals too far apart (e.g 1 or 2 meals per day) there’s obviously a higher risk that your stored glycogen will run out, and you will get a blood sugar crash.
Eating ALL the time is not a good idea for other reasons – keeping a few hours between meal engages the MMC (migrating motor complex) that works sort of like a broom to clean out the gut and small intestine. This is super important for having healthy digestion!
4. Be Careful To Balance Protein With Carbs
Many do not know this, but protein is actually highly insulinogenic (i.e increases insulin levels) and can drop your blood sugar like a rock!
Some people are more sensitive to this than others. Eating protein in isolation, or too much protein relative to carbohydrate, can cause hypoglycemia and trigger stress hormones.
As a rule of thumb:
Make sure to eat at least 2x as many carbs as protein in a single meal.
So in meal with let’s say 200 g meat (around 40 g protein) you would also want to eat at least 80 g of carbs.
5. Avoid Drinking Too Much Coffee
Coffee is great.
I love it!
Maybe a bit too much…
However, individuals with poor liver and/or adrenal function tend to get a stress response (low blood sugar) from drinking coffee.
Coffee/caffeine stimulates the metabolism and demands a lot of energy and resources; it can quickly lower your blood sugar if you haven’t eaten enough, or if your liver isn’t working at a 100% capacity and you can’t mobilize energy.
If your blood sugar is wonky or you have a tendency to get hypoglycemic, reduce coffee to maybe 1 cup per day and/or make sure to put some milk and sugar in your coffee.
6. Improve Your Liver Function
As I mentioned earlier, good liver function is ESSENTIAL for maintaining stable blood sugar levels between meals.
Being able to go 12 hours or more without eating, and without getting a stress response, is a sign of a very healthy liver!
It means your liver is doing its job of storing glycogen and releasing glucose later when the rest of your body needs it.
(Same is true for coffee tolerance – if you can drink 1 gallon of coffee without a stress response you probably have a well-functioning liver).
Not being able to go longer than 1 hour without getting hypo symptoms is a sign of poor liver health. Or waking up at 3 AM every night with adrenaline like symptoms.
If you suspect your liver needs some tender loving care, here are a few things that could help:
- Good nutrition – animal protein (meat, eggs and dairy), adequate carbohydrate intake from whole food sources such as fruits and tubers (at least 200-300 g), plant fiber for detoxification and increasing gut motility, salt to taste – ALL of these help support good liver health.
- Boost your gut microbiome – polyphenols and fiber from fruits, vegetables and spices are generally beneficial for your gut health and liver. I like coffee, pomegranate juice, ginger and cinnamon!
- Going lower in fat – this tends to help with improving insulin sensitivity and reducing fatty liver. Reducing fat to around 20% of total calories, at least for a short period, can be super helpful!
- Going lower in fructose – excluding ALL sugar and limiting fructose intake to whole fruit, or 100% fruit juice, can also help with leaning out the liver (fructose is metabolized mainly by the liver).
- Drinking coffee – as I explained in this article, coffee is an awesome liver-protective substance and drinking MORE coffee can really help improve liver function. Obviously you have to be careful that you don’t get a stress response, only drink as much as feels good.
- Avoid medications, drugs, plastics, sunscreen, environmental toxins etc.
- Get the bile flowing – when you eat a meal containing fats, your gallbladder dumps bile into the digestive tract which assists in fat digestion, and it also increases digestive enzymes. Good bile flow helps keep the liver nice and happy, and I’ve found that drinking hot water or tea between meals is excellent for promoting bile flow.
- Check your thyroid function – good thyroid function is needed in order for the liver to do its job and store carbohydrates. A doctor called Broda Barnes wrote a book about this called “Hypoglycemia: It’s not Your Mind, it’s Your Liver.” For information on how to improve thyroid function see the section “4. Improve Your Thyroid Function” in this article.
7. For Acute Hypoglycemic Episodes
Let’s face it, sometimes crap just happens and we have to adapt and deal with the situation.
So you start feeling signs and symptoms of hypoglycemia – what do you do?!
Eat or drink 15 to 20 grams of carbohydrate from fruit/fruit juice, preferably with some salt (sodium).
That should give some relief within a few minutes.
But again the best alternative is PREVENTION (i.e a good diet) and not getting low blood sugars in the first place!
For the reasons previously given, being aware of how different foods and food combinations affect your blood sugar is really, really important if you want to get rid of anxiety or depression.
If you eat something that drops your blood sugar like a rock you can be sure that you will feel bad.
Looking back at a period in my life where I felt really terribly depressed, in hindsight I think a lot of it was due to my terrible eating habits and my blood sugar going up and down like a rollercoaster.
Seriously, just making sure your blood glucose levels are stable can make such a huge difference for improving well-being and mood.
Try out some of the strategies outlined here and let me know if it helped or not.
Until next time! 🙂