"Do lions develop insulin roller coasters?" I asked, then hurried to correct myself. "They probably don't. I mean lions eat the whole animal, meat, skin, fat and all. And proteins and fats do not cause roller coaster effects."

"Right," Choua nodded. "Hypoglycemic-hyperglycemic shifts—sugar roller coasters—are problems caused by SAD, the Standard American Diet. That's your stuff."

The term hypoglycemia means low blood sugar level; hyperglycemia is opposite of that—high blood sugar level. Blood sugar levels reflect the amount of sugar in food and the rate of its absorption in the stomach and upper bowel. In health, the blood sugar level rises gradually as a wholesome meal—low in simple sugars and rich in fiber and undigested foods—is slowly digested and absorbed. In response to a gradually rising blood sugar, the pancreas secretes its hormone, insulin, in a slow, sustained fashion. Insulin, in turn, gently brings down the raised blood sugar level—regulating the sugar level within the normal range of 75 to 150 milligrams of sugar per deciliter of blood. (A deciliter is one-tenth of a liter, or equal to approximately six tablespoons of fluid.)

While insulin is the principal regulatory hormone, there are other hormones that oppose its actions and serve as counter regulatory hormones. These include adrenaline, cortisone, glucagon and growth hormone. Excessive stimulation of the vagus nerve is also considered to play a role, and some physicians use an anticholinergic drug (propantheline bromide, 7.5 mg 30 minutes before meals) to control symptoms of hypoglycemia. The blood glucose also "autoregulates" itself in the sense that it undergoes spontaneous nonenzymatic oxidation.

Eating sugary foods—such as sodas, orange juice, candy, cakes and cookies—unaccompanied by whole undigested foods and fiber causes sudden rises in blood sugar levels. Such a hyperglycemic response to sugar intake is rapidly followed by a sudden release of insulin from the pancreas. Insulin drives sugar into cells and lowers blood sugar level.

"In your hospital laboratory, you give narrative reports of glucose tolerance tests and try to emphasize the role of hyperglycemic-hypoglycemic shifts, don't you?" Choua asked.

"Yes, I do," I replied.

"Do the doctors pay any attention to your emphasis on sugar shifts?"

"To be frank, I'm not sure they ever do."

"Why?"

"I guess because mainstream notions of sugar metabolism, hypoglycemia and diabetes are oriented to absolute numbers of blood glucose values," I explained.

"Not oriented, fixated," he scowled.

"I wouldn't go that far."

"But the doctors who read your reports rarely use the sugar shifts information to manage their patients. When the blood sugar levels are high, they simply use the labels of diabetes, pre-diabetes or chemical diabetes and prescribe blood glucose-lowering drugs. They rarely, if ever, manage sugar roller coasters as a dysregulation of sugar metabolism."

"Why?"

"Because they aren't trained to diagnose sugar-insulin shifts as metabolic dysregulation. And those few who are aware of the problem just don't know how to manage those shifts. Rarely is an internist's office organized to provide the necessary nutritional education and nutrient therapies to successfully manage those cases."

"What do lions know about hypoglycemia, Choua?" I asked.

"What is hypoglycemia?" he frowned.

"Low blood glucose level."

"How is it diagnosed?"

"There are two standard criteria for the diagnosis of hypoglycemia: 1) the blood sugar level has to be 50 mg/dL or lower and 2) the low blood sugar level must be associated with hypoglycemic symptoms," I explained.

"What diagnostic tests do you perform?"

"We do three-hour or four-hour glucose tolerance tests. During the test, we ask the patients to carefully record the development of any hypoglycemic symptoms. If the blood glucose level dips to 50 mg/dL or lower and the patient experiences any symptoms, we establish the diagnosis of reactive hypoglycemia."

"You run a hospital laboratory and read most of the glucose tolerance tests. You must have signed out more than a few thousand glucose tolerance tests. Tell me, how often does that happen?"

"Actually, Choua, it's not that common. Blood sugar infrequently falls below 50 mg/dL at our laboratory."

"How often do nutritionist-physicians diagnose hypoglycemia?"

"Frequently."

"And how many of your patients suffering from food and mold allergies, disabling fatigue and chronic immune disorders tell you they've been diagnosed with hypoglycemia by previous nutritionist-physicians?"

"That's common."

"Do you think those patients suffer from hypoglycemia or not?"

"Well, that's a problem," I confessed. "When I repeat their glucose tolerance tests, they often don't meet the numerical criterion for hypoglycemia. And even when they do, the lowest blood sugar level is not accompanied by typical hypoglycemic symptoms."

"What do you make of that?"

"Nutritionist-physicians diagnose hypoglycemia largely on an empirical basis when patients complain of hypoglycemic symptoms. Then they treat their patients by prescribing low-carbohydrate diets and frequent small meals. Many think hypoglycemia is caused by yeast overgrowth and prescribe antiyeast herbs and drugs."

"Does that work?"

"That's the thing. Such management plans do work—not always though."

"What do mainstream doctors think about that?"

"They think symptoms that can be relieved by low-carbohydrate diets; small, frequent meals; and antiyeast agents are psychosomatic problems."

"In other words, it's the old all-in-the-head theory. Right?"

"Right. And that's tough for patients. The disagreement between mainstream physicians and holistic physicians causes much confusion among patients who are caught between two very different viewpoints. They go from one professional to another, encountering contradictions at each step. That's a difficult problem."

"Do you want to know what lions think of hypoglycemia?" he asked me with a wink.

"Yes." I felt relieved.

"Lions don't agree with either group. They simply sense things and act accordingly. When they feel hungry, they go looking for food. Their meals contain complete foods, with high-grade proteins and essential, unoxidized fats. There is no sugar and little starch, if any, in lions' meals. Lions usually go for the gut of their kill first."

"Why?"

"Because that's where live enzymes, vitamins, minerals and digestive juices are. Lions, unlike your university internists, have a gut sense of good nutrition."

"And, tell me, what do lions think of hypoglycemia?"

"Lions have no compulsion to fit their sensory perceptions into someone else's frivolous numerical model the way mainstream doctors do. Nor do they have any desire to make things up just to satisfy their patients as nutritionist-physicians do."

"You're an equal opportunity abuser, aren't you?" I laughed.

"Lions know an individual's metabolism is for him to know, and each of them must learn to sense his own metabolic regulations—and dysregulations—and respond to them accordingly."

"Tell me, what do lions think about the nutritionists' take on hypoglycemia?" I pushed him.

"Why don't you tell me what nutritionists do after they diagnose hypoglycemia?"

"They confirm their diagnosis by prescribing food plans that assure steady-state sugar metabolism. They look for adverse food reactions and teach their patients how to avoid them."

"What do mainstream doctors think of that?" he asked mischievously.

"Didn't I tell you they think it's quackery? They laughingly dismiss the nutritionist's diagnosis."

"Mainstream physicians like to think that what their blessed tests cannot detect doesn't exist, don't they?"

"Yes. They cling to their view that symptoms experienced by patients are imaginary, and they contemptuously accuse nutritionists of reinforcing pathologic belief systems."

"Have you ever heard a cardiologist attribute an episode of heart rhythm irregularity to sudden shifts in blood glucose?" he asked.

"No, I haven't," I replied.

"Or to sudden surges in insulin and adrenaline levels?"

"No."

"Have you ever heard a gastroenterologist blame abdominal symptoms on yeast overgrowth in the gut?"

"No."

"Or a neurologist ascribe a headache to chemical sensitivity reaction?"

"No."

"Or a pulmonologist think of mold allergy when treating an asthma attack?"

"No."

"Or a rheumatologist blame joint pains on food allergy?"

"Not that either."

"And, of course, psychiatrists are rarely burdened by any knowledge of nutritional and metabolic dysregulations when they prescribe drugs for mood disorders."

"What's the point of all this?" I asked, exasperated.

"Tell me, how do mainstream doctors think patients with hypoglycemic symptoms should be managed?"

"For one thing, they certainly don't think that legitimate psychiatric symptoms should be chalked up to quackish notions of hypoglycemia."

"Tell me, what do you think of problems caused by low blood sugar? Are they real or imaginary?"

"Real. If they weren't real, why would patients get better? That much I can assert from my own clinical experience."

"Clinical experience?" Choua grimaced. "Tell me, what's clinical experience?"

"Clinical experience is that intuitive-visceral sense a clinician develops after long periods of close observation."

"Now that's different!" His eyes brightened. "I can understand that. Indeed, that's what my Serengeti lions also know."

"How so?" I asked.

"The lions follow their instincts. Low blood sugar signals a time to get up and look around for food."

"So, do your lions agree with nutritionists? Do they also know that problems of low blood sugar are real?"

"No."

"No?"

"Lions know it's not about how low the blood sugar gets—whether it reaches 50 mg/dL or not."

"Well, we really don't know whether 50 mg/dL is the right number for lions, do we? Do the lions know that?" I teased.

"Precisely!" Choua's eyes lit up. "That's precisely the point!"

"What point?" I asked, perplexed.

"Serengeti lions don't play the numbers game. They just follow their instincts, which guide them to their next meal."

FIVE FACES OF SUGAR-INSULIN DYSREGULATION

"Sugar is the primary villain in human metabolism," Choua went on. "Excess sugar in food stresses human energy systems in many ways and causes the dysregulation of carbohydrate metabolism. Sugar-insulin dysregulation has five faces."

"What are those faces?" I asked.

"First, it creates sudden surges in blood glucose levels—a condition called hyperglycemia. Second, sudden hyperglycemia triggers the rapid release of large amounts of insulin from the pancreas—a condition called hyperinsulinemia. Third, the insulin response to high blood sugar overshoots its mark and drives the blood sugar level below the normal range—a state of low blood sugar called hypoglycemia. The fourth face of glucose-insulin dysregulation is the insensitivity of insulin receptors at cell membranes. Such receptors are overwhelmed and literally numbed by excesses of insulin."

"Do you mean peripheral insulin resistance?" I asked.

"You aren't comfortable with simple language, are you?" he retorted. "Why do you turn simple things into complicated medicalese?"

"Okay! Okay!" I replied, annoyed. "What's the fifth face?"

"The fifth face of glucose-insulin dysregulation is too much adrenaline—a state you may call adrenergic hypervigilance. When an insulin surge drives sugar below the desirable range, the adrenal glands kick in and dispense blasts of adrenaline to counter the insulin. Adrenaline is one of the most—if not the most—potent oxidant in the human body. The oxidative fires lit by adrenaline overdrive the heart causing palpitations, tighten arteries producing high blood pressure, rev up nerve-muscle conduction sites causing stiff muscles, jitters and sweating. And that sugar-insulin-adrenergic dysregulation is what the stress specialists call the stress response. Right?"

"Right."

"What are the symptoms of hypoglycemia?" Choua continued.

"The main symptoms include the jitters, sudden weakness, mood swings, nausea, abdominal discomfort, sweating, heart palpitations and brain fog."

"What's brain fog?"

"Confusion, haziness and concentration problems."

"Now, tell me, what are the symptoms of adrenergic hypervigilance? Of adrenaline rush?"

"It causes jitters, sweating and heart palpitations."

"And what else?" he pressed.

"Nausea, abdominal discomfort, sudden-onset weakness and mood swings." I found myself enumerating the symptoms of hypoglycemia.

"Huh!" Choua beamed with satisfaction. "I was hoping you'd count the symptoms of hypoglycemia in the same exact order as you would those of an adrenaline rush. But that was pretty close."

"Of course, symptoms of glucose-insulin roller coasters and adrenaline rushes show a large overlap because..."

"It isn't an overlap," he interrupted me. "It's a continuum. All of biology is a continuum, not a bunch of overlaps. Your classifications of diseases and syndromes are mere artifacts."
    

"That's absurd," I protested. "Disease classification is essential if we are to make any sense of the enormous number of diseases that we see."

"I'm not saying your disease classifications don't make your life easier for you. I am saying nature is a continuum, and so is biology. Tell me, what blood tests and scans do you use to diagnose sugar-insulin-adrenaline dysregulation?"

"That's not an easy thing. Glucose studies are simple enough to perform and three- or four-hour tolerance tests are frequently done, but insulin and adrenaline activities are rarely, if ever, evaluated in clinical medicine."

"It's far easier to chalk up the symptoms of glucose-insulin-adrenaline dysregulation to hypochondria, anxiety-neurosis or the all-time favorite, the all-in-the-head label. Isn't that the way it works in real life?" he asked sarcastically.

"No. Yes, well it isn't that..."

"Simple," he completed the sentence.

"Why do you ask me questions if you don't have the patience to hear the answers?" I complained.

"The poor patients are dismissed as doctor-shoppers or, worse, pests by their doctors, right?"

"Regrettably that does happen sometimes," I confessed.

CHOLESTEROL: AN INNOCENT MOLECULE TAKES A BUM RAP

"Sugar and insulin are the real molecular culprits in the cause of coronary heart disease," Choua resumed.

"What?" I asked, surprised. "Not cholesterol?"

"The cholesterol story is phony. Sugar and insulin are the real molecular villains in coronary heart disease," he groused.

"Now that's a switch, isn't it? The whole world thinks heart attacks are caused by cholesterol. Where did you..."

"Not the whole world," he cut me off curtly. "Only the cholesterol cats—the fat cats who make money by promoting cholesterol tests and the fatter cats who pile up riches in selling worthless drugs to lower blood cholesterol levels."

"Let's keep cheap sensationalism out of it, Choua. Do you have any evidence that excess sugar and insulin cause coronary artery disease?"

"Evidence!" he shot back. "Why don't you first tell me about the evidence that cholesterol causes heart disease?"

"That's ludicrous," I replied, irritated. "There are dozens of large studies that show reduced risk rates of heart attacks with lower cholesterol levels."
    

"You should know better than to speak so frivolously, Mr. Pathologist," his voice rose sharply. "All those studies report bloated risk reduction figures while the true rate reduction numbers are dismally poor. When they gloat about forty-four percent risk reduction, the real rate reduction is actually less than two percent."

"You look at everything through your squinty eyes," I taunted.

"Don't be fooled by the distortion of high-risk reduction figures," he continued. "Suppose two persons out of one thousand people with high blood cholesterol levels suffered a heart attack in 1985. Then all one thousand people were given a cholesterol-lowering drug. Ten years later, in 1995, only one person out of those thousand suffered a heart attack. You could rightly say that the drug had reduced the risk of heart attack by fifty percent—from two persons to one. While one out of two evidently means fifty percent, that statement would be patently absurd. Don't you see that the risk reduction of fifty percent is a meaningless number until you know something about the total number of people studied?"

"Okay, you made your point," I conceded. "Now, tell me about rate reduction."

"Rate is an accurate mathematical expression. For example, a two percent rate reduction in heart-attack patients taking a drug means that two out of one hundred people were saved from a heart attack by that drug. The remaining ninety-eight persons received no benefits from the drug. Now, if you take the raw data from the published cholesterol studies and calculate the real rate reduction number, you'll readily see the deception in bloated risk reduction numbers. You'll find that the actual rate reduction numbers are well below two percent in all those studies."

"I think you're confused, Choua," I countered. "Obviously the purpose of a drug is to help those two percent who might suffer a heart attack. Why confuse the picture with the remaining ninety-eight healthy persons?"

"I'm confused?" he scowled, then added sarcastically, "Sometimes you're maddeningly slow to catch on."

"Don't insult me," I retorted angrily.

"Don't you see the absurdity of your logic?" he asked, his face softening a bit.

"No, I don't!" I replied tersely.

Choua looked at me intently for several moments but said nothing. As my angst subsided, I wondered what that was all about but decided not to ask any questions.