Peppermint Hot ChocolateAs the year comes to a close and the holidays are thrust upon us with glittering urgency, like many Americans during this time, I feel anxious, exhausted, and even a little unrestrained. The pressure of tradition and social obligations, along with the general hum of unrelenting responsibility make what is supposed to be a joyous season far less merry. But there is something uplifting about the scent of gingerbread and the stiff aroma of peppermint hot-chocolate, and even though I refuse to submit to a super-consumer lifestyle, I find myself bustling my kids in and out of various Starbucks and toy stores imagining uses for everything I usually reject as useless. I am bombarded by advertisements for calorie dense treats and my social media feeds are teeming with images of bountiful meals or epicurean excesses. Giving thanks is utterly entwined with sharing food.

FoodIn many countries, nutritional necessity is no longer the stimulus for why we eat. Food–and, in extension, dining–has influenced many features of both the human form and the evolution of culture. What we eat, how it’s prepared, and how it is consumed changes everything from the bacteria in our guts to how we communicate. It is not news that Americans have developed a serious problem with obesity, though researchers are just beginning to understand the reasons behind the chronic issue, and we can no longer demand rigid self-control or excessive exercise when powerful hormones and faulty metabolisms are tugging at the appetency strings (read the New York Times “Biggest Loser” article). Foods high in sugar cause animals to feel temporarily happy and continue to seek out more of it, since it is typical that sweet things have more calories and, in hunter-gatherer times, would provide the brain with enough energy to continue to look for food sources when starvation was likely. Now that markets are just a few miles from our homes and we have refrigerators to stock meals for a week or so, we are free to indulge whenever we are hungry or just plain bored.

Some of us truly enjoy flavors and the artistry of compiling a beautiful dish, others are preoccupied with their appearance and develop an imbalanced, unhealthy relationship with food, and still others find filling their stomachs a laborious chore and would prefer taking a pill to satisfy their nutritional requirements. For me, eating is a complicated,confusing, and time-consuming process because I do not have a typical metabolism. I have reactive hypoglycemia. Also called “postprandial hypoglycemia”, this condition refers to a substantial drop in blood sugar within 4 hours of having a meal. Hypoglycemia can be thought of as the opposite of diabetes. Too much insulin or some other glucose transporter is produced and it quickly shuffles sugars into storage form. Though doctors have thought this condition is very rare, it turns out I’m really not alone in my suffering: Around 30% of athletes experience symptoms indicating reactive hypoglycemia. I am going to assume that many runners and endurance athletes who read this will also find they experience most or all of the associated symptoms: hunger, weakness, shakiness, irritability, sweating, light-headedness, and anxiety. The symptoms, which are mostly neurological, can arise within minutes and rapidly worsen if eating is delayed. Some research describes the cause as a sensitivity to epinephrine and/or hereditary fructose intolerance, though most cases aren’t diagnosed, nor is a cause identified. Because of their frequent conditioning, athletes’ metabolisms are altered; their bodies become very economical and quick in physiological processes. Developing an exaggerated insulin release is not uncommon in athletes, and could be why reactive hypoglycemia is experienced by nearly one third of endurance athletes.

Time to eatI was surprised to find out that the average person can go 4-5 hours without eating because that is not the reality in which I live. I usually feel hungry every 1.5-3 hours, and if I don’t have some kind of a snack I become rather unpleasant to be around. I become “hangry”. It is the feeling of panic and intolerance for anything that stands in my way of getting to food. I start shaking and sweating, and I feel like I’ll either yell or cry if any small event falls outside of easy. It’s an interesting characteristic to unveil to new friends and potential romantic partners. We like to present ourselves as likeable, agreeable, charming, articulate, but that’s impossible when blood sugar is low and the brain begins shutting down. I have had to warn co-workers and friends that I have an unflattering side that emerges every few hours and for them dismiss the crude affect if I fail in keeping the reins tight.

Feeling empty so often has made me paranoid about eating too much. I used to wonder if my body legitimately needed calories or if I am just too efficient at clearing glucose. If this is an issue of producing too much insulin then I chance devouring too many calories in the attempt to assuage the hunger drive, resulting in fatter cells and a fatter frame. Every time I look at the clock and realize it’s only been 2 hours since I last ate, my vanity and my ghrelin (the “hunger hormone”) battle it out until I either settle on nibbling on a piece of dark chocolate or chugging carbonated water for an hour until I “let” myself eat again. I can become so confused that I end up over-eating because it turns out I was actually hungry, which only leads to the frustration that I didn’t listen to my body and therefore wasn’t able to control portions better. When a patient of the condition has a hypoglycemic episode, the chances of another episode occurring that day are even higher, so management is imperative to living a healthy life. To combat the fear and resolve the physical weakness that sneaks up on me quite quickly, I’ve learned to take snacks with me everywhere I go–even if my outing is an hour long. Even more important is that I’ve discovered how and what I need to eat to manage the condition and feel less anxious about food in general.

HangryIf someone experiences any of the above symptoms of low blood sugar, doctors recommend ingesting 15 grams of high-gylcemic index carbohydrates and waiting 15 minutes to allow the brain to quiet and begin to regulate the signals of hunger and satiety. But sometimes it’s not enough. Doctors then suggest repeating the procedure and doing so until symptoms disappear. They also recommend following a balanced diet and refraining from sugary, refined foods. It’s a vague instruction, one that I’ve have to experiment with in order to stave off the blood sugar crashes and maintain my weight, and it is here where I can only appreciate how yummy holiday goodies look, not how they taste. I have to eat the same foods every day, most of which is fibrous, uncooked, and it is all very planned. It isn’t dominated by flavor or new experiences or cute date-night gratification. I cannot go out to dinner at the new ramen joint because chances are I will feel like eating again soon after and I’ll know it isn’t true hunger. Instead, I consume tons of produce and fat, and protein intake is dependent upon my activity level or if I am currently nursing an injury or illness.

Having studied exercise physiology and read various books about endurance sports training, I found the “eat 3 hours before exercise” suggestion somewhat vexing and maladaptive for certain athletes. Though it’s important to consume a healthy meal with all 3 macro-nutrients (carbohydrate, protein, fat) represented 3 hours before a race, I would advise that a small simple carbohydrate snack be eaten around 45 minutes prior to the start. It gives the necessary boost to blood sugar and the body will be topped off to cope with the exercise stress, otherwise a person like myself will bonk even before I’m a mile in, however, contrary to the pre-workout status, exercise helps stabilize blood sugar during the activity. While I’m training is the only time I don’t think I eat any more often than others.

On average, I’d say I eat around 8 times every day. I don’t count calories but I do obsess about what would happen if I stopped exercising, which is evidence that exercise is not just an enjoyable pastime for me but compulsory and potentially problematic. Perhaps the reactive hypoglycemia is a consequence of training altogether. There are numerous adaptations that occur when we routinely subject ourselves to physical demands, some are beneficial, such as having a healthy heart and cortisol (stress hormone) levels, and some can prevent high performance work entirely, as is observed in extreme cases of overtraining syndrome. It is possible that if I reduced the amount of stress in my life and didn’t push so hard in everything I try to accomplish that my glucose transporters would relax a little, too. But it is the wrong time of year to make any new resolutions–I will wait for January and the holiday hangover for that.

I am not a medical professional. If you do suspect you may have reactive hypoglycemia, talk to your doctor or just make sure to always carry something sweet with you to prevent any of the above symptoms. Clif ShotBloks or hard candies work well, as they are digested quickly, convenient and easily measured, but I prefer a few bites of whole grain bars or some raisins with nuts. Eat what makes you healthy and happy, and treat yourself when you feel comfortable with deviating from your current diet. I will admit that I eat a lot. I am not afraid of food, I am afraid of how much my body tells me I need, and that is why I have become so regimented and strict about my choices.

Written by Tanya Stahler

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