Monday, September 22, 2014

My Health Challenges: A Glance Back at the Past 10 Years

In college, I made it a routine to take as many credits as possible every semester.  On top of working and volunteering, I was consistently burdened with a schedule fit for two students because, well, I’m Asian and that’s what Asians are supposed to do.  I was never complacent and I never allowed myself to live in the moment to stop to enjoy my achievements and successes.  I was crazy obsessed with productivity and always looking towards the next rung in the academic/professional ladder to climb — often at the expense of a ‘normal’ social life.

It’s not a surprise that, even though I made it a priority to take care of my physical health, by the second semester of my junior year, my health collapsed — unbeknownst to anyone else.  I still managed to achieve all of my goals, pushing through the pain the entire way, and at the same time managing to keep all of my options open for life after college. 

Yet, I knew I had done irreversible damage to myself.  I think I was too ashamed and embarrassed to share what I was going through with anyone else.  This wasn’t supposed to happen to me — after all, I was the person who had it all figured out.  Personality and behavioral changes were the most distressing symptoms I experienced, and continued to experience in graduate school.  Bouts of anxiety began to strike, alongside indigestion, insomnia, and crippling tension headaches.  Worst of all, I was nearly emotionless.  I was well informed on physiology and pathophysiology back then and I’d even hazard to say that I offered sound advice to friends who came to me with nondescript health issues.  But the only person I couldn’t help was myself, and this thought would make me even worse.

Skipping meals, forgetting to eat, sleeping on average one fewer day per week, and constantly striving for perfectionism in all aspects of my life finally caught up with me.  But no matter what I tried, I just couldn’t snap out of it.  Maybe it was my deeply ingrained socialization to work excruciatingly hard and to excessively please/impress others with status and accomplishments, and to deem their definition of success more important than my own definition.   Or maybe it was the Korean in me which was why I was so stubborn as to continue on my path, despite the fact that it was paved with pain and suffering. 

I had the pick of the litter after college as to what graduate school/career path I wanted to pursue — one good that came out of my obsessiveness.   I chose the easiest one because, well, all the things that mattered to me then, and meant nothing to me.[*]  I wanted to get/feel better, and have as much time as possible on the side to, for once, read everything I wanted and to read and to pursue everything I wanted to pursue, instead of doing what other people — most of whom I don’t give a shit about — expected of me.

Making these tough decisions, alone, improved the symptoms I was experiencing — not by much but noticeably.  I was able to finish up my graduate work, on less than 50 percent brainpower and energy, while the entire time, keeping all of my health issues a secret, except to my parents.  To be honest, it was painful, and I still feel regret as to how much more enjoyable the experience would’ve been for me if I’d just opted to take time off before continuing on.  But I was at least afforded time to figure out what had happened to me: I was stuck in a hypoglycemic trap.

It’s important to know that every minute, the brain, on average, executes three cycles of a series of reactions that convert glucose to energy and has a respiratory quotient of 1.0, indicating an oxidation of glucose and not fatty or amino acids.   So the brain is dependent on a steady and constant supply of glucose, and it’s no surprise that an interruption or change in this supply can lead to behavioral and personality changes, which was what I was experiencing. 

All the anxiety and tension I had, yet for a long time was unaware of, and the fact that my body was constantly poised to “fight or flee” was predisposing my blood sugar to drop below “normal.”  The indigestion, insomnia, and anxiety were all symptoms of an overactive sympathoadrenal system, whose job is to raise blood glucose levels by extracting glucose from the liver, among other mechanisms, by way of cortisol and adrenalin.  As a result of this “alarm” state, my blood glucose levels would increase, after which insulin, secreted by the pancreas, would bring the levels back down to “normal.”  But in the process, my blood glucose levels would drop below “normal”; that is, what is required to function normally (not what is deemed normal by the “establishment”).  This is the trap. (What’s worse, even after the alarm state would shut down, the relative hypoglycemia and its accompanying symptoms would persist.)

I’m excited to see that Matt Stone, who has a voice in the community, is writing about this topic — a topic that is either haphazardly and lazily brushed off as not existing or, even worse, unknown altogether.  I have yet to read his book on the topic, but I think one point of neglect is the idea of normal versus functional.

As to hypoglycemia testing, reliable conclusions cannot be made on the basis of two isolated fasting (or non-fasting) oral glucose tolerance tests.   Variables such as the method of testing, the time of testing, and concomitant symptoms are contexts against which blood glucose readings should be assessed.  How silly would it be to deem a person to be “healthy” because his blood glucose levels fall within the “normal” range despite the fact that he was having an “attack” at the same time?  And are we justified in brushing off a blood glucose level reading because it falls a mere two or three points below “normal”?  I don’t think so. (Yet, it is a common occurrence.) A single blood glucose level reading is virtually worthless; instead, we should focus on dynamics. 

I’ve tested my blood glucose levels when very symptomatic and when not symptomatic, in addition to all the times in between.  I’ve recorded that when I was very symptomatic, about an hour after eating a meal, my blood glucose levels wouldn’t rise by more than 50 percent from baseline levels.  I speculatively attributed this to either a sluggish extraction of nutrients from my intestines (which could indicate hypothyroidism [a la Broda Barnes]) or to an over secretion of insulin.[†] 

On the other hand, when not symptomatic, my blood glucose levels would sky rocket about an hour after meals.  As to the significance of these observations, I have some ideas; however, none of them are concrete enough to discuss here and now, except to say that if you were to plot my glucose levels over time following a meal, the curve would appear flat, which indicates, in accordance with my symptoms, that my blood sugar levels weren’t rising high enough to meet the demands of my brain and nervous system.  Yet, they weren’t dipping low enough to deem me “hypoglycemic” per the current cutoffs.[‡] 

I think the fact that diabetes and hypoglycemia can be diagnosed in the same patient depending on when and the kind of test performed speaks to the gross inadequacies of the current system of differential diagnosis and confusion about how to interpret glucose tolerance tests.  Glucose tolerance tests can be informative, as long as they are performed properly — that is, for at least 6 hours in order to record the tail end of the curve.  However, and I’ve said this before, symptoms and responses to a particular treatment is one of the surest ways to make a diagnosis.

I think the pattern of occurrence of a patient with asthma, ulcers, hypoglycemia and diabetes could help to clarify the existence of hypoglycemia in a person.  In a person with all of these conditions, when an asthma attack strikes, he would be labeled as hypoglycemic if his blood glucose were tested at the time.  On the other hand, he would be labeled as diabetic if his blood glucose levels were checked when his ulcers were acting up.  In other words, diabetes seems to protect against asthma[§] yet worsen ulcers, whereas hypoglycemia, which indicates low levels of the stress hormones, is associated with worsening asthmatic symptoms.  Obviously not conclusive, this pattern would be worth checking for and considering as part of a differential diagnosis.  Thyroid conditions, allergies, salt, and potassium (among some other things) could be included as well, which affect and are affected by blood glucose levels. 

It took a while, but as I sit here now, I’m reminded of the journey to get back to the person I was in my younger years.  My mindset and priorities are inverted from what they were, and, I’ve let go of the idea of letting the opinions of other people dictate the decisions I make in my life.  Call it an enhanced self-esteem or shamelessness, but it took me a long ass time to get to this point (maybe its the stubborn Korean in me), and upon letting these ingrained ideas go, while consistently reminding myself to eat regularly, I’ve finally reached a point of normality (not exactly sure what that means) and I’m okay with allowing myself to be satisfied and complacent, and to celebrate my past accomplishments — finally.[**]

This post is off the beaten path from my usual fare.  It wasn’t meant to provide medical advice.  It was meant to remind myself to remember to live in the moment; to enjoy my achievements when they happen;[††] to maintain hope; to have compassion and understanding for others (who may be going through what I did); to take the time to think deeply about the motives for what I’m striving for; and instead of working to accumulate and hoard inherently worthless degrees, awards, certificates, and even recognition to some extent (all of which I’m not implying are unimportant), to work to accumulate and hoard love, goodwill, pleasure, and gratitude – all the things I neglected in my younger years that ultimately led to me pouring out my personal thoughts to write this post tonight.  I’m still a work in progress, and I’m certainly in no position to dole out advice.  But just as Hans Selye said, “the inventor of the best race car is not necessarily its best driver.”


[*] I realized this really quickly, thinking of myself as a rat in a wheel, running as hard as I could for the sake of it.

[†] Because cortisol interferes with the conversion of T4 to T3, and because T4 has a permissive effect on adrenalin, we can conceive of another trap in which the effect of adrenalin on tissues becomes intensified.  Adrenalin stimulates the HPA axis, causing more cortisol to move into the blood, further reinforcing the inhibition on the conversion of T4 to T3.

[‡] My brain responded, for lack of a better description, with a sit down strike.

[§] Certain asthma medications raise blood glucose levels.

[**] Around the time my dog died, which was around the time I first realized that I had completely overcome my health challenges, was the first time I ‘felt’ real emotion in years.  I cried, hard.  And it felt really good.

[††] And when you’re down or frustrated, think about those accomplishments, which no one can take away from you.