By David Gersten, M.D.
Over the course of the last three issues of The Light Connection, this column has been exploring the causes, symptoms, and cures for alcoholism. While we must first heal brain chemistry, all organ systems need to be supported and healed, and three major metabolic imbalances need to be targeted in the alcoholic.
1. Hypoglycemia
2. Candidiasis
3. Adrenal Exhaustion
Hypoglycemia
90-95% of alcoholics are hypoglycemic, including alcoholics who have not had a drink in years. Hypoglycemia can cause depression, digestive disorders, muscle pain, numbness, lack of sex drive, allergies, poor concentration and memory, muscle twitching, nightmares, anxiety, fear, shortness of breath, fatigue, and dizziness.
Let's look at basic sugar chemistry. Each time you consume any form of sugar, whether processed white sugar, fruit, or alcohol, your pancreas releases insulin in response to a rise in blood sugar (glucose). Insulin temporarily binds to glucose and transports it across cell membranes into our cells. Glucose is our body's main fuel and our brain's only fuel.
After insulin ?drives? glucose into the cells, blood sugar drops. Let's say that your baseline blood glucose before breakfast is 80. Thirty to sixty minutes after breakfast (or the consumption of sugar), your blood sugar might rise to 150. After insulin transports glucose into our cells, glucose in the blood drops. In the healthy individual, glucose slowly and steadily declines over a five-hour period until it is back at your baseline (80, for example). In the healthy individual, glucose will not drop below your baseline. Things are quite different for the hypoglycemic. One to two hours after eating, glucose will drop from its high point (150, for example), and will plunge below baseline. Let's say that your glucose drops to 60. It will take several hours for your glucose to slowly climb back to baseline (80). During those hours of hypoglycemia your brain will be deprived of glucose and you may feel depressed, anxious, shaky, confused, and tired. People with fatigue and depression 2 to 4 hours after eating are dealing with hypoglycemia.
The alcoholic ?cures? his hypoglycemia by drinking, for alcohol is loaded with sugar. Each sip of alcohol temporarily increases your glucose. Briefly, you will feel better and may even function better. However, alcohol is the worst source of glucose you can find.
If you are hypoglycemic, you may feel as if you are on a mental and physical roller coaster, and probably don't know why. Over time, your pancreas has a more difficult time creating insulin in response to the sugar you ingest, and so insulin-glucose chemistry becomes impaired.
The stress of hypoglycemia causes your adrenals to work overtime, releasing the hormones epinephrine and cortisol. Epinephrine causes your liver to break down glycogen into glucose. We'll talk more about the adrenal glands in a minute. For now, it is important to understand that blood sugar problems steadily pound away at the adrenals.
Treating Hypoglycemia
To begin to manage low blood sugar, you will need to change your diet by restricting sugar and low quality carbohydrates. Fruits, vegetables, and some grains are high quality carbohydrates. Junk foods and pasta are low quality carbs, and they break down quickly into sugar. By eliminating sugar, you can finally give your pancreas a rest.
Here are nutritional supplements that will help with sugar metabolism and will decrease sugar cravings:
L-Glutamine, an amino acid that decreases sugar cravings.
L-Alanine (amino acid),
Vitamin C,
Magnesium,
Pantothenic acid, and
Niacin (Vitamin B3).
Chromium picolinate stabilizes blood glucose. Alcohol and refined sugar cause a loss of chromium. One study showed low chromium levels in 91% of alcoholics.
Candida
Generalized candidiasis (also called ?candida?) is a huge problem for many alcoholics. Candida, a systemic yeast infection, causes problems from head to toe, creating symptoms that include: exhaustion and fatigue, brain fog, depression, poor concentration, poor memory, adrenal exhaustion, intestinal gas and bloating, muscle weakness . . . and hypoglycemia. By looking at this last item, hypoglycemia, you can begin to see the tangled web of metabolic chaos caused by alcoholism. Candida remains ?voodoo medicine? for much of mainstream medicine. Most conventional doctors do not believe you can have a yeast problem throughout your body unless you have AIDS, terminal cancer, or are suffering from the side effects of cancer chemotherapy.
Here is how candida begins. We all have some yeast in our gastrointestinal (GI) tract. It is part of the normal balance or ecology of the GI tract. A variety of things can cause yeast, or candida, to overgrow. Antibiotics are a main offender. You may be prescribed an antibiotic for a bladder infection, but antibiotics do not have intelligence, so they kill bacteria everywhere, including ?friendly? bacteria in our GI tracts, like acidophilus and bifidus. When healthy bacteria are killed off, candida rapidly multiplies, so that your GI tract is filled with excessive amounts of candida. This intestinal overgrowth can lead to gas, bloating, abdominal pain, constipation, diarrhea, and heartburn.
Candida has two states?a bud state and a hyphae state. Hyphae are like fingers that dig into the lining of our GI tract, causing irritation, malabsorption, and possibly leaky-gut syndrome.
Candida does its damage is several ways: 1) It causes irritation and inflammation wherever it is present. In the GI tract it causes chronic irritation and inflammation of the lining of the GI tract, 2) Candida eats some of the food you are ingesting. Instead of feeding your body, you are feeding your candida, 3) Candida produces up to 100 neurotoxins which are made up of short chains of amino acids, called ?peptides.? Candida, all by itself, can make your brain quite sick. It will not permanently poison your brain, for the toxins it releases are subtle in their action and are not deadly.
After years of intestinal overgrowth, candida easily finds its way into the blood stream, infiltrating nearly every organ and anchoring into body tissues with their hyphae. Systemic candida can be innocuous or it can cause more than 50 symptoms, as described above. In terms of alcoholism, candida causes hypoglycemia, digestive problems, fatigue, mood swings, insomnia, poor memory and concentration, allergies, and sugar cravings.
Nothing feeds candida better than alcohol, for the two ?foods? that feed yeast are sugar and yeast. Alcohol is made by a fermentation process involving fruits, grains, and sometimes yeast. Consumption of alcohol makes candida worse and worse. A 1991 study of 213 alcoholic patients showed 55% of alcoholic women and 35% of men had candida overgrowth.
There are a number of ways of diagnosing systemic candida. The history is extremely important, for one can have normal lab data, but still have candida overgrowth. If a woman has frequent vaginal yeast infections, oral thrush (white coated tongue), fungus growing between her toes and in her fingernails, I ?know? she has systemic candida, regardless of what the results of lab work are. But lab work is important and includes: 1) Stool analysis for yeast, 2) Anti-candida antibody blood test. I order the blood test through ImmunoScience Labs in Beverly Hills , California . This test indicates if one has intestinal candida overgrowth, systemic overgrowth . . . or both. It also provides a numerical value for the amount of candida, which lets me know how bad the candida problem is. When I re-test after 3 months of treatment, the anti-candida antibody test lets me know how much improvement there has been.
Treating Candida
1. Anti-fungal drugs and herbs. Medications like Nizoral and Diflucan are, by far, the most powerful agents for killing candida wherever it is. However, these medications can be hard on the liver, and so I never prescribe them without first ordering blood work to test the liver. I repeat liver tests every month. The medication Nystatin is weaker than Nizoral or Diflucan, but does not adversely affect the liver. Herbs, like Caprylic Acid, Olive Leaf Extract, and oil of oregano are useful in controlling overgrowth of intestinal candida, but are not terribly effective in treating systemic candida.
2. The amino acid, L-Glutamine, helps heal the lining of the GI tract, which is damaged by candida.
3. Probiotics, supplements containing billions of friendly bacteria (acidophilus, bifidus, and other friendly bacteria) are a must.
4. The mineral Molybdenum prevents candida from going back and forth from the bud state to the hyphae state, keeping candida in its bud state.
5. Candida diet. Avoid all forms of sugar, yeast, bread, and anything fermented or aged. With the exception of mushrooms, all vegetables are fine, whether raw or cooked, as are beef, poultry, and fish. You can find yeast-free bread.
You cannot be reductionistic in treating a chronic health problem, looking for the one and only cause. From this series of articles on alcoholism, you have seen how complex the causes of alcoholism are, and how comprehensive treatment must be. After reading about hypoglycemia and candida, you can see that there is overlap between these two problems, with candida worsening hypoglycemia. Together they gang up to cause chronic stress on the adrenal glands.
Adrenal Exhaustion
Chronic physical and mental/emotional stress ?hammer away? at the adrenal glands. The stress of candida and hypoglycemia cause the adrenal glands to produce epinephrine and cortisol in response to each signal of stress. The adrenal glands are part of our fight-or-flight system. The pituitary gland is the master gland of the endocrine (hormone) system, and is part of a feedback loop with the adrenals.
Cortisol and epinephrine mediate all the physiological reactions of the fight-or-flight response. The fight-or-flight response evolved as an emergency survival mechanism. When the caveman was confronting a cave bear, the fight-or-flight chemistry kicked in, preparing him to either run for his life, or fight for survival. Our mind/body complex cannot tell the difference between the real threat to life of the cave bear, and the threat of an angry boss. Our bodies respond to all stress as if it were life threatening. The physiology of the fight-or-flight response includes:
Glycogen breaks down into glucose so there is an instant release of ready energy.
The heart pumps faster.
All bodily functions not required for immediate survival shut down. Digestion stops.
Blood vessels in your skin shut down, so that if you are injured in combat, bleeding will be minimized. However, blood pressure goes way up.
The immune system temporarily weakens, as it is not needed to fight the cave bear. Sexual function also shuts down.
Cortisol is the main stress hormone. It functions by:
Increasing blood coagulation.
Reducing inflammation and the immune response.
Stimulating the brain and reducing sleep.
Reducing insulin secretion by the pancreas.
Increasing glucose production in the liver by breaking down glycogen.
Increasing blood sugar levels.
To review: You have already read that increased blood sugar levels cause your pancreas to produce more and more insulin. Chronic blood sugar problems, namely hypoglycemia, cause the adrenal glands to work overtime to stabilize blood sugar. r />Many of us live in a state of frequent or constant stress. With the alcoholic, much of the adrenal stress is caused by physical factors. In the early phases of stress, the adrenals are pumped up, producing high levels of cortisol and epinephrine. Over the years, the adrenals cannot keep up with the stress and so the release of cortisol becomes erratic, with the adrenals releasing too much cortisol at certain times of the day, and too little at other times. You WILL BE exhausted when your adrenals are not producing enough cortisol.
After many years of unrelenting stress (mental or physical), the adrenals give out, producing abnormally low levels of cortisol throughout the day. At this point, you become overwhelmed by stress, light, sound, emotion, and other stimuli. Social interactions that were once easy for you become challenging. We require cortisol to handle the ?normal? stress of everyday challenges. This is healthy stress. Not all stress is bad. However, when cortisol levels drop to permanently low levels, once simple tasks become difficult. Focusing and concentrating on once simple tasks can become overwhelming. At this point, you are in adrenal exhaustion and you feel fatigued most of the time.
Treating
Adrenal Exhaustion
Healing adrenal exhaustion is not easy, but here are some initial steps:
1. Practice meditation or relaxation techniques to decrease stress.
2. Take a multiple B Vitamin 2 to 3 times a day. Stress depletes B Vitamins.
3. Take the necessary steps to treat hypoglycemia and candida. By so doing, you will take an enormous stress off the adrenals.
4. Take the B Vitamin Pantothenic Acid to support adrenal function.
5. See your doctor and ask for an Adrenal-cortico stress test. This is a saliva test.
6. Your doctor may suggest that you take pregnenolone, the mother hormone for the adrenal gland, from which adrenal hormones are made. Pregnenolone is a safe hormone.
7. Your doctor may suggest taking DHEA in the range of 25 mg a day, to support the adrenal glands while they are resting and healing.
8. If you have normal blood pressure, you can take licorice root, which supports the adrenals as well as the lining of the GI tract.
9. Adrenal glandular extracts.
10. If you suffer crippling adrenal exhaustion, your doctor may recommend hydrocortisone (trade name: Cortef). Cortef should not be taken in doses greater than 15 mg a day, which is the amount your adrenals should be making. If you take too much Cortef, you will interfere with the adrenal-pituitary axis, and it will be difficult for your adrenals to recover.
Diagnosis and treatment of adrenal stress and exhaustion is complex. You want to look at all of the above recommendations as temporary solutions that give your adrenals a rest as well as the nutrients they need to recover. If you don't address issues of stress, both mental and physical, you won't give your adrenal glands a chance to recover.
Adrenal exhaustion and candida have a great deal to do with intestinal health. And blood sugar chemistry (hypoglycemia) has a lot to do with adrenal exhaustion and candida.
Full recovery from alcoholism requires a change in thinking. There are multiple causes of alcoholism. There are tremendous problems with brain chemistry that can be repaired. There are huge problems from head to toe that I call ?metabolic chaos.? Hypoglycemia, candidiasis, adrenal exhaustion, and digestive problems are the major causes of metabolic chaos. All of these problems can be tested for, diagnosed, and treated.
What is required for full recovery is a powerful commitment to change your life, your diet, and how you handle stress. You can also re-define what is really a stress for you. You can move out of the mind-set that alcoholism is an untreatable disease. You will need a good doctor, determination, understanding, and the willingness to go the distance until you achieve your level of optimal health. Do not let anyone determine or define what your highest level of functioning can be. Such labeling is usually destructive. It's your life. Go for broke, and realize that there is no false hope. To quote Bernie Siegel, ?There is only false no-hope.? When you are ready, begin your climb out of a lifetime of metabolic problems to discover that a wealth of energy, peace of mind, physical strength and well-being is probably a reasonable dream to strive for.
In the next issue, we will conclude this five-part series on alcoholism by examining psychological and spiritual issues.
David Gersten, M.D. practices nutritional medicine and psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com.
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