By: Jennifer L. Gaudiani, MD, CEDS

Hypoglycemia is a medical term that refers to low blood glucose levels. In effect, a healthy body will metabolize what you eat and break down carbohydrates into sugars, which are absorbed into your bloodstream and form a key nutritional element – glucose -- needed by your cells. The brain in particular can only run on glucose -- not on protein or fat. In between eating, when you’ve fully metabolized your last meal, your liver synthesizes glucose for you and puts it into your bloodstream, so that you always have sufficient blood glucose levels to fulfill your body’s need. To go over all the ways blood sugar goes awry would take textbooks! But let’s talk about what can happen in anorexia nervosa.

With anorexia, the liver becomes depleted of the chemical building blocks needed to create glucose, as well as depleted of glycogen, which is key to maintaining a good blood sugar. That means between meals—and for people with eating disorders, those meals are often inadequate, calorie-poor, and imbalanced—your body may stop being able to sustain blood sugar. 

What the longest “fast” during a 24 hour period? Nighttime. So blood glucose levels can be particularly low early in the morning hours when you’re asleep. Some people get symptoms when they have low blood sugar—sweats, shakes, lack of concentration, irritability—but others have no symptoms at all. Regardless of whether you get symptoms, hypoglycemia can be deadly. If your brain and heart are deprived of sufficient glucose for long enough, they will incur permanent damage. The heart can stop, or you can stop breathing, you can become comatose, or you can get brain damage. Unfortunately, it’s not well known in the medical world that anorexia nervosa carries a serious risk of hypoglycemia, or that hypoglycemia may be THE killer that causes those tragic cases in which someone just doesn’t wake up in the morning. 

A study we published shows that liver function tests more than three times normal predicts serious hypoglycemia, independent of body mass index, or BMI. It’s a reflection of the liver’s depletion from weight loss and chronic malnutrition. 

So please; if you or someone you love hears that a blood test shows hypoglycemia, this is an emergent indication that you need a) juice RIGHT NOW, b) to listen to the wake-up call and acknowledge you’re not “fine” despite your eating disordered behaviors, c) to understand your life is now in jeopardy, and d) a higher level of care, because what you’re doing right now isn’t working. 

Please take care of yourself and be safe and well this Thanksgiving week. And remember, carbs are actually great for the body, and necessary.