Salicylate induced hypoglycaemia
These are extracts from Sue Dengate’s “Fed Up with ADHD”
One morning we all arranged to go on a long bushwalk. After a short distance Rebecca stopped. “I’m too tired,” she said and lay down on the track.
“Nonsense. A child of that age should be able to walk this distance,” said our friend. She clearly thought we were being too easy on Rebecca. I had noticed food would get her moving and I gave her some dried fruit. After another ten minutes she was up again but quite white-faced and shaky. Howard helped her back to camp.
Episodes like this were to occur sporadically, usually associated with exercise. A friend suggested hypoglycemia and the symptoms did seem to fit. I talked to our doctor, who described hypoglycemia as an American fad and reassured me that Rebecca did not have diabetes. We adopted the principles of the diet anyway, feeding Rebecca every couple of hours, especially on waking and before going to sleep and avoiding refined foods and sugar. This seemed to help and so we embarked on what turned out to be the wrong track for the next six years. PP36-37
Suddenly Rebecca said “I’m tired” and lay down. She was panicky and uncoordinated and we had to almost carry her down the steep, slippery path. When we reached the tent she lay unmoving, refusing to eat. I forced her to drink some juice and soon she got up and started playing as if nothing had happened.
Episodes like this always seemed to happen when we were staying in a cabin and I remember over the week Rebecca had been eating a lot of bread and marmalade. When she suddenly said “I’m tired” I decided to see if she would sleep it off. I left her lying on her bed in the twilight.
About an hour later, expecting her to be asleep, I found her crouched under a bench in the now dark room. She did not seem to recognise me, was incapable of speech and appeared terrified. I led her gently to the kitchen and stuck a spoonful of sugar in her mouth. In a few minutes she was back to normal.
I tried to find out how to prevent these alarming episodes. The doctor I talked to said, “She’s probably got hypoglycemia, but she’s too young to have a glucose tolerance test.” He also suggested that her night waking with panic may be due to hypoglycemia and that we might have to wake Rebecca and feed her in the middle of the night.
We took his advice on feeding her before sleeping. If she spent several hours trying to fall asleep, as usual, then she ate some more supper. This did reduce the night panic and if she woke eating helped her to get back to sleep.
I thought I could see a pattern. The episodes usually occurred when we were out of our regular routine and they seemed to be associated with exercise. If Rebecca ever mentioned she was hungry I learned to feed her immediately, as the feeling quickly passed. This lack of self-awareness characterised both Howard and Rebecca.
Arran frequently complained “I’m hungry”, but food could be delayed without any ill effects. Rebecca rarely complained of hunger. I was more likely to observe, “You are getting grumpy. I think you need to eat.” She would often deny this and have to be cajoled into eating, but improved quickly after eating. If Rebecca actually said she was hungry I regarded this as a red alert situation and fed her immediately. Five minutes delay was too long. The feeling would have passed, soon becoming “I’m tired”, refusal to eat, and lying down. Sometimes there was another stage, “I want some sugar,” before the tiredness.
Many years later I would find the explanation. Salicylates can impair production of glucose in the body while increasing glucose utilisation. This causes an imbalance, resulting in salicylate-induced hypoglycemia. Rebecca’s problems while on holidays or bushwalking were related to our higher consumption of salicylate-containing foods such as dried fruit. The effect was worsened by exercise, which increases the body’s need for glucose. PP56-57
We were still worried about Rebecca’s lack of energy during exercise. When I explained the symptoms in detail to our pediatrician, he agreed to have her tested for hypoglycemia and booked her into hospital.
Rebecca spent twenty-four hours in hospital on a water-only diet, having regular blood tests to see if her blood sugar level changed. It didn’t. The hospital doctor was contemptuous. She thought that ADHD was overdiagnosed, that Rebecca’s problems were due to poor parenting and that food intolerance was “clutching at straws” but we noticed a remarkable change.
From a rude and angry start, Rebecca progressively became more polite and cooperative, sweet-natured and clear-thinking. That evening she was fun to be with and played the best game of checkers ever. We thought she was lovely. “That is how I want my daughter,” I joked to our pediatrician on our follow-up visit. “We’ve discovered the right diet for her. Water only!”
I was surprised to find he took me seriously. Hadn’t he ever believed me before?
“Perhaps the hypoglycemic symptoms are being triggered by a food sensitivity,” he suggested. The upshot was that he arranged a case conference with a new dietitian. PP107-108
For nearly six years we had been convinced that Rebecca reacted to sugar and had avoided it in our diet. Refined white sugar is permitted on the elimination diet – as part of a balanced diet – and the children were now eating sugar to compensate for the restrictions on fruit sugar.
I had to admit Rebecca did not seem to be affected, but when she had a big reaction five hours after eating a lemonade icy pole, I blamed sugar. To confirm this, we did a challenge with ten sugar cubes. No reaction. Still unconvinced, we tried again with twenty sugar cubes. Still no reaction. I had to accept that Rebecca did not react to sugar and that I had been wrong for all those years. Lemonade icy-poles contain small amounts of salicylates. I had finally seen for myself that Rebecca’s hypoglycemic symptoms had been related to salicylates not sugar.
In the years that followed, I came to understand salicylate-induced hypoglycemia. When Rebecca avoids salicylates, she can eat sugar with no problems. If Rebecca eats too many salicylates, especially while exercising, under stress or skipping some meals, she suffers a hypoglycemic episode and improves instantly with a spoonful of sugar. I would prefer my daughter to be able to eat fruit rather than sugar. But that’s not the way it is. PP114-115
I regained my carbohydrate tolerance after going on failsafe for a few weeks. I was curious because I knew that I definitely experienced reactions to carbohydrate before going on the diet. I mentioned at the time that I came across numerous studies in Medline/Pubmed (too many to list!) confirming that salicylates induce hypoglycaemia by stimulating insulin release.
When I was worst affected, at a time in my life when I was eating additives and salicylates, and before I had started low-carbing, my symptoms could be equally as bad as those listed above. I could not skip meals without very unpleasant consequences. I was regularly shaky, snappy, and even violent, and several times came close to fainting when food was not available.
In my case I managed to control my hypoglycaemic symptoms with a very strict carbohydrate-controlled diet. Friends and family could be intolerant and dismissive of my need for this (comments ranged from “yeah, yeah”, to “I think if you try to do any diet when you go out you are going to fail,” to “can’t you just try to fit in for tonight?” to all kinds of mocking and dismissive comments about what a “dangerous” diet Atkins is). Unfortunately I did not allow myself to become hypoglycaemic often enough to prove the reaction to them.
It is such a relief to know that salicylates are the cause of the hypoglycaemia I was experiencing. I had been afraid that I was damaged in some way, perhaps for the rest of my life. Ironically, though Atkins relieved my symptoms, the huge emphasis on eating “wonderful, healthy” vegetables on the Atkins diet also kept me sick.
FYI, I still keep my carbs between 40-70 grams per day, because I’ve no desire to get fat in a hurry. It’s just that I eat more milk, biscuits and bread these days.
…At this point several people will write to me to tell me “you are damaged if you can’t eat fruit and vegetables” – and I will be forced to look up the quote from the study where 60% of ordinary children experienced behavioural improvements after beginning a partial elimination diet.