POST TRAUMATIC STRESS DISORDER (PTSD)
And Hypoglycemia
By Jurriaan Plesman, BA (Psych), Post Grad Dip Clin Nutr.
 
Post Traumatic Distress Disorder can be defined as:

PTSD or post-traumatic stress disorder can occur as an acute disorder soon after a trauma or have a delayed onset in which symptoms occur more than 6 months after the trauma.  It can occur at any age and can follow a natural disaster such as flood or fire or a man-made disaster such as war, imprisonment, assault, or rape.

Post Traumatic Stress Disorder is a psychiatric disorder that usually develops after a person has experienced a traumatic life-threatening event, either in their childhood or later on in life.
The incidence of PTSD has been reported to be:

Incidence
“An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.
About 30 percent of the men and women who have spent time in war zones experience PTSD. An additional 20 to 25 percent have had partial PTSD at some point in their lives. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced "clinically serious stress reaction symptoms." PTSD has also been detected among veterans of the Gulf War, with some estimates running as high as 8 percent.“

Conventional Treatment
“PTSD is treated by a variety of forms of psychotherapy (talk therapy) and drug therapy. There is no definitive treatment, but some treatments appear to be quite promising, especially cognitive-behavioral therapy, group therapy, and exposure therapy. Exposure therapy involves having the patient repeatedly relive the frightening experience under controlled conditions to help him or her work through the trauma.”
Source: The Kansas City MArines Veteran Center.

We see from the above that conventional treatment centres around either drug and/or psychotherapy, and that the success rate is fairly low, some even asserting that PTSD is incurable.

Resistance to treatment for PTSD by victims may also be mistaken for malingering in the eyes of the alleged perpetrators in the process of law suits for compensation, especially if the mechanism for the development of PTSD is poorly understood. But PTSD is a real disease, despite absence of evidence giving a clear explanation for the disease. I say ‘disease’ in preference to disorder as it can be shown to have a biological foundation.

To understand the development of PTSD, we need to realize that any trauma - the death or loss of a loved one, moving house, war experiences or financial crisis - will cause stress hormones to interfere with the normal production of our feel good neurotransmitters such as serotonin and others. These are environmental stresses that can result in environmental depression. Nature makes sure that we have the right neuro-chemicals to deal with the stress.

Normally, after the removal of the environmental stress people start to produce serotonin again and life resumes for most people. However, for some people this is not what is happening,. They continue to be depressed for some reason not quite understood by the person. He keeps on producing excess stress hormones, such as adrenaline, that prevents him from producing serotonin. And because he fails to produce serotonin, he will also be lacking in melatonin, our sleeping hormone. Thus the clinical picture is of a person depressed and unable to sleep, waking up with sweats during the night. He may have other symptoms such as anxiety attacks and unpredictable mood swings.

It is natural for a person with PTSD to link his depression with the trauma, because this was indeed the direct cause of his depression at the time of the trauma. In fact this indelible link with the traumatic event(s) will probably amount to an obsession, as the only possible logical explanation for his physical symptoms that are internally generated by a flaw in his metabolism.

Perhaps the difference between endogenous depression and PTSD is that the latter is usually associated with a specific traumatic event. A student who becomes depressed because of exposure to stresses due to a competitive educational, program is not generally seen to be a victim of PTSD, although the underlying mechanism is the same.

The fundamental question is, why is the person not producing serotonin?

If PTSD is primarily a biophysiological disorder, then we should not expect talk therapy or even Rational Cognitive Behaviour Therapy (RCBT) alone to have great success. This approach is based on the assumption that ‘psychological experiences’ resulting from a brain disorder are the CAUSES of mental illness, instead of symptoms.

PTSD may be Associated with Insulin Resistance
A possible explanation for PTSD is that like other mental illnesses, it shares a common metabolic disorder of insulin resistance (hypoglycemia), that can fully explain the psychopathology of PTSD. Of course any other silent disease can be responsible for PTSD, but hypoglycemia happens to be a common one.

This can be easily tested with the special medical Glucose Tolerance Test for Hypoglycemia (GTTH). This test could also be used to predict the likelihood of a person developing PTSD prior to an expected series of traumatic events - such as a soldier going to war. If proved positive such person should advised to adopt the hypoglycemic or diabetic diet. An alternative home paper-and-pencil test called the NBI, will also give a fair indication for hypoglycemia. Another useful test can be found at: The Hypo Quizz.

This also explains why some people will fall prey to PTSD whilst others don’t, because not all people suffer from hypoglycemia or other biological disorder as a precondition to mental illness and perhaps PTSD.

Hypoglycemia an Unnamed Medical Condition
Hypoglycemia admittedly is a misnomer, and may confuse traditional medical practitioners with the concept of low blood sugar levels commonly found among insulin-dependent diabetics. An other good explanation is given at: Gary Null (2002)

Some nutritional doctors have attempted to replace the term with ‘dysglycemia’ to indicate that we are dealing with unstable blood sugar levels - showing abnormal peaks and falls - rather than low blood sugar levels. The problem is that the term ‘dysglycemia’ would not explain the phenomenon of ‘cerebral diabetes’ or ‘cerebral hypoglycia’, recognized by some scientists to block glucose utilization somewhere along the biochemical pathway of glycolysis. See: Holden RJ et als 1994 and Holden RJ, 1995
Dr George Samra has called this condition “Hypoglycia” to indicate a flaw in glycolysis mostly due to an imbalance between zinc and copper levels, hence an obstruction in the production of biological energy called ATP. This may occur among people with “hypoglycemic” symptoms, with normal results in a Oral Glucose Tolerance Test. (Samra,70). Neuroglycopenia is another medical candidate, but like the others wrongly assumes that low blood sugar levels is the cause. Hypoglycia is also discussed in Getting off the Hook at page 18. The closest medical term that would fit the hypoglycemic syndrome would be Syndrome X or The Metabolic Syndrome, except that the mental aspect is missing.

“Insulin resistance’ is the common element in the hypoglycemic syndrome, and many scientists see pre-diabetic hypoglycemia to be the forerunner of diabetes. But again insulin resistance by itself also fails to explain hypoglycia as an abnormal glucose metabolism within the glycolytic pathway itself. For the time being we will stick to the popular term ‘hypoglycemia’. For studies showing a significant association between depression and insulin resistance see here.

PTSD and Hypoglycemia
The connection between insulin resistance and PTSD can be explained because the body has problems responding properly to insulin. Insulin functions to transport glucose - as well as amino acids, and fatty acids - into cells for conversion to biological energy called ATP. The brain is entirely dependent on glucose as its only source of energy. Without proper energy levels the brain cannot manufacture the feel good neurotransmitters such as serotonin.

With resistance to insulin, blood sugar levels rise and the pancreas will respond by secreting more insulin into the blood stream, called hyperinsulinism. Increased insulin concentrations will trigger a sudden crash in blood sugar levels - a hypoglycemic dip. This is a signal to the brain (hypothalamus) that it is threatened with brain starvation. It responds by sending a hormonal message to the adrenal glands to dramatically increase adrenaline production. Adrenaline - a major stress hormone - functions to rapidly increase blood sugar levels by converting stored sugar, glycogen, back into glucose. (See image) The reaction happens in the twinkling of an eye.

The internal massive production of adrenaline - and perhaps cortisol to a lesser extent - prepares the body to face a crisis situation, except that in this case, there is no external cue to spark the biochemical reaction. Energy is diverted from digestive organs to the heart, muscles and brain, and these form the unexplainable symptoms of people suffering from hypoglycemia, anxiety attacks, phobias, depression, addictions, as well as PTSD. The Sympathetic Nervous System is now in overdrive! With such an mysterious assault of adrenaline on the autonomic nervous system, it is no wonder that the trauma is perceived to be directly responsible for the anxiety attack.

The Hypoglycemic Diet
The non-drug treatment for insulin resistance (hypoglycemia) is the adoption of the hypoglycemic diet, which is similar to a diabetic diet. It will normalize glucose, insulin and stress hormones and should be adjusted to the individual needs of the client, having regard to the individual nutritional biochemistry of the person. Possible allergies should be eliminated as well.
Certain nutritional supplements - such as zinc, vitamin C, fish oil, B-complex - are essential because depressed people have often been found to have specific nutritional deficiencies and requirements. Chromium picolinate will sensitize receptors for insulin and have been reported to reduce depression.

People often have the mistaken impression that hypoglycemic diet as a quick fix diet. The body needs time to readapt to normal blood sugar and insulin levels, relearn to produce enzymes and coenzymes, replenish body stores for minerals, up-regulate or down-regulate neurotransmitter receptor sites and adjust to various other hormone syntheses. Clinical experience has taught us that benefits should become apparent in about three months on this diet for most clients. If drugs have been used to treat symptoms it may take some more time for the body to repair the damage done to receptors for normal neurotransmitters.

However, more time may be needed if it has to take into account possible treatment of candidiasis, food sensitivities and allergies and/or special nutritional deficiencies. Treatment of any degenerative diseases with comorbid depression may have to take priority, such as Thyroid diseases, Coeliac disease, fibromyalgia and many others. This is one reason why better results can be obtained when treatment is under the supervision of a counsellor with expertise in both psychology and clinical nutrition.

For a full list of depression related illnesses see: Physical Causes (and Solutions) of Depression by Dr RJ Diamond

When drugs have been used, the hypoglycemic diet may speed up detoxification, especially if it is supplemented with nutrients such as B-Complex vitamins, vitamins C, E, beta carotene, B6, zinc, chromium picolinate, fish oil, and so on. On the basis of clinical experience we have found that the effects of marijuana use on behaviour may last up to six months. (I am not aware of any studies in this regard).
When more powerful street drugs have been used, such as methamphetamine or cocaine, recovery may take much longer. One study by Volkov at als. in 2001, has suggested that receptors for dopamine can be restored between 9 and 14 months following sustained abstinence.

Psychological Aspects
There is a principle in behaviourist psychology suggesting that whenever an animal experiences a strong emotion, without an external object, it tends to react to any object in the environment by the mechanism of REVERSE CONDITIONING. It may pick any outstanding object in its immediate environment and ‘perceive’ it as the cause of that emotion. In more technical psychological terms any neutral object in the environment may become a stimulus for the fear response in an animal conditioning experiment. The ringing of a bell may become the stimulus of a fear response if it has been paired by an electric shock in the past. A natural action by an animal may be reinforced if it is constantly paired with a command by its trainer.

In humans, an unexplainable strong emotion - such as an internally driven adrenaline upsurge - can be paired with any outstanding neutral object in his environment, and becomes to be perceived as the cause of that strong emotion. Thus we see how anxiety attacks, phobias can be created by pairing of unexplainable biochemical reactions to thoughts and to TRAUMATIC EMOTIONAL MEMORIES in the past. It is a mechanism to preserve our sanity, to provide some sort of ‘rational’ explanation.

We make the mistake in conventional therapy by assuming that the emotional memory of the past is the CAUSE of present biochemical adrenaline reactions, whereas in reality a biochemically driven adrenergic reaction demands that we have a rational explanation in terms of past outstanding traumatic experiences.
This explains why talk therapy often fails, because it assumes that thought processes are the cause of an adrenergic reaction: we are barking up the wrong tree!

Nutritional/Psychological treatment
Armed with this new knowledge, therapists should realize that the psychological link between an internally driven emotion and past traumatic memory helps a victim to manage his illness psychologically. He may have resorted to alcohol or drugs, or other kinds of behaviour for self-medication. If a therapist were to attempt to break the connection between ‘emotion’; and ‘past experience’ through psychotherapy or any other kind of talk therapy, the therapist would fall into the trap of confusing causes and consequences. It certainly will increase his/her client’s suffering. In other words a therapist may unwittingly “enable” a client to believe that the “cause” of the emotional disorder is the “trauma”, whereas in  fact attention should be brought to the underlying metabolic disorder operating in the here-and-now and that is generating the symptoms of PTSD.

For example, a young woman who suffers from PTSD resulting from abuse in her childhood, would be very reluctant to give up this connection, whilst she is suffering from a physical disease. The connection helps her to manage her illness and allows for a rational explanation of her behaviour for the time being.

The better psychotherapeutic strategy would be to treat the biochemical disorder first, BEFORE any attempt at psychotherapy. Thus a therapist should concentrate first on dealing with the biochemical aspect of the disease - the depression - either with the help of a doctor, or preferably a nutritional doctor or person trained in clinical nutrition. But this all depends on the therapeutic situation and should ultimately be left to the discretion of the therapist. In the case of PTSD, I feel, that a therapist should wait until the biochemical imbalance has been restored, which could take quite some time. It is then when psychotherapy could be helpful in dealing with psychological problems.

The hypoglycemic diet is a powerful tool for dealing with PTSD what is after all a nutritional disorder. It is only when we gain some control over the biochemistry of the client, that we can deal with the damage done to personality with psychotherapy.

A person who has suffered for many years with PTSD, may have developed comorbid conditions such as alcoholism, substance abuse, social anxieties and fears, lack of self-esteem or of inappropriate assertiveness, aggressiveness, and many other ‘psychological’ consequences. These can be dealt with in a course of a structured psychotherapy course.

We have a self-help psychotherapy course at this web site, but any other therapeutic approach, especially RCBT, should help clients recover from the psychological consequences of the disease, when the biological aspect has been successfully treated.
 
Research references:
Post Traumatic Stress Disorder (PTSD)
Depression and Insulin resistance
Depression and Genes
Diabetic gene
Hypoglycemia, Diabetes & Depression
Insomnia and Hypoglycemia and Melatonin
Serotonin and carbohydrates (sugars)
Zinc and picolinic acid, tryptophan

See:
 
Post Traumatic Stress Disorder (PTSD): A Disease of Body and Mind

Psychotherapy

What is Hypoglycemia?

The Serotonin Connection.

Nutritional Aspects of Depression
 
Depression is a Nutritional Disorder

Testing for Hypoglycemia

The Nutrition-Behavior Inventory (NBI)

Depression a Disease of Energy Production

Beating Anxiety and Phobias

The Biochemistry of Insomnia

References
Volkow ND, Chang L, et als. Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence. J Neurosci. 2001 Dec 1;21(23): 9414-8. PMID: 11717374
Also: Brookhaven National Laboraty News Release. And

 
 
Samra: "All the hypoglycemic diseases have in common the presence of neurocellular hypoglycia. Type 6 disease is the exception. In the breakdown of glucose both vitamins and minerals are necessary. During glycolysis one third of the energy is released by the breakdown of glucose into pyruvate (requiring B3, Magnesium, Potassium). Two third of the energy is released by the breakdown of Pyruvate to acetylCoa within the cell (requiring a multitude of vitamins including B1, B3 and B5 and the minerals Zinc, Manganese. Magnesium and Iron). This is why a GTT normal at serum glucose levels may conceal disturbance in carbohydrate metabolism at the cellular level. Type 6 disease may therefore occur in deficiency states of any of the glycolytic enzymes, coenzymes or minerals."
Dr George Samra (2002), TYE HYPOGLYCEMIC CONNECTION II, One Stop Allergies, Sydney, Australia. Page 70.    Available here.
 
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Last updated 4 January 2008