5
On Track for Nerve Damage
ARE YOUR NERVES ALREADY INFLAMED?
In the Why Should I Read This Book? Quiz, I asked you to identify a few simple conditions that could indicate you’re already experiencing the negative effects of sugar in your diet. Now I want to explore those precursors in depth.
The thirteen simple questions below will help you determine if you’re already on the way to nerve damage and type 2 diabetes, and the debilitating neuropathy that comes with it. I call it the “itis” and “ectomy” quiz because so many of the medical diagnoses you’ve already received are actually the result of nerve inflammation precipitated by excess sugar intake. You’ll recognize a couple of the topics from earlier chapters.
The “Itis” and “Ectomy” Quiz
1. Is your waist larger than 35 inches if you’re a woman or 40 inches if you’re a man?
Yes No
2. Do you get frequent headaches (more than two a week) or migraines or did you experience migraines in your teens or twenties?
Yes No
3. Do you wake up with tingling (often with itching and burning) or numbness in the fingers of one or both hands—or have you ever been diagnosed with carpal tunnel syndrome?
Yes No
4. Do you often have a runny nose, sinus headaches, or need to take over-the-counter or prescription antihistamines (drugs such as Allegra and Claritin)? Have you been diagnosed with chronic sinusitis?
Yes No
5. Do you feel tired most or all of the time?
Yes No
6. Did you have severe acne as a teenager or do you have adult acne (more than the occasional blemish) now?
Yes No
7. Do your feet sometimes feel itchy, burning, tingling, or numb?
Yes No
8. Have you ever had gingivitis, periodontal disease, or a root canal?
Yes No
9. Do you have skin tags or dark, velvety areas on your skin?
Yes No
10. Are your legs sometimes restless at night (a crawling or creeping sensation relieved by moving)?
Yes No
11. Have you ever had a gallbladder attack or had your gallbladder removed?
Yes No
12. Do you have frequent (more than two times a week) heartburn, upset stomach, constipation, or diarrhea?
Yes No
13. Do you get frequent (more than once a year) bladder or yeast infections?
Yes No
SCORING
Your score indicates risk and how quickly you are moving toward disease and debility.
1 to 3 Yes answers: Your risk is real but low.
4 to 6 Yes answers: Your risk is moderate, but immediate action to change your diet can reduce it.
More than 6 Yes answers: You may already have prediabetes or diabetes and could be far down the path to severe neuropathy. See your doctor as soon as possible.
What Your Answers Mean
Now that you’ve completed the “Itis” and “Ectomy” Quiz, you may be wondering why I’m so interested in your waist size, your headaches, and your skin—let alone your gallbladder. While the various health issues in the quiz seem to be different, they’re actually all connected by one common denominator: sugar consumption. Every one of the quiz questions is designed to explore end organs most easily impacted by high sugar consumption—and to determine how far along you are toward killing your nerves.
1. Is your waist larger than 35 inches if you’re a woman or 40 inches if you’re a man?
A large waist indicates you’re significantly overweight and probably have become resistant to the effects of insulin. This means your blood sugar is almost certainly higher than it should be—and, in turn, means damage to your nerves has already begun.
The risk factors for metabolic syndrome were discussed in Chapter 4 and you officially have the syndrome if you have at least two out of five risk factors: obesity, high triglycerides, high blood pressure, low HDL cholesterol, and a high fasting blood sugar (glucose) count. Of these, obesity (as represented by a large waist size) is usually the first factor to present itself.
Did you just wake up with this condition one morning? No. Obesity creeps up on you through years of a diet high in sugar and refined carbohydrates, combined with a sedentary lifestyle. If you’re still in the early stages of the metabolic syndrome, it’s possible to retrace your steps and get on a healthier path.
Step one?
Delete the sugar from your diet.
2. Do you get frequent headaches (more than two a week) or migraines or did you experience migraines in your teens or twenties?
If you get frequent headaches, there’s too much sugar in your diet—and your body isn’t handling it very well. As discussed in the last chapter, when glucose floods your bloodstream, this triggers a surge of insulin to clear it away. And in the early stages of the process, your body can respond by overshooting the mark, thus removing too much glucose from your blood. You may then become hypoglycemic—your blood sugar drops below normal. (This can also sometimes happen if you skip a meal.) The most common symptoms of hypoglycemia are headaches and cravings for sugary or starchy foods. You might then eat a second candy bar, which will raise your blood sugar back up to normal and relieve the headache—all at the cost of starting the whole cycle again.
Just as a quick drop in blood sugar is a common trigger for headache, it’s also a trigger for a migraine, but for a somewhat different reason.
Migraines
A migraine is a severe, often incapacitating headache frequently accompanied by nausea and sensitivity to light—it’s a headache with a vengeance. Migraines can be caused by many things, including hormonal changes, stress, low blood sugar from missed meals, and food allergies. The occasional migraine headache is manageable, but some people are chronic sufferers—and migraines experienced more than once a month can seriously disrupt their lives. Women are three times more likely to experience a migraine than are men. In fact, about 20 percent of all women have experienced at least one migraine headache (often in adolescence).* In all, 36 million Americans, or 12 percent of the population, get migraines at least once a year.
Drugs for frequent migraines have the same problem as drugs for peripheral neuropathy—they don’t work very well and have serious side effects. And yet, for some people with chronic migraines, surgical decompression of select nerves in the face or scalp can reduce the frequency of the headaches or even eliminate them. The observation leading to this concept was first made by Dr. Bahman Guyuron, a plastic surgeon in Cleveland. After brow lift surgery, a patient told him she no longer got migraines. Because this procedure involves releasing the supraorbital nerve (one of several cranial nerves associated with frequent migraines), Guyuron began offering the surgery to migraine sufferers—with outstanding results. Since then, research has confirmed that decompressing other nerves causing migraines (such as the occipital nerves that control the top and back of the scalp) can provide almost instant relief.
And for the Truly “Bad Seed”
If chronic migraine headaches are bad, trigeminal neuralgia is much worse. The trigeminal nerve (also known as the fifth cranial nerve) has three main branches that control sensation in the face. Sometimes one or more branches get compressed and become agonizingly painful and disabling. Before the development of effective treatment, trigeminal neuralgia was even labeled “the suicide disease” because of the numbers of people taking their own lives rather than enduring the pain. It usually surfaces after the age of forty and affects women in a ratio of 2:1. The nerve compression seems to come from an enlarged blood vessel pressing on the nerve (where it originates at the base of the brain), and as with other types of nerve compression, drugs don’t help much. Some patients turn to microvascular decompression, a surgical procedure that involves opening the skull, looking for the spot where the blood vessel presses on the trigeminal nerve, and placing a tiny bit of soft material between the blood vessel and the nerve.
This extremely effective technique was pioneered by Dr. Peter Jannetta, and you won’t be surprised to learn that for many years it was extremely controversial. Today Jannetta’s approach is widely used to treat not only the devastating effects of trigeminal neuralgia, but also other conditions originating from compressed nerves.*
Needless to say, while the Jannetta procedure is safe and effective, brain surgery isn’t to be taken lightly. Fortunately, for many patients there is now another option that doesn’t involve opening up your skull and that has basically no risk of death, stroke, infection, or facial numbness. New developments in radiation treatment let doctors target very small, specific areas of the brain with a onetime blast of gamma rays, which shrink the nerve, relieve compression, and eliminate pain.
Sugar-Triggered Migraine
Step one in triggering a migraine with sugar is eating a lot of it. As with headaches, this can cause first a surge in insulin and then a drop in blood sugar. When blood sugar drops quickly, the arteries in the head may not get enough glucose to fuel them properly. In people prone to migraines, low blood sugar can make the arteries spasm and constrict. In addition, the body compensates for low blood sugar by constricting arteries to raise blood pressure. This reduces blood flow even more and contributes to the migraine.
Recent research has shown that people who are prone to migraines also often have elevated levels of insulin in their blood.* This happens because they have become resistant to the effects of insulin, and so to force glucose into their cells, they need to produce extra insulin. This excess insulin can in turn cause a migraine because it interferes with the action of the nitric oxide pathway.*
If you get migraines, you may have noticed that you crave carbohydrates just before the attack begins. You may even have learned to short-circuit the migraine by eating something sweet or starchy when you first feel it coming on. You may also have recognized that you’re more likely to get a migraine if you skip a meal, which can lead to a drop in your blood sugar. Two obvious approaches will help keep your blood sugar on an even keel: limit your intake of sugary or starchy food and eat regular, low-carb meals. It’s not a guarantee, but usually, no trigger means no migraine.
The story of sugar and migraines actually begins with Thomas Willis, a seventeenth-century physician considered the father of modern neurology.* Willis had a patient and mistress named Lady Anne Conway, a renowned British philosopher who’d suffered from incapacitating migraines most of her life. She sought relief everywhere, even going so far as to have her jugular veins opened to relieve pressure. None of the treatments she endured helped and she died at age forty-seven. Willis conducted an autopsy on Lady Conway and recorded that her brain tissue was “swollen and scarred.”
Because Lady Conway was an aristocrat, her diet most certainly included the expensive treat of seventeenth-century London—sugar. Was this an early indication that inflammation and the resulting scarring could have played a part in her condition? Could the sugar in her diet have been a factor in her migraines? That’s what I hypothesize—Willis to Jannetta to Dellon. All paths lead to global compression, inflammation of the nerves caused by sugar.
3. Do you wake up with tingling (often with itching and burning) or numbness in the fingers of one or both hands—or have you ever been diagnosed with carpal tunnel syndrome?
Tingling (often with itching and burning) and numbness in the fingers are classic symptoms of carpal tunnel syndrome (CTS), a painful condition caused by compression of the median nerve, one of the three main nerves that run down the arm and into the hand. The median nerve controls movement and sensation in your thumb and all the other fingers except half of the ring finger, and the pinkie, which are controlled by the ulnar nerve.
The median nerve passes into the hand through a narrow tunnel in your wrist. The floor of the tunnel is formed by the carpal (wrist) bones; the sides are formed by tendons; and the roof is formed by the transverse carpal ligament. Because the tunnel is narrow and formed by bones, tendons, and ligaments—the toughest tissues in your body—anything that makes the nerve swell up will also squeeze it, because the swollen nerve can’t expand against the tougher tissue. The nerve gets compressed in place by its own swelling. Step on a hose and you slow or stop the flow of water; compress a nerve and you do much the same thing to the impulses that flow back and forth along it.
CTS is a form of mononeuropathy, or neuropathy that affects only a single nerve. Like all neuropathies, it usually starts gradually, with only occasional minor discomfort and then progresses to chronic itching, tingling, burning, and numbness. The symptoms gradually worsen, causing increasing discomfort and loss of strength in the hand. The condition is sometimes caused by an injury or repetitive motion, and sometimes simply by having a smaller carpal tunnel than usual. However, I believe that in most cases, compression of the median nerve is the direct result of the inflammation caused by sugar. And even distinguished public health sites such as that established by the University of Maryland Medical Center advise CTS patients to “avoid refined foods such as white bread, pasta, and sugar.”
Carpal Tunnel and Diabetes
The link between CTS and diabetes was established as early as 1930 and continues to be explored by researchers such as Martin Gulliford of King’s College London. So, when I ask if you’re having any symptoms of carpal tunnel syndrome, or if you’ve already been diagnosed with it, I’m really asking if your diet is high in sugar. I’m also asking indirectly if you already have the metabolic syndrome, since carpal tunnel syndrome is more common among people who are obese.
Among metabolically normal people, the incidence of CTS is roughly 2 percent of the population. Among those already diagnosed with diabetes but with no signs yet of diabetic polyneuropathy, the incidence of CTS is 14 percent. And among people with diabetes and polyneuropathy, the incidence of CTS is a whopping 30 percent. The longer you have diabetes, the more likely you are to develop CTS. Sugar causes global compression of the nerves—it’s the rare patient with diabetes whose nerve damage is limited to just the feet. Among my patients who have foot neuropathy, about half of them also complain of numbness, tingling, and other symptoms in their hands.
Remember, in 1973, when McComas and Upton discussed the connection between CTS and diabetes, the risk was 16 percent. It isn’t coincidental that this is also the time when high-fructose corn syrup was being widely infused into our food supplies. This serves as an example of how metabolic abnormalities that come with high blood sugar can cause problems long before diabetes shows up.
In severe cases, carpal tunnel syndrome is treated with nerve decompression surgery. The pressure on the nerve is released by cutting through the carpal ligament to open up the roof of the tunnel. In 1950, the medical literature reported only twelve instances of this operative procedure. And yet, the New York Times reports that currently more than 500,000 carpal tunnel procedures are performed every year in the United States. Prevailing medical opinion attributes this radical increase to the introduction of the personal (microcomputer) in 1977. I believe the answer lies elsewhere—with the introduction in 1957 of high-fructose corn syrup. Thus, patients were developing CTS not from typing at a keyboard, but from sipping the soda sitting on the desk. Carpal tunnel syndrome is yet another painful and disabling condition that is largely avoidable just by cutting sugar from your diet.
4. Do you often have a runny nose, sinus headaches, or need to take over-the-counter or prescription antihistamines (drugs such as Allegra and Claritin)? Have you been diagnosed with chronic sinusitis?
Sinusitis is an inflammation or infection of the sinuses, the hollow spaces within the skull surrounding the nose. Every year, 30 million cases are diagnosed. Symptoms include headaches, a thick nasal discharge, and often a decreased sense of smell. It’s usually acute, meaning it comes on quickly and goes away by itself within a couple of weeks. Most cases of acute sinusitis are caused by having a cold or a respiratory allergy. Sometimes sinusitis can become chronic, meaning it goes on forever, or so it seems.*
You have chronic sinusitis if you’ve got symptoms for more than a few weeks, or if they go away and come back, or if they just don’t ever really go away at all. Generally speaking, constant inflammation causes thickened mucus membranes in the nose and sinus cavities.
Sinusitis is one of the many itises that can be traced back to a diet high in sugar. Excess sugar in your body not only ends up in fat cells, but also gets excreted in other ways, such as through your mucus. Your sinuses are a perfect guesthouse for pathogens: They’re moist, dark, and warm. And if your diet is crummy, the mucus in them is full of the nutrient bacteria love most: sugar. Any bacteria that find their way to your sinuses may decide to settle in for a nice, long stay.
They’re hard to evict, because a diet high in sugar also affects your immune system’s ability to work efficiently. Stick with me as I explain. The white blood cells that make up your body’s immune system need plenty of vitamin C to be at their most effective. In fact, white blood cells may contain as much as 20 times the vitamin C as other types of cells. If you have high blood sugar, however, your cells have trouble absorbing vitamin C, because glucose molecules and vitamin C molecules are very similar in shape.*
In humans, insulin carries both glucose and vitamin C into our cells. But if glucose levels in the blood are too high, the glucose competes with the vitamin C to get in. Glucose always wins, because the insulin receptors in the cell wall have a higher affinity for glucose than for vitamin C. If your blood is awash with excess glucose, vitamin C is the loser.
Let’s combine what we know about the competition between glucose and vitamin C with an interesting fact about white blood cells: because they need so much vitamin C to be effective, they have about 50 times as many insulin receptors as other cells.
Now let’s connect the dots. If your blood sugar is too high, the white blood cells of your immune system can’t get enough vitamin C to work as well as they should. You’re much more likely to get sick—and stay sick—with stubborn infections. Ditto for allergic rhinitis. You can’t prevent allergies, but you can improve how efficiently your immune system responds.
A common self-help recommendation for sinusitis and allergic rhinitis is to take vitamin C supplements. This may help a bit by forcing some extra vitamin C into your cells, but it’s approaching the problem from the wrong direction. Cut the sugar from your diet and you will boost your immune system by letting it get all the vitamin C you need—without fighting sugar for the territory.
5. Do you feel tired most or all of the time?
Of all the complaints doctors hear, feeling tired all the time is in the top five. In fact, TATT is a common abbreviation in medical charts. Many, many health issues can make you feel tired, of course. If TATT is in your chart, I urge you to work with your doctor to look at possible causes and rule out serious illness, such as cancer or heart disease.
As part of the process, your doctor will order a blood test to check your blood sugar level. Chances are good that if you’re tired all the time, your blood sugar will be higher than normal—and you have hyperglycemia. Technically, you’re hyperglycemic if your fasting blood sugar is 126 mg/dL, or in the diabetic range. Hyperglycemia doesn’t really cause noticeable symptoms, however, until your blood glucose is “astronomical,” generally 200 mg/dL or higher.*
Feeling tired all the time is a very common symptom of hyperglycemia; other symptoms include excessive thirst and frequent urination. The cells of your body are desperate for some glucose, but they have become so resistant to the effects of insulin that the glucose just can’t get in. It builds up in your bloodstream instead. You feel fatigued both because your cells can’t get any fuel and because the excess glucose in your blood is making the blood thicker than normal. Think of stirring several spoonfuls of sugar into a cup of water. The sugar dissolves and the water becomes a bit syrupy. That’s what’s happening in your blood. Thick, sludgy blood doesn’t circulate very well, so your cells also aren’t getting enough oxygen or other nutrients, and their waste products aren’t being carried away very efficiently. No wonder you’re tired all the time!
By the time the constant fatigue of hyperglycemia sets in, your blood sugar has been slowly creeping up for years. As your blood sugar has been rising, your energy level has been sinking—just so gradually that you didn’t really notice. If you meet the definition of the metabolic syndrome in question 1, you may well have tipped over into type 2 diabetes without knowing it. You’re not alone—some 19 million Americans have undiagnosed type 2 diabetes.
Over those years of rising blood sugar, you’ve already done a lot of damage to your nerves. Once your blood sugar rises to seriously hyperglycemic levels, the damage can go quickly from something you didn’t even feel to something that’s painful and debilitating. You might have neuropathy in one or both feet. In some cases, undiagnosed high blood sugar can lead to diabetic focal neuropathy, or neuropathy that suddenly attacks specific nerves in the head, torso, or leg. The most common symptoms are pain and muscle weakness. Depending on the affected nerve, you might also get double vision, Bell’s palsy, severe lower back or leg pain, and chest pain that might even be mistaken for a heart attack.
If your blood sugar is high, it’s obvious that sugar in the diet is causing your constant fatigue. The solution is also obvious: no more sugar! My patients who eliminate sugar entirely report dramatic changes in their energy levels.
6. Did you have severe acne in your teen years or do you have adult acne (more than the occasional blemish) now?
Ask any dermatologist about the link between sugar in the diet and acne and you’ll be told emphatically that diet has nothing to do with it. In my mind, this flat-out refusal to even consider diet is a perfect example of how blind the medical profession can be. The evidence that sugar is behind almost all cases of acne is very convincing—and has been published in well-respected medical journals.
Exactly how sugar gives you pimples is a bit complicated, so again, stick with me. You know that when you eat carbohydrates, especially junky refined carbs, your blood sugar jumps and your body produces extra insulin to carry away the glucose. Insulin doesn’t just handle glucose, however—and one of its many other functions is to trigger the production of hormones, including one called insulin-like growth factor 1 (IGF-1). What does IGF-1 do? Among other things, it stimulates production of sebum, an oily substance produced by sebaceous glands in the skin. Sebum lubricates and waterproofs your skin and hair; every hair follicle on your skin has at least one sebaceous gland. At the same time, IGF-1 stimulates the growth of skin cells in general, including in the hair follicles. Another hormone stimulated by insulin, insulin-like growth factor binding protein 3 (IGFB-3), makes dead skin cells (which are now occurring faster because of higher insulin levels leading to higher IGF-1 levels) clump together. High insulin from too much sugar in the diet stimulates the production of sebum; faster growth of skin cells in the hair follicles means more dead cells being shed; IGFB-3 makes those dead cells clump together. You’ve now got the recipe for a clogged hair follicle, better known as a zit.
On top of all that, male adolescents normally become slightly insulin resistant as they grow toward maturity. That means they produce more insulin, which in turn means they produce more IGF-I—which means they get more zits. And who drinks the most sugar-sweetened sodas (five cans a day is not uncommon), eats the most candy bars, and has the highest consumption of junk food? Male adolescents. It’s no surprise that acne is such a problem for them.
The good news about acne is that you don’t need expensive and dangerous medications such as Accutane (isotretinoin) to treat it. You don’t even need to slather on expensive lotions, creams, and other skin treatments. All you need to do is cut the sugar from your diet. In particular, cut the sugar from crappy junk foods.* Of course, not all acne is caused by excess sugar, although I would argue that a majority is. Consult your dermatologist for a more definitive diagnosis.
7. Do your feet sometimes feel itchy, burning, tingling, or numb?
If you’re having itchiness, burning, tingling, or numbness in your feet, you’re experiencing the early symptoms of diabetic peripheral neuropathy, which I will discuss in detail in the next chapter. But if you haven’t yet been diagnosed with type 2 diabetes, you’re about to be—at least, that is, if you come to my office.
The unpleasant symptoms of peripheral neuropathy occur when the nerves in your feet are damaged from too much sugar in your bloodstream. It’s that simple, really. The nerves have swollen from excess sugar, and these swollen nerves are now pressing up against the surrounding muscle, bone, and connective tissue in your feet. The result is compression—where nerves are being squashed in place and can no longer send and receive impulses normally. Instead, there’s static on the line, in the form of pain, tingling, itchiness, and numbness.
If you have diabetes, you are almost certain to get some form of neuropathy—at least 60 to 70 percent probability. The longer you have diabetes, the more certain neuropathy becomes. Almost everyone who has had diabetes for twenty-five years or more will also have neuropathy. Sustained high blood sugar causes neuropathy. Removing sugar from the diet and getting blood sugar under control will go a long way toward ending neuropathy. It’s that simple.
8. Have you ever had gingivitis, periodontal disease, or a root canal?
I’ve had extensive conversations with dentists about the reasons for a root canal—the procedure used to repair and salvage an infected, badly decayed, or physically damaged tooth. In the procedure, the nerve and pulp within the root canal cavity of the tooth are removed. The cavity is cleaned out and then filled with a rubber compound called gutta-percha. The opening into the cavity is sealed with a filling. The dentists I talk to are convinced that the need for a root canal is caused by a mechanical problem—a hole or crack in the tooth has let infection-causing bacteria into the cavity. I’m not convinced.
I believe this is yet another example of the global compression theory. A high-sugar diet causes a compression of the nerve that supplies the tooth from the trigeminal nerve branch. With compression, the nerve begins to die, just as in diabetic neuropathy. The dentists’ hypothesis is that the damage is infection induced, but I contend that it is trauma against the already inflamed trigeminal nerve that leads to the need for a root canal. Millions of root canals are done each year in the United States. This is yet another example of a common nerve problem that is really the result of a compression neuropathy.
9. Do you have skin tags or dark, velvety areas on your skin?
Two very common but often overlooked warning signs of insulin resistance, the metabolic syndrome, and diabetes are skin tags (achrocordons) and acanthosis nigricans, dark, velvety patches on the skin.
Skin tags are benign growths and often look a little like tiny balloons. They occur most commonly on the neck and in the armpits, but they can also occur on the eyelids, in the genital area, and under the breasts. They’re a bit unsightly and can be annoying, but they’re harmless. In fact, they’re very common—about half of all adults have a few. The real problem with skin tags is that they occur much more often and in greater numbers in overweight people. When that happens, it’s a pretty good sign that insulin resistance is also occurring—because high insulin levels stimulate the growth of excess skin cells. Whenever I see a new patient and note multiple skin tags, I know without even looking at the chart that the patient has diabetes.
The same is true for acanthosis nigricans (AN), a skin condition causing areas of dark, velvety skin in body folds and creases. It’s most commonly seen in the armpits, neck area, and groin. AN is an even more certain sign of diabetes than skin tags. The skin changes are almost always found only in people who are obese or who have diabetes—and the heavier you are, the greater your risk. Like skin tags, acanthosis nigricans is harmless and doesn’t require treatment. And like skin tags, it’s caused by insulin resistance. Here, too, high insulin levels stimulate abnormal skin growth. What I find most disturbing about AN is that when it happens in an overweight kid, it’s a pretty sure predictor of type 2 diabetes at an early age, possibly as soon as the late teens.
I can’t say that cutting sugar from your diet will keep you from getting skin tags or AN or make them go away once they occur, but eliminating sugar will likely keep both conditions from getting worse.
10. Are your legs sometimes restless at night (a crawling or creeping sensation relieved by moving)?
That horrible throbbing, creeping, crawling, pulling sensation in your legs at night (or even when you’re just sitting quietly) is known as restless legs syndrome (RLS). The sensations create a powerful urge to move your legs to relieve the discomfort. Because RLS occurs at night and may even worsen as the night goes on, it’s a major cause of insomnia, daytime sleepiness, and all the bad symptoms of sleep deprivation—including elevated blood sugar. It’s considered a sleep disorder, not a complication of diabetes, but that’s what it really is for my patients.
Restless legs syndrome is still a medical mystery—we don’t know exactly what causes it and why it sometimes goes away for long periods. What we do know is that people with peripheral neuropathy also often get RLS. We also know that people with diabetes are far more likely to have RLS, whether or not they also have peripheral neuropathy—in other words, having diabetes is an independent risk factor for RLS. By some estimates, about 18 percent of people with diabetes have RLS, compared to about 5 percent of people without diabetes. For reasons we still don’t understand, women with diabetes are about twice as likely to develop RLS as are men with diabetes.
The sleep disruption of RLS can raise your blood sugar all on its own. If you have RLS and diabetes, the sleep disruption will only make your blood sugar problem even worse. So, getting your blood sugar under control will probably help relieve the RLS symptoms, and relieving the RLS symptoms will help improve your blood sugar. This is good win-win example of how giving up the sugar improves your health.
11. Have you ever had a gallbladder attack or had your gallbladder removed?
Your gallbladder is a small organ that stores bile made in your liver until it’s needed for digestion. When bile is needed, your gallbladder pumps it out through a duct leading into the small intestine. Gallstones are hard deposits that form inside the gallbladder. They’re very common—at least 20 million adults in the United States have them, though most will never know it. Gallstones are usually quite small, often no larger than a grain of sand, so if one does happen to get pumped out, it passes through the bile duct without any trouble. Sometimes, however, a gallstone can be large enough to get stuck inside the duct, and when that happens, you have a gallbladder attack.* Why do some people with gallstones never even know it, while others end up in the operating room? For many, it’s sugar.
People who are overweight or obese are more prone to gallstones. So are people with diabetes. Peter J. Dyck, of the Mayo Clinic in Rochester, Minnesota, is one of the leading neurologists in the country and author of a seminal two-volume textbook, Peripheral Neuropathy. Peter Dyck dominates the neurology literature and thinking in the medical world. It is the gold standard for the accepted treatment of diabetic peripheral neuropathy, an “incurable” disease. Dyck points out that 50 percent of people who get gallbladder disease go on to get diabetes. This is an astonishingly high statistic. And when someone with diabetes has a gallbladder attack, the attack is more likely to be severe and lead to an infection.
What’s going on here? Two things, both related to sugar. First, a diet high in refined carbohydrates raises your triglycerides—those tiny fat droplets in your bloodstream. High triglycerides seem to encourage the formation of gallstones (we’re not sure why), which raises your risk for a gallbladder attack. Second, damage to the nerves that control the gallbladder keeps the organ from contracting as well as it should, which means bile doesn’t get squirted out efficiently. Every time your gallbladder contracts, some bile remains backed up in it, where it can become sludgy and form gallstones. Then, because the nerve damage keeps the gallbladder from contracting well, the stones that do form are more likely to get stuck in the bile duct instead of being passed out of it into the small intestine.
The type of nerve damage that causes gallbladder attacks is called autonomic neuropathy. Autonomic nerves are nerves that operate in the background, automatically sending messages from your brain and spinal cord to your heart, digestive system, bladder, genitals, blood vessels, sweat glands, and the pupils in your eyes. The autonomic nerves take care of everyday housekeeping in your body, controlling everything from your bowels to your heart rate and blood pressure. You never notice the work your autonomic nerves do until something goes wrong. Even then, you don’t notice a problem with the nerve itself. Instead, when an autonomic nerve is damaged, the harm shows up in the organ it controls. Autonomic nerves are the first nerves to be affected in the metabolic syndrome process. Autonomic neuropathy is the first stage of peripheral neuropathy and has exactly the same cause: sugar. Eliminating sugar from the diet and getting your blood sugar under control may improve the symptoms of autonomic neuropathy (especially digestive symptoms) and keep them from getting worse. Unfortunately, however, the damage can’t be reversed.
Diabetic autonomic neuropathy occurs when these nerves are damaged and can no longer function correctly. It’s a very common complication of type 2 diabetes, but the damage begins long before you reach that diagnosis. Years of high blood sugar gradually restrict the blood flow to the nerves, slowly damaging them and eventually impairing their ability to transmit impulses correctly. The sugar itself makes the nerves swell up and stop working well; advanced glycation end products gum it up.
Because the symptoms of diabetic autonomic neuropathy develop slowly, it’s only when the nerve damage is fairly far along that you start to notice them. When the autonomic nerves that control your heart are damaged, for instance, your heart might develop an abnormal beat or rhythm, with possible fatal consequences. When the autonomic nerves that control your digestive system are damaged, you get gallbladder attacks, problems with constipation and diarrhea, nausea after eating, and a range of other unpleasant symptoms.
12. Do you have frequent (more than two times a week) heartburn, upset stomach, constipation, or diarrhea?
Frequent digestive problems can have a wide range of causes, yet in my experience the most common cause, sugar, is often overlooked. Years of high blood sugar, starting long before diabetes is diagnosed, damage the autonomic nerves that control your digestive system from end to end. Eventually, like nearly 75 percent of all people with diabetes, you develop some form of diabetic autonomic neuropathy. For example, nearly half of all people with diabetes have at least some signs of gastroparesis, or partial paralysis of the stomach muscles caused by damage to the vagus nerve. Gastroparesis keeps your stomach from emptying its contents into your small intestine normally, leading to a variety of unpleasant symptoms, including severe heartburn, bloating, nausea, vomiting, dangerous blood sugar swings, and the aptly named dumping syndrome.
Many of my patients have been scoped and scanned up and down in an attempt to find the source of their ongoing digestive issues, only to be told that the problem must be stress. That’s doctor-speak for “I have no idea what’s wrong with you, so I’m blaming it on your mental issues. Take these antidepressants and these antacids and come back in three months.”
The doctors are only trying to help their patients, of course, but if the problems are caused by autonomic neuropathy, these drugs will actually make them worse. Once again, let’s connect some dots. Diabetic autonomic neuropathy is caused by nerve damage from sugar. The most commonly prescribed antidepressants today are selective serotonin reuptake inhibitors (SSRIs) such as Lexapro (escitalopram), Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). While these drugs may help relieve symptoms of depression, they also raise your blood sugar and increase your risk of type 2 diabetes.
About a quarter of all people who take these drugs will also gain weight—not good for the blood sugar or for nerves that are already damaged. Antacids, especially proton pump inhibitors (PPIs) such as Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), and Protonix (pantoprazole), can block your absorption of vitamin B12 (crucial for healthy nerves) and lower your levels of magnesium. (Many people with diabetes are low on this essential mineral.) This is also not good for nerves that are already damaged. Put the two drug classes together and, while there may be some temporary relief of symptoms, in the end the combination only worsens the neuropathy.
Unfortunately, there’s not a lot we can do to reverse autonomic neuropathy once it starts. Getting the blood sugar under control by removing sugar from the diet usually helps to slow down or even halt the neuropathy. And if the problem is caught early enough, lifestyle changes and standard treatments can help quite a bit with the symptoms.
13. Do you get frequent (more than once a year) bladder or yeast infections?
Bladder infections, also known as urinary tract infections (UTIs) or cystitis, are very common among women—nearly half of all women have had a bladder infection at some point.* If you get them frequently, however, you probably have high blood sugar, even if you don’t know it yet. The excess glucose in your bloodstream is making you much more susceptible to UTIs both directly and indirectly.
Directly, excess sugar from your bloodstream is excreted through your kidneys and ends up in your urine. In fact, one of the oldest diagnostic tests in medical history is tasting the urine. If it tasted sweet, the patient had diabetes. Sugary urine is a fertile breeding ground for bacteria, which is why women with diabetes are two to three times more likely to have bacteria in their bladder than are women without diabetes. At any given time, about 20 percent of all women with diabetes have a bladder infection.
Indirectly, you’re getting UTIs because the excess sugar in your blood has slowly damaged the autonomic nerves controlling your bladder. More than half of all people with diabetes have some degree of damage to the nerves that control the bladder. Among other things, the nerve damage means you’ll have trouble emptying your bladder fully. The leftover urine pooling in the bladder makes a great place for bacteria to breed. At the same time, diabetes also causes poor circulation to the area, which limits how many white blood cells can arrive to fight the infection; high blood sugar limits how well the white blood cells work. It’s not surprising that women with diabetes are more likely to end up in the hospital from a UTI.
If you get frequent bladder infections, even if your blood sugar is normal, eliminating sugar from your diet will almost certainly help cut back on them. You’ll get the infections less often, the symptoms will be less annoying, and you’ll get over them faster.
What goes for UTIs also goes for yeast infections, also known as candidiasis. Vaginal yeast infections are very common among all women, but women with type 2 diabetes get them a lot more often. If your blood sugar is consistently high, even if you don’t have diabetes, the mucus in your vagina will contain excess sugar, just as your urine will. Single-celled yeast organisms are normally found in the vagina in small numbers. Take that moist, warm environment and add sugar to it, and the yeast take off, multiplying rapidly and causing unpleasant symptoms such as a thick white discharge, itching, and burning during urination. As with the bladder, over the long run high blood sugar reduces blood circulation to the area, which makes it that much harder for your white blood cells to get to the infection and fight it off.
Getting your blood sugar under control is an essential first step in treating and preventing yeast infections.
Past Problems Predict Present Problems
Wendy, in her late forties, came to my office seeking relief for her achy, burning feet. She reported taking two common drugs for high blood pressure, and was overweight, but the standard medical history revealed no other health issues.
I asked about the high blood pressure.
She responded, “I don’t have high blood pressure because I take medicine to keep it down.”
I explained there’s a difference between the normal numbers she had when I took her blood pressure and having the disease called high blood pressure, but she didn’t want to think of herself as someone with a chronic disease. I knew she wasn’t going to like what I’d have to say after checking her feet.
Her foot discomfort was caused by the earliest phase of diabetic peripheral neuropathy. A lifetime of eating sugar had caught up to her—causing mild damage to the small nerves in her feet and resulting in some numbness. Fortunately, the damage hadn’t progressed too far and she could quickly reverse by cutting sugar from her diet.
Wendy had different ideas.
“My family doctor checked my blood sugar and said it was just a little on the high side,” she said. “How can I have diabetic neuropathy if I don’t have diabetes?”
I explained that the actual number doesn’t matter. Her fasting blood sugar was 112 mg/dL—below 125 mg/dL, the official level for diabetes as recognized by the American Diabetes Association—but she was still in trouble because it’s the long-term trend that counts. She already had three out of the five markers for the metabolic syndrome: high blood sugar, excess weight in the stomach area, and high blood pressure.
Next stop on the blood sugar express: type 2 diabetes.
“Did you have acne as a teenager?” I asked.
“Yes,” she said. “It was awful. It didn’t clear up until I went to college.”
“Let me guess,” I said. “You became a vegetarian then, right?”
“I did! I told everyone I didn’t want to eat anything that had a mother because it made me seem cool, but it was really so I could lose weight. It worked, too. Instead of gaining the freshman fifteen, I lost it. Of course, I’ve gained it back and more since then. How did you know that?”
“Because when you became a vegetarian to lose weight you stopped eating junk food, too. With sugar out of your diet, your skin cleared up. Now, let me make another guess. You’ve always suffered with headaches.”
“And they’re getting worse,” she said. “When I was young, I had migraines.”
“Your body has never handled sugar very well—that’s why you got acne and migraines and it’s why you get headaches now. It’s also why you’re having foot trouble and high blood sugar. We can stop your foot neuropathy and keep you from getting diabetes, but it means big changes.”
Wendy was still unconvinced. What she wanted was a magic pill to make her foot pain go away; instead I gave her advice on taking care of her feet and keeping an eye out for anything that looked like a cut or infection. I also gave her a diet plan and scheduled her for follow-up in three months.
A few weeks later, I was surprised to see her again. Wendy was there because her kitten had scratched her on the foot. She hadn’t even noticed at first, but in a few days that tiny scratch had become an infected, painful sore that kept getting worse instead of healing naturally.
I decided to lay it all on the line.
“You have some numbness in your foot, so you didn’t notice the scratch. Bacteria got into your skin and your high blood sugar fed them the food they like best. Now you have a real problem that’s going to take weeks of antibiotics and bandages to get better. And this is just the start. I guarantee that you’ll be back with another infection within a year. And ten years down the line, I could be cutting off your foot. The choice is pretty simple: change your diet or lose your foot.”
She was finally listening. There’s nothing like a painful hole in your foot and the threat of amputation to get your attention.
“I guess I really do need to eat better,” she said. “Can I have that diet again?”
Because she decided to remove sugar and junk carbohydrates from her diet, Wendy’s foot healed a bit faster than I expected. I’m happy to say her neuropathy also improved quite a bit, to the point where I no longer need to see her.