Addiction

Definition

Addiction is a physical or mental dependence on a behavior or substance that a person feels powerless to stop.

Description

Addiction is one of the most costly public health problems in the United States. It is a progressive syndrome, which means that it increases in severity over time unless it is treated. The term has been partially replaced by the word "dependence" for substance abuse. Addiction has been extended, however, to include mood-altering behaviors or activities. Some researchers speak of two types of addictions: substance addictions (for example, alcoholism, drug abuse, and smoking); and process addictions (for example, gambling, spending, shopping, eating, and sexual activity). There was as of 2004 a growing recognition that many addicts are addicted to more than one substance or process. Substance abuse is characterized by frequent relapse or return to the abused substance. Substance abusers often make repeated attempts to quit before they are successful.
The National Survey on Drug Use and Health (NSDUH) is conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services. Among the findings of the 2003 study are the following:

• In 2003, an estimated 19.5 million Americans, or 8.2 percent of the population aged 12 or older, were current illicit drug users. Current illicit drug use means use of an illicit drug during the month prior to the survey interview. The numbers did not change from 2002.
• The rate of illicit drug use among youths aged 12–17 did not change significantly between 2002 (11.6%) and 2003 (11.2%), and there were no changes for any specific drug. The rate of current marijuana use among youths was 8.2 percent in 2002 and 7.9 percent in 2003. There was a significant decline in lifetime marijuana use among youths, from 20.6 percent in 2002 to 19.6 percent in 2003. There also were decreases in rates of past year use of LSD (1.3 to 0.6%), ecstasy (2.2 to 1.3%), and methamphetamine (0.9 to 0.7%).
• About 10.9 million persons aged 12–20 reported drinking alcohol in the month prior to the survey interview in 2003 (29.0 percent of this age group). Nearly 7.2 million (19.2%) were binge drinkers and 2.3 million (6.1%) were heavy drinkers. The 2003 rates were essentially the same as those from the 2002 survey.
• An estimated 70.8 million Americans reported current (past month) use of a tobacco product in 2003. This is 29.8 percent of the population aged 12 or older, similar to the rate in 2002 (30.4%). Young adults aged 18–25 reported the highest rate of past month cigarette use (40.2%), similar to the rate among young adults in 2002. An estimated 35.7 million Americans aged 12 or older in 2003 were classified as nicotine dependent in the past month because of their cigarette use (15% of the total population), about the same as for 2002.

Demographics

In 2003, the rate of substance dependence or abuse was 8.9 percent for youths aged 12–17 and 21 percent for persons aged 18–25. Among persons with substance dependence or abuse, illicit drugs accounted for 58.1 percent of youths and 37.2 percent of persons aged 18–25. In 2003, males were almost twice as likely to be classified with substance dependence or abuse as females (12.2% versus 6.2%). Among youths aged 12–17, however, the rate of substance dependence or abuse among females (9.1%) was similar to the rate among males (8.7%). The rate of substance dependence or abuse was highest among Native Americans and Alaska Natives (17.2%). The next highest rates were among Native Hawaiians and other Pacific Islanders (12.9%) and persons reporting mixed ethnicity (11.3%). Asian Americans had the lowest rate (6.3%). The rates among Hispanics (9.8%) and whites (9.2%) were higher than the rate among blacks (8.1%).
Rates of drug use showed substantial variation by age. For example, in 2003, some 3.8 percent of youths aged 12 to 13 reported current illicit drug use compared with 10.9 percent of youths aged 14 to 15 and 19.2 percent of youths aged 16 or 17. As in other years, illicit drug use in 2003 tended to increase with age among young persons, peaking among 18 to 20-year-olds (23.3%) and declining steadily after that point with increasing age. The prevalence of current alcohol use among adolescents in 2003 increased with increasing age, from 2.9 percent at age 12 to a peak of about 70 percent for persons 21 to 22 years old. The highest prevalence of both binge and heavy drinking was for young adults aged 18 to 25, with the peak rate of both measures occurring at age 21. The rate of binge drinking was 41.6 percent for young adults aged 18 to 25 and 47.8 percent at age 21. Heavy alcohol use was reported by 15.1 percent of persons aged 18 to 25 and 18.7 percent of persons aged 21. Among youths aged 12 to 17, an estimated 17.7 percent used alcohol in the month prior to the survey interview. Of all youths, 10.6 percent were binge drinkers, and 2.6 percent were heavy drinkers, similar to the 2002 numbers.
Rates of current illicit drug use varied significantly among the major racial-ethnic groups in 2003. The rate of illicit drug use was highest among Native Americans and Alaska Natives (12.1%), persons reporting two or more races (12%), and Native Hawaiians and other Pacific Islanders (11.1%). Rates were 8.7 percent for African Americans, 8.3 percent for Caucasians, and 8 percent for Hispanics. Asian Americans had the lowest rate of current illicit drug use at 3.8 percent. The rates were unchanged from 2002. Native Americans and Alaska Natives were more likely than any other racial-ethnic group to report the use of tobacco products in 2003. Among persons aged 12 or older, 41.8 percent of Native Americans and Alaska Natives reported using at least one tobacco product in the past month. The lowest current tobacco use rate among racial-ethnic groups in 2003 was observed for Asian Americans (13.8%), a decrease from the 2002 rate (18.6%).
Young adults aged 18 to 25 had the highest rate of current use of cigarettes (40.2%), similar to the rate in 2002. Past month cigarette use rates among youths in 2002 and 2003 were 13 percent and 12.2 percent, respectively, not a statistically significant change. However, there were significant declines in past year (from 20.3% to 19%) and lifetime (from 33.3% to 31%) cigarette use among youths aged 12 to 17 between 2002 and 2003. Among persons aged 12 or older, a higher proportion of males than females smoked cigarettes in the past month in 2003 (28.1% versus 23%). Among youths aged 12 to 17, however, girls (12.5%) were as likely as boys (11.9%) to smoke in the past month. There was no change in cigarette use among boys aged 12 to 17 between 2002 and 2003. However, among girls, cigarette use decreased from 13.6 percent in 2002 to 12.5 percent in 2003.

Causes and symptoms

Addiction to substances results from the interaction of several factors.

Drug chemistry

Some substances are more addictive than others, either because they produce a rapid and intense change in mood or because they produce painful withdrawal symptoms when stopped suddenly.

Genetics

Some people appear to be more vulnerable to addiction because their body chemistry increases their sensitivity to drugs. Some forms of substance abuse and dependence seem to run in families; a correlation that may be the result of a genetic predisposition, environmental influences, or a combination of the two.

Brain structure and function

Using drugs repeatedly over time changes brain structure and function in fundamental and long-lasting ways. Addiction comes about through an array of changes in the brain and the strengthening of new memory connections. Evidence suggests that those long-lasting brain changes are responsible for the distortions of cognitive and emotional functioning that characterize addicts, particularly the compulsion to use drugs. Although the causes of addiction remain the subject of ongoing debate and research, many experts as of 2004 considered addiction to be a brain disease, a condition caused by persistent changes in brain structure and function. However, having this brain disease does not absolve the addict of responsibility for his or her behavior, but it does explain why many addicts cannot stop using drugs by sheer force of will alone.

Social learning

Social learning is considered the most important single factor in causing addiction. It includes patterns of use in the addict's family or subculture, peer pressure, and advertising or media influence.

Availability

Inexpensive or readily available tobacco, alcohol, or drugs produce marked increases in rates of addiction. Increases in state taxes on alcohol and tobacco products have not resulted in decreased use.

Personality

Before the 1980s, the so-called addictive personality was used to explain the development of addiction. The addictive personality was described as escapist, impulsive, dependent, devious, manipulative, and self-centered. Many doctors in the early 2000s believe that these character traits develop in addicts as a result of the addiction, rather than the traits being a cause of the addiction.

When to call the doctor

The earlier one seeks help for their teen's behavioral or drug problems, the better. How is a parent to know if their teen is experimenting with or moving more deeply into the drug culture? Above all, a parent must be a careful observer, particularly of the little details that make up a teen's life. Overall signs of dramatic change in appearance, friends, or physical health may signal trouble. If parents believe their child may be drinking or using drugs, they should seek help through a substance abuse recovery program, family physician, or mental health professional.

Diagnosis

In addition to noting a preoccupation with using and acquiring the abused substance, the diagnosis of addiction focuses on five criteria:

• loss of willpower
• harmful consequences
• unmanageable lifestyle
• increased tolerance or escalation of use
• withdrawal symptoms on quitting

Treatment

According to the American Psychiatric Association, there are three goals for the treatment of persons with substance use disorders: (1) the patient abstains from or reduces the use and effects of the substance; (2) the patient reduces the frequency and severity of relapses; and (3) the patient develops the psychological and emotional skills necessary to restore and maintain personal, occupational, and social functioning.
In general, before treatment can begin, many treatment centers require that the patient undergo detoxification. Detoxification is the process of weaning the patient from his or her regular substance use. Detoxification can be accomplished "cold turkey," by complete and immediate cessation of all substance use, or by slowly decreasing (tapering) the dose that a person is taking, to minimize the side effects of withdrawal. Some substances must be tapered because cold-turkey methods of detoxification are potentially life threatening. In some cases, medications may be used to combat the unpleasant and threatening physical and psychological symptoms of withdrawal. For example, methadone is used to help patients adjust to the tapering of heroin use.
The most frequently recommended social form of outpatient treatment is the 12-step program. Such programs are also frequently combined with psychotherapy. According to the American Psychological Association (APA), anyone, regardless of his or her religious beliefs or lack of religious beliefs, can benefit from participation in 12-step programs such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). The number of visits to 12-step self-help groups exceeds the number of visits to all mental health professionals combined. There are 12-step groups for all major substance and process addictions.

Alternative treatment

Acupuncture and homeopathy have been used to treat withdrawal symptoms. Meditation, yoga, and reiki healing have been recommended for process addictions; however, the success of these programs has not been well documented through controlled studies.

Prognosis

The prognosis for recovery from any addiction depends on the substance or process, the individual's circumstances, and underlying personality structure. People who have multiple substance dependencies have the worst prognosis for recovery. It is not uncommon for someone in a treatment program to have a relapse, but the success rate increases with subsequent treatment programs.
Recovery from substance use is notoriously difficult, even with exceptional treatment resources. Although relapse rates are difficult to accurately obtain, the National Institute on Alcohol Abuse and Alcoholism cites evidence that 90 percent of alcohol dependent users experience at least one relapse within four years after treatment. Relapse rates for heroin and nicotine users are believed to be similar. Certain pharmacological treatments, however, have been shown to reduce relapse rates. Relapses are most likely to occur within the first 12 months of having discontinued substance use. Triggers for relapses can include any number of life stresses (problems in school or on the job, loss of a relationship, death of a loved one, financial stresses), in addition to seemingly mundane exposure to a place or an acquaintance associated with previous substance use.

Prevention

The most effective form of prevention appears to be a stable family that models responsible attitudes toward mood-altering substances and behaviors. Prevention education programs are also widely used to inform young people of the harmfulness of substance abuse.

Parental concerns

Parents and guardians need to be aware of the power they have to influence the development of their kids throughout the teenage years. Adolescence brings a new and dramatic stage to family life. The changes that are required are not just the teen's to make; parents need to change their relationship with their teenager. It is best if parents are proactive about the challenges of this life stage, particularly those that pertain to the possibility of experimenting with and using alcohol and other drugs. Parents should not be afraid to talk directly to their kids about drug use, even if they have had problems with drugs or alcohol themselves. Parents should give clear, no-use messages about smoking, drugs, and alcohol. It is important for kids and teens to understand that the rules and expectations set by parents are based on parental love and concern for their well being. Parents should also be actively involved and demonstrate interest in their teen's friends and social activities. Spending quality time with teens and setting good examples are essential. Even if problems such as substance abuse already exist in the teen's life, parents and families can still have a positive influence on their teen's behavior.

KEY TERMS

Binge drinking—Consumption of five or more alcoholic drinks in a row on a single occasion.
Detoxification—The process of physically eliminating drugs and/or alcohol from the system of a substance-dependent individual.
Reiki—A form of energy therapy that originated in Japan. Reiki practitioners hold their hands on or slightly above specific points on the patient's body in order to convey universal life energy to that area for healing.

BOOKS

Haugen, Hayley Mitchell. Teen Smoking. Minneapolis, MN: Sagebrush Bound, 2004.
Raczek, Linda Theresa. Teen Addiction. San Diego, CA: Lucent Books, 2003.
Stevens, Sally J., and Andrew R. Morral. Adolescent Substance Abuse Treatment in the United States: Exemplary Models from a National Evaluation Study. Binghamton, NY: Haworth Press, 2002.
Townsend, John. Drugs—Teen Issues. Chicago, IL: Raintree, 2004.

PERIODICALS

Johnson, Kate. "Tobacco Dependence: Even Minimal Exposure Can Cause Rapid Onset; Daily Smoking Not Necessary." Family Practice News (June 15, 2004): 66.
Kaminer, Yifah, and Chris Napolitano. "Dial for Therapy: Aftercare for Adolescent Substance Use Disorders." Journal of the American Academy of Child and Adolescent Psychiatry (September 2004): 1171.
"SAMHSA Reveals State Estimates of Substance Use for the First Time: Washington, D.C. Ranks Highest in Illegal Drug Use." Alcoholism & Drug Abuse Weekly (August 16, 2004): 31.
"Sexually Active Friends Can Signal Increase in Teen's Substance Abuse Risk." Obesity, Fitness & Wellness Week (September 18, 2004): 410.
Sherman, Carl. "Early Disorders Often Precede Substance Abuse." Clinical Psychiatry News (June 2004): 34.

ORGANIZATIONS

Alateen. 1600 Corporate Landing Parkway, Virginia Beach, VA 23454. Web site: <www.al-anon.alateen.org>.
National Academy of Child & Adolescent Psychiatry. 3615 Wisconsin Ave. NW, Washington, DC 20016. Web site: <www.aacap.org>.

WEB SITES

"Fact Sheet: Addiction (Substance Dependence)." New York Presbyterian Hospital. Available online at <www.noahhealth.org/english/illness/mentalhealth/cornell/conditions/substdep.html> (accessed November 8, 2004).
"National Youth Anti-Drug Media Campaign." Parents: The Anti-Drug. Available online at <www.theantidrug.com> (accessed November 8, 2004).
Bill Asanjo, MS, CRC Ken R. Wells

What is the benefit from fasting?

http://falconblanco.com/health/fasting.htmFasting 

What is fasting? - Preparation for Your Fast - Why Fast? - Activity Level -  Fasting enhances mental acuity - Protein & Fasting Points - Healing Aiding -  Elimination of Toxins - Fasting decreases dependency on authorities - Reactions from Fasting - Benefits of Fasting - Healing Crisis - One Day Fast -  Going off your Fast - Water Fast - Water Fasting Tips - Fasting Concerns - Reactions from Fasting - Spiritual - Weight Loss - Pre-existing Conditions - Greater Sensitivity - Master Cleanse - Juice Fasting - References/Links -  Additional Reading - Disclaimer What is Fasting? Fasting is a period of abstinence from all food or specific items. Fluids are consumed in sufficient quantity to satisfy thirst and physiologic requirements. During the absence of food, the body will systematically cleanse itself of everything except vital tissue. Starvation will occur only when the body is forced to use vital tissue to survive. Although protein is being used by the body during the fast, a person fasting even 40 days on water will not suffer a deficiency of protein, vitamins, minerals or fatty acids. In the breakdown of unhealthy cells, all essential substances are used and conserved in a most extraordinary manner. There is an unwarranted fear of fasting that strength diminishes from the catabolism of proteins from muscle fibers. Even during long fasts, the number of muscle fibers remains the same. Although the healthy cells may be reduced in size and strength for a time, they remain perfectly sound. A. J. Carlson, Professor of Physiology, University of Chicago, states that a healthy, well-nourished man can live from 50 to 75 days without food, provided he is not exposed to harsh elements or emotional stress. Human fat is valued at 3,500 calories per pound. Each extra pound of fat will supply enough calories for one day of hard physical labor. Ten pounds of fat are equal to 35,000 calories! Most of us have sufficient reserves, capable of sustaining us for many weeks. Rest is understood to be a big factor in enhancing recovery, as it is when the body is at rest that it is able to direct the most energy towards the various chemical and mechanical processes of detoxification. When fasting, a person experiences recovery at a rate that is swifter than normal. He is ridding his body of toxins and excesses; allowing the body to use its own wisdom to healthfully reorganize itself from the atomic level. As the toxic load is reduced, the functioning of every cell is enhanced. In the same way that vital nerve energy is accumulated during a night's sleep, the faster builds nerve energy through rest, sleep, and detoxification.  The human body has many ordinary modes of achieving elimination: the liver, lungs, kidneys, colon, etc. When these are overloaded, the body will resort to "extra ordinary" methods of elimination: boils, mucous and other discharges, sweats, vomiting, diarrhea, and many others. Should elimination be impossible or uneconomical of body energy, the toxic overload will go into storage forms in the joints, vessels, muscles, organs; almost any tissue in the body. While fasting, the body is highly conservative of its energy and resources. During this deep and profound rest, toxin intake and production are reduced to a minimum while autolysins and elimination proceed unchecked. Anabolic processes such as tissue and bone healing also proceed at a maximal rate during the fast. In the body, the first stage of cleansing removes large quantities of waste matter and digestive residues. The first few days of a fast can be rough due to the quantity of waste passing into the blood stream. The tongue becomes coated and the breath foul as the body excretes waste through every opening. After the third day of the fast, there is little desire for food. The second stage is the cleansing of mucous, fat, diseased and dying cells, and the more easily removed toxins. As the fast continues, the cleansing process becomes more thorough. The last stage is the cleansing of toxins that have been accumulating in your cellular tissue from birth, and the microscopic tubes that carry vital elements to the brain. Cleansing of the last layer is only possible through a combination of juice fasting, water fasting, and a healthy diet high in raw foods. To overcome a severe disease like cancer, it is important to continue through a series of fasts, to the point where the full scouring action of catabolism removes the disease from the tissue. During extended fasts the body removes: dead, dying and diseased cells; unwanted fatty tissue, trans-fatty acids, hardened coating of mucus on the intestinal wall; toxic waste matter in the lymphatic system and bloodstream; toxins in the spleen, liver and kidney; mucus from the lungs and sinuses, imbedded toxins in the cellular fibers and deeper organ tissues; deposits in the microscopic tubes responsible for nourishing brain cells and excess cholesterol. Nearly everyone who fasts, discovers the same thing, that when they fast they actually have no hunger and more energy than they normally have. It is indeed liberating to find out that if we let go and trust that we will be taken care of. Fasting is the simplest, easiest and most effective way to find out that we do indeed have the power and freedom to heal and take control of our bodies. Why Fast? Probably the most important reason is that the body uses quite a bit of energy to digest food, and when fasting this energy becomes available for other uses. In the fasting state, the body will scour for dead cells, damaged tissues, fatty deposits, tumors, abscesses, all of which are burned for fuel or expelled as waste. The elimination of these obstructions restores the immune system functionality and metabolic process to an optimum state.  Fasting restores good digestion and elimination, and peristaltic action is quickened. Fasting allows a deep, physiological rest of the digestive organs, and the energy saved goes into self-healing and self-repairing. By eliminating obstructions, by cleansing, detoxification, and purifying the intestines, the blood, and the cells, we can overcome many of our physical ills or handicaps as well as getting a boost in energy. Fasting not only removes obstructions and helps the body to heal itself, it is also rejuvenating and life-extending. These resulting benefits can have lasting affects in your mental and emotional health. The other very important aspect is that your self-awareness will be elevated. If you are sick and depressed, then this might be the most important thing you can try in your healing program, because it gives you immediately an energy boost and increased awareness which might allow that you see things more clearly, allowing you the first step out of your sickness and onto the path of recovery. While fasting you become more aware of your body process, your life and with everything you are doing. It becomes a period where you can evaluate all that you're doing more objectively, and you naturally have more time for contemplation because you aren't using time amassing, preparing, eating, eliminating and cleaning up all which is used to prepare food. You become more aware of what your body likes and doesn't like when you start to eat again. You gain self-confidence in your ability to control your life process, to set a goal and carry out an intention. Fasting enhances mental acuity  Perhaps the most instructive testimony as to the acuteness of mental powers during fasting comes from Dr. Herbert Shelton who supervised the fasting of more than 40,000 people over a period of fifty years. His message is that the freer the body is of toxic materials flowing through the blood and lymphatic system, the clearer is the ability to think. These facts are due to physiological causes. Large amounts of blood and nervous energies have to be sent to the digestive organs to digest a meal. If these energies are not required there, they may be used by the brain for better thinking. This increase in mental acuity doesn’t usually happen until after the first few days of a fast, because the body is busy cleaning out excess toxins and substances and so the first few days can be a period of depression, with headaches and various pains as this process is underway. This makes the first stage of fasting difficult but after the body has thrown off it’s load of toxins, then the brain is fed by a cleaner bloodstream and the mental powers and clarity of thought are extraordinarily increased and the other senses also become more acute.  One’s mind becomes clearer and one’s ability to think and solve intricate problems is enhanced. One is simply more alert, and one’s mind seems to open up into new fields. The mental and physical senses are heightened, and often there can be a feeling of euphoria, especially during longer fasts. Some, for the first time, will experience emotional stability. The reasons for this are multifold - the elimination of the emotional dependence on food, exclusion of stimulating foods like caffeine, processed sugars, recreational drugs, tobacco and trans-fatty acids, all of which can have a devastating effect on delicate emotions. Dr. Ehret stated an amazing fact at the turn of the 20th century. He said that, for a water fast to awaken the higher mind functions, it had to be longer than 21 days. Fasting has a history of awakening intuitive senses, creativity, and deeper spiritual questions in those with enough determination to get past the 21 day mark. Healing  During a fast, a metamorphosis occurs. The body undergoes a tearing down and rebuilding of damaged materials. For this reason, fasting is famous for its ability to rejuvenate and give the body a more youthful tone. Why does fasting have such a powerful effect in healing the body? Fasting dissolves diseased cells in a systematic manner, leaving healthy tissue. The result is a thorough cleansing of the tube, membrane and cellular structures. There is a remarkable redistribution of nutrients in the fasting body. It hangs on to precious minerals and vitamins while catabolizing on old tissue, toxins and inferior materials. Each cell of your body is a complete living entity with its own metabolism. It needs a constant supply of oxygen and sufficient nourishment. When due to nutritional deficiencies, sluggish metabolism, sedentary life, overeating and consequent poor digestion and assimilation of food, lack of fresh air and sufficient exercise and rest, our cells are deprived... they start to degenerate... the normal process of cell replacement and rebuilding slows down and your body starts to grow old, its resistance to disease will diminish and you become ‘sick’.  Animals will naturally fast when they are sick or injured, and when we are ill, our hunger diminishes. If we get out of the way and allow nature to take its course, we will find that we can heal from any problem. Since the dawn of recorded time, in fact since before the word "doctor" came into existence, priests provided sanctuaries where people could go to fast. Whereas modern medical practitioners admit that they have no cures, only drugs that mask the symptoms while causing yet other symptoms to appear. “I had a medical practice for 20 years in NYC, supervised hundreds of long fasts, and I found that the physical healing or weight loss was but a pleasant side effect. What really happened is that the person got in touch with their higher self, their true self, and came to the experience that healing can take place at every level, simply by letting go and allowing Mother Nature to do her work.” – Dr. Rai Casey Fasting has been beneficial for these conditions: Although fasting is not recommended in every situation, (cancer of the liver is one instance where fasting is contraindicated), in many situations fasting is the only known solution. Fasting has been beneficial for arthritis, asthma, high blood pressure, lupus, chronic fatigue, colitis, Crohn's disease, diverticulitis, spastic colon, irritable bowel, cases of paralysis, neuritis, neuralgia, neuroses, and mental illness as well as many others. Fasting will also break down tumors and for this reason, many have overcome cancer with fasting.  Fasting decreases dependency on authorities How many of us believe that when we get sick, that a doctor is going to save us from pain and death? We just assume that the technology is going to be able to repair us when we break down, by giving us a pill, a treatment or a surgery. We are so alienated from our bodies that we think that a doctor knows more about us than we do. The reality is that doctor’s don’t have the cures that we need, what is offered by the traditional system of healers is only the possibility to treat our symptoms never being able to cure us or root out the cause. When we take these kinds of treatments to suppress our symptoms then that cause, which is the underlying reason we are sick, goes unattended, then in fact our illness continues to grow. We will never be healthy until we take responsibility for our own health . We need to stop blaming the outside for making us sick, whether it is corporations, a person, our immediate environment or a government, and to recognize instead that our sickness is a symptom telling us something is inside needs to be addressed. For sure there are outside influences that we can’t control, but there is much that we can control by taking responsibility for ourselves and working to change our habits. Benefits of Fasting  Mental clarity is improved and brain fog is lifted.  Rapid, safe weight loss is achieved without flabbiness  The nervous system is balanced  Energy level and sensory perception is increased. The longer the fast, the bigger increase in energy and vitality. You normally need less sleep. Organs are revitalized  Cellular biochemistry is harmonized The skin becomes silky, soft, and sensitive There is greater ease of movement Breathing becomes fuller, freer and deeper The digestive system is rejuvenated and becomes more effective; the peristaltic action of the intestines (the cause of a natural bowel movement) is stronger after fasting. Fasting retrains your tasting sense back to more healthy food as acute sensitivity is restored.  Fasting can increase confidence in our ability to have control over our lives and our appetite, and that our body is self-regulating and a self-healing organism capable or establishing balance when given the possibility to do so. Normal metabolic and cell oxygenation are restored. Detoxification - as soon as the body realizes that it's fasting it will begin to eliminate those things that cause disease, such as fat cells, arterial cholesterol plaques, mucus, tumors, stored up worries and emotions. One Day Fast  One way to start is to fast one day, working towards fasting regularly, one day per week or for longer periods of time. You can fast from all food, or only from solid food. You can choose a one day fast with only: water fresh fruit juice  fresh vegetable juice  raw fruit  raw vegetables      Avoiding during the fast: cooked vegetables, cooked whole grains, whole grain flour products, bread, pasta, etc. vegetable protein, soy products, etc.  dairy: milk, cheese, yogurt, ice cream, butter, eggs, meats, fast food, junk food, prepared foods, etc., chemicals: sugar, caffeine, artificial flavoring, sweeteners, etc.  Not to consume any drugs, nicotine and alcohol during fast should be clear. Water Fast  You can fast from 1 to 40 days. Try to drink 2 liters of water or more per day.  The ten day water fast has become a recommended number of days. Ten days on water will cause the same weight loss as 30 days on juice. But water fasting is far more difficult, especially if you have a fast metabolism. Water fasting cleanses the body aggressively removing toxins rapidly. Water fasting can be more beneficial than juice fasting in combating more persistent forms of cancer, cleansing the tissues more aggressively. Water fasting demands mental preparation, the less pressure and responsibility you have during a water fast the better. Think of it a holiday away form the normal patterns of living. Some recommend that the week before your fast, you drink fresh juices and eat mostly raw fruits and vegetables to cleanse the body so that the detoxification during water fasting will be less aggressive. Water fasting should always include two of three days of juice fasting before and after the water fast. This alternating between juice and water fasting is the most effective method of achieving a full cleansing through fasting. Water Fasting Tips Avoid water straight from the faucet. Distilled water is the best for cleansing because of its inherent, magnetic properties and ability to absorb and suspend large quantities of toxins, flushing them from the body. The perceived value of mineral water is misleading because the inorganic minerals are like huge boulders to the cellular membranes, making them impossible to assimilate. Plants are able to break down the minerals from the soils, allowing them to be completely absorbable to the cells of the body. The best water is distilled, secondly, spring or filtered. There are no calories or nutritional value in water. On a water fast you have given your body no options but to turn to itself for fuel. This can create a problem when you have spent years depositing counterfeit fuel. Living exclusively on dirty fuel during a fast takes tremendous courage & strength. To ease into water fasting some recommend juice fasting with periods of water fasting. For example 3 days on juice, 2 days on water, 5 days on juice, then 3 days on water. You can juice when you have to work and water fast on the weekend when you can rest.  Water Fasting Concerns It is not advisable to water fast under the conditions of hyperglycemia, hypoglycemia, schizophrenia or a chronic heart condition. If you have existing conditions it is best if you consult with a fasting expert and/or be monitored throughout your fast. Be careful of dizziness and black outs. The heart is resting as much as it can during water fasting. Before you stand up, take one or two deep breaths to get the heart pumping. If you start to black out, sit down or crouch down on one knee. This will immediately stop the dizziness. Master Cleanse Fast  The Master Cleanse or Lemon Cleanse is between a water fast and a juice fast. Basically it consists of drinking a mixture of freshly squeezed lemons, water and maple syrup for a period of 8 to 40 days. It is easier to do than a water fast because you are still getting nutrients and energy from the lemons and the maple syrup. This fast can be done while still maintaining your normal work, yet is less calories than what you would get from a juice fast. It is normal to lose weight on this fast and it is excellent for cleansing the colon. For full details on how to do this fast see the following link: Stanley Boroughs Master Cleanse  Juice Fast Juice fasting is safe and can allow the body to clean itself of toxins while greatly improving conditions for health. A benefit is that your energy level is high because you are receiving sufficient nutrients from the juices, so you can carry out normal activities. A juice fast takes some burden off the digestive system and frees up some energy for accelerated healing though a water fast does much better in that regard. Also, juices can make available extra quantities of nutrients that a person might lack. Juices are easy to assimilate and take hardly any digestive energy from the body, allowing the body to put more energy into healing and rejuvenation. Packed with vitamins, minerals, living enzymes, antioxidants, phytochemicals, yet low enough in calories to force the body to cannibalize on its filthy waste, propelling you to vigorous physical health and clarity of mind. For your first fast and for the purpose of healing disease most experts recommend a juice fast over a water fast. Fasting on water has become a near impossible exercise for a body that has been nurtured on poisons. The juice of fruits and vegetables are filled with healing and cleansing properties that allow the body to gently and safely detoxify. Juice fasting has become an effective stepping-stone to water fasting. Through juice fasting, thousands of individuals have been freed from serious diseases such as cancer, leukemia, arthritis, high blood pressure, kidney disorders, skin infections, liver disorders, alcoholism and smoking. The thirty-day juice fast is a standard. This length of fast feels about right because after 30 days it seems like you have been fasting forever. Less then 30 days and you can miss the best experiences of the fast. If you are juice fasting, a few days on water occasionally will intensify the fast and assist with weight-loss if you have a slow metabolism. Most people can juice fast safely for up to 30 days. The exceptions are those with hypoglycemia, diabetes, hypo thyroid, and Wilson's Syndrome. For these conditions, eat slices of avocado and banana every few hours, add high quality vegetable source protein powder to your juices, and add psyllium or another good bulking agent to your juices twice a day to regulate blood sugar levels. Do not juice fast if you have impaired kidney function. The amount of juice you drink will determine the intensity of cleansing. Drinking small amounts of juice supplies fewer calories, thereby increasing detoxification. The more intense the cleansing, the greater the discomfort. Juice fasting allows you to have control over the process of elimination. However, when the body enters a cleansing crisis due to toxins in the blood, no amount of juice will eliminate the discomfort. You must wait it out. Drink all-vegetable or all-fruit juices, never combine fruits & vegetables to create juice. Make your juice from fresh vegetables or fruits. You can also include herbal teas with honey, vegetable broth, Barley Green, wheat grass juice and supplements helpful for your specific condition. Drink juice whenever hunger develops until pleasantly full as opposed to stuffed full. It is best if you filter or strain the juices, removing any excess fiber or pulp so that you continue to give the digestive system a rest. Also if it looks like you are not losing weight on your fast, you can dilute the juices with water. You may consider modifying the fast by including quarter slices of avocado or banana to slow the cleansing process. Modified juice fasting is good for those with health restrictions such as diabetes or hypoglycemia. Bananas and avocados are slow to digest and maintain a stable blood sugar level. Their high calorie content slows the intensity of the fast and, because they are easy to digest, the body still devotes energy to cleansing. Preparation for Your Fast Inform yourself about fasting: by doing your own investigation, reading all you can about the fasting process, the various kinds of fasts and what you can expect as side affects. If you have a pre-existing health condition then you should find out if there are contrary indications with fasting and your condition. Determine your cleanse duration and time period:  Try to arrange that your fast is in a time period where you have low activity or lobsters. Avoid heavy kinds of work if at all possible. When it comes to long fasts and inability of somebody to handle a long fast, you just do the best you can. When detoxification increases as it does during fasting, the liver, kidneys, lungs and immune system work extra hard to handle the load. If these systems were already compromised before the fast, one must proceed carefully. You go as long as you can tolerate it, whether physiologically or emotionally, and then come back to eating again. Once you have some energy and are a few steps further toward health, you can consider doing another fast. Several short fasts can definitely do wonders if one long fast cannot be undertaken. Long fasts are preferable to short ones because once the body is in the fasting state it cleanses systematically into the harder to get at body tissues. For this reason, most of the recoveries from illness have taken place in the latter parts of long juice or water fasts. Long fasts give the body the uninterrupted time to do the work of healing. The first few days of fasting gets rid of the gross waste products of digestion, but only after this can the body pull out its tools to get to work on healing. Frequency of Fasting Of course, the best is that people stay on a good daily health regime and then when the need comes to fast to go ahead and do it for a week to 10 days or longer if indicated. At least long enough to move completely into the fasting physiology and accelerated detoxification.  Ideally people should fast once or twice a year just as a tune-up to deal with the environmental toxins and junk in our foods as well as the emotional build up. Traditionally people have fasted in the spring and fall, when the weather is mild.  Activity Level It is good to at least have mild exercise and movements with short walks to keep the lymphatic fluid moving and to the keep the vascular system working.  The amount of exercise you can do is very much dependent on your existing condition and how you are feeling that day and what kind of fast you are doing. Basically one needs to be alert and listen to one’s body and not to overdo. Fasting is resting, not a marathon! You may feel weak during a water fast and may need to rest more often. While juice fasting, you may experience an abundance of energy that makes exercise easy. If you experience energy loss, limit yourself to stretching exercises, light walking or deep breathing. Proteins & Fasting It was theorized that protein loss during fasting was harmful and that a fast should be supplemented with protein. Fasting with protein became known as the Opti-fast. Fasters took nothing but water and a protein drink. Sadly, several people died. Protein digestion during the fasting state created an overload of urea and the blood become acidic. In this condition, the organs become more damaged instead of healing. To the body, fasting is a natural process. During water or juice fasting, the protein levels of the blood remain constant. Although protein is being utilized, a person fasting 40 days on water will not suffer a deficiency of either protein, vitamins, minerals or fatty acids. In the breakdown of dying and diseased cells, all essential substances are available while fasting for reuse within the body. These dead cells are utilized in a systematic manner. Protein deficiency is non existent in North America. You never hear of anyone being diagnosed with protein deficiency. Fruit and vegetable juices have water-soluble highly absorbable proteins. The body has a store of protein, and it uses it selectively. Dying cells are the first to be used and healthy and vital tissues are the very last and will only be used as a last resort. Only during starvation is protein being stripped from healthy tissue to be used to survive. This may take 30 to 80 days of fasting on water to reach this point. The systematic searching of cells to be metabolized is crucial in the healing of cancer. A cancer cell represents protein and calories. Some cancers are so persistent that you have to force the body to choose between healthy cells and cancer cells. This requires a long fast on small portions of juice combined with days of water fasting. Aiding Elimination of Toxins Enemas: If you are not having natural bowel movements then an enema is advised to move out the toxic material that is being scoured by your body. You will feel much better after taking an enema. An enema can be taken daily in the beginning days of a fast, then bi-daily for the remainder using just plain water. Mucus: . It is common, during fasting, for the nose and throat to pass sticky mucus, clogging the sinuses. White strands of mucus may be found in the stool. You may find that you are more comfortable if you use a Neti Pot to clear the sinus cavities, to prevent getting a cold with the clogged sinuses. You can also drink lemon juice with water to help clear the mucus.  Showers/Bathing:  Plan to shower or bath daily to aid in cleaning the pores and assist the removal of toxins. The skin is a large organ and many toxins are removed through the pores causing a gummy deposit on the surface of the skin. It may help to brush the skin removing the sludge that is deposited there.  Reactions from Fasting The 'healing' reactions you get from fasting are dependent on your existing health and the toxic load present in your body when you start. The first three days can be the most difficult until one's appetite for food goes away, which it normally does after the third day. Many people experience headaches, joint pain and other discomforts in the first few days. Your tongue will become coated and your breath foul, and you may notice increased body odor. These are all normal detox reactions as the toxins move out of your body. With extended fasting you will notice some days are symptom free, then as you move into deeper layers of detoxification you will experience episodes of symptoms as your body cleanses these other systems. In the later stages you remove the mucous from your system and this can increase your likelihood to catch a flu or a cold. At times you may feel weak or tired, so you should listen to your body and rest. Periods of high-energy and mental clarity will be experienced and can be variable, alternating between periods of healing reactions and symptom free days. With extended fasts it is normal to also have strong emotional reactions that have been suppressed, as the body brings these to the surface also for healing... This can be a difficult period, but can be dealt with more easily with meditation or Emotional Freedom Technique (EFT). The cleansing response that happens is dependent on experience with fasting, current health and level of toxins and sickness in your body.  If you have an existing health condition, it is possible that you get a strong healing reaction or healing crisis. A link to a page describing this reaction in detail is given below.  If cleansing responses arise (headache, stomach upset, mental fog, lethargy,.etc) exercise great patience and take rest until symptoms pass. It's all part of the process. Always go to your capacity but never over-do. If unreasonably strong physical or emotional symptoms occur, it may be wise to discontinue. The following are common reactions and what can be done to ease the symptom while you are fasting.  Spiritual As the system detoxifies, many of these spiritual aspects of ourselves that have been waiting to come through for a long time are finally able to, and that person, hopefully fasting in an environment that is calm and serene and peaceful and loving, will be able to express and deal with these spiritual phenomena such that it can have a very beneficial and positive effect. Meditation, EFT and other tools can be used to help relate to spiritual and emotional phenomena. Weight Loss Weight loss can initially be as high as three to four pounds per day, but as the fast continues, the average loss will be one pound per day. If you are juice fasting and not losing weight, the juice is supplying all the calories you need. You may have to cut down on the juices or alternate between water fasting and juice fasting if losing weight is part of your goal. The slower your metabolism the slower the weight loss. If you are thin or average weight and you fast for 30 days on juice or 10 days on water, you will become thin. Ribs will show, the face will become gaunt, and friends and family will display concern. But the body will quickly normalize its weight in 5 to 10 days after the fast. If you are thin to start with, fasting may allow you to gain additional weight after the fast. Metabolism is normalized due to the cleansing process. It is very important not to try to gain weight too quickly. The body can rebuild only at a set rate. Overeating will burden the body and undermine the rebuilding process. Dizziness You may experience dizziness, if you do get down on one knee and the dizziness will stop immediately. Backache Back pain may increase due to toxins in the lower intestine. The blood vessels that draw nutrients from the colon are very close to the nerves of the spine. Back pain often decreases after elimination of the toxins. Back exercises also can relieve some pain. A cold pack also will help. An enema may be in order...  Bad Breath Waste passes through the lungs which are an eliminative organ. Brushing the tongue with a tooth brush, using dental floss and rinsing with mouthwash will reduce bad breath. Canker Sores These may develop from a toxic buildup in the mouth. Unhealthy bacteria increases between the teeth. The tongue becomes coated with waste. To stop cankers, gargle with sea salt mixed with water several times daily. Dabbing the sore with tea tree oil or vitamin E quickens the healing process. Cold Virus Mucoid is the perfect food for viruses. Toxins weaken the immune system. When large quantities of toxins and mucus are in the blood due to a fast, they can cause a susceptibility to colds. To fight a cold, continue fasting to eliminate the mucus. Reduce the liquid intake and drink lemon juice. Blackouts During fasting the body conserves energy. The heart pumps slower and blood pressure lowers. Standing or moving quickly from a resting position will cause the blood to flow to the legs. For a few seconds, the brain may not get enough oxygen, causing blackouts and dizziness. To stop a blackout get down on one knee or sit. Lowering your center of gravity will instantly stop a blackout. Blackouts are more frequent during water fasting. Diarrhea Fruit juices have a laxative effect that is more pronounced after water fasting. It can be stopped by using the enema. Using psyllium husk during diarrhea will help regulate the system. Strong Emotions  Try to journal, EFT, meditate, talk a walk, or rest. Headaches Toxins can cause muscle tightness in the neck and shoulders. This can result in tension headaches. Massaging the neck and shoulders will help relieve the tension. The herb Fever Few, which is available in health food stores, is well worth trying. Mucus  Drink lemon juice with water, combine with Neti Pot.  Muscle Tightness The muscles may become tight and sore due to toxin irritation. The legs can be the worst affected as toxins accumulate in the legs. A self massage, hot baths, stretching and exercising will help to release the toxins. Nausea When waste is released too quickly by the lymph glands, some of the toxic overload is taken by the liver and secreted with bile into the stomach. This causes nausea. Drinking water or carrot juice will dilute the bile and toxin mixture helping to flush it from the system. Nervousness The elimination of toxins can irritate damaged nerves. Exercise will relieve tension. Use quarter slices of avocado to slow the fast or drink fruit juice if on a water fast. However, you should note that any food intake may cause one's hunger to return and make it more difficult to stay on the fast, just do the best that you can. Skin disturbances The skin may become oily as rancid oils are purged from the body. People with problem free skin may have a few days of pimples or boils. A pallid complexion is also a sign of waste in the blood. When cleansed of mucus and toxins, the skin will be healthy, soft and unblemished. Tiredness Tiredness is normal during water or restricted juice fasting. If the tiredness is too much, increase the quantity of sweet juices like melon and carrot juice. Pre-existing Conditions Heart Disease Include bananas and avocados when juice fasting to balance the blood sugar level. Toxins in the blood and reduced blood sugar levels may cause a weak heart to labor. Like any other organ, the heart needs nutrients, a toxin free environment, and time to heal. Also if one has the disorder of POTS it is advisable to take salt so that the blood pressure does not get too low.  Hypoglycemia Do not juice fast unless you use bananas and avocados to balance the blood sugar level. Kidney problems Fasting can irritate damaged kidneys due to the amount of toxins they filter. Try short juice fasts of 3 to 5 days before progressing to longer fasts. Liver Disease The liver can become toxic due to abuse. If the liver is badly degenerated, cleansing must be done in stages. Start with short juice fasts and lead to fasts over five days. Avoid heavy proteins, refined flours and fatty foods. Eat meals of fruits or vegetables between the fasts. Age Nobody is too old to fast - it is exactly what the body needs to feel young again. Shorter fasts are recommended to start. Assess your physical state as you proceed. If juice fasting becomes too intense, bananas and avocados will lessen the intensity by slowing the cleansing. Ulcers Fasting will help significantly. Choose the juices that do not irritate the condition. Healing Crisis  (The cleansing reaction, the detox reaction, or the Herxheimer reaction.) During your fast you may enter into a healing crisis, which indicates that a deeply seated sickness is being healed, but also this means that you are going in reverse through the reactions that you went through as your sickness progressed. This is normally a good thing, because it shows that there is a major healing happening, but the downside is that it is not easy to go through because of the uncomfortable reactions that cause pain, etc. If you are feeling quite ill then you should read through the healing reaction article to try to determine if this is what is going on with you or not. It may be advisable to check with your medical professional at this point, to try to determine if you want to continue the fast or not. For more information read the following article: Healing Reaction Going Off Your Fast "It’s a fact that eating causes a cycle of hunger. It’s only when we stop eating that we lose hunger!  Think about it. All fasting experts agree that hunger sensations are usually lost on or shortly after the third day of fasting, and sometimes don’t return for weeks, but when they do return, usually very strongly, it’s the time to break the fast." But all fasting experts point out that it is important to resume eating very lightly, and very gradually, in exact relationship to the duration of the fast. Therefore, if breaking a 40-day fast, you may want to start with only small quantities of fruit juice for several days up to a week, before actually resuming with solid food like regular fruit. Important: Keep the first solid meal light and simple even though the mental temptation to dive into heavier favorites will probably be high. Be gentle with your digestive system and your digestive system will not only thank you but the overall benefits of the cleanse will last much longer. If you were on a water fast, then your first day can be juices, if your were on a juice fast, then your first day should be raw vegetables or fruits. The next meal may include heavier items such as potato, avocado or corn, but in any case you will notice that your body is very sensitive to what you eat and you should use this period of transition to learn more about what your body likes and doesn't like you to put into it. When waking up a slumbering digestive system, the desire to eat will be intense. The flavors and textures of food will be enhanced by super clean nasal passages. Eating will be a brand new experience. This is the time to flex your new-found muscles of discipline and self-control. As the body screams, I want more, wisdom whispers, you have had enough.  Eating small amounts of raw fruits and vegetables for the first five or six days will allow the body to gently wake up the digestive system. The body will continue to detoxify and cleanse during this period. Any toxins that have accumulated will begin to move due to the sweeping action of the soft fibers of fruits and vegetables. For six days gradually increase the amount of raw fruits and vegetables in your diet. To break a fast and gorge on meat, bread or junk food will be disaster. Jarring the system this intensely when the digestive system is in a sensitive state can cause stomach cramps, nausea and weakness, negating much of the benefits of the fast. Eat slowly and chew your food well. Saliva has enzymes that assist in digestion. Up to 80 percent of the starch, 30 percent of the protein and 10 percent of the fat can be digested by the enzymes in saliva. Do not overeat! Discover the amount of food that your body needs to live a vibrant, healthy life. Discern the difference between cravings and hunger. Never feed your emotions. When breaking a fast over ten days, the break-in period should be extended one day for every 4 days of fasting. Greater Sensitivity - Restored Senses An interesting phenomenon occurs after a fast. The years of conditioning your body to tolerate unhealthy foods is reversed. The body is as clean as a newborn baby. Try feeding a newborn baby Grandma's apple pie. When the body is full of toxins, its defense systems are not able to operate effectively. After a fast the natural defenses are restored and sensitivity to unhealthy food is increased. You will feel satisfied with smaller amounts of food and sluggish and tired when overeating. Rich foods, full of fat, salt, and processed sugars will cause nausea, headaches and weakness. A handful of fruit will be thoroughly satisfying. Because the digestive system has to work less, there will be boundless energy to spare. Why? After a fast your body is clean, and has far less tolerance to the poisonous foods that you were used to eating previous to the fast. Understand, feeling sick when eating poison is a sign that your body is functioning normally. Fasting restores the body's ability to violently react to harmful, health damaging, food. If you really desire, you can desensitize your body by slowly introducing harmful foods back into your diet, but why you should? You better select your food carefully, even though it is not possible to avoid toxins as these are every where. So fasting as a regular cleaning is important and will keep you healthy.  References/Links Healing Through Fasting - Excerpt from Fasting to Freedom Interview Part IV - Juice Fasting - Strategies for True Health by Natural Hygienist Dr. Sniadach HUNGERSTRIKE! - By Dr. Ria Casey The Essene Gospel of Peace, Book 1 Sun Meditation by BeiYin Additional Reading:  Herbert Shelton, founder of the Natural Hygiene Society, supervised more cases of fasting (at his sanitarium in Texas) than almost any other fasting doctor, and has written extensively on this subject with many case studies of people who healed near-incurable diseases with fasts ranging from a couple of weeks up to 90 days.     Shelton authored the following books, and more: Fasting Can Save Your Life; Fasting For Renewal of Life;  Food Combining Made Easy;  Getting Well;  Superior Nutrition; Facts About Fasting;  Health For All;  Health For the Millions;  Living Life to Live it Longer;  Rubies in the Sand; Natural Hygiene: The Pristine Way of Life;  The Science and Fine Art of Fasting; The Science and Fine Art of Natural Hygiene;   Human Life:  Its Philosophy and Laws;  and also:  Human Beauty: Its Culture and Hygiene.

FalconBlanco home  | Health index page  |  For comments send email Note: You can investigate about everything yourself, but before you start with a treatment, a cleansing, fasting or whatever, you should consult a health professional - We can't give any advice. Read the "Medical Disclaimer"

http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/

Hypoglycemia

On this page:

• What is hypoglycemia?
• What are the symptoms of hypoglycemia?
• What causes hypoglycemia in people with diabetes?
• How can hypoglycemia be prevented?
• How is hypoglycemia treated?
• Hypoglycemia in People Who Do Not Have Diabetes
• Points to Remember
• Hope through Research
• For More Information

What is hypoglycemia?

Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels. Glucose, an important source of energy for the body, comes from food. Carbohydrates are the main dietary source of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.

After a meal, glucose is absorbed into the bloodstream and carried to the body’s cells. Insulin, a hormone made by the pancreas, helps the cells use glucose for energy. If a person takes in more glucose than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. The body can use glycogen for energy between meals. Extra glucose can also be changed to fat and stored in fat cells. Fat can also be used for energy.

When blood glucose begins to fall, glucagon—another hormone made by the pancreas—signals the liver to break down glycogen and release glucose into the bloodstream. Blood glucose will then rise toward a normal level. In some people with diabetes, this glucagon response to hypoglycemia is impaired and other hormones such as epinephrine, also called adrenaline, may raise the blood glucose level. But with diabetes treated with insulin or pills that increase insulin production, glucose levels can’t easily return to the normal range.

Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. If left untreated, hypoglycemia can get worse and cause confusion, clumsiness, or fainting. Severe hypoglycemia can lead to seizures, coma, and even death.

In adults and children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment. Hypoglycemia can also result, however, from other medications or diseases, hormone or enzyme deficiencies, or tumors.

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What are the symptoms of hypoglycemia?

Hypoglycemia causes symptoms such as

• hunger
• shakiness
• nervousness
• sweating
• dizziness or light-headedness
• sleepiness
• confusion
• difficulty speaking
• anxiety
• weakness

Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include

• crying out or having nightmares
• finding pajamas or sheets damp from perspiration
• feeling tired, irritable, or confused after waking up

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What causes hypoglycemia in people with diabetes?

Diabetes Medications

Hypoglycemia can occur as a side effect of some diabetes medications, including insulin and oral diabetes medications—pills—that increase insulin production, such as

• chlorpropamide (Diabinese)
• glimepiride (Amaryl)
• glipizide (Glucotrol, Glucotrol XL)
• glyburide (DiaBeta, Glynase, Micronase)
• nateglinide (Starlix)
• repaglinide (Prandin)
• sitagliptin (Januvia)
• tolazamide
• tolbutamide

Certain combination pills can also cause hypoglycemia, including

• glipizide + metformin (Metaglip)
• glyburide + metformin (Glucovance)
• pioglitazone + glimepiride (Duetact)
• rosiglitazone + glimepiride (Avandaryl)
• sitagliptin + metformin (Janumet)

Other types of diabetes pills, when taken alone, do not cause hypoglycemia. Examples of these medications are

• acarbose (Precose)
• metformin (Glucophage)
• miglitol (Glyset)
• pioglitazone (Actos)
• rosiglitazone (Avandia)

However, taking these pills along with other diabetes medications—insulin, pills that increase insulin production, or both—increases the risk of hypoglycemia.

In addition, use of the following injectable medications can cause hypoglycemia:

• Pramlintide (Symlin), which is used along with insulin
• Exenatide (Byetta), which can cause hypoglycemia when used in combination with chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, and tolbutamide

For more information about diabetes medications, see the National Diabetes Information Clearinghouse’s booklet What I need to know about Diabetes Medicines, available at www.diabetes.niddk.nih.gov/dm/pubs/medicines_ez or by calling .1–800–860–8747

Other Causes of Hypoglycemia

In people on insulin or pills that increase insulin production, low blood glucose can be due to

• meals or snacks that are too small, delayed, or skipped
• increased physical activity
• alcoholic beverages

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How can hypoglycemia be prevented?

Diabetes treatment plans are designed to match the dose and timing of medication to a person’s usual schedule of meals and activities. Mismatches could result in hypoglycemia. For example, taking a dose of insulin—or other medication that increases insulin levels—but then skipping a meal could result in hypoglycemia.

To help prevent hypoglycemia, people with diabetes should always consider the following:

• Their diabetes medications. A health care provider can explain which diabetes medications can cause hypoglycemia and explain how and when to take medications. For good diabetes management, people with diabetes should take diabetes medications in the recommended doses at the recommended times. In some cases, health care providers may suggest that patients learn how to adjust medications to match changes in their schedule or routine.
• Their meal plan. A registered dietitian can help design a meal plan that fits one’s personal preferences and lifestyle. Following one’s meal plan is important for managing diabetes. People with diabetes should eat regular meals, have enough food at each meal, and try not to skip meals or snacks. Snacks are particularly important for some people before going to sleep or exercising. Some snacks may be more effective than others in preventing hypoglycemia overnight. The dietitian can make recommendations for snacks.
• Their daily activity. To help prevent hypoglycemia caused by physical activity, health care providers may advise
  
  • checking blood glucose before sports, exercise, or other physical activity and having a snack if the level is below 100 milligrams per deciliter (mg/dL)
  • adjusting medication before physical activity
  • checking blood glucose at regular intervals during extended periods of physical activity and having snacks as needed
  • checking blood glucose periodically after physical activity
  
  
• Their use of alcoholic beverages. Drinking alcoholic beverages, especially on an empty stomach, can cause hypoglycemia, even a day or two later. Heavy drinking can be particularly dangerous for people taking insulin or medications that increase insulin production. Alcoholic beverages should always be consumed with a snack or meal at the same time. A health care provider can suggest how to safely include alcohol in a meal plan.
• Their diabetes management plan. Intensive diabetes management—keeping blood glucose as close to the normal range as possible to prevent long-term complications—can increase the risk of hypoglycemia. Those whose goal is tight control should talk with a health care provider about ways to prevent hypoglycemia and how best to treat it if it occurs.

What to Ask the Doctor about Diabetes Medications

People who take diabetes medications should ask their doctor or health care provider

• whether their diabetes medications could cause hypoglycemia
• when they should take their diabetes medications
• how much medication they should take
• whether they should keep taking their diabetes medications when they are sick
• whether they should adjust their medications before physical activity
• whether they should adjust their medications if they skip a meal

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How is hypoglycemia treated?

Signs and symptoms of hypoglycemia vary from person to person. People with diabetes should get to know their signs and symptoms and describe them to their friends and family so they can help if needed. School staff should be told how to recognize a child’s signs and symptoms of hypoglycemia and how to treat it.

People who experience hypoglycemia several times in a week should call their health care provider. They may need a change in their treatment plan: less medication or a different medication, a new schedule for insulin or medication, a different meal plan, or a new physical activity plan.

Prompt Treatment for Hypoglycemia

When people think their blood glucose is too low, they should check the blood glucose level of a blood sample using a meter. If the level is below 70 mg/dL, one of these quick-fix foods should be consumed right away to raise blood glucose:

• 3 or 4 glucose tablets
• 1 serving of glucose gel—the amount equal to 15 grams of carbohydrate
• 1/2 cup, or 4 ounces, of any fruit juice
• 1/2 cup, or 4 ounces, of a regular—not diet—soft drink
• 1 cup, or 8 ounces, of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey

Recommended amounts may be less for small children. The child’s doctor can advise about the right amount to give a child.

The next step is to recheck blood glucose in 15 minutes to make sure it is 70 mg/dL or above. If it’s still too low, another serving of a quick-fix food should be eaten. These steps should be repeated until the blood glucose level is 70 mg/dL or above. If the next meal is an hour or more away, a snack should be eaten once the quick-fix foods have raised the blood glucose level to 70 mg/dL or above.

For People Who Take Acarbose (Precose) or Miglitol (Glyset)

People who take either of these diabetes medications should know that only pure glucose, also called dextrose—available in tablet or gel form—will raise their blood glucose level during a low blood glucose episode. Other quick-fix foods and drinks won’t raise the level quickly enough because acarbose and miglitol slow the digestion of other forms of carbohydrate

Help from Others for Severe Hypoglycemia

Severe hypoglycemia—very low blood glucose—can cause a person to pass out and can even be life threatening. Severe hypoglycemia is more likely to occur in people with type 1 diabetes. People should ask a health care provider what to do about severe hypoglycemia. Another person can help someone who has passed out by giving an injection of glucagon. Glucagon will rapidly bring the blood glucose level back to normal and help the person regain consciousness. A health care provider can prescribe a glucagon emergency kit. Family, friends, or coworkers—the people who will be around the person at risk of hypoglycemia—can learn how to give a glucagon injection and when to call 911 or get medical help.

Physical Activity and Blood Glucose Levels

Physical activity has many benefits for people with diabetes, including lowering blood glucose levels. However, physical activity can make levels too low and can cause hypoglycemia up to 24 hours afterward. A health care provider can advise about checking the blood glucose level before exercise. For those who take insulin or one of the oral medications that increase insulin production, the health care provider may suggest having a snack if the glucose level is below 100 mg/dL or adjusting medication doses before physical activity to help avoid hypoglycemia. A snack can prevent hypoglycemia. The health care provider may suggest extra blood glucose checks, especially after strenuous exercise.

Hypoglycemia When Driving

Hypoglycemia is particularly dangerous if it happens to someone who is driving. People with hypoglycemia may have trouble concentrating or seeing clearly behind the wheel and may not be able to react quickly to road hazards or to the actions of other drivers. To prevent problems, people at risk for hypoglycemia should check their blood glucose level before driving. During longer trips, they should check their blood glucose level frequently and eat snacks as needed to keep the level at 70 mg/dL or above. If necessary, they should stop for treatment and then make sure their blood glucose level is 70 mg/dL or above before starting to drive again.

Hypoglycemia Unawareness

Some people with diabetes do not have early warning signs of low blood glucose, a condition called hypoglycemia unawareness. This condition occurs most often in people with type 1 diabetes, but it can also occur in people with type 2 diabetes. People with hypoglycemia unawareness may need to check their blood glucose level more often so they know when hypoglycemia is about to occur. They also may need a change in their medications, meal plan, or physical activity routine.

Hypoglycemia unawareness develops when frequent episodes of hypoglycemia lead to changes in how the body reacts to low blood glucose levels. The body stops releasing the hormone epinephrine and other stress hormones when blood glucose drops too low. The loss of the body’s ability to release stress hormones after repeated episodes of hypoglycemia is called hypoglycemia-associated autonomic failure, or HAAF.

Epinephrine causes early warning symptoms of hypoglycemia such as shakiness, sweating, anxiety, and hunger. Without the release of epinephrine and the symptoms it causes, a person may not realize that hypoglycemia is occurring and may not take action to treat it. A vicious cycle can occur in which frequent hypoglycemia leads to hypoglycemia unawareness and HAAF, which in turn leads to even more severe and dangerous hypoglycemia. Studies have shown that preventing hypoglycemia for a period as short as several weeks can sometimes break this cycle and restore awareness of symptoms. Health care providers may therefore advise people who have had severe hypoglycemia to aim for higher-than-usual blood glucose targets for short-term periods.

Being Prepared for Hypoglycemia

People who use insulin or take an oral diabetes medication that can cause low blood glucose should always be prepared to prevent and treat low blood glucose by

• learning what can trigger low blood glucose levels
• having their blood glucose meter available to test glucose levels; frequent testing may be critical for those with hypoglycemia unawareness, particularly before driving a car or engaging in any hazardous activity
• always having several servings of quick-fix foods or drinks handy
• wearing a medical identification bracelet or necklace
• planning what to do if they develop severe hypoglycemia
• telling their family, friends, and coworkers about the symptoms of hypoglycemia and how they can help if needed

Normal and Target Blood Glucose Ranges
Normal Blood Glucose Levels in People Who Do Not Have Diabetes
Upon waking—fasting	70 to 99 mg/dL
After meals	70 to 140 mg/dL
Target Blood Glucose Levels in People Who Have Diabetes
Before meals	70 to 130 mg/dL
1 to 2 hours after the start of a meal	below 180 mg/dL

Source: American Diabetes Association. Standards of Medical Care in Diabetes—2008. Diabetes Care. 2008;31:S12–S54.

For people with diabetes, a blood glucose level below 70 mg/dL is considered hypoglycemia.

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Hypoglycemia in People Who Do Not Have Diabetes

Two types of hypoglycemia can occur in people who do not have diabetes:

• Reactive hypoglycemia, also called postprandial hypoglycemia, occurs within 4 hours after meals.
• Fasting hypoglycemia, also called postabsorptive hypoglycemia, is often related to an underlying disease.

Symptoms of both reactive and fasting hypoglycemia are similar to diabetes-related hypoglycemia. Symptoms may include hunger, sweating, shakiness, dizziness, light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness.

To find the cause of a patient’s hypoglycemia, the doctor will use laboratory tests to measure blood glucose, insulin, and other chemicals that play a part in the body’s use of energy.

Reactive Hypoglycemia

Diagnosis
To diagnose reactive hypoglycemia, the doctor may

• ask about signs and symptoms
• test blood glucose while the patient is having symptoms by taking a blood sample from the arm and sending it to a laboratory for analysis^*
• check to see whether the symptoms ease after the patient’s blood glucose returns to 70 mg/dL or above after eating or drinking

A blood glucose level below 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis. The oral glucose tolerance test is no longer used to diagnose reactive hypoglycemia because experts now know the test can actually trigger hypoglycemic symptoms.

Causes and Treatment
The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body’s normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe deficiencies in glucagon secretion might lead to reactive hypoglycemia.

A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastric—or stomach—surgery can cause reactive hypoglycemia because of the rapid passage of food into the small intestine. Rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, also may cause reactive hypoglycemia.

To relieve reactive hypoglycemia, some health professionals recommend

• eating small meals and snacks about every 3 hours
• being physically active
• eating a variety of foods, including meat, poultry, fish, or nonmeat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products
• eating foods high in fiber
• avoiding or limiting foods high in sugar, especially on an empty stomach

The doctor can refer patients to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet to treat reactive hypoglycemia.

Fasting Hypoglycemia

Diagnosis
Fasting hypoglycemia is diagnosed from a blood sample that shows a blood glucose level below 50 mg/dL after an overnight fast, between meals, or after physical activity.

Causes and Treatment
Causes of fasting hypoglycemia include certain medications, alcoholic beverages, critical illnesses, hormonal deficiencies, some kinds of tumors, and certain conditions occurring in infancy and childhood.

Medications. Medications, including some used to treat diabetes, are the most common cause of hypoglycemia. Other medications that can cause hypoglycemia include

• salicylates, including aspirin, when taken in large doses
• sulfa medications, which are used to treat bacterial infections
• pentamidine, which treats a serious kind of pneumonia
• quinine, which is used to treat malaria

If using any of these medications causes a person’s blood glucose level to fall, the doctor may advise stopping the medication or changing the dose.

Alcoholic beverages. Drinking alcoholic beverages, especially binge drinking, can cause hypoglycemia. The body’s breakdown of alcohol interferes with the liver’s efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be serious and even fatal.

Critical illnesses. Some illnesses that affect the liver, heart, or kidneys can cause hypoglycemia. Sepsis, which is an overwhelming infection, and starvation are other causes of hypoglycemia. In these cases, treating the illness or other underlying cause will correct the hypoglycemia.

Hormonal deficiencies. Hormonal deficiencies may cause hypoglycemia in very young children, but rarely in adults. Shortages of cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. Laboratory tests for hormone levels will determine a diagnosis and treatment. Hormone replacement therapy may be advised.

Tumors. Insulinomas are insulin-producing tumors in the pancreas. Insulinomas can cause hypoglycemia by raising insulin levels too high in relation to the blood glucose level. These tumors are rare and do not normally spread to other parts of the body. Laboratory tests can pinpoint the exact cause. Treatment involves both short-term steps to correct the hypoglycemia and medical or surgical measures to remove the tumor.

Conditions occurring in infancy and childhood. Children rarely develop hypoglycemia. If they do, causes may include the following:

• Brief intolerance to fasting, often during an illness that disturbs regular eating patterns. Children usually outgrow this tendency by age 10.
• Hyperinsulinism, which is the overproduction of insulin. This condition can result in temporary hypoglycemia in newborns, which is common in infants of mothers with diabetes. Persistent hyperinsulinism in infants or children is a complex disorder that requires prompt evaluation and treatment by a specialist.
• Enzyme deficiencies that affect carbohydrate metabolism. These deficiencies can interfere with the body’s ability to process natural sugars, such as fructose and galactose, glycogen, or other metabolites.
• Hormonal deficiencies such as lack of pituitary or adrenal hormones.

*A personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia.

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Points to Remember

Diabetes-related Hypoglycemia

• When people with diabetes think their blood glucose level is low, they should check it and treat the problem right away.
• To treat hypoglycemia, people should have a serving of a quick-fix food, wait 15 minutes, and check their blood glucose again. They should repeat the treatment until their blood glucose is 70 mg/dL or above.
• People at risk for hypoglycemia should keep quick-fix foods in the car, at work—anywhere they spend time.
• People at risk for hypoglycemia should be careful when driving. They should check their blood glucose frequently and snack as needed to keep their level 70 mg/dL or above.

Hypoglycemia Unrelated to Diabetes

• In reactive hypoglycemia, symptoms occur within 4 hours of eating. People with reactive hypoglycemia are usually advised to follow a healthy eating plan recommended by a registered dietitian.
• Fasting hypoglycemia can be caused by certain medications, critical illnesses, hereditary enzyme or hormonal deficiencies, and some kinds of tumors. Treatment targets the underlying problem.

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Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) was established by Congress in 1950 as one of the National Institutes of Health of the U.S. Department of Health and Human Services. The NIDDK conducts and supports research in diabetes, glucose metabolism, and related conditions. Researchers supported by the NIDDK are investigating topics such as the causes of hypoglycemia and whether use of continuous glucose monitoring devices can help prevent hypoglycemia.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

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For More Information

National Diabetes Education Program
1 Diabetes Way
Bethesda, MD 20814–9692
(6337)
TTY:
Fax: 703–738–4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov1–888–693–NDEP1–866–569–1162

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
(342–2383)
Email: AskADA@diabetes.org
Internet: www.diabetes.org1–800–DIABETES

Juvenile Diabetes Research Foundation International
26 Broadway, 14th Floor
New York, NY 10004
(2873)
Fax: 212–785–9595
Email: info@jdrf.org
Internet: www.jdrf.org1–800–533–CURE

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-f () or visit www.fda.gov. Consult your doctor for more information.1–888–INFO–FDA1–888–463–6332

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National Diabetes Information Clearinghouse

1 Information Way
Bethesda, MD 20892–3560

TTY:
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov1–800–860–87471–866–569–1162

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by Vivian A. Fonseca, M.D., F.R.C.P., Tulane University Health Sciences Center, New Orleans, LA; Catherine L. Martin, M.S., A.P.R.N., B.C.-A.D.M., C.D.E., University of Michigan Health System, Ann Arbor, MI; and Neil H. White, M.D., C.D.E., Department of Pediatrics, Washington University School of Medicine and St. Louis Children’s Hospital, St. Louis, MO.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

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NIH Publication No. 09–3926
October 2008