Are sugar and concussion recovery related? The short answer is sometimes. The better question is; can your body’s sugar regulation make concussion worse? That one is a definite yes! The problem isn’t the sugar, it’s how it is delivered to the brain. Having a concussion can make you hypoglycemic or hyperglycemic but more likely, concussion will bring out a sugar regulation pattern you already had, but might not have noticed. In this article we’ll talk about how poor sugar regulation increases post-concussion syndrome symptoms and what you can do about it.
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Brain Fog and Sugar
Cognitive fatigue or brain fog after concussion is one of the most common and aggravating symptoms of mTBI. Basically, the brain cells get tired quickly. They cannot keep up with the energy requirements for both thinking and healing. This is because brain inflammation damages the mitochondria in nerve cells. Mitochondria are special parts of each cell that take either glucose, (sugar) or ketones, (made from fat in the liver) and converts it into ATP, fuel.
You would think that having more sugar would give you more fuel. It might for a little while, but it could also make you crash either right away or after a short sugar high. What those tiny mitochondria really need is a smooth steady supply of sugar. It’s the Goldilocks principle; not too much not too little.
Poorly regulated blood sugar increases brain inflammation and directly damages brain cells. This comes from the highs and lows in sugar levels as well as highs and lows of chemicals the body releases to try to maintain steady levels. These chemicals are insulin from the pancreas and cortisol, epinephrine (adrenaline), and norepinephrine from the adrenal glands. Any of these chemicals in too high or too low concentration in the blood can contribute to brain inflammation. So really when we think about sugar and concussion recovery, we are really looking at a bigger system. Maybe the better title would have been sugar regulation and brain inflammation and post-concussion syndrome, but that’s a bit long and complicated.
What is Sugar anyway?
Sugar is a carbohydrate. Surprise! Most people think of bread, pasta or potatoes when they think carbohydrate. These foods contain starch which is a complex carbohydrate. Sugar is the most basic carbohydrate. Glucose is the most basic sugar and the only kind of sugar the brain can use for energy. Glucose is sometimes referred to as refined sugar, the kind you would use in baking or put in coffee. Of course it’s found in everything from soda to crackers.
If you look at the nutritional information on any product it will have total carbohydrates then break out the dietary fiber, total sugar and how much of that total sugar was added. The total sugar may be a blend of fruit sugar, milk sugar and glucose. The added sugar is glucose. Fiber is also a carbohydrate, but they break it out of the total because you do not digest it or use it as sugar.
The body can make glucose from starch. It can even make glucose from protein. The body can also store glucose in the liver as glycogen and convert it back to glucose later when needed. All these processes that convert starch, protein and glycogen to sugar are a big part of the mechanism for keeping the glucose supply steady. Think of them as various types of wood on a bonfire slowly burning. Eating raw sugar is like throwing gasoline on the fire.
How do you know if you are hyperglycemic or hypoglycemic?
The most common symptom of blood sugar metabolism problems is a change in your energy level after eating – either an increase or a decrease. People who are hyperglycemic, otherwise known as insulin intolerant or pre-diabetic tend to become tired after a meal. People with reactive hypoglycemia tend to get a burst of energy when they eat. Another very common symptom for both groups is sleep issues.
Of course the best way is to have a health care professional read your blood tests. You should know that normal ranges on a blood test are different when testing for pathology or function. Pathology means disease, like Diabetes. Readings within the normal functional range means everything is operating well. Outside of the normal functional range means things could be working better. Way outside the function range would be pathology. Sometimes taking action in that space between functional normal and disease can make all the difference.
Insulin resistance and concussion
Insulin resistance, (hyperglycemia or pre-diabetes), happens when the cells of the body get too much sugar to the point that they don’t want it anymore. Normally, insulin is released by the pancreas when sugar is detected in the blood. That signals all the cells to take in the sugar and use it. When you are insulin resistant, the cells say, “no thank you, I’m full right now.” That leaves a lot of sugar and insulin floating around your body in your blood. That causes more brain inflammation.
The most common symptom of insulin resistance is being tired after eating. That tiredness is a sign that you have just consumed more carbohydrates than your body can accommodate. Other symptoms are;
- Craving sweets
- Strong appetite and thirst
- Over-eating large, high-carbohydrate meals
- Difficulty losing weight
- Waist bigger around than you hips
- Frequent urination
- Problems falling asleep
- Wake up tired even after sleeping well
- Frequent yeast or skin infections
- Slow healing cuts
Hypoglycemia and concussion
Hypoglycemia can also be very hard on the post-concussion syndrome sufferer because you never really have enough glucose for fuel. This is especially true at night when you haven’t eaten for a while. Normally, during sleep, the glucose stored as glycogen is converted back to glucose, but hypoglycemic people don’t have that storage. Instead the body breaks down protein into glucose. Both of these processes use cortisol which happens to be neuro-inflammatory.
Cortisol is also related to stress. As an mTBI patient, I can guarantee you are stressed possibly to the point that your adrenals are fatigued out and your cortisol production is low. In that case your body will try to convert protein into glucose using adrenaline. This is why hypoglycemic often wake up in the middle of the night and why they don’t feel like eating in the morning. Other symptoms of hypoglycemia are;
- Eating gives you a burst of energy
- Caffeine dependence especially for getting going in the morning
- Sugar cravings before meals and bed
- Crashing between meals
- Pale skin
- Blurred vision
- Fast heart rate
- Facial tingling or numbness
- Feel shaky, agitated or nervous between meals
- Lightheadedness
- Poor concentration
You can see that both insulin resistance and hypoglycemia have some of the same symptoms as post-concussion syndrome. This is one reasons why these issues may be missed allowing them to continue exacerbating the post-concussion symptoms by increasing brain inflammation, interrupting sleep and disturbing the production of energy in the brain. To make matters a bit more confusing, you can have what is called a mixed pattern, meaning that between meals you may have some hypoglycemic tendencies while after eating more insulin resistance tendencies.
How to regulate sugar when you have a concussion
Regulating blood sugar is not a DIY project. You will be best served if you have the assistance of a trained health care practitioner. In addition to dietary changes, there may be recommendations for supplements or even medication. If you have type 1 or type 2 diabetes, you will definitely want the guidance of a professional.
Generally speaking in terms of diet we can learn a lesson from type 2 diabetics. If you really want to keep your blood sugar consistent, you need to eat throughout the day. No skipping breakfast. All meals and snacks should have some lean protein and healthy fats to balance out carbohydrate intake. Reduce overall carbohydrate consumption, especially items high in sugar. Watch your energy levels throughout the day. If you feel tired between meals that could be a concussion symptom or you may need a snack. If you feel tired after eating, you may have had too many carbs. It’s also not a good idea to eat before going to bed, especially sweets.
How much carbohydrates you consume and when is a big factor in how your body responds. Another factor in sugar and concussion recovery is how quickly a food will raise your blood sugar levels. This is called the glycemic index, a high glycemic index means that a food raises your blood sugar quickly. To keep the flow of energy as even as possible low glycemic index foods are recomended.
Sugar and concussion recovery is complicated by the fact that concussion can change your sugar regulation. Your body may have been fine with your diet before your concussion, but be less tolerant or responsive after concussion. Dietary changes, exercise and supplementation may be enough to restore the smooth delivery of glucose to your brain. However, there is another alternative that has even greater benefit for concussion and post-concussion syndrome sufferers.
That alternative is changing your raw material for fuel production for the brain from glucose to ketones. The ketogenic diet involves eating mostly fat, some protein and very little carbohydrates. It requires discipline and a firm commitment, but for the head injured especially, can make a huge difference in health. I’ll be covering that in another post. For now look at your sugar metabolism and leave the option of the ketogenic diet as food for thought.
Even if you are on the ketogenic diet, the brain still needs some glucose to create fuel. Usually people on the keto diet allow themselves 5-8% of their total calories as carbohydrates. Whether or not you choose to go on a ketogenic diet, sugar and concussion recovery is still a matter of providing that sugar in a steady even pace. You would want to eat a donut for breakfast and no carbs the rest of the day. That might keep you within the target range of the diet and keep your body producing ketones, but it would give you a spike in blood sugar and insulin levels which would affect brain inflammation.
