The Fad Disease

Hypoglycemia is being diagnosed too often

The symptoms seem to occur a few hours after meals: dizziness, weakness, tremors, sweating, even heart palpitations. Worried that they might have that "in" condition, hypoglycemia (low blood sugar), the patients consult their physicians. More often than not, after a test or two, the doctors agree with the diagnosis and prescribe a restrictive, highprotein, low-carbohydrate diet with frequent feedings. Indeed, hypoglycemia has reached epidemic proportions. Now some doctors are raising warning flags. They insist that the malady is largely illusory.

Sugar, in the form of glucose, is the body's main source of fuel. Derived from all foods, but most quickly from carbohydrates, it is present in the blood in varying amounts at all times. Directly after meals, the glucose level rises. Then, as insulin secreted from the pancreas helps move sugar into cells, the glucose concentration drops. But in people with hypoglycemia it falls to an abnormally low level. In a small percentage of patients, low blood sugar can be traced to tumors of the pancreas, liver disease or previous gastrointestinal surgery. But most of today's cases are attributed to disturbances in sugar metabolism following meals.

The standard method of diagnosing hypoglycemia is the glucose tolerance test (GTT). After an overnight fast, the patient is given a high-glucose solution to drink. Blood samples are then taken at intervals over the next five to six hours and analyzed to see if the glucose content drops below normal levels.

But many doctors believe the test does not diagnose hypoglycemia so much as cause it. For one thing, interpreting the results is difficult because no one is sure what the normal level of glucose really should be. Depending on the specialist, the lowest "normal" can be any point between 35 mg and 60 mg of glucose in 100 ml of blood. Doctors now stress that the diagnosis cannot be based on numbers alone; the data must be matched to symptoms. One study found values as low as 22 mg per 100 ml in apparently healthy women. Says Endocrinologist Simeon Margolis of Johns Hopkins University: "It does not mean anything if somebody's blood sugar is lower than some arbitrary value. What matters is if low blood sugar produces ill effects."

But some physicians believe that even if symptoms do show up, the test is so artificially structured that the results are suspect. Declares Internist Leonard Madison of Southwestern Medical School in Dallas: "Hypoglycemia is a normal response to the glucose tolerance test. Man was not built to take an overload of glucose like that. Look at it this way: if you run up a flight of stairs and find yourself short of breath, it does not mean you have heart disease." Madison, like others, believes that the GTT should be junked in favor of taking glucose measurements after normal meals or when symptoms occur.

Hypoglycemia faddists, most of them laymen, have for years been trumpeting the dangers of the malady (linking it to everything from juvenile delinquency to schizophrenia), touting questionable remedies (among them adrenal cortical extract injections and multi-vitamin shots), and steering anxious patients to doctors who specialize in its treatment. Notes Dr. Donald Holub of Manhattan's Columbia University College of Physicians and Surgeons: "There are a few M.D.s who have espoused hypoglycemia much as some others have become 'weight doctors.'

Perhaps the biggest factor in the current epidemic is that, for many, a diagnosis of hypoglycemia fulfills a need for a convenient physical malady to explain symptoms that really result from psychological problems--usually stress or anxiety, but sometimes severe depression. In a recent study at the Mayo Clinic in Rochester, Minn., reported in the Journal of the American Medical Association, researchers found that most of 129 patients with symptoms of hypoglycemia (86 with negative GTTs done during the occurrence of symptoms) also had emotional disturbances that emerged in an accompanying personality test. Says Madison: "It is a lot easier to say that you have hypoglycemia than to admit you have an emotional disorder."

Some physicians cater to this need, especially with patients who reject a psychological explanation of their problems. Often the doctors are well intentioned, but the results can still be damaging. Says Dr. Daniel Foster of Dallas' Southwestern: "The fact is that all of this false diagnosis is creating patients out of people who probably should not be, making them virtual invalids because they believe they have a disease."

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