Poor carbohydrate metabolism or poor glycogen storage in the liver often cause hypoglycemia, because both make it difficult for the body to control blood sugar levels. Symptoms of hypoglycemia include nervousness, the need to eat frequently, craving for sugar, shakiness, and the inability to concentrate or think properly.  The diagnostic standard is blood sugar levels below 50 mg/dL, and abnormal response to a sugar challenge given in a test called the glucose tolerance test.

I nickname hypglycemia "sub-clinical glycogen storage disease" (real gsd) because in 1996 while in Kathmandu, Dr Mana was examining a hypoglycemic patient and demonstrated via palpation that the liver had shrunk in size, indicating low levels of glycogen. In TAM, this problem, linked to low blood pressure, fatigue, and nervousness in a disease called ojaskshya, and is considered to be the result of weak digestion and blood deficiency (rasaksaya).  The problem is often found in nerve-natured (Vata prakriti) patients.  It is treated by combining digestive herbs and general rasayana tonics (Bajracharya, 1988). This insight led me to understand much more clearly my treatment goals. Many patients have found relief following the below strategies.

• Eating frequent meals, up to 6 per day, and increasing protein intake will often alleviate this problem.  I have people follow the diet for reducing wind, which strengthens the nervous system.

• Especially important is to avoid simple sugars.  Complex carbohydrates are more slowly absorbed carbohydrates and reduce the glycemic index (a measure of how fast sugars enter the blood) and therefore lower insulin production (Vanderhoof, 1998).

• For more serious cases I sometimes construct an herbal formula using tonics, especially shilajatu and triphala.  This medicine tonifies the blood and aids the liver in storing glycogen(Mitra SK et al.  1996).

• Because the liver is the major storehouse for sugars, liver tonics such as dandelion root, milk thistle seed, bupleurum root and white peony root may also help with hypoglycemia.  Look for signs of restricted energy (Liver Qi restriction), with a tense wiry pulse.  

• Digestive aids like ginger root,  black pepper or trikatu are always useful in my experience, and should be combined with general tonics like shilajatu, dang gui root, ashwaghanda root, cooked rehmannia root, shou wu root etc.  The standard tonic chyvanaprash is also useful.

• Hypoglycemia may be a symptom of more serious underlying diseases, such as chronic hepatitis, diarrhea or chronic diarrhea, anemia, and urinary diseases.  These should be investigated and ruled out.