Dr. Phil Bate
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Explosive Anger Disorder/Intermittent Rage Disorder
Explosive Anger Disorder! (EAD). Or, Intermittent Rage Disorder (IRD). Take your pick of labels and/or abbreviations.
These are "new" labels in the lexicon of the psychologists and psychiatrists. (You should know that most such labels are made up in order to get paid by insurance companies, and have no relation to real diagnosis.) It's for an old problem that has been around for many decades. The funny thing is that most doctors have refused to recognize it, or the cause, and most still don't.
The official party line of the American Medical Assn is that if there is no diabetes (measurable sugar affect), then there's no sugar problem. As is often the case, they're WRONG! The problem is virtually always a sugar problem. ( Of course, Big Pharma doesn't want you to know what the actual cause is, as they would sell less tranquilizers ).
Hypoglycemia is a medical term for "low blood sugar". The brain requires large amounts of glucose and oxygen for fuel. When it goes below a certain point, a hypoglycemic episode occurs. This can become almost any symptom up to and including coma and even death. In most cases, such a hypoglycemic episode may only cause drowsiness or sleepiness, but fainting and passing out is not unknown.
Let's examine the actual cause of the "new" disease (label for insurance purposes) called "Explosive Anger Disorder" (EDT). As a result of blood sugar going low because of excessive insulin released, both adrenalin and testosterone may be released in males. (In women, estrogen is released which doesn't cause anger with adrenalin.) In some males, this combination causes what is called "undifferentiated" rage. Does that sound like "explosive anger" to you? Of course it is. Why do medical researchers keep re-inventing the wheel? And, all too often the wrong wheel?
This is undoubtedly is a part of the current "road rage" problem as well as childhood tantrums, spousal abuse, bar fights, etc.
Back in the 1980's, I had several male patients who had this form of hypoglycemia. I also found that they all fit a "special" format of the MMPI (Minnesota Multiple Personality Inventory) test for "psuedo-schizoprenia". Since that time, I have seen such "rages" in boys, and some men. If investigated, it will usually be found that they are in a 3-4 hour time period after eating (or drinking) a lot of carbohydrates and sugars.
Temper tantrums are not unusual, particularly in "spoiled kids", but if it occurs about 3-4 hours after a "sweet meal", you can be pretty sure that child has a sugar handling problem, and needs to limit carbohydrates/sugars.
Glucose is the form of sugar in the blood. This has been transformed in the digestive process from other sugars and starches into glucose then passed into the bloodstream.
Hypoglycemia is usually caused by too much insulin driving too much glucose into the body cells, which depletes the supply of glucose available to the brain (and other areas). Since the brain depends on a constant supply of both oxygen and glucose to even function, there are several methods that the body uses to make sure that glucose is available. First is the release of adrenalin (the fight or flight response in effect). If this not enough, then fatty acids and hormones are released and changed into glucose.
Since glucose is as necessary to proper brain function as is oxygen, there are many different symptoms possible. These can range from a simple yawn about a half hour to an hour after eating, to a full-blown anxiety attack, or even a real depression (the term "sugar blues" has a basis in real fact), passing out/fainting, or even death for diabetics, or almost anything in between. Sometimes, allergies can cause similar symptoms, or even cause a hypoglycemic episode!
In non-diabetic persons, too much insulin can be the result of a sugar overload, and this can cause hypoglycemia. To some "sensitive persons", this can be as simple as eating a doughnut or drinking a full glass of orange juice on an empty stomach. (It happened to me once!) The response to low sugar/glucose is individual, and everyone reacts slightly differently. Also, one person can eat a dozen doughnuts one time with no bad effects, and have a hypoglycemic episode from just one doughnut at another time.
Let's look at a simple example, which will help clear up some of the confusion surrounding this subject. If a normal (whatever that is) person eats an apple, he/she will gain approximately the equivalent of 3 teaspoons of sugar. It will take about 3 hours to digest the apple in the following way:
So, eating an apple has an immediate effect of raising glucose (blood sugar) somewhat, and this "blip" is fast compensated for by insulin release, and from that point the incoming sugar is pretty well balanced by insulin release over the three or so hours of digestion. In effect, there is very little change in blood sugar, and that's what nature intended - the sugarstat is working as designed.
- As sugar is absorbed in the mouth, in the stomach, and the small intestine, the amounts are measured and the brain determines how much insulin to release into the blood. For simplicity, let's call this process a "sugarstat". We don't fully understand how it works, but we do know the effects.
- From millions of years of evolution, the sugarstat "knows" that with the amount of sugar absorbed over a certain time it needs a certain amount of insulin and releases that amount accordingly.
- Now, it takes 3-4 hours for all the sugar to be digested from the apple fiber as it passes thru the digestive system. It's a downward curve, and the insulin released also has a similar downward curve, and it lasts about the same 3 hours in the blood, as it's used.
The situation is drastically different if we "pre-digest" the same apple by squeezing it in a cider press. In effect, all we have removed is the fiber, and retained all the sugar, vitamins/minerals, etc. (A glass of apple juice might contain the juice from 10 apples or 30 teaspoons of sugar). Now, there is much more sugar absorbed very fast, and the sugarstat is "fooled" into releasing many times the amount of insulin actually needed as a result.
Remember that for millions of years of evolution, we didn't have cider presses, let alone the "designer" apples of today. Let alone the processed foods! We simply aren't designed to handle the amounts of sugar we get. (In the 1800's the average intake of sugar per person per year was about 5 pounds. Today it's over 200 pounds).
This "overdose" of insulin drives blood sugar into body cells at a furious rate, and even though the blip is now much larger, it quickly lowers it.
The sugarstat has released enough insulin for 3 hours of digestion, but all the sugar is actually digested and within the bloodstream within minutes. This results in way too much insulin (hyperinsulinism), since enough insulin has been released for three hours of this same amount of intake. The sugarstat has been "fooled", by not evolving far enough to handle our "modern" food processing.
This excess insulin "drives" all the glucose it can find in the blood into the body cells (its job). This results in a shortage of glucose to the brain.
Now, since the brain MUST have glucose as well as oxygen, for fuel, several body mechanisms go into action to raise the glucose. (Few people realize that without BOTH glucose AND oxygen, brain cells start to die in about 4 minutes).
The two most important body hyperinsulinism defenses are adrenalin release, which releases stored glucose for emergencies (the flight/fight response), and the release of some fats and sex hormones that can be quickly converted to glucose. The combination of adrenaline and testosterone may result in EAD. (Explosive Anger Dysfunction - a new name for an old mostly undiagnosed sugar-handling problem).
From the above scenario, it can be seen that hypoglycemia isn't really an actual disease, but in fact, it is actually normal to we humans, even though the effects are individual and may vary greatly. It's our modern sugary diet full of processed or pre-digested food that's really to blame.
These body defenses against low blood sugar also cause some very different symptoms in different individuals. Usually, this is about 3+ hours after eating a sugary processed meal. This time may also vary from about 2.5 hours to 5 hours in different individuals at different times.
One symptom that is common in women is a panic/anxiety attack, or even fainting. This is a reaction to the mix of adrenaline and estrogen. Men sometimes might experience these symptoms, but not as often.
An anxiety attack caused by a hypoglycemia episode while driving might result in a phobia of driving, or if driving in a tunnel, a phobia about that, or if on a bridge, a phobia about that. In practice, I've seen all three of these phobias generated by hypoglycemic episodes!
In1982 I wrote a paper 1982 describing "Adult Onset Phobias", and how hypoglycemia episodes can cause them in the Behavior Journalist. Of course, it was belittled by many, but some wrote that they had found similar cases and thanked me. (Non so blind….)
Men have another symptom. The combination of testosterone and adrenalin may trigger "undifferentiated" anger in a man. He will have a "rational" (to him) reason for the anger, but bystanders can't understand how he got so angry for "no real reason". Men who change personality dramatically while drinking are often this type.
I once helped to save a marriage by simply advising the husband to eat a handful of peanuts and raisins every two hours after lunch. (He was her boss, and at 3PM, she couldn't do anything right according to him - his lunch included a candy bar and a soda!!)
Anyone who has a sugar handling problem might be well advised to carry a bag of peanuts and raisins around, and make sure that they eat a handful every two hours or so. (A ratio of about 5 peanuts to 1 raisin seems to work well.) The raisins will provide glucose within a relatively short time, and the peanuts will provide protein and fats that can be converted into glucose over a longer time. This was what I usually advised hypoglycemic sensitive persons to do, and it works well. Really sensitive persons should know to eat 6-8 small meals every day. A meal might be a hard-boiled egg, or half an apple, etc.
On the usual Glucose Tolerance Test (for diabetes or hypoglycemia), the subject is given a measured dose of glucose in a horribly sweet soda type of drink, and measurements are made before this drink, 1/2 hour after drinking, then at one hour, and then every hour until either 5 or 6 hours have passed.
This test is more often done wrong than perhaps any other medical test used. These are the common mistakes made by medical practitioners and hospitals:
The above applies primarily to GTT's where diabetes is not a factor. A fasting glucose test will find diabetes instead, and is much safer.
- They just give the standard 10 oz bottle to anyone, and it's way too much for a child or a small person. There is a weight/volume slide rule that should be used, but usually isn't. At 6' tall and 200 pounds, I should take only 7 ounces!
- The measurements are too mechanical. I believe (along with most other knowledgeable practitioners) that the patient should be advised strongly to let the person (usually a nurse) giving the glucose test know if they experience any symptoms at all from yawning to headaches, etc. Actually, the person giving the test should watch the person taking it and ask how they are, if they even begin to look. or act dfferently.
- Between 3 and 4 hours of the test is the most likely time for most persons to experience "severe" hypoglycemia, even passing out in some cases. If no symptoms are noticed, it is a good idea to test at the 3 1/2 hour mark.
- When the test is concluded, do NOT let the patient leave the clinic, office, or hospital, until they have been given food, preferably fast digesting food. I often used a small glass of freshly squeezed orange juice, in season, and out of season the handful of peanuts and raisins. Many persons have left a clinic or office and passed out on the street, or perhaps had an auto accident.
In Orlando, where I checked on all the hospitals, and several MD's offices, I found none that did all the above correctly, and most made all the above mistakes. Be advised.
I hope this helps you in your quest for better health.