Almost everyone I’ve worked with has at least a few days of experiencing sugar cravings and uneven energy when they first switch to a Paleo diet. This is especially true if they’re transitioning from a “Standard American” or other higher carbohydrate diet such as low-fat/vegetarian/vegan. For some people, though, these symptoms can persist beyond the initial few days. They continue to experience some combination of:
- Intense sugar cravings (that are often unrelieved by eating carbohydrates)
- Energy dips or crashes — especially after meals, or in the late afternoon
- Lightheaded, dizzy, jittery or shaky
- Anxious or agitated
- Brain fog and difficulty concentrating
- Extreme hunger (i.e. feel like you’re going to die of you don’t eat)
- Spaced out
It’s not hard to understand why you might give up on Paleo if you continue to have these symptoms for more than a few days. They’re incredibly disruptive and they make it hard to function normally. Fortunately, they’re usually not difficult to address once you understand what’s causing them. In my work with patients I’ve discovered that the three primary causes of these symptoms are:
- Sluggish fat burning.
- Blood sugar imbalances.
- Micronutrient deficiencies.
Let’s look at each of these in more detail.
Sluggish fat burning
Our bodies are capable of producing energy from both fat and carbohydrates. If you’ve been eating a diet high in carbohydrates and lower in fat, and you abruptly switch over to a lower carb, higher fat diet, there’s usually a transition period where your body has to switch from primarily burning carbs for energy to primarily burning fats. During this transition period it’s not uncommon to experience intense sugar cravings and dips or even crashes in energy, because your body is not yet getting the cellular fuel it needs.
For the lucky ones, this adaptation only takes a few days. For others, it takes longer and may not happen completely without additional support. The process of turning dietary fat into usable energy requires several nutrients; carnitine and riboflavin (B2) are especially important. Carnitine is a derivative of the amino acids lysine and methionine. It plays a key role in transporting fatty acids into the mitochondria — the “power plant” of the cell — during the conversion of fat to energy. When carnitine reserves are low or enzyme availability is impaired, fatty acids won’t be efficiently shuttled into the mitochondria and energy production will drop.
Though carnitine can be synthesized from the essential amino acid L-lysine, digestive impairment, genetic polymorphisms and a diet low in animal protein or legumes (the primary sources of lysine) can lead to a functional carnitine deficiency. For example, low stomach acid could potentially lead to deficiencies in L-lysine even if you’re eating adequate protein in your diet.
Riboflavin is another key nutrient in the process of converting fat to energy. Once inside the mitochondria, fatty acids can’t be “burned” for fuel without riboflavin coenzymes. Riboflavin is found in many foods, including asparagus, bananas, green beans, persimmons, okra, chard, dairy products, meat, eggs and fish. While deficiency due to inadequate dietary intake is rare, other conditions such as intestinal inflammation or dysbiosis can reduce the body’s ability to absorb riboflavin and lead to sub-optimal levels. Other signs of riboflavin deficiency include cracked and red lips, inflammation of the lining of mouth and tongue, mouth ulcers and cracks at the corners of the mouth, though these aren’t necessarily present in all cases.
Blood sugar imbalances
The spectrum of blood sugar imbalances includes hyperglycemia (high blood sugar), hypoglycemia (low blood sugar) and reactive hypoglycemia (a combination of both high and low blood sugar). Each of these conditions is associated with fatigue, irregular energy and sugar cravings, along with numerous other symptoms. Glucose is used in all cells for energy production, so any difficulty in delivering glucose into the cells will quite literally affect every system of the body. This is especially true for the brain, which has a higher need for glucose than other body tissues. (Ketones can substitute for glucose as brain fuel if they are being produced in adequate amounts.)
The regulation of blood sugar is a complex and controversial topic. I’ve written about it extensively elsewhere, but in a nutshell the process of developing a blood sugar imbalance happens like this:
Modern diet and lifestyle + genetic predisposition > inflammation and oxidative damage > leptin resistance > insulin resistance and impaired glucose tolerance
Blood sugar problems can also be caused by low cortisol (a.k.a. “adrenal fatigue”) or disruptions of the cortisol/melatonin circadian rhythm, micronutrient deficiencies (which I’ll cover next), poor thyroid function and stress.
In addition to carnitine and riboflavin, which are two of the most important nutrients for fat burning, there are several micronutrients essential to energy production and blood sugar regulation. These include chromium, magnesium, biotin, choline and CoQ10.
Chromium is an essential mineral that enhances the role of insulin and helps transport glucose into cells. Deficiency due to dietary intake is rare, but diets high in simple and refined sugars deplete body chromium stores, and even mild deficiencies of chromium can interfere with blood sugar regulation and cause fatigue, anxiety and sugar cravings. (1) Infection, intense exercise, pregnancy and lactation, and chronic stress can also reduce chromium levels, especially if they were already low to begin with. (2) This may explain why an estimated 20-25% of Americans are deficient in chromium, despite adequate dietary intake.
Magnesium in another mineral that plays a crucial role in blood sugar regulation. It is used by the body’s enzymes to process glucose efficiently, and it has been shown to decrease inflammation, which is one of the primary drivers of insulin resistance. A 2010 study showed that people who took in the highest amounts of magnesium were half as likely to develop diabetes 20 years later than people who took in lower amounts. (3)
Studies show that most Americans are deficient in magnesium. The median intake across all racial groups is far below the RDA, which is 420 mg/d for men and 320-400 mg/d for women. Although half of Americans take a multivitamin daily, most don’t contain enough magnesium to prevent deficiency.
Magnesium is also difficult to obtain from food. Nuts, seeds and dark chocolate are among the highest sources, but they’re also high in phytate, which inhibits the absorption of magnesium. Another issue is that magnesium levels in food have dropped as modern soils have become increasingly depleted. This means is that if you’re not supplementing with magnesium, you’re probably not getting enough. (Even if you are supplementing, you still might be deficient if you’re not taking a chelated form like magnesium glycinate. I can’t tell you how many patients I’ve seen that are magnesium deficient in spite of supplementing for years with magnesium oxide or citrate.)
Biotin is a water-soluble vitamin often referred to as vitamin B7 or vitamin H. It’s a coenzyme involved in energy production, and it helps with the metabolism of fats and carbohydrates into glucose. Specifically, biotin is a co-factor for fatty acid synthesis and may increase utilization of glucose for fat synthesis. Studies have shown that biotin levels are inversely correlated with blood sugar levels; in other words, those with higher biotin stores tend to have lower blood sugar, and vice versa. In one human study, biotin levels were significantly lower in 43 patients with type 2 diabetes than controls, and one month of biotin supplementation decreased fasting blood sugar levels by 45%. (4)
Biotin is found in meat, fish, egg yolks, milk, poultry and some legumes and grains. It’s also produced by gut bacteria in amounts approximately 2-5x higher than what is generally obtained from the diet. As is the case with chromium an riboflavin, deficiency of biotin due to inadequate dietary intake is not common. However, anything with a negative effect on the gut flora (such as antibiotics, birth control pills, gut infections, inflammation, SIBO, stress, etc.) could potentially decrease biotin production and lead to deficiency.
CoQ10 is a fat-soluble antioxidant “vitamin-like” substance that is present in the mitochondria of all cells. It plays a major role in generating cellular energy in the form of ATP. 95% of the body’s usable energy is produced in this way, so even a mild deficiency of CoQ10 can have a significant impact on energy and cellular function.
CoQ10 deficiency can be caused by low dietary intake (CoQ10 is highest in red meat and liver and some fish), oxidative damage and insufficient levels of B vitamins, vitamin C and selenium.
How to prevent energy dips and cravings
Improve your fat burning capacity
The Metametrix Organic Acids Basic profile has some good markers (adipate, suberate and ethylmalonate) for detecting impaired fatty acid oxidation. If any of these are elevated, it’s likely that carnitine and/or riboflavin levels are not sufficient. That said, in most cases this test is not necessary. One benchmark I use for deciding if I should order a test or not is whether the results will affect how I treat. If the treatment would be the same regardless of the test result, it’s cheaper and easier to simply go ahead with the treatment. If I suspect someone has problems metabolizing fat, I usually skip this test and go straight to the following interventions:
- Improve your absorption of amino acids. Your body uses lysine and methionine to produce carnitine, which is essential for metabolizing fat. Replace stomach acid and enzymes if they’re low, and address any other digestive issues that may be present.
- Boost your fat-burning nutrients. Consider supplementing with L-carnitine, riboflavin and magnesium to enhance fatty acid metabolism. In most cases this need only be done for a short period, ranging from 3-9 months depending on the person.
Regulate your blood sugar and restore micronutrients required for energy production
This is, of course, a huge topic that I can’t possibly cover in adequate detail in this short post. However, I can give you some basic pointers I’ve found to be helpful with most of my patients.
- If you have high blood sugar: you’ll probably benefit from a lower-carbohydrate approach, perhaps limiting carb consumption to less than 75 grams per day. There’s no hard and fast rule here; some do better with more, and others do better with less. The best way to figure out where you are on the spectrum is to experiment. In addition to reducing carbohydrate intake, additional steps such as intermittent fasting and eliminating snacks may be helpful.
- If you have low blood sugar: you may benefit from eating more frequently (every 2-3 hours), eating a high protein breakfast within 30 minutes of waking up, eating a snack with protein and fat just before bed, and possibly even eating a small snack if you wake up in the middle of the night.
Managing your stress is crucial with blood sugar abnormalities, because as I mentioned above, adrenal and brain dysfunction are often involved.
Several micronutrients can be helpful in restoring insulin sensitivity and glucose tolerance and improving energy production, including biotin, vanadium, alpha lipoic acid, chromium, magnesium and manganese. Some of these can be obtained through the diet. Biotin can be increased by eating prebiotic foods (such as onions, leeks, jerusalem artichokes that increase the production of intestinal bacteria; however, people with digestive issues are often intolerant of these foods in the FODMAP family, so be careful. Nuts and seeds are good sources of magnesium, but only if they’re soaked and dehydrated or roasted at low temperature to inactivate the phytate they contain before consuming them.
Along the same lines, since blood sugar issues are often at least in part caused by inflammation and oxidative damage, nutrients like green tea extract (ECGC), CoQ10 and glutathione precursors such as alpha lipoic acid, glycine, NAC can also be helpful. CoQ10 can be obtained from red meat and liver, and glutathione levels can be increased by eating raw fruits and vegetables (again, be careful if you have digestive issues) or by consuming raw dairy products.
Because many of these nutrients are somewhat difficult to obtain even in the context of a healthy diet, I often recommend supplementing with a blend of them until your blood sugar normalizes and your fat and carbohydrate burning become optimally efficient.
Putting it all together
Energy dips and sugar cravings are probably the most common reason that people fall off the wagon with Paleo. Digestive problems are no fun, but most people are willing to put up with them for a while during the transition. But if you can’t think straight, you feel shaky and jittery all the time, you have insomnia and you are so tired at 3pm that you can hardly keep your eyes open, it’s going to be pretty hard to stick with a Paleo diet — no matter how much you believe in it or want it to work.
As a clinician that specializes in working with people experiencing these kinds of issues, the most important thing for me is to help them get through that difficult transition period. Solving these problems with dietary changes alone is always the goal, but in my experience people often need additional support. This is where targeted, therapeutic supplementation comes in. The supplements can be like a raft that gets you from one side of the river (“struggling with Paleo”) to the other side of the river (“thriving with Paleo”). Once you’re on the other side, you don’t need the raft anymore.
In the last article I expressed my frustration with many of the existing digestive supplements out there. My solution was to create one myself. Well, I did the same thing for energy dips and sugar cravings. There are a lot of products out there that address parts of the problem, but I couldn’t find a product that provided the full spectrum of nutrients required for both fat and carbohydrate metabolism, blood sugar regulation, improved insulin sensitivity and glucose tolerance, and optimal mitochondrial energy production. So Robb Wolf and I put our heads together to create one as part of the new line of supplements we’re launching next week. You can learn more about it here.
In the next article we’ll cover the third challenge that can get in the way of a smooth transition to Paleo: impaired detox capacity.
Now I’d like to hear from you. Did you experience energy dips and sugar cravings when you first switched to Paleo? Do you still experience them now? What did you find helpful in dealing with them?
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