A few more thoughts on airway, breathing and oxygen.
First, at some point the inhalers that many patients depend on to help open their airways became very expensive. I remember when generic albuterol inhalers were about $2.75 from the hospital pharmacy. As recently as this year, I have had patients report that they were charged over $70 for the same albuterol inhaler. We can now obtain generic medications from Anda Pharmaceuticals, with generally much better prices. The albuterol inhaler is about $31. I will talk more about Anda, and how you can compare prices with theirs, in a later email!

It’s worth reflecting that the whole purpose of the cardiovascular and respiratory systems in the body is to get oxygen and fuel (sugars, fats and sometimes proteins) to each individual cell, so that energy can be produced by the mitochondria. The whole elaborate system is for this simple purpose:

Respiratory system: nose, mouth, pharynx, trachea, bronchi, bronchioles (little airways), lungs with alveoli (air sacs) surrounded by tiny capillary blood vessels to take up the oxygen into the blood …and give up carbon dioxide to be sent back to the atmosphere..
Circulatory system: capillaries in the lungs bringing blood to the pulmonary veins full of oxygen, back to the heart to pump blood through miles of large arteries then small arterioles to the capillaries by the individual cells, bringing them both oxygen and nutrients. These are absorbed by the cell and delivered by a network of ‘roads’ within the cell to the mitochondria. Then waste products are sent out of the cells, and travel by the vein side of the circulatory system back to the heart, to be pumped again to the lungs to be reoxygenated.
So the point of all of this is to enable us to produce energy, and if there is a problem anywhere along the way, or at several places along the way you won’t be able to produce energy optimally. Energy is a lot like money for the body. Picture how you feel when you don’t have enough money to maintain basic function. You are probably anxious! So it is worth thinking through the energy production system methodically, looking for where there could be a problem for you.
For example, you could have nasal polyps and can’t breathe optimally through your nose, so you breathe through your mouth, and the airflow does not reach the deep lungs as well, so you have less volume of air to take oxygen from. Or maybe you have some scarring of your airways from asthma (maybe from allergy to hay as a kid). Maybe your blood vessels have scarring as well from damage from a high sugar diet, impairing the delivery of oxygen and nutrients, including vitamins and minerals, to the cells and thence to the mitochondria inside the cells. You get the idea. It is like the engine of a car, in which gasoline (fuel) and oxygen combust to give the energy needed to move the car. That is why airway and breathing and oxygenation are so important that I will come back to this topic a few more times before this series is done!

For now, it leads us right to the topic of blood sugar control. Blood sugar, or glucose, is the short term energy currency of the body. Carbohydrates are large molecules that are made from sugar building blocks. They are broken down in the gut and liver to simple sugars such as glucose. In a desperate situation, proteins can be broken down to amino acids and these can be used for fuel by the mitochondria. Fats are a bit of a different story: they are made in the body from sugar for long term energy storage. Fats in the diet are processed along a different set of biochemical tracks and do not have much effect on the level of the blood sugar.
So it is obvious why the blood sugar level would matter, but maybe it isn’t obvious why it matters SO MUCH. Glucose and other sugars are actually toxic to the body if levels are too high in the blood for too long. The brain doesn’t function well. The sugars coat structures in the cell like proteins and fats, damaging them. If you have ever carmellized onions by cooking them in sugar, you can imagine what it is like to carmellize structures in your body. “Age spots” for example, are carmelilzed fat! This is not a beauty spot! Hemoglobin A1C, which is measured to screen for diabetes, is simply the amount of sugar coated hemoglobin molecules. Ugh.
The kidney has to get rid of excess sugar in the blood stream for this reason (its toxicity over time). However, it must send water out with the sugar in the urine so that the sugar doesn’t crystallize in the urinary tract. Ultimately, this can be dehydrating.

The most concerning effect of high blood sugars might be the impact on brain function. Many years ago, when I was in medical school, the normal range of blood sugar was considered to be from 80-120. (The range is set by a international group of experts who meet periodically in a nice location). I remember being happy if someone had a fasting blood sugar of 110. The change in thinking came for me from the experience of the military, specifically, the Navy Seals. The Navy Seals, it turns out, care a lot about their blood sugar levels and changes in that level. This is because they must have optimal function of their decision making abilities. Much research went into not only how to optimize their physical function, but also their brain function. We will take up some of their other discoveries, particularly about sleep, and the use of ketogenic diets, later on. For now, we need to realize that blood sugar levels matter, and when they aren’t right, the body will very reasonably feel uneasy and anxious.
For example, let’s say you have a Mountain Dew, with tons of sugar, and your blood sugar level goes to 240. You will trigger the production of a lot of insulin from the pancreas in an effort to get the sugar level down to something livable. The overreaction will cause hypoglycemia (low blood sugar) and now the body really panics and the levels are pushed back up by adrenaline. Adrenaline makes you feel anxious.

The great news, from my point of view, is that it is now possible to be aware of our blood sugars in almost real time, using a gadget called a ‘continuous blood glucose monitor’. There are two companies making these to my knowledge, Dexcom and Free Style Libre. The FSL has become quite affordable, so I will start the Anxiety series #4 letter off by talking about it.
Best regards,
Dr Helman