Understanding the Dawn Phenomenon
Posted by Andrea Nakayama
It’s not uncommon to say one size doesn’t fit-all in relation to shoes, jeans, or even a dietary recommendation. This is especially the case when a client comes our way with a set of concerns that takes some of our favorite foods (literally) off the table.
Recently in the FxNA Clinic we met with a client who has Antiphospholipid Antibody Syndrome (APS). This is an autoimmune condition that causes hyper coagulation of her blood. (Imagine major blood clotting with very high platelet counts and a need to manage the intake of any foods that are high in vitamin K, like kale and broccoli!)
As we discussed her nighttime wakings and I reviewed her most recent labs, I noticed that she had a slightly high morning blood glucose of about 92 mg/dl. Now that’s obviously not an excessively high fasting glucose, but it is higher than I’d like to see for a woman in her early 40’s with two small children, some unwanted fatigue, and an existing autoimmune condition who already eats a low carbohydrate diet. I’d rather see that number hovering around 80 mg/dl.
Taking a Functional Approach
Putting her situation in Functional context, it’s important to remember that one autoimmune condition can breed the possibility for other autoimmune conditions, like diabetes. In addition, any physiological imbalance can add to the symptoms we may associate with the diagnosed condition, and can also contribute to that condition’s expression. That’s why we always “back it up“ and look to bring balance to the physiological terrain as a route to invite full body health and healing.
Even seemingly unrelated symptoms and body reactions may be a clue for where to go next with our clinical recommendations!
As this client is a nurse, and has participated in some of my previous trainings, she had picked up on one of our tricks of the trade and began tracking her blood sugars throughout the day as I sometimes recommend. This turned out to be a good move!
Through her tracking she was able to confirm that while her blood sugars were well within a functional range throughout the day, even after eating (hovering between 78 – 88 mg/dl), her waking blood sugars were often in the 90’s. Sometimes even higher.
Is this something to worry about or not?
These numbers are not pathologically high. In fact, most medical practices would even say they look great.
In addition, it’s natural for morning blood sugars to start to rise a bit, even after fasting all night long. That’s because the body is secreting key hormones—including adrenaline, glucagon, cortisol and growth hormone—to support the part of the circadian cycle that gets us up-and-at-’em in the AM. That hormone activity is counter-regulatory. That means that it suppresses insulin production and insulin’s blood sugar lowering powers.
When insulin is suppressed, there’s nothing to clean up the blood glucose, so up go the blood sugars.
The Dawn Phenomenon
When this happens in the morning like this, upon waking, it’s called the Dawn Phenomenon.
It’s where blood sugars are high in the morning despite the fact that nothing has been consumed for hours on end. It’s a common occurrence for many of us, but even harder for the body to handle in the presence of diabetes, insulin resistance, or dysregulated blood sugar management.
And blood sugar management is one of those one-size-doesn’t-fit-all situations. Whereas 92 mg/dl may be fine or even low for a person whose blood sugars usually sit in the 100 mg/dl range, they are on the higher side for our nurse with the diagnosed APS. And that daily morning sugar bath is destructive to her cells, causing them to get dehydrated and less responsive to immune disruption.
While that’s just some of the destruction that’s happening inside the body in response to heightened blood sugars, our client may feel fuzzy-headed or dizzy upon waking. She may have a headache, feel a bit ornery, be extra hungry, and not be able to concentrate. She may grab some caffeine for energy and mental clarity, even when she doesn’t like how the morning coffee makes her feel later in the day.
Ultimately the blood sugar shifts we experience should be quite subtle. That’s why elevated blood sugars in the morning still need to be managed–even when the degree of elevation is based on the individual, not the pathological.
As we know, what goes up, must come down, like the “crash” we can experience after eating a cookie (high blood sugar followed by the inevitable dip).
And that’s not the way we want our clients starting the day!
Recommending Steps Toward Resolution
We determined that the client with APS would continue to watch her fasting morning blood sugars over the coming week with a few key Functional Nutrition recommendations in place:
- make 8 hours of sleep a priority
- review a comprehensive 5-day Food/Mood/Poop/Blood Sugar Journal to watch for spikes and patterns throughout the day
- highlight protein, fat and fiber at both breakfast and dinner
- consume breakfast within a half hour of waking
In keeping with the ART of the practice, where we Assess, Recommend, and Track (and make that process cyclical), our next steps will be determined only by what we learn from this week’s recommendations, tracking and reporting.
That’s because one person’s Dawn Phenomenon may be different (or have different underpinnings) than another. Our job is to continue to ask Why so that we can make the difference at the roots.
The Art of Counseling Step 1: Assess
The Importance of Blood Sugar
Functional Nutrition Tool: Blood Sugar Balance Done-4-You
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