What\u2019s sweet, red, sticky, and deadly?<\/p>\n
Blood sugar. (I\u2019m sure there are other things that qualify, but most of them contain sugar of some sort so I\u2019m sticking with it.)<\/p>\n
Too little of it, and you go into hypoglycemic shock. That can kill you if left untreated.<\/p>\n
Too much of it, and you waste away slowly. Chronic overexposure to sugar will degenerate your tissues and organs.<\/p>\n
Yes, getting blood sugar right is extremely important. Vital, even.<\/p>\n
Today, I\u2019m going to explain how and why we measure blood sugar, what the numbers mean, why we need to control it, and how to maintain that control.<\/p>\n
What is Blood Sugar?<\/h2>\n
First, blood sugar is tightly controlled in the body. The average person has between 4-7 grams of sugar circulating throughout their body in a fasted state\u2014that\u2019s around a teaspoon\u2019s worth. How does that work when the average person consumes dozens of teaspoons in a single day?<\/p>\n
Again, it\u2019s tightly controlled.<\/p>\n
The majority of the sugar \u201cin our system\u201d is quickly whisked away for safekeeping, burning, or conversion. We store as much of it as glycogen in our liver and muscle as we can. We burn some for energy. And, if there\u2019s any left over, we can convert it to fat in the liver.<\/p>\n
But sometimes, sugar lingers. In diabetics, for example, blood sugar runs higher than normal. That\u2019s actually how you identify and diagnose a person with diabetes: they have elevated blood sugar.<\/p>\n
How to Measure Blood Sugar<\/h2>\n
There are several ways to measure blood sugar.<\/p>\n
- \n
- The basic finger prick:<\/strong> Prick your finger, produce a few drops of blood, place blood on test insert, test blood sugar level. It\u2019s the most common method.<\/li>\n
- Fasting blood sugar<\/strong>: Your blood sugar level when fasted. These tests are usually taken first thing in the morning, because that\u2019s the only time most people haven\u2019t eaten in the last few hours. \u201cNormal\u201d is under 100.<\/li>\n
- Postprandial blood sugar<\/strong>: Your blood sugar after eating. These tests measure your blood sugar response to food; they also measure your ability to dispose of blood glucose.<\/li>\n
- HbA1C<\/strong>: Average blood sugar over 2\/3 months. HbA1c measures the degree of glycation of your red blood cells\u2019 hemoglobin; this is an indirect measure of how much blood sugar your cells are exposed to over time, since a red blood cell that\u2019s exposed to more sugar in the blood over its life cycle\u20142-3 months\u2014will have more glycation. Thus, A1c seeks to establish the average level of blood sugar circulating through your body over the red blood cell\u2019s life cycle, rather than track blood sugar numbers that rapidly fluctuate through the day, week, and month. It\u2019s a measurement of chronic blood sugar levels, not acute.<\/li>\n
- The continuous glucose monitor<\/strong>: A wearable device that measures your blood sugar at regular intervals throughout the day and night. This is becoming more common. The beauty of the CGM is that you get a visual display of blood sugar\u2019s rise and fall throughout the day in response to meals, workouts, fasts, stress, etc. Since elevated blood sugar does its damage over the long term, seeing the entire daily trend is more illuminating than taking single snapshots with a finger prick. It\u2019s similar in power to HbA1c, only with greater accuracy.<\/li>\n<\/ul>\n
What\u2019s \u201cNormal\u201d Blood Sugar?<\/h2>\n
According to the American Diabetes Association, any fasting blood sugar (FBG) under 100 mg\/dl is completely normal<\/strong>. It\u2019s safe. It\u2019s fine. Don\u2019t worry, just keep eating your regular diet, and did you get a chance to try the donuts in the waiting room? They only start to worry at 110-125 (pre-diabetic) and above 125 (diabetic).<\/p>\n
This may be unwise. Healthy people subjected to continuous glucose monitoring have much lower average blood glucose\u201489 mg\/dl. A 2008\u00a0study found that people with a FBG of 95-99\u2014still \u201cnormal\u201d\u2014were 2.33 times more likely to develop diabetes in the future<\/strong> than people on the low-normal end of the scale.<\/p>\n
As for postprandial blood glucose, the ADA likes anything under 140 mg\/dl.<\/p>\n
How about HbA1c? A \u201cnormal\u201d HbA1c is anything under 5.7. And 6.0 is diabetic. That\u2019s what the reference ranges, which mostly focuses on diabetes. What does the research say? In this\u00a0study, under 5 was best for heart disease. In this study, anything over 4.6 was associated with an increased risk of heart disease.<\/p>\n
That 5.7 HbA1c isn\u2019t looking so great.<\/p>\n
Why Normal isn\u2019t Necessarily Normal<\/h3>\n
What\u2019s \u201cnormal\u201d also depends on your baseline state.<\/p>\n
Healthy FBG depends on your BMI<\/strong>. At higher FBG levels, higher BMIs are protective. A recent study showed that optimal fasting blood glucose for mortality gradually increased with bodyweight. Low-normal BMIs had the lowest mortality at normal FBG (under 100), moderately overweight BMIs had the lowest mortality at somewhat impaired FBG (100-125), and the highest BMIs had the lowest mortality at diabetic FBG levels (over 125).<\/p>\n
If you\u2019re very low-carb, postprandial blood glucose will be elevated after a meal containing carbs<\/strong>. This is because very low-carb, high-fat diets produce\u00a0physiological insulin resistance to preserve what little glucose you have for the tissues that depend on it, like certain parts of the brain. The more resistant you are to insulin, the higher your blood glucose response to dietary glucose.<\/p>\n
HbA1c depends on a\u00a0static red blood cell lifespan<\/strong>. A1c seeks to establish the average level of\u00a0blood sugar\u00a0circulating through your body over the red blood cell\u2019s life cycle, rather than track blood sugar numbers that rapidly fluctuate through the day, week, and month. If we know how long a red blood cell lives, we have an accurate measurement of chronic blood sugar levels. The clinical consensus assumes the lifespan is three months. Is it?<\/p>\n
Not always. The life cycle of an actual red blood cell differs\u00a0between and even within individuals, and it\u2019s enough to\u00a0throw off the\u00a0results by as much as 15 mg\/dl.<\/p>\n
Ironically, people with healthy blood sugar control might have inflated HbA1c levels<\/strong>. One\u00a0study found that folks with normal blood sugar had red blood cells that lived up to 146 days, and RBCs in folks with high blood sugar had life cycles as low as 81 days. For every 1% rise in blood sugar, red blood cell lifespan fell by 6.9 days.<\/p>\n
What does this mean?<\/p>\n
- \n
- In those with better blood sugar control, RBCs lived longer and thus had more time to accumulate sugar and give a \u201cworse\u201d HbA1c reading.<\/li>\n
- In people with poorer blood sugar control, red blood cells live shorter lives and have less time to accumulate sugar, potentially giving them \u201cbetter\u201d HbA1c numbers.<\/li>\n<\/ul>\n
Anemia can inflate HbA1c<\/strong>. Anemia depresses the production of red blood cells. If you have fewer red blood cells in circulation, the ones you do have accumulate more sugar since there are fewer cells \u201ccompeting\u201d for it. Anemia isn\u2019t anything to sniff at, but it does throw off HbA1c.<\/p>\n
Health Effects of High Blood Sugar<\/h3>\n
Okay, is hyperglycemia actually a problem? I\u2019ve heard some suggest that hyperglycemia is a\u00a0marker<\/em> of poor metabolic health, but it\u2019s not actually causing anything bad itself. I agree with the first part\u2014hyperglycemia indicates poor metabolic health and is a risk factor for things like heart disease and early mortality\u2014but not the last. Indeed, hyperglycemia is both an effect and direct cause of multiple health issues.<\/p>\n
Most cell types, when faced with systemic\u00a0hyperglycemia, have mechanisms in place to regulate the passage of glucose through their membranes. They can avoid hyperglycemic toxicity by keeping excess sugar out. Other cell types, namely pancreatic beta-cells, neurons, and the cells lining the blood and lymphatic vessels, do not have these mechanisms. In the presence of high blood sugar, they\u2019re unable to keep excess sugar out. It\u2019s to these three types of cells that hyperglycemia is especially dangerous.<\/p>\n
Unfortunately, these are all pretty important cells.<\/p>\n
What happens when too much glucose makes it into one of these cells?<\/strong><\/p>\n
Reactive oxygen species\u00a0(ROS) generation is a normal byproduct of glucose metabolism by the cell\u2019s mitochondria. If the stream of glucose into the cell is unregulated, bad things begin to happen:\u00a0excessive\u00a0<\/em>ROS, a mediator of increased oxidative stress; depletion of glutathione, the prime antioxidant in our bodies;\u00a0advanced glycation endproduct (AGE) formation; and activation of protein kinase C, a family of enzymes\u00a0involved in many diabetes-related complications. It\u2019s messy stuff.<\/p>\n
How does this play out in the specific cell types that are susceptible, and what does it mean for you?<\/strong><\/p>\n
Pancreatic beta-cells<\/strong>: These cells are responsible for secreting insulin in response to blood glucose. They essentially\u00a0are<\/em>\u00a0the first line of defense against hyperglycemia. If maintained for too long or too often, hyperglycemia inhibits the ability of pancreatic beta-cells to do their job. For instance, type 2 diabetics have\u00a0reduced pancreatic beta-cell mass; smaller cells have lower functionality. Mitochondrial ROS (often caused by hyperglycemia) also reduce the insulin secreted by the cells, thereby reducing their ability to deal with the hyperglycemia and compounding the initial problem.<\/p>\n
Neurons<\/strong>: The brain\u2019s unique affinity for glucose makes its glucose receptor-laden neuronal cells susceptible to hyperglycemia. It simply soaks up glucose, and if there\u2019s excessive amounts floating around, problems arise. Hyperglycemia is\u00a0consistently linked to cognitive impairment,\u00a0causes the\u00a0shrinking of neurons and the inducement of spatial memory loss, and\u00a0induces neuronal oxidative stress. It also impairs the production of nitric oxide, which is involved in the hippocampus\u2019 regulation of food intake.<\/p>\n
Endothelial cells<\/strong>: Flow mediated dilation (FMD) is the\u00a0measure of a blood vessels\u2019 ability to dilate in response to increased flow demands. Under normal conditions, the endothelial cells release nitric oxide, a vasodilator, in response to increased shear stress. Under hyperglycemic conditions, nitric oxide release is inhibited and FMD reduced. Lower FMD means your endothelial function is compromised and may cause atherosclerosis.<\/p>\n
Electrolyte depletion<\/strong>: Persistent hyperglycemia can cause the body to shed glucose by urinating it out. In doing so, you also end up shedding electrolytes.<\/p>\n
Okay, okay. Controlling your blood sugar is important. Avoiding hyperglycemia is one of the most important things you can do for your health and longevity. How do I do it?<\/p>\n
How to Improve Blood Sugar<\/h2>\n
- \n
- Go for a walk<\/strong>. A short walk after eating will reduce blood sugar. Fifteen minutes is probably enough (although more is always better).<\/li>\n
- Eat vinegar before<\/strong>. Eating vinegar before a meal that contains carbohydrates will improve the blood glucose response to that meal.<\/li>\n
- Exercise<\/strong>. Exercise depletes muscle glycogen, which opens up storage depots for incoming glucose. If glucose is converted to glycogen and deposited in your muscles, your blood glucose will normalize. Pretty much any kind of exercise works.<\/li>\n
- \n
- \n
- Sprint and\/or intervals<\/strong>. A review looked at the blood glucose responses of diabetics (type 1 and type 2) to \u201cbrief high intensity exercise,\u201d as which sprinting definitely qualifies, finding that although glucose was elevated immediately post workout, blood glucose control is improved for one to three days following a sprint session. Research finds that endurance training works, too, but sprinting may work faster and better.<\/li>\n
- Steady state endurance<\/strong>. Then again, steady state endurance training was just as effective as sprinting at reducing glucose variability and improving glucose spikes in overweight women. There was no difference between the two\u2014both beat doing nothing.<\/li>\n
- Resistance training<\/strong>.<\/li>\n
- All of the above<\/strong>. As different types of training target different tissues, deplete glycogen at different rates, and induce different metabolic effects, doing sprints, weights, and low level aerobic activity is your best bet for improving glucose control.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
When I take a bird\u2019s eye view of all this, the best glucose-lowering exercise is the one you\u2019ll do on a regular basis. It\u2019s all good.<\/p>\n
- \n
- Avoid unnecessary carbohydrates<\/strong>. Carbs you earn through glycogen-depleting exercise will not contribute to hyperglycemia. Those are \u201cnecessary,\u201d or at least \u201cearned.\u201d Carbs you didn\u2019t earn will contribute to hyperglycemia. A surefire way to avoid hyperglycemia is to avoid the foods that induce it\u2014carbs.<\/li>\n
- Eat more protein and fat, fewer carbs<\/strong>. This is a simple one for most of you guys, but many people never consider it. A basic swap of whole eggs (or egg whites) for carbs reduces not just postprandial glycemia but also endothelial dysfunction.<\/li>\n
- Get enough sleep<\/strong>. Sleep deprivation increases blood glucose variability and impairs regulation.<\/li>\n
- Eat fermented dairy<\/strong>. Kefir improves glycemic control in patients with type 2 diabetes. Yogurt does too. Cheese is also associated with better glucose control.<\/li>\n
- Use spices<\/strong>. Spices can have profound anti-hyperglycemic effects.<\/li>\n<\/ul>\n
If you\u2019re low-carb or keto and need to pass a glucose tolerance test, eat 150-250 grams of carbs per day in the week leading up to the test<\/strong>. This will give you a chance to shift back into sugar-burning mode.<\/p>\n
For long-term glucose control<\/strong>, consistency is everything<\/strong>. Consistently doing all the little tips and hacks we just went over that lower blood sugar in the moment will lead to long term blood sugar control. If you take vinegar before and walk after every single meal for the rest of your life, you will control postprandial blood sugar for life. If you avoid excess carbohydrates, you will exert long-term control over blood sugar levels. If you exercise 3-4 times a week and get plenty of low-level activity, you\u2019ll be much less likely to have hyperglycemia.<\/p>\n
Thus concludes the Definitive Guide to Blood Sugar. If you have any questions or comments, drop them in down below. Thanks for reading!<\/p>\n
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- Eat more protein and fat, fewer carbs<\/strong>. This is a simple one for most of you guys, but many people never consider it. A basic swap of whole eggs (or egg whites) for carbs reduces not just postprandial glycemia but also endothelial dysfunction.<\/li>\n
- Steady state endurance<\/strong>. Then again, steady state endurance training was just as effective as sprinting at reducing glucose variability and improving glucose spikes in overweight women. There was no difference between the two\u2014both beat doing nothing.<\/li>\n
- Eat vinegar before<\/strong>. Eating vinegar before a meal that contains carbohydrates will improve the blood glucose response to that meal.<\/li>\n
- Go for a walk<\/strong>. A short walk after eating will reduce blood sugar. Fifteen minutes is probably enough (although more is always better).<\/li>\n
- Fasting blood sugar<\/strong>: Your blood sugar level when fasted. These tests are usually taken first thing in the morning, because that\u2019s the only time most people haven\u2019t eaten in the last few hours. \u201cNormal\u201d is under 100.<\/li>\n
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