What is Blood Sugar and Why Does it Matter?

Blood sugar, or glucose, is the primary fuel source for our cells. When we eat, especially carbohydrates, our blood sugar levels rise. In response, our body releases insulin, a hormone that helps cells absorb this glucose. However, frequent large spikes in blood sugar, high variability in levels throughout the day, or consistently elevated fasting glucose can lead to various health issues over time.

By carefully managing blood sugar levels — keeping them stable and avoiding extreme highs and lows — we can potentially improve our overall health, reduce the risk of chronic diseases, and possibly extend our lifespan and healthspan.

Why Managing Your Glucose Levels is Crucial

Managing your glucose levels is important for the following reasons:

• Diabetes Prevention and Management: For those with type 1/2 diabetes, insulin resistance, or prediabetes, balancing glucose levels is crucial. For others, it can help prevent developing these conditions.
• Reduce Inflammation and Slow Aging: Stable glucose levels can decrease systemic inflammation and slow down glycation, a process that contributes to aging.
• Long-term Disease Prevention: Proper glucose management may reduce the risk of Alzheimer's disease (sometimes called "type 3 diabetes"), fatty liver disease, and certain cancers.
• Overall Well-being: It can improve your immune system function, sleep quality, mental clarity, hormonal balance, and even skin health.

Understanding Glucose Variability

Recent research suggests that glucose variability — the swings between highs and lows — might be even more important than average glucose levels:

• Aim to minimize glucose swings rather than just focusing on average levels.
• Target postprandial (after meal) peaks below 140 mg/dL, ideally under 120 mg/dL.
• For optimal health, aim for fasting glucose below 85 mg/dL.

The Nature of Glucose Spikes

It's normal and necessary to experience some increase in blood glucose after eating. Our goal isn't to eliminate spikes entirely, but to moderate them:

• Spikes occur as your body digests and processes food, converting it to glucose for energy.
• The concern is with extreme, prolonged spikes, which can lead to oxidative stress, glycation (protein damage), and over time, insulin resistance.

The Insulin-Glucose Dance

Understanding the relationship between insulin and glucose is key:

• Insulin is the primary hormone responsible for regulating blood glucose levels.
• It signals cells to absorb glucose from the bloodstream and inhibits the liver from producing more glucose.
• Insulin sensitivity refers to how effectively your cells respond to insulin. Better insulin sensitivity generally indicates better metabolic health.

How to Track

There are several methods to track your glucose levels, each with its own advantages:

• Continuous Glucose Monitoring (CGM): Now more affordable and accessible, CGMs provide real-time, continuous data on glucose fluctuations. It's recommended to use a CGM for 2-4 weeks to understand your baseline levels, diet/nutrition impact, and lifestyle modifications. After this initial period, you can discontinue usage and potentially check again 1-2 times per year or when making major lifestyle changes.

• Hemoglobin A1C (HbA1c) Test: This blood test, typically part of regular physicals, measures your average blood sugar level over the past two to three months. It's a useful long-term indicator and can serve as a sanity check once you discontinue CGM use.

• Glucose Tolerance Test: While more of a diagnostic tool for prediabetes or type 2 diabetes, this test can show how your body responds to a glucose challenge. However, for most people, CGM and HbA1c tests should provide sufficient information at a lower cost and with more convenience.

Analyzing Your Data

When reviewing your glucose data, consider:

• Your fasting blood glucose levels
• The variability in your levels and what your spikes look like after meals
• How specific foods and lifestyle factors impact your glucose levels

Become your own scientist: experiment with different foods, meal timings, and activities to see how they affect your glucose levels. Try things like having an apple for a snack vs. some mixed nuts; going for that walk after dinner; experimenting with food order in your meal, etc. Remember that your main focus is to blunt / mitigate those large spikes in your blood sugar levels.

Strategies for Better Glucose Management

Food Order and Composition

1. Start with Fiber and Protein:
   • Begin meals with fiber-rich vegetables and proteins before consuming carbohydrates.
   • Example: Start with a salad and grilled chicken before having pasta.
2. Strategic Meal Composition:
   • Pair carbohydrates with proteins, fats, and fiber to slow glucose absorption.
   • Choose complex carbohydrates over simple sugars. (e.g., whole grains instead of white bread)
   • Opt for savory breakfasts (e.g., eggs with vegetables and chicken sausage instead of pancakes and syrup)

Lifestyle Hacks

1. Post-Meal Movement: Take a 10-minute walk after meals, do some air squats / light yoga, or just do some chores that involve moving around and being moderately active. If your schedule doesn't allow for this, consider doing some light exercise before the meal, although studies suggest that post-meal activity is slightly more effective.

2. Regular Exercise: Incorporate strength training and high-intensity interval training to improve insulin sensitivity and use up glycogen stores.

3. Prioritize Sleep: Aim for 7-9 hours of quality sleep for better next-day glucose control. If you get a bad night of sleep, consider eating fewer carbs that day.

4. Stress Management: Chronic stress elevates cortisol, which can increase blood glucose. Try things like yoga, meditation/breathing exercises, keeping your house clean, spending quality time with family / friends, reducing social media use, staying active, spending time in nature, etc.

5. Vinegar Hack: Consider consuming 1 tablespoon of vinegar (diluted in water) before carb-heavy meals to potentially improve glucose response. You could use Apple Cider Vinegar, Balsamic Vinegar, etc., in your salad dressing, try a fancy shot, or just dilute vinegar in water and drink it directly.

Action Items

• Purchase a continuous glucose monitor to track your data (Lingo or Stelo seem like good options. I'm currently trying Lingo, will update this with my thoughts after a couple of weeks. One negative thing I don't like is that there isn't any obvious way to export the data into Apple Health, but I'll see if there are any workarounds here)
• If you drink sugary beverages, eliminate them! These are so bad for you, stop drinking soda, iced coffee with tons of sugar in it, fruit juices, etc. No no no!
• Play around with food order and meal composition to see what works for you. Two main takeaways are to have savory breakfasts and to try eating lunch/dinner where you have a salad or veggies, then your protein, then your carbs (and try to have more "complex carbs" vs. simple carbs)
• Start going for walks or doing chores where you're up and moving after eating carb heavy meals
• If you don't already, start incorporating some resistance training and/or HIIT workouts to regularly deplete glyocen levels and improve insulin sensitivity / resistance
• Do whatever you need to do to manage your stress (I find personally that keeping my house clean, spending time with family/friends, staying active, and getting good sleep helps a lot)
• Really try to get quality sleep if you can, make it a priority. Some little tricks here would be to have a consistent shut down ritual, stretch and hot shower / bath before bed, turn your devices off, consider using a sleep mask and/or earplugs, keep the bedroom cold, etc.

Conclusion

Optimizing glucose management is a powerful lever for overall metabolic health, potentially reducing risks of various chronic diseases. There are new relatively inexpensive tools to measure and evaluate, and some practical lifestyle hacks to consider. Personally, I'm particularly interested in anything that can be done to reduce likelihood of cardiovascular disease, risk of diabetes, or (especially) alzheimer's and other neurodegenerative diseases

Notes / Resources

• Outlive by Peter Attia, especially Chapter 6: "The Crisis of Abundance"
• Jessie Inchauspé, aka The Glucose Goddess, has some great review of scientific papers

TODO: Insights

• I just started using CGM, I'll track some bullet points of things I discovered that surprised me or were useful insights.
• I can't believe how much white rice made my blood sugar skyrocket. It almost immediately jumped up from 90 mg/dL to 130 mg/dL!

TODO: Appendix

Add references and specific details around disease prevention here