I’ve been reading and watching stuff on diabetes for years because I have family with it so I want to prevent it for myself. I’ve never once seen someone say 120 was deadly. 120 isn’t even a diabetic fasting glucose. Not sure what you read, but it’s probably a troll trying to scare uneducated viewers.
No, the problem is type twos are broken. We don’t spike for 30 minutes. We spike for 2 to 3 hours sometimes and it may take days to actually get back to normal since we know we are broken. It’s better to minimize the spike as much as possible or less is, zero spike meal is better, every spike and long duration with high insulin and BG is damaging
I almost have no words for how impressed I was by this video. I just started using one of the new OTC CGMs and was wondering what criteria was being used for its spike notifications. I still am not sure - maybe it is the rise by 30. But thank you ever so much for the extended description of studies on normal individuals, and on what patterns correlate to chronic disease. You have just won a new subscriber!
Great video! I despise all these fear-mongering influencers and "doctors". It's so irresponsible and partly even dangerous. And then people copy these weird and silly arguments, share them on social media and with friends and contribute. So thank you for doing what you're doing!
This video was outstanding. I began wearing a CGM after a T2 diagnosis. I moved to a low carb diet and have seen my A1C drop from 9.5 to 5.2 and lost 50lbs. I continue to wear a CGM to hold myself accountable in managing glucose spikes. I have been using 160 as my definition of a spike and focus managing post meal increases to 160 or below. I really appreciate your time educating us with facts based upon science.
If the keto diet is working for you, that’s great. Just be aware that it will make insulin resistance worse in the background. A diet high in saturated fat is how scientists cause insulin resistance in lab rats for studies. Keto makes the numbers look better, but the only way to reverse type 2 permanently is a very low fat diet high in whole plant foods and low in animal products. Not trying to discourage you because you’ve made a ton of progress! I just want you to know the truth. The End of Diabetes by Dr. Joel Fuhrman and the book Mastering Diabetes do an amazing job explaining the science behind it if you want to learn more.
@tarabooartarmy3654, I am sorry to disagree. If you watch the video linked below, there is basically no impact of the dietary macronutrient composition on insulin resistance, once we take body weight changes out of the equation. And similarly, the science on the impact of saturated fatty acids and their impact on insulin resistance is not nearly as clear as suggested by these and other individuals. When considering the cumulative evidence, I do not hold the view that a ketogenic diet or saturated fatty acids trigger insulin resistance. And I am saying this as someone who has published one of the few papers showing negative effects of a diet rich in saturated fatty acids on insulin sensitivity. ruclips.net/video/ZcVenUbqsYY/видео.htmlsi=3zGTlJvoo2whKcvS However, a very low-carb diet such as a ketogenic diet will reduce insulin secretion, and specifically the first-phase insulin response, temporarily. That is a reversible phenomenon, and people on low-carb diets do well do eat all of their meals low-carb, and to reintroduce carbs slowly should they want to switch to a higher-carb diet. Sadly, some studies showing impacts of low-carb diets on glucose tolerance have been incorrectly interpreted by proponents of plant-based diets as suggesting that dietary fat or saturated fat trigger insulin resistance. This is, IMO, not supported by the cumulative evidence. The effect seen in these studies instead is a reduction in glucose tolerance induced by reduced insulin secretion. Best, Mario
Another top-notch presentation. Highly recommended. I really love Mario's dispassionate no-nonsense presentation style as well as the high level of the information he presents.
I’d like to see you do a video about the long-term 22:01 health risks of someone who has pre diabetes for say 5 plus years- An A1C of 5.7 to 6.1 for example. This person has higher fasting blood sugars - say 5.7 to 6.3 - but no spikes above 7.8.
Thanks Mario. I wish the folks at ZOE were similarly clear about what exactly we should be concerned about and what we shouldn’t. I hope they invite you to do a ZOE podcast soon and you can put them straight. Although something tells me that your message might actually cost them because their low level fear-mongering is a significant source of revenue for the ZOE brand. More power to you. Danke aus Schottland!
one of the best video on the internet, absolutely well explained and as a scientist, I appreciate all the data and very well presented data! very well done!!!
As always, Thank you Mario! You have placed definitive cutoff readings so frequently presented within an understandable context but retained an awareness of their relevance. It is not real easy to work out personal glucose tolerance but you have removed some of the angst by providing a way forward. Cheers
Excellent presentation! Low carbers may note: A slower insulin response is normal (07:03) after months of carb restriction. One way to make sure is by a HOMA IR test which will quantify(?) the IR. By the way, Cortisol response due to psych. factors (fight/flight) plays havoc with blood sugar 🙄. (One solution for this is to water fast for 6~8 hours after such events.)
Thank you so much for this informativ video. I have missed your Videos so much. You have said, that after a low carb diet, we should integrate more carbs to restore our insulin respond. Could you explain why?
If you're regularly consuming carbs, the pancreas will be used to responding to them, and will actually keep some premade insulin stored so it can respond and release it right away. When you don't eat carbs it stops keeping that store because you don't need it. Then when you eat carbs unexpectedly the beta cells have to make all the insulin on the spot. So it is a slower response. But if you consume carbs for a while again the pancreas will know it needs to maintain that store again
Thanks Mario for another superb balanced video based on science. I found one study based on oggt that suggested 1hr > 155 could be predictive for diabetes ( jcem 1hr postload hyperglycaemia 2018 fiorentino ...link wont upload) would be grateful for your views on whether this could extend to food. Thank you again for all your work.
Yes, I know that paper. It's interesting, but I am not sure it holds a lot of value for the layperson, beyond what I shared in this video. First, the papers are based on OGTTs, which constitute a very different glycemic load than normal meals. Second, the paper in essence just shows that people with higher postprandial blood glucose to a standardized load have a higher risk of later developing diabetes. That is hardly surprising, right, because glucose intolerance is a continuous process, and it would seem plausible that hyperglycemia and glucose intolerance develop gradually. That said, for most people, the spike after a meal occurs around 45 min after the start of the meal. That means that glucose levels should be on a downward movement at 60 min, and if they consistently are still above 155 mg/dL, that would strike me as a sign of at least mild glucose intolerance. Again, because the data suggest that increases in blood sugar into the 140-180 mg/dL range do occur even in very glucose tolerant people, but they are infrequent and brief. Best, Mario
@@nourishedbyscience Thanks Mario for a really detailed answer ... that is what I took from the paper too (and yes not a lay person) but many are looking for optimal and like you I believe this is an area where we can get over worried so will include this paper when i present my findings... you are so good to help us all in this way.
This was very interesting and quite informative. Thank you for doing it. And thank you for mentioning that laying on a sensor can cause a low reading. I have been involved in a face group group for type twos in which it comes up regularly. Usually when someone new to cgm's is woken up by the alarm and not understanding its a fluke takes an excessively large amount of sugar with out doing a blood sugar check to confirm what was going on.
Better test of diabetes is measuring insulin. HOMA IR or Kraft insulin Assay Test. Early detection is better than cure. Hyperinsulinimia even if blood sugar thresholds are still normal. Definition of diabetes should change
Diabetes is actually insulin resistance + Relative Insulin Deficiency because pancreatic Beta cells fatigue or dysfunction= Type 2 Diabetes. Or not able to follow Insulin's Own Natural Circadian Rhythm.
Measuring insulin is not a 'better test of diabetes'. By definition, diabetes is a condition of glucose intolerance, and while related to insulin resistance, is not the same. Let's try to be clear and not muddle up things. Insulin resistance is important, and you'll find many videos on my channel about that as well, but glucose intolerance and hyperglycemia are independent risk factors for many severe chronic diseases in their own right. My position is we should normalize both insulin sensitivity and glucose tolerance, but this video was just about glucose tolerance and glycemia. Best, Mario
@@nourishedbyscience Science is challenging the status quo. Proving existing guidelines wrong. High insulin levels using root cause analysis and 5 why's will show that high insulin levels even if your glucose value is still low is abnormal from the acceptable fasting insulin levels or using Kraft insulin Assay Test. Catching this high insulin levels early will be the best way to cure Diabetes faster and easier with low carb or keto diet
@@nourishedbyscience Best to challenge the status quo of a glucose centered approach to diabetes. The only constant thing in this world is to change for the better
Thank you for this video! I found your videos a year ago after questioning the 30mg/dL rise being touted as “unhealthy” and subsequently changing CGM companies for this reason. I know exactly which company you’re talking about 😉
The average glucose rise needs to be accompanied by the deviation range. But otherwise I’m pleased with your presentation. BTW, I am a Type 1 diabetic over 31 years.
If someone meets the criteria, as outlined, their SD will be low. And I beliebe that these criteria are more intuitively grasped by most people than SD. Cheers Mario
I have glucose peaks of 170 to 200 when I eat more than 30 to 70 grams of carbohydrates in a single meal, after 2 hours it drops to 80 to 70, sometimes it goes from 150 to 80 in 15 minutes. But, I just finished the keto diet 3 days ago, so I guess as the days go by I will improve. My fasting insulin at the end of the diet was 2.4 fasting, meaning I wasn't producing enough insulin I guess.
Your low fasting insulin probably means that you are very insulin sensitive. My best guess is that you have a (temporarily) diminished first-phase insulin response due to your long-term low-carb diet. The first-phase insulin response is based on pre-formed insulin that is stored in the pancreatic beta-cells and that can be secreted into the blood within seconds of consuming carbs. That first insulin secretion prevents a spike from happening. Just re-introduce carbs a bit more gradually, and eat some non-starchy veggies or salad AND some protein before you eat carbs for the next few weeks. That'll slow down your carb digestion, and the protein also stimulates insulin secretion before your carbs are absorbed. Cheers Mario
Yes, correct, but IMO, this criterion should not be applied to CGM data without further testing, as the false positive rate would be too high. I think the issue is that if a patient comes into a doctors office once, usually fasting or a while after eating, and has a glucose > 200 mg/dL, the likelihood that they indeed have diabetes is high. However, with CGM, we get data every 5 minutes, including immediately after eating, and I don't think that the relationship between sensitivity and specificity of the random glucose test hold up very well under these conditions. I am hoping that we get updated criteria on this with CGM data, and would assume that the threshold for when diabetes is suspected is going to be a bit higher than 200 mg/dL. Cheers Mario
Im wearing a cgm. Only for 14 days. Early on I noticed that porridge ( not instant, steel cuts oat) accompanied by Greek yoghurt made my blood sugar rise by a good 50 mg/dl. From about 80 mg/ dl to 130. So I was quite apprehensive to test 75 g glucose. But if you don't try you don't know so I did and it rose by 55 mg/dl. I expected more tbh. Or porridge and Greek yoghurt to make it rise less. I'm not diabetic nor pre diabetic and my blood sugar is able to rise from 85 to 140/ 145, easy so quite a jump. Then i it will start going down then back up again down up again for about 5 or even 6 hours hours if I consume a big meal including carbs. To reduce that length I can go for a fast walk and iit will go down quicker tho. My blood sugar rises quite a lot when I exercise. It also rises when I take a shower or do the dishes. Also when I fast. It seems whenever I need extra energy it will rise which I found strange at first but ok.. Also I tend to experience hypoglycemia ( or is that dawn syndrome or reactive hypoglycemia?) at night. But when I replace sweet snack by cheese or an avocado or don't snack at all tthen I don't go hypoglycemic. I managed to reduce this occuring from 11% to 2% so wearing a cgm has been great if only for that). Hopefully that helps give my liver a break and having to" rescue me" ;-) My BMI is 20.2 and AC1 4.7% Fascinating experience imo. It's been like a little journey within some part of my body that was so far unknown. Thank you very much for another outstanding video.
Dear Mario, I appreciate the valuable educational content you provide. Regarding your discussion on high LDL levels, are you advocating for a reduction in the intake of foods high in saturated fats, such as full-fat dairy products and red meats? also about Visceral fat storage dysfunction is a contributing factor to diabetes. If dietary and lifestyle changes are not effective, what are the recommended safe medical intervention. Thank you in advance for your response and effort.
Very useful, thank you. That being said, I am still not clear on the difference between normal and optimal. A spike to say 170 may be normal but is it optimal? Is it something to be OK with if it happens daily? More to the point, is the pancreas meant to be "exercised" once in a while with carb challenges or is it more like the liver with respect to alcohol, i.e. a healthy one can handle 4 drinks but, really, optimal is as little as possible. Between the two extremes: keto vs very high carb diet would you say moderate low and complex carb would be ideal?
I don't think we have any data to support any specific macronutrient composition as optimal for everyone. If someone is glucose intolerant, they may benefit from reducing their carb content, at least until their glucose tolerance has been normalized. My sense is that currently we do also do not have any data to link short blood sugar increases into the 140-180 mg/dL range to negative health outcomes. It is possible, as you say, that it's suboptimal, but that would be a guess and not based on any data I am aware of. Best, Mario
I am one of those otherwise healthy people who wore a CGM for a month. I follow a predominantly plant-based diet. My glucose levels would “spike” every time I ate anything. I could have avoided spikes by swapping my fruit and beans for beef jerky and hard boiled eggs. I’ll stick with my plants and take my chances!
This was very good, indeed one of the best looks at the published data deciphered for a general audience. BUT the final synthesis, by emphasizing being under 140 mg/dL “most of the time,” missed the most important metric a CGM can give: average blood glucose (ie, area under the curve). Having a healthy average blood sugar between 90 and 100 mg/dL would not result if one were at around 130 “most of the time.” It’s really down to how readily one returns to a fasting level after their meals.
I suggest that if someone meets all of the criteria, as outlined, their average blood glucose will be low. That is because there are exactly zero people who have normal glucose tolerance and who keep their blood sugar in the 70-140 mg/dL range 95%+ of the time who have stable blood glucose at 130 mg/dL for more than a few minutes. If someone can regulate their blood sugar as I outline as normal, then their blood sugar will never just hang around 130 mg/dL. Does that make sense? Best, Mario
Maybe the discrepancy with normal individuals is not normal it’s because the food is so substantially changed and inferior quality worse every day that it could negatively affect the blood glucose response and evolution has certainly not caught up with our inferior food supply
Thanks for the video. BTW, given glucose concentration 5mmol/L and molar mass 180g/mol, the homeostatic glucose in the blood in human readable form is 0.9g/l or 4.5g for the whole 5 liters blood volume. The glucose adsorption is around 96%. There is the question: why we abuse the body with the external glucose in many times bigger concentration that body have? We know that there is no storage for glucose nowadays for sedentary population.
I feel strongly that the issue we should address is glucose intolerance, and that blaming carbs is short-sighted. If someone is glucose tolerance, they can eat all the carbs they want and not have any problems. What we should be talking about a lot more is why people are glucose intolerant, and - again - it's not carbs per se IMO. Best, Mario
@@nourishedbyscience , thanks. Based on Glucose - Fatty acid cycle, historically, we rarely mixed glucose with non-glucose sources, until last 12-10k years ago. Given that, the genetic and evaluation aren't fast process, IMO, I'm still not convinced it was long enough to get humans adapted to such glucose surge every meal. BTW, Homo Paranthropus extinct.
Still.....how do we know that we're even supposed to eat the foods that raise the blood sugar that much? Also how do we know what normal is if the study's general purpose is to find exactly that with "normal" individuals?
This is an excellent question. Love this. Thanks. My view here is that from observing the normal range in which the body keeps glucose regulated, we can actually get a sense of which foods our ancestors ate as we evolved. From the data I shared, it does seem very clear that the body makes substantial efforts to keep blood glucose in the 70-180 mg/dL AT ALL TIMES. That is absolutely remarkable, because the amounts of glucose we often eat in a typical mixed meal are multiples of the total glucose content in all of our blood. And this system shows some evidence of redundancies, such that defects in one component can be compensated by another component (insulin resistance can be compensated by higher insulin secretion). So the fact that such a nuanced, robust glucose homeostatic mechanism exists seems like indirect evidence to me that humans are adapted to consume glucose-containing foods (sugar, starch). To phrase differently, our body does NOT seem to have any homeostatic mechanisms to always keep blood glucose in the 70-100 mg/dL. Admittedly, this is not strong, conclusive evidence, but to me suggests that humans evolved on diets that contained at least some carb-containing foods. Cheers Mario
@@nourishedbyscience Very interesting look....you can definitely find logic in that. But going the same route...how about blood pressure regulation? BP is also pretty tightly regulated and the body if healthy would increase it to 150/100 for example when stressed. But these days everybody is stressed overtime, numbers climb and we have new normal. Despite many people are very sick and have degenerated cardiovascular system, the body is still giving its best to keep the numbers under 200 systolic. But that's not healthy we can agree? Acute stress is better than chronic stress....but lower instances of acute stress is even better. If I eat as similar as possible to our ancestors, my glucose would absolutely never rise more that 20-25mg/dl. Also if we get even more basic - if we're close to peeing out sugat at that levels 180mg/dl.....how the hell would testing the absolute limits of the system regularly be healthy?
my CGM (freestyle Libre) always shows my fasting blood glucose in 80's and 90's in the morning but glucometer always shows 10 points more (i.e 100 or above.)
I don't know I think people who say that 30 mg/ dl rise is too much are on keto or something. Im not diabetic nor prediabetic, my AC1 is 4.7 , average blood glucose level 88 and I observe 50 mg/ dl rises .
That happens to a lot of people, in fact during intense exercise I think it's normal to have blood glucose above 150 for many people and it's not a sign of being unhealthy. The highest my blood glucose has ever been is 160 and it was after doing a 3 mile run with five max effort sprints thrown in, all while about 15 hours fasted.
Thank you. I thought so. Mine went from 77 to 107. So not out of the ordinary. I'm just getting back to exercise and probably overdoing it. Pushing myself is going to recruit stress hormones to raise blood sugar. I'm 73 but previously very fit.
My father-in-law recently is on CMG and has been diabetic for years and have all the medications taking consistently, after meals, his glucose level is around 380. That is our worries but by the morning come, his number is below 200 which is good to me. We are very conscious about his diet too. He has low carb diet for years too like browse rice, protein and fiber. Any suggestions will be help. Thanks
Also, recently learning from glucose goddess hack by taking the protein intake before the starch and coffee in the breakfast, I notice the glucose results very nicely like around 220. But it is only for a few days, but then it goes back way high again. I scratch my head … His normal breakfast is like eggs, cereal/ oatmeal and a cup of those Asian instant coffee.
Here is example today. Before breakfast glucose 170. Then just a couple toast with peanut butter (2 tblespoon) no coffee. A couple hour later 326. So the worry is roller coasting.
If you are not type 1 diabetic, stop worrying about this! 🤷♂️🤦♂️Get an A1c test instead. You might better be off worrying about hormone 😮levels, and you likely don't measure them once a year.
I generally agree about not worrying too much, but I suggest that HbA1c in addition to these CGM data, properly interpreted, can be valuable. Best, Mario
I've heard that 90% of prediabetics and 25% of diabetic ( global numbers ofc they're worth what they are worth) ignore they're diabetics. People should worry about it. That's a huge problem. I have been wearing 1 cgm for 2 weeks and it showed me so much about how my metabolism works. I was 11% of the time outside the healthy range, I managed to get back to only 3% just by understanding what's going on and making changes. It might not be for everyone but for some it's very educational.
Dexcom just came out with a new CGM that doesn't require a prescription in the US. Fairly affordable as well, compared to other CGM sensors: www.stelo.com/ (I have no association with Dexcom of any kind)
Big mistake is looking only over blood sugar number while it’s a lot more important how much insulin is secreted to bring the levels back to normal. That’s why fasting insulin is ever more important than A1C
If you look through videos on my channel, you will find that I also see insulin resistance and chronic hyperinsulinemia as a major risk factor for chronic disease. However, it's hard to claim that it's clearly more important that elevated blood sugar, which in and of itself is strongly linked to numerous severe health issues. Why not try to normalize both? Cheers Mario
@@TasteOfButterfliesThat’s not entirely accurate. Type I is when they don’t produce any insulin at all, or at times, very little. But even type I patients can develop insulin resistance based on their self-administered doses.
I suggest you watch this video here on how insulin resistance relates to glucose tolerance: ruclips.net/video/Yg9AS2sfY9Y/видео.htmlsi=gIGcgWXuN1hwuTPR Cheers Mario
Am I to take the prominent placement of “the Hungry Brain” as an endorsement? I don’t see the book rated on Red Pen Reviews (possibly due to a conflict of interest), but I realize the author is a founder.
That is highly unusual. There is a lag between changes in blood and interstitial fluid (which is what the CGM measures), but it's usually only about 15 min.
5:46 what is a definition of a “your typical meal”? There could be a meal with almost no any carbs and there won’t be any spikes, or another meal with lot of carbs, so that spike can be elevated for hours… it would be more helpful if you can provide concrete numbers, like “after a meal with about xxx grams of carbs”. Also, it is very important to mention for what kind of person size/gender/age/activity level that stats are relevant. Because for one person 75g of glucose is “full stomach” dose, for another it is not even a half…
15:56 “fasting state” is another uncertain definition. After year of experiments with CGM I realized that “fasting state” is very outdated meaning. The morning blood sugar numbers could be easily manipulated with meals taken day(s) before the measurement. And another factor is body composition and amount of physical activities before the measurement. Say a person with high muscle mass can easily consume glucose from blood with just few minutes of walk and little stretching… I’m just trying to say, that the diagnosis by measuring blood glucose with single test is outdated, it must be considered in the dynamic.
Yes, I agree that ideally a doctor would diagnose diabetes or prediabetes based on several tests. It is definitely true that morning/fasting glucose can fluctuate a little bit up and down based on a few factors. However, I had good reasons to not provide more specifics about the exact g of carbs during a meal. While the amount of carbs plays a role, the quality of these carbs (i.e., their glycemic index) matters at least as much, as does the composition of the rest of the meal. As long as we are eating some carbs, however, all of these things are dwarfed by our glucose tolerance. As I explain in the video, as long as we are regularly eating some carbs as we are wearing a CGM, we should be able to get a pretty good sense of our glucose tolerance, irrespective of what the specific amounts and GIs of these carbs are. If I had included specifics of what a optimal blood glucose response would be in response to a specific glycemic load, the video would have immediately become useless, because most people cannot or don't want to calculate the glycemic load of their meals. So, of course, this could be done in a more academically precise way, but I believe the way I have presented it here is the better balance between usefulness rigorous consideration of what is known about normal glucose homeostasis. Hope this makes sense. Best, Mario
The problem is that the lab assay for 1,5-AG doesn't seem to be as well standardized as for other biomarkers. As a result, the thresholds suggested by different studies can differ substantially. This means that 1,5-AG can be used to compare people within one study, as long as all blood samples were analyzed together in the same lab, but less so when comparing data from different labs. Also, we don't have a good clinical definition of what normal means. My best estimate based on most assays and most papers I have seen is that 15 ug/mL or higher, or better 20 ug/mL or higher, would be indicative of totally normal blood glucose regulation without frequent spikes to 180 mg/dL or higher. People with diabetes seem to commonly be below 10 ug/mL or even below 6 ug/mL, so we can assume that under 10 ug/mL is indicative of frequent levels above 180 mg/dL. Sorry I can't provide a fully conclusive answer at this point. It may be that individual labs that conduct this test can provide a normal range; however, I'd be worried that the lower end of that normal range includes some people who experience frequent spikes. Best, Mario
It's a good and common question. I'd argue that if you are glucose intolerant, then following a low-carb diet is a good idea. It just wouldn't be smart to continue exposing the body to a nutrient it cannot handle well. At the same time, I suggest we should also address glucose intolerance IN ADDITION to lowering our dietary glycemic load, because many of the factors that cause glucose intolerance are in and of themselves risk factors for other chronic diseases. For example, glucose intolerance could be caused by insulin resistance due to fatty liver, and a fatty liver is a risk factor for liver fibrosis, cirrhosis, and liver cancer. Insulin resistance could also be the result of low muscle mass (itself a predictor of poor health outcomes), chronic stress (same), physical inactivity (same), or a chronic inflammatory condition (same). Of course, some of the underlying problems could be addressed over the long term by a low-carb diet as well, but depending on what the specific causal factor is, not necessarily so. Best, Mario
@@nourishedbyscience Makes sense. I personally have switched to a low-carb high fat (and high cholesterol) diet and my markers have improved greatly. Even my blood pressure is great now and my inflammation and joint pains are much better. I forgot that I was diagnosed with osteoarthritis more than 20 years ago after MRI. I likely am more glucose tolerant than I used to be based upon claims about triglyceride levels, but I am not going to test it. I am also doing the low seed oil thing. I was on a kitesurfing trip with people mostly 20-30 years old and only one person had more stamina than I had (I am age 59). It does appear that all of these things like joint pain and inflammation go together. I remember explaining to my doctor about 20 years ago that my problems would come at the same time (GI tract, joint pains, inflammation) so I didn't think they were unrelated. Now we now.
@@davidsuzukiispolpot If low-carb works for you, it would make sense to stick with it. In general, being low-carb has a lot of benefits; I am just not one to claim that it's the only healthy way to eat. For people who are very glucose tolerant, there are also ways to eat that include carbs, or even mostly high-carb foods. I know that 'seed oils' are considered poisonous by many in the low-carb community, against all evidence. I personally am not a fan of consuming too many n-6-PUFA, and I am also not a fan of UPF or empty calories, so I don't mind it if people eat less oils. I am not sure that cutting out seed oils is the reason people are having less inflammation and joint pain though. My best guess is that by going low-carb, low-carbers eat less of certain antinutrients in plants. I think it's a reasonable hypothesis that certain lectins or oxalates could contribute to inflammation and pain in susceptible people. And lectins and oxalates are all found only in plant foods. That's an area we have only a limited understanding of, but I'd say that it's possible. Cheers Mario
@@nourishedbyscience I agree. I don't know what caused my improvements as I did not just change my macro-nutrients but all the other changes came along for the ride. I eat almost no processed food and the types of food have changed. It may or may not be low-carb that has has been the answer to all of my problems. But the reason I was asking is that it seemed the video implied the pathology (and perhaps medicine itself by virtue of the definition of diabetes to fail a glucose tolerance test) that if the glucose levels are held in check by not having carbs, does the pathology of not tolerating a glucose tolerance test even matter? I know people who are told by their doctors that their type 2 diabetes is just a function of age or genetics and also other people type 2 that just plan to take insulin along with their carbs. Even my own doctor told me that she thinks the most important thing is a "balanced" diet. I wonder if it would work for almost anyone with type 2 diabetes.
Dexcom just came out with a new CGM that doesn't require a prescription in the US. Fairly affordable as well, compared to other CGM sensors: www.stelo.com/ (I have no association with Dexcom of any kind)
@@nourishedbyscience Sure. I've seen several different numbers for what constitutes "normal" fasting glycemia in pregnancy. 90, 92, 95, 105 mg/dl. Non-pregnant cutoffs are more uniformly 100 mg/dl. Why is this?
"Root cause" of glucose intolerance is Ultra Processed Foods, 80 percent of which contain ultra high amounts of sugars, including HFCS (in USA). UPF causes BG spikes way above 180, and when BG levels begin to fall later, hunger pangs kick in, causing us to eat "snacks", which is usually more UPF, i.e. soda and candy or crackers (very few eat a carrot, celery, or apple for snack). The snack causes another BG spike, then freewill, which triggers hunger again. The result is, we snack from wake up till bed time, and most of the day with BG >180, usually 200-300. That BG level does not mean we are diabetic, it just means we need to stop eating UPF, including during meals. Just eat real food, and for carbs just eat veggies and fruits (be careful with too many fruits). This way, we'll never develop diabetes, which can better be labeled "processed food disease". In the 1970s, junk carbs from sugar were proposed to be labeled "anti-nutrients", but Big Food lobbyist won out, and called them carbs (confusing us with what real carbs are - fruits, veggies and grains. Nowadays, UPF is lumped in with "carbs" and we're told we can maintain health by eating UPF. In short, UPF is driving the global diabetes epidemic, but it the elephant in the room nobody wants to talk about, and "research" skirts around, or simply lies about.
My issue is: I have to choose between taking an aromatase inhibitor (because of my estrogen fed cancer) which causes my estrogen to drop significantly vs not taking the pill. The pill in turn causes my glucose to have wild fluctuations since estrogen is a glucose moderator. So I have to choose between cancer or diabetes. UGH!
@@sheila7814 that's tough for you ... all the best with your decision .. the pill may protect your life though and there are lots of ways to manage glucose responses to food ...you will need bone protection too ...
@@asr9217 Yes. Thank you. I think the day I wrote that I was having a hard day. I try not to do that online….. Hugs to you, common sense tells me to keep taking the AI pill and manage the rest. I do work out with weights to help my bones, but am 61 and feeling it is sometimes hard to manage all the “stuff” needed to deal with it all - I appreciate your tips. Thanks again
Hi Sheila, Very sorry to hear, but usually patients need to take AI inhibitors only for a limited period of time (5 years)? It may be an option to modify your diet while taking the AI inhibitor to prevent the development of diabetes. If you look around my channel, you should find some other videos that may help you navigate this. Best wishes to you, Mario
@@nourishedbyscience Thank you. I am now wearing a CGM and following some of the methods you have shared. It does seem to be helping. The day I posted that message I was very frustrated about the extra layer of health issue due to the AI. Plus, I want others that are on AI to know they might want to get their A1C checked in case they become one of the 33% that develop diabetes from taking this pill. I do feel blessed to have found your site, and to be able to wear a CGM now that we have identified my problem. Cancer: tackled; Diabetes: hopefully tackled! :)
You need more research on this topic. You keep using normal when what we are looking for is optimal. Also if u like at non industrial trdationl ancient cultures some even had fasting glucose in low 60s. Their is a rnage. 30 or less is optimal. Generally does not stay above 149 for significant periods. 180 is way to lax and normal on a consistent basis. 30 to 50 points I'd okay but remember the foods kids are choosing. Most normal people aren't really super health conscious. So I think your using weak standards.
His focus appears to have more of a public health perspective rather than personal optimal nutrition. To that end, I think his videos do a good job of spelling out acute health risks and pathologies. I also suspect that the literature on “bio-optimization” is sparse.
One of the best videos about this subjects I have ever seen. A lot of people are obsessed with their blood sugar and tell people 120 mg/dl is deadly.
So true!😊
I’ve been reading and watching stuff on diabetes for years because I have family with it so I want to prevent it for myself. I’ve never once seen someone say 120 was deadly. 120 isn’t even a diabetic fasting glucose. Not sure what you read, but it’s probably a troll trying to scare uneducated viewers.
In a fasted state it's too high indeed.
The subject is spikes not fasted blood sugar.
No, the problem is type twos are broken. We don’t spike for 30 minutes. We spike for 2 to 3 hours sometimes and it may take days to actually get back to normal since we know we are broken. It’s better to minimize the spike as much as possible or less is, zero spike meal is better, every spike and long duration with high insulin and BG is damaging
I almost have no words for how impressed I was by this video. I just started using one of the new OTC CGMs and was wondering what criteria was being used for its spike notifications. I still am not sure - maybe it is the rise by 30. But thank you ever so much for the extended description of studies on normal individuals, and on what patterns correlate to chronic disease. You have just won a new subscriber!
Great video! I despise all these fear-mongering influencers and "doctors". It's so irresponsible and partly even dangerous. And then people copy these weird and silly arguments, share them on social media and with friends and contribute. So thank you for doing what you're doing!
This video was outstanding. I began wearing a CGM after a T2 diagnosis. I moved to a low carb diet and have seen my A1C drop from 9.5 to 5.2 and lost 50lbs. I continue to wear a CGM to hold myself accountable in managing glucose spikes. I have been using 160 as my definition of a spike and focus managing post meal increases to 160 or below. I really appreciate your time educating us with facts based upon science.
If the keto diet is working for you, that’s great. Just be aware that it will make insulin resistance worse in the background. A diet high in saturated fat is how scientists cause insulin resistance in lab rats for studies. Keto makes the numbers look better, but the only way to reverse type 2 permanently is a very low fat diet high in whole plant foods and low in animal products.
Not trying to discourage you because you’ve made a ton of progress! I just want you to know the truth. The End of Diabetes by Dr. Joel Fuhrman and the book Mastering Diabetes do an amazing job explaining the science behind it if you want to learn more.
@tarabooartarmy3654, I am sorry to disagree. If you watch the video linked below, there is basically no impact of the dietary macronutrient composition on insulin resistance, once we take body weight changes out of the equation. And similarly, the science on the impact of saturated fatty acids and their impact on insulin resistance is not nearly as clear as suggested by these and other individuals. When considering the cumulative evidence, I do not hold the view that a ketogenic diet or saturated fatty acids trigger insulin resistance. And I am saying this as someone who has published one of the few papers showing negative effects of a diet rich in saturated fatty acids on insulin sensitivity.
ruclips.net/video/ZcVenUbqsYY/видео.htmlsi=3zGTlJvoo2whKcvS
However, a very low-carb diet such as a ketogenic diet will reduce insulin secretion, and specifically the first-phase insulin response, temporarily. That is a reversible phenomenon, and people on low-carb diets do well do eat all of their meals low-carb, and to reintroduce carbs slowly should they want to switch to a higher-carb diet.
Sadly, some studies showing impacts of low-carb diets on glucose tolerance have been incorrectly interpreted by proponents of plant-based diets as suggesting that dietary fat or saturated fat trigger insulin resistance. This is, IMO, not supported by the cumulative evidence. The effect seen in these studies instead is a reduction in glucose tolerance induced by reduced insulin secretion.
Best,
Mario
@@tarabooartarmy3654 you are so wrong!
@@tarabooartarmy3654 lol
Another top-notch presentation. Highly recommended. I really love Mario's dispassionate no-nonsense presentation style as well as the high level of the information he presents.
Academic-level information presented in a clear, understandable way!
Thanks, Saba.
Cheers
Mario
I’d like to see you do a video about the long-term 22:01 health risks of someone who has pre diabetes for say 5 plus years- An A1C of 5.7 to 6.1 for example. This person has higher fasting blood sugars - say 5.7 to 6.3 - but no spikes above 7.8.
Much needed video!
Thanks Mario. I wish the folks at ZOE were similarly clear about what exactly we should be concerned about and what we shouldn’t. I hope they invite you to do a ZOE podcast soon and you can put them straight. Although something tells me that your message might actually cost them because their low level fear-mongering is a significant source of revenue for the ZOE brand. More power to you. Danke aus Schottland!
one of the best video on the internet, absolutely well explained and as a scientist, I appreciate all the data and very well presented data!
very well done!!!
As always, Thank you Mario! You have placed definitive cutoff readings so frequently presented within an understandable context but retained an awareness of their relevance. It is not real easy to work out personal glucose tolerance but you have removed some of the angst by providing a way forward. Cheers
Excellent presentation! Low carbers may note: A slower insulin response is normal (07:03) after months of carb restriction. One way to make sure is by a HOMA IR test which will quantify(?) the IR. By the way, Cortisol response due to psych. factors (fight/flight) plays havoc with blood sugar 🙄. (One solution for this is to water fast for 6~8 hours after such events.)
Many thanks for these useful facts ,Mario!
You remain the best educator in this field to me and many more like me . Keep it we are supportive 🙏🏼
Thank you.
Like the new scenario! Amazing video as always
Thank you so much for this informativ video. I have missed your Videos so much. You have said, that after a low carb diet, we should integrate more carbs to restore our insulin respond. Could you explain why?
If you're regularly consuming carbs, the pancreas will be used to responding to them, and will actually keep some premade insulin stored so it can respond and release it right away. When you don't eat carbs it stops keeping that store because you don't need it. Then when you eat carbs unexpectedly the beta cells have to make all the insulin on the spot. So it is a slower response.
But if you consume carbs for a while again the pancreas will know it needs to maintain that store again
Yes, what @tselski said! Thanks!
👏👏 best talk on this topic. Congratulations
Thanks a lot for this valuable information! Glad that I found your channel
Thanks Mario for another superb balanced video based on science. I found one study based on oggt that suggested 1hr > 155 could be predictive for diabetes ( jcem 1hr postload hyperglycaemia 2018 fiorentino ...link wont upload) would be grateful for your views on whether this could extend to food. Thank you again for all your work.
Yes, I know that paper. It's interesting, but I am not sure it holds a lot of value for the layperson, beyond what I shared in this video. First, the papers are based on OGTTs, which constitute a very different glycemic load than normal meals. Second, the paper in essence just shows that people with higher postprandial blood glucose to a standardized load have a higher risk of later developing diabetes. That is hardly surprising, right, because glucose intolerance is a continuous process, and it would seem plausible that hyperglycemia and glucose intolerance develop gradually.
That said, for most people, the spike after a meal occurs around 45 min after the start of the meal. That means that glucose levels should be on a downward movement at 60 min, and if they consistently are still above 155 mg/dL, that would strike me as a sign of at least mild glucose intolerance. Again, because the data suggest that increases in blood sugar into the 140-180 mg/dL range do occur even in very glucose tolerant people, but they are infrequent and brief.
Best,
Mario
@@nourishedbyscience Thanks Mario for a really detailed answer ... that is what I took from the paper too (and yes not a lay person) but many are looking for optimal and like you I believe this is an area where we can get over worried so will include this paper when i present my findings... you are so good to help us all in this way.
Thank you! Helpful
Welcome back. I was sent here by a recommendation by Nutrition Made Simple.
This was very interesting and quite informative. Thank you for doing it. And thank you for mentioning that laying on a sensor can cause a low reading. I have been involved in a face group group for type twos in which it comes up regularly. Usually when someone new to cgm's is woken up by the alarm and not understanding its a fluke takes an excessively large amount of sugar with out doing a blood sugar check to confirm what was going on.
Objective and scientific knowledge 🎉❤🎉❤
Nice to hear from you, you have such a good quality content 🤗
Thank you so much 🤗
Better test of diabetes is measuring insulin. HOMA IR or Kraft insulin Assay Test. Early detection is better than cure. Hyperinsulinimia even if blood sugar thresholds are still normal. Definition of diabetes should change
Diabetes is actually insulin resistance + Relative Insulin Deficiency because pancreatic Beta cells fatigue or dysfunction= Type 2 Diabetes. Or not able to follow Insulin's Own Natural Circadian Rhythm.
Measuring insulin is not a 'better test of diabetes'. By definition, diabetes is a condition of glucose intolerance, and while related to insulin resistance, is not the same. Let's try to be clear and not muddle up things.
Insulin resistance is important, and you'll find many videos on my channel about that as well, but glucose intolerance and hyperglycemia are independent risk factors for many severe chronic diseases in their own right. My position is we should normalize both insulin sensitivity and glucose tolerance, but this video was just about glucose tolerance and glycemia.
Best,
Mario
@@nourishedbyscience
Science is challenging the status quo. Proving existing guidelines wrong. High insulin levels using root cause analysis and 5 why's will show that high insulin levels even if your glucose value is still low is abnormal from the acceptable fasting insulin levels or using Kraft insulin Assay Test. Catching this high insulin levels early will be the best way to cure Diabetes faster and easier with low carb or keto diet
@@nourishedbyscience
Best to challenge the status quo of a glucose centered approach to diabetes. The only constant thing in this world is to change for the better
@@nourishedbyscience
Interview Dr Ben Bikman expert in insulin
Thank you for this video! I found your videos a year ago after questioning the 30mg/dL rise being touted as “unhealthy” and subsequently changing CGM companies for this reason. I know exactly which company you’re talking about 😉
The average glucose rise needs to be accompanied by the deviation range. But otherwise I’m pleased with your presentation. BTW, I am a Type 1 diabetic over 31 years.
If someone meets the criteria, as outlined, their SD will be low. And I beliebe that these criteria are more intuitively grasped by most people than SD.
Cheers
Mario
What a good discussion, as always well thought out, with data and presented in a logical manner. congratulations for the great work you do Dr.
Very nice . Mario is very knowledgeable and explain very well , and his content is evidence based.
Excellent video! Thank you for disseminating evidence based information!
So clear, practical and helpful - thank you.
I have glucose peaks of 170 to 200 when I eat more than 30 to 70 grams of carbohydrates in a single meal, after 2 hours it drops to 80 to 70, sometimes it goes from 150 to 80 in 15 minutes. But, I just finished the keto diet 3 days ago, so I guess as the days go by I will improve. My fasting insulin at the end of the diet was 2.4 fasting, meaning I wasn't producing enough insulin I guess.
Your low fasting insulin probably means that you are very insulin sensitive. My best guess is that you have a (temporarily) diminished first-phase insulin response due to your long-term low-carb diet. The first-phase insulin response is based on pre-formed insulin that is stored in the pancreatic beta-cells and that can be secreted into the blood within seconds of consuming carbs. That first insulin secretion prevents a spike from happening. Just re-introduce carbs a bit more gradually, and eat some non-starchy veggies or salad AND some protein before you eat carbs for the next few weeks. That'll slow down your carb digestion, and the protein also stimulates insulin secretion before your carbs are absorbed.
Cheers
Mario
Thank you for another great video! So grateful for you!
Love your videos. FYI in the US T2DM can also be diagnosed with a random blood glucose level ≥ 200 mg/dL (11.1 mmol/L) at any time of the day.
Yes, correct, but IMO, this criterion should not be applied to CGM data without further testing, as the false positive rate would be too high.
I think the issue is that if a patient comes into a doctors office once, usually fasting or a while after eating, and has a glucose > 200 mg/dL, the likelihood that they indeed have diabetes is high. However, with CGM, we get data every 5 minutes, including immediately after eating, and I don't think that the relationship between sensitivity and specificity of the random glucose test hold up very well under these conditions. I am hoping that we get updated criteria on this with CGM data, and would assume that the threshold for when diabetes is suspected is going to be a bit higher than 200 mg/dL.
Cheers
Mario
Incredibly informative - thanks
Excellent content & presentation
Im wearing a cgm. Only for 14 days. Early on I noticed that porridge ( not instant, steel cuts oat) accompanied by Greek yoghurt made my blood sugar rise by a good 50 mg/dl. From about 80 mg/ dl to 130. So I was quite apprehensive to test 75 g glucose. But if you don't try you don't know so I did and it rose by 55 mg/dl. I expected more tbh. Or porridge and Greek yoghurt to make it rise less. I'm not diabetic nor pre diabetic and my blood sugar is able to rise from 85 to 140/ 145, easy so quite a jump. Then i it will start going down then back up again down up again for about 5 or even 6 hours hours if I consume a big meal including carbs. To reduce that length I can go for a fast walk and iit will go down quicker tho.
My blood sugar rises quite a lot when I exercise. It also rises when I take a shower or do the dishes. Also when I fast. It seems whenever I need extra energy it will rise which I found strange at first but ok..
Also I tend to experience hypoglycemia ( or is that dawn syndrome or reactive hypoglycemia?) at night. But when I replace sweet snack by cheese or an avocado or don't snack at all tthen I don't go hypoglycemic. I managed to reduce this occuring from 11% to 2% so wearing a cgm has been great if only for that). Hopefully that helps give my liver a break and having to" rescue me" ;-)
My BMI is 20.2 and AC1 4.7%
Fascinating experience imo. It's been like a little journey within some part of my body that was so far unknown.
Thank you very much for another outstanding video.
Dear Mario, I appreciate the valuable educational content you provide. Regarding your discussion on high LDL levels, are you advocating for a reduction in the intake of foods high in saturated fats, such as full-fat dairy products and red meats? also about Visceral fat storage dysfunction is a contributing factor to diabetes. If dietary and lifestyle changes are not effective, what are the recommended safe medical intervention. Thank you in advance for your response and effort.
Very useful, thank you. That being said, I am still not clear on the difference between normal and optimal. A spike to say 170 may be normal but is it optimal? Is it something to be OK with if it happens daily? More to the point, is the pancreas meant to be "exercised" once in a while with carb challenges or is it more like the liver with respect to alcohol, i.e. a healthy one can handle 4 drinks but, really, optimal is as little as possible. Between the two extremes: keto vs very high carb diet would you say moderate low and complex carb would be ideal?
I don't think we have any data to support any specific macronutrient composition as optimal for everyone. If someone is glucose intolerant, they may benefit from reducing their carb content, at least until their glucose tolerance has been normalized.
My sense is that currently we do also do not have any data to link short blood sugar increases into the 140-180 mg/dL range to negative health outcomes. It is possible, as you say, that it's suboptimal, but that would be a guess and not based on any data I am aware of.
Best,
Mario
Reassuring: thank you sooo much xx
Super....
Very helpful, mil grazie Mario.
Thank you
People should start making difference between acute and chronically
I am one of those otherwise healthy people who wore a CGM for a month. I follow a predominantly plant-based diet. My glucose levels would “spike” every time I ate anything. I could have avoided spikes by swapping my fruit and beans for beef jerky and hard boiled eggs. I’ll stick with my plants and take my chances!
So how did ypu manage the spikes?
You could still try to front-load your high-glycemic carb meals with fiber-rich veggies, salad, and plant protein.
Awesome explaination.
Many thanks very helpful
This was very good, indeed one of the best looks at the published data deciphered for a general audience. BUT the final synthesis, by emphasizing being under 140 mg/dL “most of the time,” missed the most important metric a CGM can give: average blood glucose (ie, area under the curve). Having a healthy average blood sugar between 90 and 100 mg/dL would not result if one were at around 130 “most of the time.” It’s really down to how readily one returns to a fasting level after their meals.
I suggest that if someone meets all of the criteria, as outlined, their average blood glucose will be low. That is because there are exactly zero people who have normal glucose tolerance and who keep their blood sugar in the 70-140 mg/dL range 95%+ of the time who have stable blood glucose at 130 mg/dL for more than a few minutes. If someone can regulate their blood sugar as I outline as normal, then their blood sugar will never just hang around 130 mg/dL.
Does that make sense?
Best,
Mario
@@nourishedbyscienceit does to me, cheers.
19:40 Abbott have this data 😊
Yes, we'd just need to get them and link them to long-term health outcomes data. May happen at some point.
@@nourishedbyscience I'm sure they'll do it - for a price! Selling other people's data is all the rage on Wall Street these days.
Thanks! Type II trying to prevent Type 1 with CGM
Thank you for your support.
Maybe the discrepancy with normal individuals is not normal it’s because the food is so substantially changed and inferior quality worse every day that it could negatively affect the blood glucose response and evolution has certainly not caught up with our inferior food supply
Thanks for the video. BTW, given glucose concentration 5mmol/L and molar mass 180g/mol, the homeostatic glucose in the blood in human readable form is 0.9g/l or 4.5g for the whole 5 liters blood volume. The glucose adsorption is around 96%. There is the question: why we abuse the body with the external glucose in many times bigger concentration that body have? We know that there is no storage for glucose nowadays for sedentary population.
I feel strongly that the issue we should address is glucose intolerance, and that blaming carbs is short-sighted. If someone is glucose tolerance, they can eat all the carbs they want and not have any problems. What we should be talking about a lot more is why people are glucose intolerant, and - again - it's not carbs per se IMO.
Best,
Mario
@@nourishedbyscience , thanks. Based on Glucose - Fatty acid cycle, historically, we rarely mixed glucose with non-glucose sources, until last 12-10k years ago. Given that, the genetic and evaluation aren't fast process, IMO, I'm still not convinced it was long enough to get humans adapted to such glucose surge every meal. BTW, Homo Paranthropus extinct.
Thanks! It was useful.
Thank you.
Still.....how do we know that we're even supposed to eat the foods that raise the blood sugar that much? Also how do we know what normal is if the study's general purpose is to find exactly that with "normal" individuals?
This is an excellent question. Love this. Thanks.
My view here is that from observing the normal range in which the body keeps glucose regulated, we can actually get a sense of which foods our ancestors ate as we evolved. From the data I shared, it does seem very clear that the body makes substantial efforts to keep blood glucose in the 70-180 mg/dL AT ALL TIMES. That is absolutely remarkable, because the amounts of glucose we often eat in a typical mixed meal are multiples of the total glucose content in all of our blood. And this system shows some evidence of redundancies, such that defects in one component can be compensated by another component (insulin resistance can be compensated by higher insulin secretion). So the fact that such a nuanced, robust glucose homeostatic mechanism exists seems like indirect evidence to me that humans are adapted to consume glucose-containing foods (sugar, starch).
To phrase differently, our body does NOT seem to have any homeostatic mechanisms to always keep blood glucose in the 70-100 mg/dL.
Admittedly, this is not strong, conclusive evidence, but to me suggests that humans evolved on diets that contained at least some carb-containing foods.
Cheers
Mario
@@nourishedbyscience Very interesting look....you can definitely find logic in that. But going the same route...how about blood pressure regulation? BP is also pretty tightly regulated and the body if healthy would increase it to 150/100 for example when stressed. But these days everybody is stressed overtime, numbers climb and we have new normal. Despite many people are very sick and have degenerated cardiovascular system, the body is still giving its best to keep the numbers under 200 systolic. But that's not healthy we can agree? Acute stress is better than chronic stress....but lower instances of acute stress is even better. If I eat as similar as possible to our ancestors, my glucose would absolutely never rise more that 20-25mg/dl. Also if we get even more basic - if we're close to peeing out sugat at that levels 180mg/dl.....how the hell would testing the absolute limits of the system regularly be healthy?
Thanks!
Thank you for your support.
my CGM (freestyle Libre) always shows my fasting blood glucose in 80's and 90's in the morning but glucometer always shows 10 points more (i.e 100 or above.)
I don't know I think people who say that 30 mg/ dl rise is too much are on keto or something. Im not diabetic nor prediabetic, my AC1 is 4.7 , average blood glucose level 88 and I observe 50 mg/ dl rises .
My blood sugar goes up more than 30 when I'm exercising during a fast. Seems odd.
That happens to a lot of people, in fact during intense exercise I think it's normal to have blood glucose above 150 for many people and it's not a sign of being unhealthy. The highest my blood glucose has ever been is 160 and it was after doing a 3 mile run with five max effort sprints thrown in, all while about 15 hours fasted.
Thank you. I thought so. Mine went from 77 to 107. So not out of the ordinary. I'm just getting back to exercise and probably overdoing it. Pushing myself is going to recruit stress hormones to raise blood sugar. I'm 73 but previously very fit.
I'm wearing a cgm and it rises pretty high whenever I exercise. It even rises when I shower or do the dishes ;)
My father-in-law recently is on CMG and has been diabetic for years and have all the medications taking consistently, after meals, his glucose level is around 380. That is our worries but by the morning come, his number is below 200 which is good to me. We are very conscious about his diet too. He has low carb diet for years too like browse rice, protein and fiber. Any suggestions will be help. Thanks
Also, recently learning from glucose goddess hack by taking the protein intake before the starch and coffee in the breakfast, I notice the glucose results very nicely like around 220. But it is only for a few days, but then it goes back way high again. I scratch my head …
His normal breakfast is like eggs, cereal/ oatmeal and a cup of those Asian instant coffee.
Here is example today. Before breakfast glucose 170. Then just a couple toast with peanut butter (2 tblespoon) no coffee. A couple hour later 326. So the worry is roller coasting.
If you are not type 1 diabetic, stop worrying about this! 🤷♂️🤦♂️Get an A1c test instead. You might better be off worrying about hormone 😮levels, and you likely don't measure them once a year.
I generally agree about not worrying too much, but I suggest that HbA1c in addition to these CGM data, properly interpreted, can be valuable.
Best,
Mario
I've heard that 90% of prediabetics and 25% of diabetic ( global numbers ofc they're worth what they are worth) ignore they're diabetics.
People should worry about it. That's a huge problem. I have been wearing 1 cgm for 2 weeks and it showed me so much about how my metabolism works. I was 11% of the time outside the healthy range, I managed to get back to only 3% just by understanding what's going on and making changes. It might not be for everyone but for some it's very educational.
I cant check my glucos levels because my nurse just gave me metformin tablets. Nothing eles.
Dexcom just came out with a new CGM that doesn't require a prescription in the US. Fairly affordable as well, compared to other CGM sensors:
www.stelo.com/
(I have no association with Dexcom of any kind)
Is the problem glucose intolerance or excess glucose?
Big mistake is looking only over blood sugar number while it’s a lot more important how much insulin is secreted to bring the levels back to normal. That’s why fasting insulin is ever more important than A1C
If you look through videos on my channel, you will find that I also see insulin resistance and chronic hyperinsulinemia as a major risk factor for chronic disease. However, it's hard to claim that it's clearly more important that elevated blood sugar, which in and of itself is strongly linked to numerous severe health issues. Why not try to normalize both?
Cheers
Mario
Very good information. Thank you. I'm wondering, is glucose intolerance the same as insulin resistance? or does one precede the other?
Insulin resistance is one possible reason of glucose intolerance.
Type 1 diabetes is glucose intolerance without insulin resistance.
@@TasteOfButterfliesThat’s not entirely accurate. Type I is when they don’t produce any insulin at all, or at times, very little. But even type I patients can develop insulin resistance based on their self-administered doses.
I suggest you watch this video here on how insulin resistance relates to glucose tolerance:
ruclips.net/video/Yg9AS2sfY9Y/видео.htmlsi=gIGcgWXuN1hwuTPR
Cheers
Mario
Am I to take the prominent placement of “the Hungry Brain” as an endorsement? I don’t see the book rated on Red Pen Reviews (possibly due to a conflict of interest), but I realize the author is a founder.
No, I am not endorsing anything. Just reading it right now. Very good book though.
Cheers
Mario
My CGM doesn't show a glucose rise after I eat until 3 to 3.5 hours later. Doing finger sticks, though, I usually see the rise 2 to 2.5 hours later. 🤷
That is highly unusual. There is a lag between changes in blood and interstitial fluid (which is what the CGM measures), but it's usually only about 15 min.
5:46 what is a definition of a “your typical meal”?
There could be a meal with almost no any carbs and there won’t be any spikes, or another meal with lot of carbs, so that spike can be elevated for hours… it would be more helpful if you can provide concrete numbers, like “after a meal with about xxx grams of carbs”. Also, it is very important to mention for what kind of person size/gender/age/activity level that stats are relevant. Because for one person 75g of glucose is “full stomach” dose, for another it is not even a half…
15:56 “fasting state” is another uncertain definition. After year of experiments with CGM I realized that “fasting state” is very outdated meaning. The morning blood sugar numbers could be easily manipulated with meals taken day(s) before the measurement. And another factor is body composition and amount of physical activities before the measurement. Say a person with high muscle mass can easily consume glucose from blood with just few minutes of walk and little stretching… I’m just trying to say, that the diagnosis by measuring blood glucose with single test is outdated, it must be considered in the dynamic.
Yes, I agree that ideally a doctor would diagnose diabetes or prediabetes based on several tests. It is definitely true that morning/fasting glucose can fluctuate a little bit up and down based on a few factors.
However, I had good reasons to not provide more specifics about the exact g of carbs during a meal. While the amount of carbs plays a role, the quality of these carbs (i.e., their glycemic index) matters at least as much, as does the composition of the rest of the meal. As long as we are eating some carbs, however, all of these things are dwarfed by our glucose tolerance. As I explain in the video, as long as we are regularly eating some carbs as we are wearing a CGM, we should be able to get a pretty good sense of our glucose tolerance, irrespective of what the specific amounts and GIs of these carbs are. If I had included specifics of what a optimal blood glucose response would be in response to a specific glycemic load, the video would have immediately become useless, because most people cannot or don't want to calculate the glycemic load of their meals. So, of course, this could be done in a more academically precise way, but I believe the way I have presented it here is the better balance between usefulness rigorous consideration of what is known about normal glucose homeostasis.
Hope this makes sense.
Best,
Mario
What might be "good" Levels of 1,5-AG.
I have red that a Level of above 12 mircogramm per mL might be OK, do you agree in that ?
The problem is that the lab assay for 1,5-AG doesn't seem to be as well standardized as for other biomarkers. As a result, the thresholds suggested by different studies can differ substantially. This means that 1,5-AG can be used to compare people within one study, as long as all blood samples were analyzed together in the same lab, but less so when comparing data from different labs. Also, we don't have a good clinical definition of what normal means.
My best estimate based on most assays and most papers I have seen is that 15 ug/mL or higher, or better 20 ug/mL or higher, would be indicative of totally normal blood glucose regulation without frequent spikes to 180 mg/dL or higher. People with diabetes seem to commonly be below 10 ug/mL or even below 6 ug/mL, so we can assume that under 10 ug/mL is indicative of frequent levels above 180 mg/dL.
Sorry I can't provide a fully conclusive answer at this point. It may be that individual labs that conduct this test can provide a normal range; however, I'd be worried that the lower end of that normal range includes some people who experience frequent spikes.
Best,
Mario
@@nourishedbyscience thanks for the explanation 👍
My "baseline" is usually in the mid to high 6's. Is this ok or should one work on getting it to the 5's to low 6's?
The baseline and fasting should be below 100 mg/dL = 5.7 mmol/L.
Cheers
Mario
@@nourishedbyscience I'm seeing recommendations for someone with T2 as 4-7 - is this wrong then?
Why does it matter if my glucose tolerance is poor if I never ingest much glucose?
It's a good and common question.
I'd argue that if you are glucose intolerant, then following a low-carb diet is a good idea. It just wouldn't be smart to continue exposing the body to a nutrient it cannot handle well.
At the same time, I suggest we should also address glucose intolerance IN ADDITION to lowering our dietary glycemic load, because many of the factors that cause glucose intolerance are in and of themselves risk factors for other chronic diseases. For example, glucose intolerance could be caused by insulin resistance due to fatty liver, and a fatty liver is a risk factor for liver fibrosis, cirrhosis, and liver cancer. Insulin resistance could also be the result of low muscle mass (itself a predictor of poor health outcomes), chronic stress (same), physical inactivity (same), or a chronic inflammatory condition (same).
Of course, some of the underlying problems could be addressed over the long term by a low-carb diet as well, but depending on what the specific causal factor is, not necessarily so.
Best,
Mario
@@nourishedbyscience Makes sense. I personally have switched to a low-carb high fat (and high cholesterol) diet and my markers have improved greatly. Even my blood pressure is great now and my inflammation and joint pains are much better. I forgot that I was diagnosed with osteoarthritis more than 20 years ago after MRI. I likely am more glucose tolerant than I used to be based upon claims about triglyceride levels, but I am not going to test it.
I am also doing the low seed oil thing. I was on a kitesurfing trip with people mostly 20-30 years old and only one person had more stamina than I had (I am age 59). It does appear that all of these things like joint pain and inflammation go together. I remember explaining to my doctor about 20 years ago that my problems would come at the same time (GI tract, joint pains, inflammation) so I didn't think they were unrelated. Now we now.
@@davidsuzukiispolpot If low-carb works for you, it would make sense to stick with it. In general, being low-carb has a lot of benefits; I am just not one to claim that it's the only healthy way to eat. For people who are very glucose tolerant, there are also ways to eat that include carbs, or even mostly high-carb foods.
I know that 'seed oils' are considered poisonous by many in the low-carb community, against all evidence. I personally am not a fan of consuming too many n-6-PUFA, and I am also not a fan of UPF or empty calories, so I don't mind it if people eat less oils. I am not sure that cutting out seed oils is the reason people are having less inflammation and joint pain though. My best guess is that by going low-carb, low-carbers eat less of certain antinutrients in plants. I think it's a reasonable hypothesis that certain lectins or oxalates could contribute to inflammation and pain in susceptible people. And lectins and oxalates are all found only in plant foods. That's an area we have only a limited understanding of, but I'd say that it's possible.
Cheers
Mario
@@nourishedbyscience I agree. I don't know what caused my improvements as I did not just change my macro-nutrients but all the other changes came along for the ride. I eat almost no processed food and the types of food have changed. It may or may not be low-carb that has has been the answer to all of my problems. But the reason I was asking is that it seemed the video implied the pathology (and perhaps medicine itself by virtue of the definition of diabetes to fail a glucose tolerance test) that if the glucose levels are held in check by not having carbs, does the pathology of not tolerating a glucose tolerance test even matter? I know people who are told by their doctors that their type 2 diabetes is just a function of age or genetics and also other people type 2 that just plan to take insulin along with their carbs. Even my own doctor told me that she thinks the most important thing is a "balanced" diet. I wonder if it would work for almost anyone with type 2 diabetes.
Where do I get a CGM?
Dexcom just came out with a new CGM that doesn't require a prescription in the US. Fairly affordable as well, compared to other CGM sensors:
www.stelo.com/
(I have no association with Dexcom of any kind)
Any idea why the fasting glycemia is different for gestational diabetes?
Can you explain what you mean?
@@nourishedbyscience Sure. I've seen several different numbers for what constitutes "normal" fasting glycemia in pregnancy. 90, 92, 95, 105 mg/dl. Non-pregnant cutoffs are more uniformly 100 mg/dl. Why is this?
"Root cause" of glucose intolerance is Ultra Processed Foods, 80 percent of which contain ultra high amounts of sugars, including HFCS (in USA). UPF causes BG spikes way above 180, and when BG levels begin to fall later, hunger pangs kick in, causing us to eat "snacks", which is usually more UPF, i.e. soda and candy or crackers (very few eat a carrot, celery, or apple for snack). The snack causes another BG spike, then freewill, which triggers hunger again. The result is, we snack from wake up till bed time, and most of the day with BG >180, usually 200-300. That BG level does not mean we are diabetic, it just means we need to stop eating UPF, including during meals. Just eat real food, and for carbs just eat veggies and fruits (be careful with too many fruits). This way, we'll never develop diabetes, which can better be labeled "processed food disease". In the 1970s, junk carbs from sugar were proposed to be labeled "anti-nutrients", but Big Food lobbyist won out, and called them carbs (confusing us with what real carbs are - fruits, veggies and grains. Nowadays, UPF is lumped in with "carbs" and we're told we can maintain health by eating UPF. In short, UPF is driving the global diabetes epidemic, but it the elephant in the room nobody wants to talk about, and "research" skirts around, or simply lies about.
🎉
My issue is: I have to choose between taking an aromatase inhibitor (because of my estrogen fed cancer) which causes my estrogen to drop significantly vs not taking the pill. The pill in turn causes my glucose to have wild fluctuations since estrogen is a glucose moderator. So I have to choose between cancer or diabetes. UGH!
@@sheila7814 that's tough for you ... all the best with your decision .. the pill may protect your life though and there are lots of ways to manage glucose responses to food ...you will need bone protection too ...
@@asr9217 Yes. Thank you. I think the day I wrote that I was having a hard day. I try not to do that online….. Hugs to you, common sense tells me to keep taking the AI pill and manage the rest. I do work out with weights to help my bones, but am 61 and feeling it is sometimes hard to manage all the “stuff” needed to deal with it all - I appreciate your tips. Thanks again
It is indeed hard to juggle many health balls .. glad you've made the right choice and hope you find the strength to do the rest ...
Hi Sheila,
Very sorry to hear, but usually patients need to take AI inhibitors only for a limited period of time (5 years)? It may be an option to modify your diet while taking the AI inhibitor to prevent the development of diabetes. If you look around my channel, you should find some other videos that may help you navigate this.
Best wishes to you,
Mario
@@nourishedbyscience Thank you. I am now wearing a CGM and following some of the methods you have shared. It does seem to be helping. The day I posted that message I was very frustrated about the extra layer of health issue due to the AI. Plus, I want others that are on AI to know they might want to get their A1C checked in case they become one of the 33% that develop diabetes from taking this pill. I do feel blessed to have found your site, and to be able to wear a CGM now that we have identified my problem. Cancer: tackled; Diabetes: hopefully tackled! :)
Hall Eric Thompson Jeffrey Young Mark
You need more research on this topic. You keep using normal when what we are looking for is optimal. Also if u like at non industrial trdationl ancient cultures some even had fasting glucose in low 60s. Their is a rnage. 30 or less is optimal. Generally does not stay above 149 for significant periods. 180 is way to lax and normal on a consistent basis. 30 to 50 points I'd okay but remember the foods kids are choosing. Most normal people aren't really super health conscious. So I think your using weak standards.
His focus appears to have more of a public health perspective rather than personal optimal nutrition. To that end, I think his videos do a good job of spelling out acute health risks and pathologies. I also suspect that the literature on “bio-optimization” is sparse.
He’s a PhD who is involved in a lot of research on this topic. Likely way more research than you’ve done. RUclips videos don’t count as research.
@@cbgbstew4072 I like how u make a bunch of assumptions
You are welcome to draw your own conclusions. I don't agree with them, but can't do anything other than discuss the data as I see them.
Best,
Mario
Interesting, but it's a bit boring-it feels like you're reading from a script. The content is valuable, but the format is very hard to engage with.
Sorry ...!
Thank you
🎉