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Food isn't the only factor in blood sugar regulation

9/23/2020

We’re wrapping up a series on blood sugar. Seriously you guys, this topic is so important. And now more than ever. The mainstream media isn’t great about sharing the data that researchers are finding on the relationship with COVID moralities and metabolic syndrome, but it’s incredibly frightening!!!

The Lancet recently published some data from a study they performed in England looking at the relationship between COVID deaths and diabetes. They found that type 1 and type 2 diabetes were both independently associated with a significant increased odds of in-hospital death with COVID-19.

Obviously all of this data is new, but the relationship between metabolic syndrome and pretty much every other disease is NOT new. The Journal of the American Medical Association published in 2004 (a long time ago!) that the presence of the metabolic syndrome was associated with a 1.4-fold increase in the risk of all-cause mortality for both men and women, and with a 2.3-fold increase in the risk of cardiovascular disease mortality for men and 2.8-fold for women.

Metabolic syndrome is a series of conditions that increase the risk of heart disease, stroke, and diabetes. Those conditions include high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. So obviously we need to be mindful of ALL of those conditions, but blood sugar is one that can affect EVERYONE (including lean athletes) regardless of their age and sex and often times people have no idea they have pre-diabetes.

Pre-diabetes and type 2 diabetes can both be reversed pretty easily with more mindfulness around diet and lifestyle. So if you haven’t read the last 3 posts on the diet portion of how to balance your blood sugar, start there. If you have, and you’ve dialed in your diet but your blood sugar is still high, you’re in luck. Because that is exactly what we’re talking about this week!

In private practice, I have yet to find a client with high blood sugar who only has to adjust their diet to get back into normal blood sugar ranges! Usually, there are lifestyle factors that also need to be adjusted. So let’s dive into what those are...

Using Non-Caloric Sweeteners

Have you ever heard of Pavlov’s dogs experiment? Pavlov was a scientist who showed the theory of classical conditioning through his infamous dog experiment. He presented a stimulus (e.g. the sound of a metronome) and then gave the dog food; after a few repetitions, the dogs started to salivate in response to the stimulus.

We humans are also subject to classical conditioning. When you place something sweet into your mouth, your brain receives a signal that something sweet is on the way. In response, the brain can send a signal to the pancreas to release insulin to prepare for the sweet thing to enter the bloodstream. But nothing arrives. And you repeat this action again. And again. And again.

You continue to use non-caloric sweeteners, but your body continues to respond as if sugar is coming in leading it to wear out it’s blood sugar regulation system.

You can see how if you constantly chew sugar-free gum, drink non-caloric sweetened drinks (such as diet soda) or eat treats that are sweetened with non-caloric sweeteners, that your pancreas can quickly become incapable of keeping up with the insulin demands, and the cells of the liver and muscles can become immune to the signals of insulin.

This is especially important for those that have a level of insulin resistance already. Limiting and/or avoiding non-caloric sweeteners all together can help your body be sensitive to insulin, which is what you want for longevity!

Stress

In psychological terms, stress is the reaction to something that threatens our physical or mental equilibrium1. This means that it can come from a ferocious tiger threatening to eat us, or an overdue credit card bill that we don’t have the funds available to pay.

Genetically, our body is hard wired to deal with stressors in a way that is meant to protect us from things like predators and angry enemies. Historically, these types of threats were typically quick to come and quick to go. Between threats, our body could unwind and had time to recover before another threat revealed itself.

Today, most of us no longer have to worry about dangerous animals threatening to eat us, or our neighbors breaking into our house with a spear. Today’s threats are much different.

In the book The Adrenal Reset Diet author Alan Christianson says “within the last few decades our world has gotten more toxic, a lot noisier, and much faster pace. Our food has more sugar, less fiber, and many more chemicals. We spend less time in sunlight and we sleep less. We take more medications, feel less certain of our financial futures, and have fewer friends.”

Not only are all of these things causing increased stress, but the type of stress has turned from acute to chronic. This type of chronic stress has a completely different effect on our adrenal glands than acute stressors.

The adrenal glands are responsible for the production and output of our main stress hormones: cortisol and adrenaline. Neither of these hormones were intended to be in the system for the long term. These hormones help you survive immediate threats by raising your blood pressure, blood sugar and shunting blood to your working muscles and brain, so you can fight or flee.

In today’s world, where threats are not solved in a single afternoon, these hormones are working overtime to try to protect you. Meanwhile, your blood pressure remains high, your immune system is weakened, your digestive system slows down and does not work properly, your sleep is affected because you are wired (and exhausted), your ability to learn decreases, and…you guessed it…your blood sugar stays higher than normal.

If you have balanced your diet and still feel frustrated that your fasting blood sugar levels are higher than normal, you needed to consider that stress is playing a large role in this.

Remember that anything in your life that creates a chronic stress response can create a chronically higher than normal blood sugar.

Many of these stressors are things that have become part of our normal day-to-day life and therefore we don’t look at them as a stress anymore. But how does your autonomic nervous system feel about that?

Some of the areas to really explore when trying to reduce the stress load are:

lack of sleep, lack of sleep, lack of sleep!
exposure to toxins (chemicals, molds, etc)
nutrient poor diet
poor digestion, which creates a lack of nutrient absorption
lack of social face-to-face interaction
guilt, grief, depression, anxiety, lack of self-esteem
increased financial obligations
illness
lack of sleep (did I already mention that?!?)

And the list goes on and on.

In addition to higher blood glucose levels, other symptoms commonly associated with high stress are: you lack a sex drive; crave sweets and salt; get dizzy when you stand up quickly; have achy joints or other body aches; have low blood pressure; suffer from mild depression; require stimulants to get moving in the morning or stay awake in the afternoon; or have been told that your cholesterol is high.

Reducing the load on the adrenals and supporting your system with the proper nutrients can help balance your steroid hormones and therefore lower your blood glucose over time.

Sleep

Sleep is one of four biological needs (the others being: eating, drinking and mating). Sleep has been shown to have a direct impact on overall health, lifespan, productivity, safety and ability to learn. Sleep is one of the top five reasons that patients visit a clinic for care every year and lack of sleep has been associated with an increased risk of type 2 diabetes.

A study performed at the Leiden University Medical Center took 9 healthy individuals, with healthy blood sugar response, and restricted sleep for one night (subjects were allowed to sleep from 1am to 5am). The result was insulin resistance in multiple metabolic pathways in all subjects.

Additionally, data from large published studies, including: Sleep Heart Health Study; Finnish Type 2 Diabetes Study; Quebec Family study; Behavioral Risk Factor Surveillance System; National Health Interview Study; and Isfahan Healthy Heart Program, have all demonstrated that middle-aged to elderly subjects with self- reported short sleep duration are approximately twice as likely to be diagnosed with type 2 diabetes and are at higher risk for impaired glucose tolerance.

Most adults need between 7-9 hours of sleep each night. Not 7-9 hours in bed with the lights out laying awake. 7-9 hours of actual sleep. If this isn’t your situation, here are the first steps to dial in:

1) Follow a sleep schedule.

2) Eat a diet that promotes quality sleep at the right times:

Eat a dinner full of melatonin rich foods.
Avoid caffeine, including chocolate after 12pm.
Avoid alcohol before bed.
Avoid large meals and beverages 2 hours before bedtime.

3) Exercise at the time that best suits your chronotype. Avoid intense exercise 2-3 hours before bedtime. If AM blood sugar is higher than ideal, choose 20-30 minutes of a relaxing activity before bed, like gentle walking.

4) Get your daily dose of natural sunlight for a minimum of 30 minutes per day. If you can not get out into the natural sun, consider morning exposure to artificial light for at least 1 hour.

5) Only nap before 3pm.

6) Schedule time for relaxation for at least 20 minutes before bed. Espom salt baths, foot soaks, reading and meditation are all great options.

7) Create a bedroom that is most conducive for proper sleep.

avoid electronics in the bedroom
create complete darkness
The general suggested temperature for an ideal night's sleep is between 60-67 degrees Fahrenheit.
invest in comfortable and non-toxic clothing, pillow, mattress and linens.

8) Avoid medications that cause stimulation before bed. Some examples of these medications are hypertension, allergy, and thyroid medications. Consult with your doctor about options for taking these medications at earlier times of day in order to optimize your ability to sleep.

9) Don’t stay in bed if you haven’t fallen asleep after 30 minutes.

One book I absolutely love that talks about sleep is called Why We Sleep by Matthew Walker. If your blood sugar is still high and sleep is an issue, you definitely want to dive down this rabbit hole more deeply!

If you are consistently following the 9 sleep foundations above, and are still experiencing constant fatigue and irritability during the day after getting 7-9 hours of sleep, waking up several times during the night, staying awake for more than an hour without being capable of falling back to sleep, or taking longer than 30 minutes to fall asleep, and/or higher than normal fasting blood sugar levels, it might be time to seek out a sleep specialist for help.

In Summary

So there you have it. All the steps you need to test your blood sugar levels, test your diet to make sure it supports healthy blood sugar levels (carb testing), carb timing so you can still enjoy carbs and sugar from time to time without having it affect your overall wellness, and lastly, other considerations if you blood sugar is still high after dialing in your diet.

I hope this series has helped you step closer to optimal blood sugar and health. As always, if you're struggling with blood sugar or just reaching your health, wellness and/or sport performance goals, reach out to me! I’d love to set up a free discovery call with you to find out if working together to discover your own personalized path to reach your goals is the right fit for both of us!

REFERENCES:
1. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30272-2/fulltext
2. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217011

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How many carbs should you eat? And when should you eat them?

9/16/2020

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This is part 3 of a 4 part series on blood sugar. In part 1, we address the basics of blood sugar and why everyone, including athletes, should care about their blood sugar levels. In part 2, we discussed the importance of testing your own body to specific carbohydrates and how exactly to do that. In this article, we are going to address how to use carbohydrates in your diet so they fuel your life instead of create disease. There are some very important things to address before we jump into the details of how to properly “carb cycle.” Starting with what carb cycling is and why this even matters?

What is carb cycling?

Carb cycling is a method of eating in which you go back and forth between higher carb days and lower carb days. There may even be days that are “keto.” Typically, “carb cycling” is a method of eating used by athletes where they consume higher carbs on days that involve more intense exercise. In my experience, this method of eating works best for athletes who are already fat adapted. This creates an ideal situation to burn fat on days of low intensity training (which is usually 80% or more of an endurance athlete's training) and strategically use carbohydrate on days when you want to include more high intensity. This type of eating can ensure you are getting enough carbohydrate in your diet to aid in recovery, but not so much that your body starts to prioritize sugar for energy over fat.

I realize that the terms "low" and "high" are relative. That's because it really does depend on how "fat adapted" you are. For an athlete who has trained their body to efficiently burn fat, it is not uncommon to see them eat 120-150g of carbohydrate on a "high" carb day and 50-80g of carbohydrate on a "low" carb day.

You can test your body in a lab to discover exactly how "fat adapted" you are by getting a lactate threshold test completed. This type of data can help you learn what a "high" and "low" day might look like for you.

Periodization

If you are an athlete, or have even been an athlete, you should be fairly familiar with periodization. Periodization is a strategy in which you target varying specificity, intensity and volume at specific times of year to improve your performance. By training at the right intensity and volume at the right time of year for your sport, you increase the chance of obtaining your performance goals.

Successful athletes do not typically train at the exact same paces at the exact same distances all year long. For example, if you are training for a marathon, most well built training plans will have a period where you focus on building your endurance, which is typically separate from a time of building speed, which is all together separate from a time of recovery.

Of course there is a blend of endurance, speed and recovery in each microcycle but the general focus for each block of training at different times of year is also different. Nutrition can, and should be treated the same way (curious about this approach to training, check out my post on building an annual nutrition plan that lines up with your on and off seasons!). When training volume is high, the amount of food you eat and the types of foods you eat will be different than the amount and types of foods you would eat during a recovery block.

Once you understand how important it is to change your diet in order to support the different demands your sport can bring throughout the year, it makes it much easier to understand why learning to “carb cycle” can be important to your performance and recovery!

You Need Carbs… but the right ones and in the right amounts!

Carbohydrates are the preferred fuel for sports performance. However, depending on your gender and size, your body can only store approximately 1,400-2,000 calories of sugar in your liver and muscles.

That means that if you train or race for longer than 90-120 minutes, it is likely that you’ll deplete most of your stored sugar and be left low in energy (aka- BONK!). And since we know that your gut can only absorb about 1g of carbohydrate across the gut lining into the blood each minute, that means that you are likely burning more carbohydrates than you can consume. Unless you have 1. done the metabolic training to burn more fat and 2. keep your heart rate low enough that your body utilizes more fat than carbs.

The FASTER study showed that you can train your body to do this with diet. There have been numerous other studies that have since then been published that support the same outcome.

I bring this important fact up because your need for carbs depends greatly on how much fat you are able to burn. If you are metabolically flexible and can easily tap into your own stored body fat, you conserve your stored sugar and don’t require as much exogenous consumption as someone who mostly burns sugar.

Since the bulk of the questions I get from clients around how much carbohydrate to use and at what times are from “fat adapted” athletes, that is what I am addressing here. If you have not done the work to get fat adapted, this model will likely not work for you and you will need to consume more carbohydrates more frequently to keep your energy levels up.

However, if you’ve fat adapted, let’s talk about how and when you should use carbs to fuel your life and performance.

As we discussed above, as your physical training changes, so should your nutrition. In order to keep this relatively simple, I’m going to break down how much and when I advise using carbohydrates per training cycle.

Base Training

In base training, we are typically focused on building the cardio engine, creating injury resilience (which usually means strength training for most endurance athletes) and focusing on metabolic flexibility. I wrote an entire blog with more details on this phase that you can check out HERE. From a nutritional perspective in this phase, this means, from a day-to-day eating perspective, I recommend a low carb, high fat diet.

Everybody is different in exactly how much carbohydrate they should be eating in this phase, but it usually falls somewhere between 50g-150g per day. If you’re training volume is generally low (<3 hours per day) and your intensity is also relatively low, you can and should be on the lower end of carbohydrate consumption with a priority on eating lots of good healthy fats (mostly monounsaturated fats like avocados, olives, nuts and seeds) and majority of your carbs coming from high fiber, low starch whole foods.

This is the perfect time of year to track your blood glucose (refer back to the first blog of the series) and then carb testing (read about that here) as you get ready to approach the start of your season.

During training, you should consume water and electrolytes only. If you have a hard session or have done strength training, add about 30-50g of carbs in your post workout meal. Outside of that, carbs are low.

Build Training

The build phase of training involves an increase in both volume and intensity with a subsequent increase in your energy requirements (i.e., calories!).

If you want to read more details on this phase, check out THIS BLOG post. For this reason, from a nutritional perspective, the primary goal is strategic carb cycling. Using the carbs that you tested well to when you carb tested, here is how I generally recommend adding them into the diet:

For day to day nutrition, remain low carb. For most athletes, the total carbohydrate intake during this time is between 100-150g per day, depending on their activity level.
For high intensity training (which should be 2-3 sessions each week)- add in about 25-30g of carbohydrates during your training session if it is 90 minutes or longer. I typically use liquid calories for this like Skratch Hydration mix. If your hard session is shorter than 90 minutes, consider adding in a small amount of carbs pre-workout (if you stomach can tolerate it), like 1/2 banana, and get around 30-50g of whole food carbs in your post workout meal. My favorite go-to post workout meal is a smoothie with coconut milk blended with 1 scoop Equip Prime Protein and 1/2 cooked sweet potato.
For endurance training- add in about 25-30g of carbohydrates per hour of training that lasts longer than 2+ hours. If your training session is shorter than 2 hours, prioritize water and electrolytes only. Then, in the meal following your endurance session, consider adding in 25-35g of carbohydrate to help with recovery. This is especially important if you have another session less than 24 hours away.

Event Specific Training

In event specific training, we are typically prioritizing event specific efforts. This is usually the phase of training when athletes are doing 2-a-day training sessions and carbohydrates can get up closer to 200g per day for some athletes.

Like in other phases, most athletes find that they recover faster when they consume the bulk of their carbohydrates after their harder session of the day.

Since most athletes are not doing 2 hard sessions per day, this means that you would likely only have 1 higher carbohydrate real food meal per day. I usually recommend prioritizing that meal right after your hard session.

During this entire block of training, you can and should test race specific nutrition for a few of your longer sessions that have race pace work in them. This ensures that your body can tolerate your race day fueling strategy.

Since the body can tolerate up to 60g of carbohydrate per hour, you can and should test how many carbs your gut can tolerate during a long session. I typically recommend picking a few endurance workouts in this block to use as nutrition testing sessions.

Start these sessions fasted (if possible) and start consuming your nutrition within the first 2 hours. Prioritize water and electrolytes until then.

At the 2 hour mark, slow drip in your planned race fuel, which should be mostly carbohydrate with little protein and even less fat and fiber. If your race is longer than 4 hours, you might try eating some whole food carbohydrates like cooked potato, bananas, or whole food bars. If your race is less than 4 hours, try using liquid calories, like Skratch, or whole food gels, like Huma or Spring gels.

The amount of carbohydrates to consume each hour is very specific to you, so testing is critical.

Start with 30g per hour and increase the amount you eat each week. Pay attention to your gut and your energy levels. If you can tolerate 60g of carb per hour without getting any gut discomfort, GREAT!

If not, how many grams can you tolerate before starting to feel discomfort in your belly? If you have trained your body to burn fat and you can maintain your race pace at a relatively low % of your VO2 max, you may not need to consume as much carbohydrate as you think.

Recovery/Off-Season

In your recovery phase or off-season, getting recovered is the priority. That usually means a decrease in both volume and intensity during training. Hopefully, this also means you switch up your sport for something that supports the goals of your specific sport, but AREN’T your specific sport. For example, if you’re an endurance runner or triathlete, you spend your off-season mountain biking or cross country skiing.

From a nutrition perspective, since volume is decreased, carbohydrates can also be reduced in this phase of training. For day-to-day eating, I highly recommend doing a 2 week phase of eating very low carbohydrates. For many, this is usually around 35-65g per day and will result in the production of ketone production.

Once this reset is complete, moving back to a low carb day-to-day diet of anywhere from 50-150g of carbs per day can be done. Most training in this phase is less than 2 hours and water and electrolytes should be prioritized over carbohydrates.

It can not be understated how critical it is for athletes to play around with these recommendations! Every single athlete is so unique in what their body needs. These are merely a recommendation of a jumping off point. But the absolute best thing you can do for yourself is TEST, TEST, TEST!!!

And since my hope is that every single athlete who is reading this is interested in long term health, ensuring that your diet fuels your athletic goals while making sure you are not doing long term damage to your health should be a top priority!

If you’ve gone through the process of becoming fat adapted and are staying focused on what your carb intake is in relation to your activity level, but you’re still experiencing high blood glucose levels, then check back in next week where I dive into WHY you may still be experiencing those issues!

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How to find our which carbs are best for YOUR body.

9/9/2020

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Last week, we started a series on blood glucose and why you should care about it. We talked about how pre-diabetes is NOT just a disease affecting the obese, but can actually affect endurance atheltes at nearly the same rate as non-athletes. We talked about the general physiology, types of sugars, how to read labels and the basics of how to measure your blood glucose levels. If you missed that post, make sure you take a moment to read it, especially if this topic is new to you.

This week, we’re going to dive a little deeper. You heard me say last week that ‘If there is one single thing you can do to discover your own personalized diet and monitor your own health over time, it is to use a blood sugar meter regularly.’ But a common question I get is ‘now that I’ve tested my fasting blood glucose for 7+ days, now what?’

There are 3 different scenarios that can happen once you’ve taken your fasting blood glucose for 7+ days in a row…

1- your average fasting blood glucose is falling between 80-99mg/dL which is IDEAL!
2- your average fasting blood glucose is all over the board. Some days it’s higher than 99mg/dL, some days it’s lower than 80mg/dL and some days it falls right in the middle.
3- your average fasting blood glucose is consistently above 99g/dL.

If scenario 1 is your reality, AWESOME! If you love the diet you are currently following, then I recommend you stick with it and just check your blood glucose levels every 3-6 months to make sure you are staying in a healthy range.

However, if you're eager to find out how your blood sugar responds to different types of carbohydrates, then you can use your blood sugar meter to test that by completing a carbohydrate tolerance test. The instructions for carbohydrate tolerance testing can be found below, but I highly recommend that you read the “Glucose v. Fructose” section before moving onto the carbohydrate tolerance section.

If scenario 2 or 3 is your reality, then I recommend jumping onto a lower carb diet for 30 days.

You can read more about ‘How blood sugar can go WRONG’ from last week's blog. While you transition to a lower carbohydrate diet, you might feel hungrier and experience some symptoms. This is why I recommend eating smaller meals more frequently during the transition. Instead of eating 2-3 balanced meals per day (which is what I recommend when your blood glucose is stable), I would eat 3 smaller, low carb meals and include 2-3 small low carb snacks between them.

Some of my favorite low carb snacks are:

Macadamia nuts
½ avocado
Hard boiled egg
Marinated olives

After 30 days of lower carbohydrate eating, test again.

You might also notice during these 30 days that your urge to snack starts to go away. This is a sign that your blood sugar is starting to stabilize and is a great sign! Follow your hunger signals and transition to eating 2-3 low carb meals per day as you start to experience less hunger.

If your new 7+ day fasting blood glucose tests average between 80-99mg/dL, and you miss having more carbohydrates in your diet, it’s time to complete a carbohydrate tolerance test! But before we jump into exactly how to do that, first let’s briefly talk about carbs and sugar.

Glucose vs. Fructose

Not all carbohydrates are created equal. The way our body processes 50g of sweet potato is not the same as if eating 50g of high fructose corn syrup. But to keep things simple, let’s just talk about monosaccharides. These are typically known as “simple sugars” and they are the most basic units of carbohydrates. Examples of these are glucose, fructose and galactose.

Glucose and fructose are the two most common types of sugars contained in natural foods. Glucose is found in most of the starchy foods, such as potatoes, rice, breads and pasta. Glucose is the preferred fuel for the cells of our body, including the cells in our brain. Glucose is absorbed into the bloodstream within our small intestines. If the body needs energy immediately, the ingested glucose can be used by the muscles and/or brain right away. If the body does not have an immediate need for glucose, it is stored in the liver or in our skeletal muscles. The liver and the skeletal muscles can only store a limited amount of glucose. Once these stores are full, the liver converts excess glucose into fat and stores it in adipose (fat) tissue.

Fructose is found naturally in fruits and some vegetables. Fructose consumed in large quantities can be toxic to the liver. Excess fructose consumption is known to create fatty liver disease which leads to insulin resistance and obesity. It has been shown that overeating fructose can cause insulin resistance within one week and only eight weeks to become pre-diabetic.
Additionally, fructose does not provide a signal of satiety. If you were to eat 500 calories of a potato, you would feel very full. Drinking 500 calories of soda containing high fructose corn syrup does not create this same feeling of fullness, causing overeating. If we are not feeling the satiety sensation, you can see how easy it is to over eat and potentially create newly formed fat.

I'm not suggesting that fructose is bad. What I am suggesting is that too much of anything is bad. Too much glucose is bad. Even too much water is bad. But how much is too much? In this situation, that depends on your body. And one way to help you discover that is by doing a carbohydrate tolerance test, so let’s jump into that...

Carbohydrate Tolerance Testing

For many people, the amount of carbohydrates and sugars that have been consumed over the course of their lifetime is excessive. The excess consumption of these carbohydrates has led to irregular blood sugar which can lead to lethargy, excess body fat retention, fatigue, poor sleep, and less than optimal health. If after testing, you’ve established that your blood sugar is normal, you can complete a carbohydrate tolerance test to learn what life can be like when you consume healthy forms of carbohydrates in the appropriate amounts for your body. (In other words, what it is like to eat balanced.)

In Robb Wolf’s book, Wired To Eat, he details a process he calls ‘the 7 Day Carb Test.’ Your blood glucose levels rise and fall when you eat a meal containing carbohydrates. How high it rises and how long it stays high depends on: the quality of the carbohydrates; the quantity of carbohydrate; and your own bio-individuality. In order to learn how your own body responds to the quality and quantity of carbohydrate, you should consider a carbohydrate tolerance test.

During this test, you use a blood sugar meter to test your body’s personal tolerance to 50g of effective net carbs to a specific food. The point of completing this type of test is to learn more about how your body can properly handle (or not handle) different types of carbohydrates. It might surprise you that some people can tolerate sugary pastries better than a banana, but it is true. This is bio-individuality at its finest. As Robb says in his book, “finding the ‘right’ carbohydrate(s) for your body allows you to dial in your specific carbohydrate tolerance and therefore keep our hormonal profile in a state that is favorable for fat loss while repairing our metabolism.’

How to test

Choose a test carb to test. (for example: sweet potato, black beans, or rice).
Choose the amount of carbohydrate to test. Aim to consume a reasonable amount of the specific carbohydrate. If you are unsure of a good amount, start with 50g of effective net carbs. Effective net carbs are TOTAL CARBS - FIBER = NET CARBS
Prepare your carbohydrate the night before you choose to test.
First thing the following morning, take your fasting blood sugar. Then, eat your test carb. You will eat no other food at this time. Allowable beverages are black coffee and water. If you do have a beverage make sure to have that same beverage each morning you are testing.
Write down which carbohydrate you are testing and the time you ate it.
Set a timer for 2 hours from the time you take your first bite of carbohydrate. Aim to consume your test carbohydrate within 5- 10 minutes.
Test your blood glucose and record your blood glucose reading at the 2 hour mark.

What you are looking for
The most important things to look for (that would indicate that the carb is not the best carb for your body) are:

symptoms (foggy head, inability to focus, anger, depression, anxiety, shaky, etc)
a large fluctuation in your blood sugar:

At the 2 hour blood glucose reading, your ideal blood glucose should be ~115 mg/dL.

If your blood sugar goes much above 120 mg/dL at the 2 hour mark of the test, this can be a sign that your blood sugar has “spiked” and this is not an ideal carb for you. It would be expected that your blood sugar would then drop rapidly, causing you to feel poorly.

The opposite is also true. If your blood glucose reading at the 2 hour mark is below your fasting reading, this is just another sign of the wrong carb for your body.

Ideally, you want to find a carb that doesn’t make you feel badly, and that brings your blood glucose level up (no higher than ~115 mg/dL), and has a slow decline over the next 4 hours.

GIVE THE CARB TOLERANCE TEST A TRY!

Using a blood glucose monitor is by far the easiest way to get insight on how your body is handling the sugar that you eat. And running a carb tolerance test allows you to get even clearer on what specific carbohydrates work for you (and vice versa).

Next week, we’ll dive even deeper into knowing how to use the carbohydrates that are best for your body at the right times of day so you keep stable energy and not store them as fat!

Stay tuned...

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Hitching a Ride on the Blood Sugar Roller Coaster - Part 1

9/2/2020

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We have all heard that eating too much sugar could eventually result in a diagnosis of Type 2 Diabetes. However, just because you have not been diagnosed with diabetes, does not mean your body is tolerating the amount of sugar in your diet.

In 2017, Outside Magazine published an article titled Are Endurance Athletes More Susceptible to Diabetes? In it, the author introduced an endurance runner who also happened to be an intern at the University of Canterbury Center for Bioengineering, which was researching the clinical potential of continuous glucose monitors (CGM).

After a hard bonk in her last ultra endurance event, she wondered if she could use a CGM to help her better understand her blood sugar levels during a long run, see when her levels started to drop and prevent the bonk all together by using exogenous glucose (aka- a gel). After some self experimentation and seeing some potential for future research, she soon found herself in a PhD program studying the potential uses of glucose monitoring in athletes.

In 2016 her first initial pilot study on ten runners and cyclists was published in the Journal of Diabetes Science and Technology and the findings were quite a shock.

“Instead of bonk-inducing blood sugar lows, the more common problem in her subjects, who typically averaged at least six hours of training a week, was high blood sugar throughout the day—an outcome that pointed to an elevated risk of Type 2 Diabetes in these seemingly super-fit athletes. ‘I was incredibly surprised to see the results,’ Thomas says. ‘It seemed contrary to almost everything else in the field.’”

Her initial findings were that 3 out of 10 athletes in the study had fasting blood glucose levels that were by the ADA definition, in the pre-diabetes range. Although the current numbers don’t support the claim that endurance athletes are more susceptible to diabetes, there is certainly a very large range of pre-diabetes that many of us sit in.

We Eat a LOT of Sugar

Today, more than 1/3 of Americans over the age of 18 have pre-diabetes. That means that if the initial data from the study mentioned above actually correlates out when a larger study is completed, slightly less than ⅓ of athletes are also pre-diabetic. That’s frightening!

Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. If lifestyle and dietary intervention is not done, pre-diabetes can easily develop into Type 2 Diabetes.

One of the most challenging aspects of pre-diabetes and Type 2 Diabetes is they are often accompanied by NO symptoms. Occasionally, people complain of increased thirst, frequent urination, extreme hunger, fatigue and irritability. I don’t know about you, but those are things I can feel quite regularly during a block of hard training and easily brush it off as such.

You Don't Have to be Overweight to Develop Diabetes

Many people believe that pre-diabetes and Type 2 Diabetes are diseases that only affect people that are overweight or lack a regular movement routine. Additionally, many athletes and medical professionals believe that if someone workouts all the time and are generally lean, that they cannot become pre-diabetic or Type 2 Diabetic.

Finally, after years of these false beliefs, we are starting to see (even in medical literature) that pre-diabetes and Type 2 Diabetes can affect athletes and sedentary people alike.

Dr. Timothy Noakes, a South African researcher and author of The Lore of Running is an advocate for a blood sugar controlled diet for athletes after years as an endurance runner, he himself developed pre-diabetes.

A similar story exists for Dr. Peter Attia. Cardiologist, founder of the Nutrition Science Initiative and endurance athlete, Dr. Attia discovered in 2009 that he too had developed insulin resistance. Both doctors believe that a diet high in refined carbohydrates is to blame for their (and many other endurance athletes) blood sugar conditions.

For these reasons, the constant conversations I have with my athlete clients regarding energy levels, and my own personal experience with blood sugar regulation, I’m dedicating this month to providing more education on blood glucose.

Of course this education is great for EVERYBODY, but I am particularly interested in helping athletes better understand how to manage their energy levels without developing a disease like Type 2 Diabetes!

This is a HUGE topic and in order to make it digestible, I’ll be dividing it up over the next few weeks. So stay with me as we get started with understanding the basic physiology of blood sugar regulation and why you should be monitoring yours!

Basic Physiology

The body prioritizes blood sugar regulation over other bodily functions to ensure that the brain and other organs have the necessary energy to operate. Our body was designed to use a variety of macronutrients (protein, carbohydrates and fat) for energy sources.

Each human body has its own speciﬁc formula for how much of each of these macronutrients it needs to maintain optimal health and wellness. If the specific formula is off, you become susceptible to disease. There are many factors that play a role in your own specific nutrition formula, such as genetics, stress and activity levels.

Carbohydrates are the fastest burning of the 3 macronutrients. When properly digested, all carbohydrates turn into sugar in the body. Once these sugars are absorbed into the bloodstream, a healthy body will release insulin (a hormone) into the blood to help store these sugars away in the liver and muscles.

The liver and muscles have limited storage for these sugars. If the consumption of carbohydrate (or sugar) is higher than our body’s storage in the liver and muscles, the body will convert the excess sugar into fat and store it in fat cells, in which we have an unlimited storage.

Since carbohydrates burn faster than fat and protein, a diet that is high in carbohydrates will require frequent consumption of carbohydrate to keep energy levels up. If this cycle of frequent consumption of carbohydrates is repeated day after day, month after month, year after year, the body can become less effective at producing and/or using insulin to store away digested carbohydrates.

Once this process begins, we see levels of sugar in the blood begin to rise. This is the very early stages of Type 2 Diabetes (pre-diabetes) and typically there are little to no symptoms associated with the early stages of pre-diabetes and the rise in blood sugar levels.

For athletes, we obtain most of our energy from sugar (either exogenously from the foods we eat during training or endogenously from our stored sugar in the muscles and liver). We can obtain some energy from fat, but this can be a slow conversion and is a system that needs to be trained.

The major benefit to undergoing this adaptation process is that it is well known the body can only absorb so much energy per hour. Most endurance athletes are burning much more than they can comfortably consume in the gut and will inevitably hit the notorious “wall” and bonk at some point.

If you train your body to be able to obtain energy from your own stored body fat in a more efficient way, you can conserve your limited glucose supply for later in your training or race or when you really need it.

If you’ve never gone through the process of training your body to burn more fat for energy, it’s something to consider. I have a 6 week program specifically for this called the Keto Reset and you can learn more about it by clicking HERE.

How Blood Sugar SHOULD Work

When you wake up in the morning after a 12 hour fast, your blood sugar should be at a healthy level, around 85 mg/dL.

After consuming a well-balanced meal, the body digests the macronutrients from your meal and they are absorbed into your bloodstream. This causes a healthy rise in blood sugar over the next 2 hours (to around 115 mg/dL) and a signal to the body to release the hormone insulin from the pancreas.

Insulin’s job is to remove any excess sugar from the blood and store it in the liver and/or muscles for later use.

After a few hours without a meal, the blood sugar levels begin to drop back toward the fasting levels (85 mg/dL) and the brain sends a signal to the pancreas to release the hormone glucagon.

Glucagon's job is to release stored glucose from the liver back into the bloodstream to be used as energy until the next meal is consumed.

NORMAL BLOOD SUGAR LEVELS should be between 80-99mg/dL fasting and should range between 85-115 mg/dL throughout the day.

How Blood Sugar Can GO WRONG

When you wake up in the morning after an 8-12 hour fast, your blood sugar should be at a healthy level, around 85 mg/dL. However, if the hormones that regulate blood sugar overnight cannot function properly, it is not uncommon to see blood sugar levels drop below 79 mg/dL. This often causes people to crave carbs, sweets and/or caffeine.

If a standard American breakfast of cereal, sweetened yogurt, oatmeal, pancakes with syrup, fruit juice, sweetened coffee creamers, etc are consumed, the body digests the macronutrients from your higher sugar/carb meal, absorbs into your bloodstream quickly, and causes a rapid rise in blood sugar levels.

In a standard American breakfast, it is not uncommon to see upwards of 30g of sugar in that single meal. Take for example a yogurt parfait. A single serving of Chobani black cherry flavored greek yogurt has 17g of carbohydrate (which includes 15g of sugar). Top that with 1/2 cup of organic Love Crunch granola, and you've added an additional 40g of carbohydrate (which includes 12g of sugar). That's a 400 calorie breakfast that includes 57g of carbohydrates and 27g of sugar!!!! WHOA!

Your hormones are fighting to keep approximately 5g (that's 1 tsp) of sugar in your blood stream at any given time. That means that your "healthy" greek yogurt parfait just created a crisis in your body because you now have over 5x the amount of sugar in your blood stream. This causes the body to rapidly release the hormone insulin from the pancreas in response to the high levels of sugars in the blood.

As mentioned earlier, it is insulin’s job is to remove any excess sugar from the blood and store it in the liver and/or muscles for later use. However, we only have a limited amount of storage in our body for sugar. So that excess sugar that doesn't have a place for storage, guess what happens to it?

It turns into FAT.

Because lucky for us, we have an unlimited storage for fat. But that fat topic is for another day...let's get back to what's happening to your blood sugar...

So that rapid spike in blood sugar, creates a rapid release of insulin, which rapidly drops your blood sugar and easily creates a another low blood sugar situation. This creates more cravings for carbs, sweets and caffeine, and the vicious cycle starts over again a few hours after your breakfast.

If this cycle isn't addressed with more balanced meals (less carbs and more protein and/or fat), the body will eventually become less capable of creating the amount of insulin need to drop your blood sugar levels into the normal range. This is what is known as insulin resistance.

Insulin resistance creates higher than normal levels of blood sugar throughout the day. If using a blood sugar meter, you will see levels ranging between 100-199 mg/dL regularly. If this condition is not reversed with lifestyle and dietary interventions, your blood sugar levels will continue to rise.

Once a persons fasting blood glucose level goes above 200 mg/dL, they will typically be diagnosed with type 2 diabetes.

Fasting PRE-DIABETIC SUGAR LEVELS are between 100-199 mg/dL.
Fasting DIABETIC SUGAR LEVELS are above 200 mg/dL.

Complications from Blood Sugar Dysregulation

Blood sugar dysregulation disrupts all aspects of human physiology, including:

energy
the integrity of the tissues of every organ and blood vessel
hormonal balance
brain health

People can begin to experience anxiety, agitation, depression, fatigue or high levels of stress when blood sugar is out of normal ranges (either too high or too low). This is because the hormones regulating fuel distribution affect your mood.

Diabetic nerve damage (neuropathy) can also occur and affects approximately 60-70 percent of patients with diabetes. The longer a person has diabetes and the greater the degree of severity, the greater the risk of neuropathy. Neuropathy affects the nerves in the lower extremities first: the feet, hands and also the arms. Symptoms include tingling, numbness, burning and pain. The constant pain of diabetic neuropathy can be debilitating and worse for some people at night.

Heart attacks are a known complication of diabetes. When the blood vessels supplying the heart are damaged, the body responds by depositing plaques of fatty material, known as cholesterol, within the inner walls of the blood vessels. As the body works to repair the damage, the blood vessels narrow and harden with this plaque. The blood is not able to supply oxygen through the narrowed vessels, resulting in the death of part of the heart muscle. 68% of diabetics aged sixty-five or older will die of heart disease, and a further 16% will die of stroke.

Identifying Sugar

When many people think of sugar, they think of foods like cookies, cakes or cereal.

Yet sugar is hidden in over 80% of other foods like catsup, relish, mayonnaise, crackers, bread, canned fruit and even low-fat yogurt!

Food manufactures have different names for sugar, making it very confusing for people to identify sugar as an ingredient.

Some of the other names listed for sugar are: dextrose, barley malt, disaccharides, fruit juice concentrate, lactose, malt and sucrose, to name a few.

Types of sweeteners (from best to worst…):

NATURAL SUGARS such as unrefined raw honey, raw cane sugar, and fruit, that when unprocessed, maintain some nutrient value to the body.
NATURAL SWEETENERS such as stevia. Usually an herb. It tastes sweet but is not sugar. The more they are processed, the less healthy they are.
REFINED SUGARS such as white cane sugar, processed honey, agave and corn syrup. Natural in origin, but the refining process generally makes them unhealthy.
SUGAR ALCOHOLS such as xylitol, erythritol, sorbitol and mannitol. Real food but highly processed. These sugar alcohols are incompletely structured and are likely to cause digestive upset.
ARTIFICIAL SWEETENERS such as splenda and aspartame. These are man made chemicals that are made to taste sweet. Artificial sweeteners, such as aspartame, Nutrisweet and Equal, which carry no caloric value, have been shown to increase your risk of a metabolic syndrome by more than 34%. Additionally, there is a 43% increase of a vascular event (such as stroke and heart attacks) in those that consume artificial sweeteners regularly.

Since athletes need to consume carbohydrates to fuel longer workouts, finding the right sugars in the right balance is key! Stay with me as we explore exactly how to do this over the next few weeks.

Reading Labels

The American Diabetic Association recommends a daily sugar consumption below 20g for women, 36g for men, and less than 12g for children. The average American consumes 71.14g of sugar every day, well over the recommended amount. One of the simplest ways to reduce the intake of added sugar is by learning to read food labels.

Look for foods with 5g of sugar or less per serving!

Keep in mind that:

As of July 2018, added sugars are listed separately on food labels in America, but not in all countries.
Naturally occurring sugars from whole foods are not considered added sugars.
Lactose is the naturally occurring sugar from dairy. The amount of sugar from dairy can vary from product to product. Generally speaking, there is approximately 5g of sugar per 100g of dairy with no added sweeteners.

Check the ingredient list for any added sugars!

There are currently 61 different names for added sugar in the US, which makes them challenging to identify.

The main things to keep in mind are:

Words ending in “-ose” are added sugars.
Words ending in “-tol” are added sugars.
Words such as “syrup,” “juice,” “concentrate,” and “crystals” are sugars.

Just because the label lists “zero” sugar, does not mean that there are no added sugars in the ingredients. You must check both!

Monitoring Your Blood Sugar

One of the best ways to prevent (or reverse) pre-diabetes or Type 2 Diabetes and discover exactly how your speciﬁc body tolerates different types of carbohydrates/sugars (the type, load and frequency) is to monitor your own blood sugar levels.

This can be easily done with an at home blood glucose monitor. These monitors are sold over the counter at many drug stores and range from $20-$50. If there is one single thing you can do to discover your own personalized diet and monitor your own health over time, it is to use a blood sugar meter regularly.

To test, always start with your FASTING blood sugar in the morning before you do anything like eat, drink, or brush your teeth. Follow the instructions included with your specific kit to get an accurate test result.

Healthy fasting blood sugar readings should be around 85mg/dL. Consistent fasted readings below 80mg/dL may indicate hypoglycemia, and consistent fasted readings above 99mg/dL may indicate pre-diabetes. Keep in mind that there are other factors that can affect your blood sugar, such as sleep and stress (more on this coming up!)

The most important part of blood sugar testing is to be consistent. Timing is everything. It is highly advised that you set an alarm to make sure you stay consistent with testing for 7 days. This will allow you to start seeing a pattern. It is important to note that there is a degree of error with all blood sugar meters.

The goal is not to become ﬁxated on each and every number, but to see all the numbers together and the pattern they create. To get the most out of testing, you should also be keeping a food and lifestyle journal and be noting things that affect your blood sugar, like: sleep, stress, exercise, macronutrients, and hormone cycles.

Coming Up Next

Understanding blood sugar and learning how to balance it takes a bit of time. That is why, rather than inundating you with information, I have decided to dedicate the entire month of September to teaching you the ins and outs of blood sugar and how balancing it can be crucial to your athletic performance and overall health.

Coming up next, we continue to talk about blood sugar, with a stronger focus on how to find a better balance between carbs, fats and proteins so you can fuel your workouts appropriately and not put yourself at risk for developing disease.

If you have any questions about blood sugar, you can email me! And, if you’re ready to take the next step by becoming a fat burning machine rather than an exhausted sugar burner, then sign up for the Keto RESET Program waitlist! This 6 week course is dedicated to teaching you how to transition your body so that it can efficiently burn fat for fuel allowing you to experience vitality and great health.

REFERENCES:

National Institute of Diabetes and Digestive and Kidney Diseases. Nerve damage (diabetic neuropathies) 2013 Nov. Available from: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetic-neuropathies-nerve-damage-diabetes/Pages/diabetic-neuropathies-nerve-damage.aspx Accessed 2017 Jun 6.
American Heart Association. Cardiovascular disease & diabetes. 2015 Aug. Available from: http//www.heart.org/HEARTORG/Conditions/More/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp/#.WZYRWK3MXE4 Accessed 2017 Jun6.
Lutsey PL, Steffen LM, Stevens J Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities Study. Circulation. 2008 Feb 12; 117(6): 754-61.
2016, March. 2015-2016 Dietary Guidelines for Americans, Eighth Edition. Cut down on added sugars.

0 Comments

Food isn't the only factor in blood sugar regulation

Using Non-Caloric Sweeteners

Stress

Sleep

In Summary

How many carbs should you eat? And when should you eat them?

What is carb cycling?

Periodization

Base Training

Build Training

Event Specific Training

Recovery/Off-Season

How to find our which carbs are best for YOUR body.

Glucose vs. Fructose

Carbohydrate Tolerance Testing

Hitching a Ride on the Blood Sugar Roller Coaster - Part 1

We Eat a LOT of Sugar

You Don't Have to be Overweight to Develop Diabetes

Basic Physiology

How Blood Sugar SHOULD Work

How Blood Sugar Can GO WRONG

Complications from Blood Sugar Dysregulation

Identifying Sugar

Reading Labels

Monitoring Your Blood Sugar

Coming Up Next

Author

Archives

Categories

Telephone

Food isn't the only factor in blood sugar regulation

Using Non-Caloric Sweeteners​

Stress​

Sleep​

In Summary​

How many carbs should you eat? And when should you eat them?

What is carb cycling?

Periodization

Base Training

Build Training

Event Specific Training

Recovery/Off-Season

How to find our which carbs are best for YOUR body.

Glucose vs. Fructose

Carbohydrate Tolerance Testing

Hitching a Ride on the Blood Sugar Roller Coaster - Part 1

We Eat a LOT of Sugar​

You Don't Have to be Overweight to Develop Diabetes​

Basic Physiology​

How Blood Sugar SHOULD Work​

How Blood Sugar Can GO WRONG​

Complications from Blood Sugar Dysregulation​

Identifying Sugar​

Reading Labels​

Monitoring Your Blood Sugar​

Coming Up Next​

Author

Archives

Categories

Telephone

Using Non-Caloric Sweeteners

Stress

Sleep

In Summary

We Eat a LOT of Sugar

You Don't Have to be Overweight to Develop Diabetes

Basic Physiology

How Blood Sugar SHOULD Work

How Blood Sugar Can GO WRONG

Complications from Blood Sugar Dysregulation

Identifying Sugar

Reading Labels

Monitoring Your Blood Sugar

Coming Up Next