How important is glucose flattening?

In My Humble Opinion
81

It might help with accuracy in the label, but from your doctor’s POV, it likely wouldn’t change much? From their perspective you were already incorporating the lifestyle recommendations that would be advised with a prediabetes label. What does the label add?

That said, it could alter your anxiety level some to be confident that what you are doing is keeping you out of the prediabetes grouping.

But the crux was the anxiety expressed here:

So? Were you? How high were you going after meals in baseline? You now have information on what your FBG is before your body starts up the engines knowing there is a 45 minute walk about to happen, what your max peaks are, and how much time you on average spend where. Of course what normal values are is not well determined but that is much more than both FBG and HgbA1c together!

FWIW there were the two related threads below that of some interest to this discussion. The first cued to were discussion of CGM began.

For those who are not diabetic I worry about a pursuit of best flatness misdirecting on healthy behaviors and increasing rather than decreasing anxiety.

82

My last A1c measurement was just kissing the bottom of the “pre diabetic” range i looked up my history, and i had the same reading a few years ago (it was lower in the interim) but it was considered normal at the time, because the guidelines have changed.

I have been thinking i might do some glucose monitoring to learn what matters. I think it’s extremely unlikely that I’ll learn that all vegetables raise my blood sugar. But i might learn that white rice raises it more than brown rice, and maybe that will look big enough to be worth eating less white rice. And honestly, if i learned that bananas spiked my blood sugar more than any other fruit, i would avoid them. I wouldn’t totally stop eating fruit, that would be a ridiculous change. But i might change which fruits i eat or when i eat them.

If i saw a modest increase during exercise i would interpret that as a normal accommodation to feed my muscles. It seems vanishingly unlikely that I’ll learn that exercise spikes my blood sugar in a bad and persistent way. If i did see that, I’d want to talk to my doctor about it.

I feel like immediate feedback would give me a lot more to work from than an average reading, though, and might help me reduce my overall blood sugar a bit.

83

And “I am sure it can be helpful to some” …

I also however am starting to keep the label of prediabetes as currently defined with one eyebrow raised. With 38% of adult Americans meeting the definition ISTM that the grouping may be as much of a mixed bag as those labeled overweight on BMI. (Some with a BMI of 27 are over fat and unfit; some are very fit and have a lower mortality rate than most labeled normal BMI.)

To the degree getting labeled motivates proven positive changes in diet and exercise, wonderful. Great to have a label that is highly sensitive at identifying future risk even at the cost of over labeling (poorer specificity). But when healthy individuals start limiting which fruits they eat because one gives them a higher normal level after eating than another? That seems to me like more harm than good. I would for a general population worry about some having disordered eating triggered in some meaningful fraction.

That is @LSLGuy’s point as I read it, but while he is right that none of us can know, for our OP or anyone else, I am not as sure that the individual would know much better.

FWIW generally better to have brown or red or black rice over white. Even without knowing blood sugar response.

84

Exactly, and I might learn things I could do better, like avoiding foods that cause higher than normal glucose spikes, which would further reduce my anxiety given my high FBG. (I’m coming to the conclusion that my FBG is what it is, it might even been hereditary, and there may be nothing I can do about it.) However, I can still reduce my glucose spikes, which AFAIK is still a good thing, as long as I don’t obsess about it and drive my wife crazy.

85

In baseline I was doing fine as long as I stayed on a Low-Carb Mediterranean Diet, but by adding carbs, especially simple cards, caused big spikes. I seem to be very sensitive to carbs in general, and simple carbs in particular, think sugary fruit, sugary drinks, and desserts. Whether everyone is like this I don’t know, but since going off Keto I have been trying to incorporate more “healthy” carbs back into my diet.

My dietician wants me to be at 35% carbs, but when I increase my carbs over 15%, adding complex carbs only, I put on weight and my spikes get higher than I want. How high? I try to keep my three spikes below 160 mg/dl, and if I watch my carbs I can do that fairly easily. Maybe that’s unrealistic long term, but that’s what I aim for since it gives me a 20 mg/dl buffer under 180 mg/dl. BTW, the baseline average of my three spikes is 130 mg/dl.

Keep in mind I’m starting from 100-110 mg/dl during daytime fasting and it doesn’t ever drop below that until the middle of my nighttime fasting. My spikes don’t last that long, and my BGL is usually back to baseline within 90 minutes of eating. And yes, I see my BGL rise when I am on a strenuous dog walk in the morning, and I don’t worry about it because I understand what is happening and it’s expected.

86

I couldn’t agree more, but I wouldn’t call it an obsession just because I am wearing a CGM, and I don’t think I’m “misdirecting on healthy behaviors”. I’m curious what you think I might be doing that is misdirecting a healthy behavior. If I avoid a few fruits and other sugary foods how is that unhealthy? I feel great, my brain fog has lifted, I have plenty of energy, and I’m sleeping better than I have in years. Don’t confuse tenacious curiosity with anxiety.

The human body is extremely complicated, and I don’t know enough physiology or biochemistry to understand the nuances of what the data is telling me. I’m collecting data for nine different parameters daily on a spreadsheet and making graphs so I can look for correlations. It’s certainly time consuming, but I’m hoping some genuine insights will come from it.

87

This is exactly what I’m trying to do. For example, I’ve learned using my CGM that I can eat brown rice and not raise my BGL significantly, compared to white rice. Does that mean I will never eat white rice again? Of course not, since I would never give up my favorite sushi restaurant. Will I stop eating white rice at home on a regular basis? Yes, or more accurately I will substitute brown rice for white rice.

That’s just one minor dietary change that will reduce my glucose spikes. Will it make a difference to my longevity or getting Metabolic Syndrome? Who knows? Will it hurt me in some way to make this change? I doubt it, and I’m not suggesting anyone else make this change since their body may react differently to white rice than mine does… but there’s only one sure way to find out. If it even matters to them.

88

Again, not speaking with any expert knowledge, but my impression is that those seem high.

Maybe the future holds creating some indices based on CGM of normal populations followed prospectively as a new gold standard?

Let us know what your doc thinks when you share this with them!

89

Which seem high?

90

Prior to this thread I had not heard of the concept of “glucose flattening”, but it describes how I eat.

Since May I have been trying to be steadfast into bodybuilding (that is, following an exercise and nutrition plan to optimize muscle and minimize body fat).

Nutrition - far more than exercise - is the most important aspect, and my eating is based on all of the “bro science” I’ve picked up over the years of reading about working out. And it basically follows the strategies laid out by the OP.

I eat 6 small meals a day, with the goal being to maintain a relatively steady blood sugar level. This way, the logic goes, the body will be constantly fueled for muscle recovery while avoiding gains in fat brought about by huge insulin spikes.

What’s the methodology? Basically what has been described herein. Each meal is “complete” - that is, it must always include a quality protein source and fiber, while minimizing added sugars.

I believe that this is the healthiest way to eat, as it amounts to consuming a diet of nutrient dense food, and a wide variety of it. It also means that you don’t mindlessly snack on food, since you’ll never eat just some carbohydrate or fat laden treat. And it keeps you full, so you’re not feeling deprived, while letting you enjoy sweet and savory things, so you aren’t beset by cravings.

My typical carbohydrates are whole grain bread, brown rice, steel cut oats, and sweet potatoes. I also eat lots of fruit and vegetables. And the protein is stuff like chicken, beef, and eggs.

As an example, here’s today’s (typcial) menu:

Breakfast:
Banana
Greek yogurt
Atkins protein shake (I like them because they have 7 grams of fiber along with 23 grams of protein.

Meal 2
Peanut butter sandwich (I use Dave’s Killer Bread; it’s got lots of seeds in it. And I use Nutzo peanut butter, made from like 8 different nuts)
Apple
V8 vegetable juice

Meal 3
Cup of brown rice
Chicken
Fruit cup (I do berries - black, ras, blue, smurf, quisen, et al - along with dried apricots and prunes)

Meal 4
Beef
Salad (of carrots and cucumbers)
Mixed nuts
Orange

Meal 5
(This is post workout) - a protein shake

Meal 6
2 eggs
Steamed broccoli and soybeans

(On weekends, meal 2 and 3 is usually oatmeal, chicken, and some fruit, and meal 4 is usually a salad with beef and nuts)

Regardless of the blood glucose thing, I can attest that this is a very sustainable way to eat. While I pretty much eat the same thing each day, I eat a wide variety of foods each day, so I don’t get bored. And I don’t get hungry, either, since I’m eating every few hours and the foods are filling (you could also set a clock by my bowel movements, twice a day).

I’m rooting for you, @dolphinboy. I hope it proves as worthwhile to you as my nutrition habits have become to me.

91

We know diabetes is an epidemic. It is a disease that hardly affected anyone slightly over a hundred years ago, and that is now very, very commonplace. It is a disease of the nerves and blood vessels and kidneys. So it affects eyesight, heart and kidney function, leads to strokes and leg amputations, influences sexual satisfaction and need for dialysis and need for injected medicines. We know it reduces life expectancy, especially when poorly controlled, and it can greatly reduce quality of life. We know the diagnosis is often made later than it should be. We know of a metabolic syndrome with other problems where damages increase even faster.

It is also reasonable to assume there is a spectrum and that elevated sugar levels, prediabetes, can increase the risk of diabetes and that there is a risk for similar pathology though likely at a slower rate.

The first advocate for continuous monitoring I was aware of was a book by Dr. Peter Attia about longevity. It is well-written, firmly evidence based and in a field with lots of hype and hypocrisy seems reasonable. I do disagree with some of what he says. He advocates people finding out which foods cause spikes in a given individual so that these can be eaten less often or in smaller amounts or not at all. He discusses some of the strategies mentioned in this thread, advocating short-term experiments to better understand one’s individual physiology and reaction to food. He does not suggest avoiding fruits nor vegetables and is a strong advocate for more exercise.

Does everyone need this? No. Diabetics would benefit more from this knowledge. But if you have had diabetes for years before diagnosis than some important damage has already occurred. If you do a self-experiment, in theory you can avoid the things which most affect you. Avoiding diabetes is a pretty big health benefit and maybe more knowledge motivates people to move more and eat better or make other beneficial changes. Exercise is perhaps more important than overfocusing on sugars, but that hardly makes knowing sugars unimportant.

Of course, doctors are familiar with patients who measure their blood pressure twenty times a day and are alarmed when it is high, which often occurs since anxiety influences pressure. It isn’t helpful to weigh yourself to often and many advanced medical tests recommended by book authors are a waste of money and make things worse by increasing anxiety. Lots of people might interpret these results in ways that are inaccurate or unhelpful. More testing is often not a very good answer in the goal of increasing health span. That doesn’t always make it unwise, but it often is.

But this is a time limited experiment. Interesting and potentially useful. With motivated patients the risk of increased harm may be lessened. It is not outrageously expensive to monitor glucose for a month. Glycemic indices aren’t very helpful since foods are not eaten individually but as parts of meals. Accordingly, I am interested to see if any of the interventions proposed has a big effect or if they do cumulatively. But caution should be applied to applying these insights to other people or making changes which are too strict or detrimental. If preventative medicine means much, and I think this should be the future trend, I see it as a worthwhile thing to try even if glycated hemoglobins, etc. are not very elevated.

92

Oh wow, people are different. There’s no way i would do that every day. I was exhausted just reading about it. :wink: Also, i want to eat more different foods. I like to mix up my proteins over the week, with duck and lamb and lentils as well as beef and chicken.

But i do like Dave’s “good seed” bread, also because it has a lot of seeds in it. I find it a really tasty and satisfying sandwich bread that goes very well with pb&j.

93

What I do not want to imply is more data is always better (often false, especially in medicine), or that glucose spikes can be afforded too much attention and so be misinterpreted.

94

I’m tempted to try an experiment like this because even if i learn that my body is exactly like everyone else’s, and all the standard advise is what i ought to be doing, i think it will be more compelling to see numbers from me than to read exhortations about what “good people” ought to do. And there’s a lot of moralizing mixed in with nutrition advice, especially for overweight women.

95

I guess I would have expected the between meal numbers lower and less high peaks?

Tried to find something to educate myself on what normal should be. Found this.

Meal spikes up to 160 to 168 were within 1 SD and 120s average spike was … average.

So your peaks are not bad? Not too curvy but yeah most had 80% of their time 59 to 100. You seem more than that?

That said that study was what? 21 people? Not quite large enough to state normal ranges.

Here’s another more recent.

So at least you have something to compare yourself to.

96

I’m pretty into my routines, but there’s no reason you can’t be more judicious in your food choices, or add more variety (I should eat more fish).

Even I will vary it up. At a local BBQ place I can get smoked turkey, a sweet potato, and beans. When I really want something sweet I’ll go to dark chocolate covered almonds. I also love pistachios as a snack.

The general principles, though, are the same: eat small meals frequently throughout the day, and ensure that every meal includes protein and some fiber (so, for a “meal”, you might have an apple with some peanut butter. Or what my son calls a “Daddy Special” - some steak and a side of fresh fruit: watermelon goes so good with a lean cut of beef).

I think that if you follow those two rules your blood sugar will stay relatively stable. That’s useful for maintaining consistent energy levels and staying lean.

97

Yeah, that’s the part that feels like work. I don’t want to have to think about food that often, and i want to take some time and enjoy my food when i do think about it.

I talked to a nutritionist who thought i was probably doing okay eating less often. But again, of i had actual data from my body suggesting i needed to eat more smaller meals, i might be inclined to try.

98

That’s fair. Some people think of food as simply fuel for the body, but clearly cooking and cuisine is about so much more.

For what it’s worth, the concept of the “cheat meal” is popular amongst those who tend to be consumed with their nutrition. I enjoy what I eat, so I don’t usually get that compunction. But it does justify the occasional night out to dinner, where you can enjoy the chef’s specials without worrying about what’s in the sauce. (And I recommend always springing for the crème brûlée)

I’d also add that the concept of healthy eating is fairly simple once you start eating minimally processed foods. All fruits and vegetables are good to eat; have as much as you want (but eat protein with it). For protein, avoid saturated fats (ironically, the healthiest beef is the cheapest, because it’s not full of marbling). Otherwise, just consume foods that didn’t go through too much transformation before they got to you.

Seeds, grains, oats? Yes!

Artificial colors, or served by a clown? You should probably pass.

99

I agree with your food choices, and adding protein, such as peanut butter, to an apple makes sense. I never eat naked carbs myself, but as far as the number of meals goes, that doesn’t fit with my intermittent fasting in which I only eat three good-sized meals a day, breakfast at 9 am, lunch at 1 pm, and dinner at 5pm. From about 5:30 pm until 9 am I’m not hungry and don’t eat anything, and there’s no snacking during the day. That gives my body time to switch between energy storage mode to energy burning mode. That also happens, to a much lesser degree, between my three daily meals. I am not trying to build muscle like you are, just maintain the muscle I have as I lose weight. Body building has a very different energy dynamic, so having lots of small meals makes sense for you. If you feel good during the day , aren’t hungry, and have enough energy for your workouts, it must be working. I applaud your dedication. Not everyone has that kind of discipline.

100

Thank you for the two references. I’ll read them and get back to you on what I think, and how it applies to my situation.