How to prevent diabetes and heart disease for $16

November 26, 2010 in Diabesity | 60 comments


relionIn the last article we discovered that the blood sugar targets established by the American Diabetes Association are far too high, and do not protect people from developing heart disease, diabetes or other complications. And we looked at what the scientific literature indicates are safer targets for fasting blood sugar, hemoglobin A1c and either OGTT or post-meal blood sugar.

In this article I’m going to introduce a simple technique that, when used properly, is one of the most effective ways to maintain healthy blood sugar and prevent cardiovascular and metabolic disease – without unnecessary drugs.

I love this technique because it’s:

  • Cheap. You can buy the equipment you need for $16 online.
  • Convenient. You can perform the tests in the comfort of your home, in your car, or wherever else you might be.
  • Personalized. Instead of following some formula for how much carbohydrate you can safely eat, this method will tell you exactly what your carbohydrate tolerance is, and which carbs are “safe” and “unsafe” for you.
  • Safe. Unlike the oral glucose tolerance test (OGTT), which can produce dangerous and horribly uncomfortable spikes in blood sugar, this strategy simply involves testing your blood sugar after your normal meals.

The strategy I’m referring to is using a glucometer to test your post-meal blood sugars. It’s simple, accessible and completely bypasses the medical establishment and pharmaceutical companies by putting the power of knowledge in your hands.

It’s one of the most powerful diagnostic tools available, and I use it with nearly all of my patients. Here’s how to do it.

Step one: buy a glucometer and test strips

A glucometer is a device that measures blood sugar. You’ve probably seen them before – they’re commonly used by diabetics. You prick your finger with a sterilized lancet, and then you apply the drop of blood to a “test strip” that has been inserted into the glucometer, and it measures your blood sugar.

There are literally hundreds of glucometers out there, and their accuracy, quality and price varies considerably. The one I recommend to my patients is called the Relion Ultima, which can be purchased with 20 test strips for $16.00 online at Walmart.com. (Note: as a rule I don’t like to support Walmart, but I haven’t been able to find this unit anywhere else at a similar price.) Even better, the test strips, which you’ll need on an ongoing basis to monitor your blood sugar, are relatively cheap for the Relion Ultima. You can get a 100 of them for $39 at Walmart online ($0.39/strip).

I’m sure there are many other choices that work well, but this is the unit I have the most experience with, and in general it is very reliable. Another good choice is the TrueTrack meter drugstores sell under their own brand name (i.e. Walgreens, Sav-on, etc.). Other models to consider are the One Touch Ultra or one of the Accu-Chek meters. The problem with these, however, is that the test strips tend to be more expensive than the Relion Ultima.

Step two: test your blood sugar

  1. Test your blood sugar first thing in the morning after fasting for at least 12 hours. Drink a little bit of water just after rising, but don’t eat anything or exercise before the test. This is your fasting blood sugar level.
  2. Test your blood sugar again just before lunch.
  3. Eat your typical lunch. Do not eat anything for the next three hours.Test your blood sugar one hour after lunch.
  4. Test your blood sugar two hours after lunch.
  5. Test your blood sugar three hours after lunch.

Record the results, along with what you ate for lunch. Do this for two days. This will tell you how the foods you normally eat affect your blood sugar levels.

On the third day, you’re going to do it a little differently. On step 3, instead of eating your typical lunch, you’re going to eat 60 – 70 grams of fast acting carbohydrate. A large (8 oz) boiled potato or a cup of cooked white rice will do. For the purposes of this test only, avoid eating any fat with your rice or potato because it will slow down the absorption of glucose.

Then follow steps 4-6 as described above, and record your results.

Step three: interpret your results

If you recall from the last article, healthy targets for blood sugar according to the scientific literature are as follows:

Marker Ideal*
Fasting blood glucose (mg/dL) <86
OGGT / post-meal (mg/dL after 1 hour) <140
OGGT / post-meal (mg/dL after 2 hours) <120
OGGT / post-meal (mg/dL after 3 hours) Back to baseline
Hemoglobin A1c (%) <5.3

*To convert these numbers to mmol/L, use this online calculator.

Hemoglobin A1c doesn’t apply here because you can’t test it using a glucometer. We’re concerned with the fasting blood sugar reading, and more importantly, the 1- and 2-hour post-meal readings.

The goal is to make sure your blood sugar never rises higher than 140 mg/dL an hour after a meal, drops below 120 mg/dL two hours after a meal, and returns to baseline (i.e. what it was before you ate) by three hours after a meal.

There are a few caveats to this kind of testing. First, even reliable glucometers have about a 10% margin of error. You need to take that into account when you interpret your results. A reading of 100 mg/dL could be anything between 90 mg/dL and 110 mg/dL if you had it tested in a lab. This is okay, because what we’re doing here is trying to identify patterns – not nit-pick over specific readings.

Second, if you normally eat low-carb (less than 75g/d), your post-meal readings on the third day following the simple carbohydrate (rice or potato) challenge will be abnormally high. I explained why this occurs in the last article, but in short when you are adapted to burning fat your tolerance for carbohydrates declines. That’s why your doctor would tell you to eat at least 150g/d of carbs for three days before an OGTT if you were having that test done in a lab.

If you’ve been eating low-carb for at least a couple of months before doing the carbohydrate challenge on day three of the test, you can subtract 10 mg/dL from your 1- and 2-hour readings. This will give you a rough estimate of what your results would be like had you eaten more carbohydrates in the days and weeks leading up to the test. It’s not precise, but it is probably accurate enough for this kind of testing.

Step four: take action (if necessary)

So what if your numbers are higher than the guidelines above? Well, that means you have impaired glucose tolerance. The higher your numbers are, the further along you are on that spectrum. If you are going above 180 mg/dL after one hour, I’d recommend getting some help – especially if you’re already on a carb-restricted diet. It’s possible to bring numbers that high down with dietary changes alone, but other possible causes of such high blood sugar (beta cell destruction, autoimmunity, etc.) should be ruled out.

If your numbers are only moderately elevated, it’s time to make some dietary changes. In particular, eating fewer carbs and more fat. Most people get enough protein and don’t need to adjust that.

And the beauty of the glucometer testing is that you don’t need to rely on someone else’s idea of how much (or what type of) carbohydrate you can eat. The glucometer will tell you. If you eat a bowl of strawberries and it spikes your blood sugar to 160 mg/dL an hour later, sorry to say, no strawberries for you. (Though you should try eating them with full-fat cream before you give up!) Likewise, if you’ve been told you can’t eat sweet potatoes because they have too much carbohydrate, but you eat one with butter and your blood sugar stays below 140 mg/dL after an hour, they’re probably safe for you. Of course if you’re trying to lose weight, you may need to avoid them anyways.

You can continue to periodically test your blood sugar this way to see how you’re progressing. You’ll probably notice that many other factors – like stress, lack of sleep and certain medications – affect your blood sugar. In any case, the glucometer is one of your most powerful tools for preventing degenerative disease and promoting optimal function.

Resources

If you haven’t already, check out Jenny Ruhl’s excellent Blood Sugar 101 site. Jenny won’t tell you this herself, but she’s an authority on blood sugar and probably knows more about it than 99.9% of health care practitioners (she’s an author). In particular, check out the “Painless Blood Sugar Testing”, “Frequently Asked Questions” and “How to Lower Your Blood Sugar” sections. I’d link to them directly, but her site uses frames and doesn’t allow it.

{ 60 comments }

Kim November 26, 2010 at 11:08 am

Hi Chris! Just wanted to tell you a little research will net a FREE glucometer. I got mine last week and it included a free membership to get the test [email protected] a discount. It’s a Freestyle Life and uses the smallest blood sample on the market. The offer is probably still available.

lynn November 26, 2010 at 11:30 am

Great post! I have done the fasting and one and two hour PP’s, but I never did the 3 hour one. Interesting…

I will get some new strips and go for it.

BTW, what does it mean if the 3 hr PP is not back to baseline?

Thanks.

Chris Kresser November 26, 2010 at 12:21 pm

Kim: thanks for the tip!

Lynn: in general it’s suggestive of poor glucose tolerance, but specifically may point to a compromised phase II insulin response or cortisol dysregulation.

Lynn November 26, 2010 at 12:47 pm

What would a compromised phase II insulin response be? How could one fix that? Re: cortisol, would it be high or low cortisol causing issues?

When you say back to baseline, does that mean the exact figure? Like if the pre meal figure was 85, would the 3 hr PP of 89 be okay?

[email protected] November 26, 2010 at 1:00 pm

You’re right, Jenny rocks! One comment: her site doesn’t use frames; the URL weirdness is because of the way she’s redirecting one domain to the other.

You can get to your favorite sections via the following URLs:

Painless Blood Sugar Testing: http://www.phlaunt.com/diabetes/19774432.php

Frequently Asked Questions: http://www.phlaunt.com/diabetes/16162265.php

How to Lower Your Blood Sugar: http://www.phlaunt.com/diabetes/14045524.php

Chris Kresser November 26, 2010 at 1:02 pm

Thanks for the clarification, and for the direct links. I’ve been wanting to be able to do that for a long time.

Michael Barker November 26, 2010 at 2:47 pm

I loved this!
The one point that I keep reiterating on my site is that people should eat to their meter and that is what they should base their dietary guidelines on.

I began taking this tack after talking with various diabetics on diet. Invariably, they were given advice on what to eat by their diabetes educators and docs. What I had to say was meaningless to them because of the prevailing wisdom being put out there by people who should know. There is a loop hole, however, and it relates to food allergies. No food, no matter how “healthy” it’s supposed to be, should be eaten if the person has a bad reaction to it. This loophole allowed to me to put this diet information in a form that is allowed by both FDA and ADA so I could get around the credentials issue.

Testing for food intolerances using a glucometer is something anyone can understand. Healthy becomes what does not push that meter over 140. All the rest of the diet seems to fall in place after that.

The other way to couch it is through vanity. Tell people that they can use this meter to lose weight and suddenly they will pay the 60 bucks so they can look better on the beach next summer.

Jenny is a wonderful resource. No matter what arcane piece of research I’m digging in, her site or blog always seems to pop up.

My most recent post, having to do with self-experimentation, points up the fact that prediabetes is diabetes. My loss of 1st phase insulin response, due to glucose desensitization, in the “prediabetic” range shows there’s nothing “pre” about it.

Again, good job!

NoGluten November 26, 2010 at 3:10 pm

Wonderful post! This is where the rubber hits the road – you and your meter can create the right diet for you. The comment about food intolerances is spot on too!

Bev Carney November 26, 2010 at 6:31 pm

The Walmart meter and strips are also the only ones I’ve found that allow storage at temperatures under 59 degrees. We keep a cool house and nighttime temperatures dip into the 40′s upstairs. Most strips won’t tolerate that.

That said, I do notice a difference with a cold meter and strips (even though within the Reli-on guidelines) and a meter and strips pre-warmed to 80 degrees or thereabouts. Any idea why that happens?

Thanks

Rodney November 26, 2010 at 7:38 pm

I just made a trip to Wally World and bought the ReLion Ultima for $9. No strips, but 10 lancets come with it. Strips were $20 for 50, or $39 for 100. The WalMart site says that ReLion is a brand made specifically for them, so that is why it can’t be found elswhere, unless it is under a different brand name from the same manufacturer.

I have a strong family history of diabetes and at age 45 finally checked my sugar while visiting a relative recently. My fasting was around 102, and a 2 hr post pancake binge was around 125 or so. It surprised me because my weight is fine and I do exercise. I also love sugar, and now finally have a “hit home” reason to deny myself all of those frequent guilty pleasures. Clearly now is the time to buckle down on the diet a bit. I will now be able to follow my progress directly with the new monitor.

Thanks for the outstanding service you provide. The education is priceless!

Karen Koshgarian November 27, 2010 at 11:09 am

I’m totally with you Chris, regarding Walmart. I took it upon myself, with the suggestion of a diagnosed diabetic friend, to get the ReliOn Ultima at Walmart. I don’t patronize that store, but made the exception because in his experience, this meter had the least error because each pack of lancets comes with a calibrator for that particular pack.

Testing my glucose has been eye opening, in that I’ve discovered on my own, that balance in food really works. The feedback loop of having a meter has made all the difference in my life. I can have whatever I want, so long as I control portions, and eat carb fat combos. I didn’t understand why this was working until I read this post. You’re brilliant, helpful, wonderful, and I’m thankful for your work and genuine caring about health. I read you religiously.

Ned Kock November 27, 2010 at 1:56 pm

One thing to consider adding to these suggestions is a simple test of reactive hypoglycemia. This would be useful, because reactive hypoglycemia so often precedes a pre-diabetic condition.

I don’t have the references now, but if I recall correctly, RH usually occurs 2-4 h after a high-carb. meal, and the key piece of evidence is a BG reading that is significantly lower than the baseline.

Chris Kresser November 27, 2010 at 4:06 pm

Karen: thanks! It’s nice to be appreciated.

Ned: I agree. That’s something I see fairly regularly in practice. Generally appears as a below baseline reading at the 3-hour mark after significantly elevated readings 1- and 2-hours after the meal.

I’ve seen another strange pattern a few times where the patient’s blood sugar actually decreases after the meal at the 1- and 2-hour mark, and then increases at the 3-hour mark. i.e. it might be 105 before the meal, then 95 one hour later, and 90 two hours later, and then 110 again three hours later. That one definitely has me scratching my head, but I suspect cortisol/glucagon dysregulation.

NoGluten November 27, 2010 at 5:04 pm

“I’ve seen another strange pattern a few times where the patient’s blood sugar actually decreases after the meal at the 1- and 2-hour mark, ”

FWIW, Before my spouse went gluten free, he had a similar pattern.

Chris Kresser November 27, 2010 at 5:07 pm

Interesting. But these patients are not only gluten free, but completely grain free (paleo).

Lynn November 27, 2010 at 5:09 pm

This article and the comments section is so educational. I thought I knew lots about this issue, but it has been great to learn more about what RH is, and about strange PP numbers.

Ned Kock November 27, 2010 at 8:27 pm

Hi Chris. Yes, I agree.

Another strange pattern that I think was discussed on Stephan’s blog was a marked increase in blood glucose several hours after a high-protein meal. This I suspect is also related to a delayed and abnormal glucagon secretion.

Btw, I think you’ve seen this graph from Christiansen’s research group, which suggests that blood glucose varies chaotically, even in the normoglycemic:

http://healthcorrelator.blogspot.com/2010/05/blood-glucose-variations-in-normal.html

Tom Naughton suggested that the folks with the highest peaks of BG would probably develop diabetes later on (the participants were young at the time the measures were taken). I have my doubts, because the highest peaks were not consistently found in the same individuals after meals.

Chris Kresser November 28, 2010 at 9:10 am

Hi Ned,

I’ve seen that graph (and entire presentation) and I read your blog post about it too. The question that remains is how “normal” those subjects really were. We know that metabolism can be damaged very early on in life – even in utero. It’s entirely possible in my mind that the people having the greatest blood sugar fluctuations throughout the day were not normal, but metabolically damaged. Perhaps these are the folks that go on to develop diabetes. Perhaps they already had some degree of reactive hypoglycemia, swinging from 170 mg/dL to 50 mg/dL. A1c is just an average. If someone is bouncing around from 170 mg/dL to 50 mg/dL, they may have a normal A1c because that would be an average of very high and very low readings. But that doesn’t mean they have normal BG. There’s also a lot of research, which I mentioned in a recent article, suggesting that post-prandial BG is a much more sensitive marker for predicting future problems than A1c.

It’s also possible, of course, that spikes up to 170 mg/dL and down to 50 mg/dL are normal and part of a chaotic daily fluctuation even in healthy people. I still wonder why that happens in some healthy people, and not in others. It certainly indicates some difference in glucose tolerance and utilization. Whether that difference is significant or not would be the more important question.

Michael Barker November 28, 2010 at 11:21 am

Given the action of counter regulatory hormones, genetics, environment, and the heterogeneous nature of diabetes, that graph is to be expected. The graph is for two days and tells us nothing about progression or diet. It is said that these people were not diabetic but that is taken from the A1c and we have already talked about problems there.

Every single one of the people in that graph could, in fact, be a future diabetic. We have no way of knowing since diabetes is inferred from a group of tests. I suffer from abrupt type 2 diabetes onset. This is the graph I wish to show.

http://1.bp.blogspot.com/_N02EMssBLJU/TJZ4InFu_rI/AAAAAAAAACE/F9LchHIVEAU/s1600/weight+A1c+graphs_26526_image002.gif

What you see shows no real progression. It stays steady and then takes off. A person with this could pass all manner of tests and still be in the hospital within a year. My little experiment points me to cumulative trauma as the problem here, persistent glycemic excursions breaking down the normal insulin mechanism.

We really have no idea what “normal” is but we do know what levels cause damage. There might be some who escape damage much like people who only smoke a little a day but the great majority are going to be harmed. The numbers are clearly there and going over them, in general, leads to damage and going over them consistently will lead to cumulative damage.

Chris Kresser November 28, 2010 at 11:30 am

Wow, that’s quite a steep curve! I know Jenny Ruhl has written a lot about the myth that the onset of T2DM is gradual. As often as not, it’s quite sudden as your graph indicates. This does support the idea that repeated post-meal spikes are problematic regardless of what the average (A1c) is. Of course this is supported by the literature, as well.

Gregory Barton March 27, 2011 at 5:45 am

“This does support the idea that repeated post-meal spikes are problematic regardless of what the average (A1c) is. Of course this is supported by the literature, as well.”

Could you expand on this or link to references?

Michael Barker November 28, 2010 at 3:29 pm

I had to remake that graph because I couldn’t get it to copy. The ones from the paper look far worse.

http://diabetes.diabetesjournals.org/content/53/3/645.full.pdf

You can imagine the results of telling a patient to come back in 6 months to a year and you’ll check it again.

This is the reason I like what you’ve just put out. My blog is a “sick” blog related to a specific, if common, type of diabetes. My audience is limited. Yours is a “health” blog. As you can see from the graph, FBS and A1c won’t protect you from this problem. The meter, however, will work for almost everyone.

Plethon November 29, 2010 at 8:14 am

Readers should be aware that most pharmacies will give you a meter for free. We’re constantly inundated with coupons to process free glucometers for folks, and happy to give them to anyone interested.

raquel November 30, 2010 at 5:12 am

Hi Chris!!!

I’m Raquel from Spain (woman, 45). I really like your blog and I follow it everyday.
Recently I have my new cholesterol test results:

Total Cho: 266 mg/dl
TG: 51 mg/dl
HDL-Cho: 79 mg/dl
LDL-Cho: 177 mg/dl

I read your post “I have high cholesterol and I don’t care” and I’ve deduced that there isn’t any reason to be worried about because my LDL is in the large buoyant type.
Since two years ago I follow a diet similar to Zona, but recently (since I dicovered you) I decided eat more saturated fats (though here, we eat and cook with olive oil a lot), eggs, butter, cream, and whole fat foods. I wanted to make an experiment and see what happens, however I wasn’t sure (our whole life we’ve heard about fatty monster and it’s in our collective subconscious) and here in Spain, most doctors also wants reduce your total cholesterol at all costs.
Finally, as I have your opinion into high consideration, should I have anything to be worried about?? I know what my doctor will say (high total Cho, high LDL)

Thanks a lot

Raquel

Chris Kresser November 30, 2010 at 8:44 am

No te preocupes, Raquel. The most important number is the ratio between triglycerides and HDL. If that number is <2, you’re at low risk for heart disease. In your case, it’s not only below 2, it’s below 1 (0.65), so you’re in a good place. A TG/HDL ratio of <2 suggests you have predominantly large, buoyant LDL, which as you know from the video, is not a risk factor for heart disease.

Rodney December 1, 2010 at 2:49 pm

Hey Chris,

What are your thoughts on how “grazing”, or eating small snacks throughout the day between meals affects blood sugar levels? It would seem the levels would always be moderately elevated except between the last meal of the day and breakfast the next day. If so, is this where 16 hour IF’s come to the rescue? Or, is it better not to eat so frequently during regular daytime hours to give sugar levels a chance to recover to baseline?

All of this assumes no readings would be above the 140 danger threshold.

I am just wondering what approach to take after I finish your sugar testing as outlined above. Cut the snacks way down in frequency or don’t worry about it?

Thanks,

Rodney

Chris Kresser December 1, 2010 at 3:03 pm

Rodney: some people with reactive hypoglycemia and adrenal/cortisol issues do better with small meals throughout the day. It doesn’t raise their blood sugar, but rather keeps it from plummeting if they wait too long to eat. The only way to determine your ideal is to try different approaches and test for each.

raquel December 2, 2010 at 6:56 am

Thanks!!!

I appreciate your words.
One the other hand I’m very interested in the connection between high insulin and IGF-1 and acne. Do you think drinking milk would increse them? Could other dairy products do the same?
Maybe, there’s a post about this because I still haven’t read all.

Chris Kresser December 2, 2010 at 9:39 am

I think the acne/dairy connection, when/if there is one, is more related to food intolerance than IGF-1. The only way to find out is to remove dairy for a period of time, and then add it back in and track what happens.

Tim December 2, 2010 at 7:31 am

Hi Chris,

I’ve taken up this challenge and found some things I’m a little confused about.

My FBG and post-meal numbers have been generally good (FBG in mid 80s), with one sticking point. After a starchy meal (white rice or potatoes), I’ll have fine 1hr post-meal numbers (between 105 and 115, though I’ve had a few register in 120s and 130s, never anything over 140). But at 2hrs, the number will be the same, and often a little bit higher. This does not happen with low carb meals, which consistently give me numbers below 100, and baseline at 2hrs.

Could it be that I have a problem with starches? Is it something to worry about, even though my numbers don’t get all that high?

For background, I’ve been on a pretty low carb diet for the past couple of years (rarely over 70g/day, with some cheating on weekends). But for the past month or so I’ve reincorporated safe starches back into my diet.

Chris Kresser December 2, 2010 at 9:41 am

You may have a delayed or compromised phase 2 insulin response, or you may have delayed gastric emptying or slow digestion when you eat starch. When you eat starch, what are your numbers at 3 hours?

Rodney December 2, 2010 at 8:17 am

Thanks Chris,

I guess the crux of my question is whether for someone with fairly normal glucose control is it better to cycle between roughly 85 – 130 a few times during the day, or is it ok to eat more frequently but have your sugars range from say 105-130 except during the longer nightly fast? Is there harm staying a little bit high, or benefit from getting down to 85 several times daily?

Thanks for the continued education!

Chris Kresser December 2, 2010 at 9:42 am

If you’re not having any reactive/hypo events (dropping below 70-75) then there’s no need to eat frequently throughout the day, and it’s probably better if you just fast between meals.

Tim December 2, 2010 at 4:20 pm

Chris,

At 3 hours, I’m been at or near baseline/FBG. But I’ve only tested 3 hours on starchy meals a couple of times, so I’ll need to verify that after a few more measurements.

bannon December 3, 2010 at 5:13 am

Hola, en mi última analítica tengo estos resultados:

Cho total: 217 mg / dl
TG: 181 mg / dl
HDL-Cho: 39 mg / dl
LDL-Cho: 146 mg / dl

Tengo 33 años.

Estoy algo preocupado, por los valores de trigliceridos y hdl.¿Que debo hacer?

Chris Kresser December 3, 2010 at 8:21 am

Hay que comer mas grasas saturadas y menos carbohidratos. Carbohidratos aumenta trigliceridos y “small, dense LDL”, y reduce HDL, mientras que grasas saturadas reduce trigliceridos y “small, dense LDL” y aumenta HDL.

Stan December 15, 2010 at 5:26 am

Hi Chris

Following a recent FBG test that showed 6.1 mmol/l (previous test june’10 – 4.5), I decided to invest in a BG meter. The first day I tested – before main meal 4.4, 1hr 5.7, 2hr 5.3, 3hr 7.3, then I decided for a 4hr test 5.3. Meal included potatoes with clarified butter. The next morning two tests 6.2 and 5.3 – one after the other, and that is quite a variations which I understood is normal 20% variance. I do not eat grains, legumes, sugar etc. Major carb food I eat is potatoes 3-4 times/week, nuts, carrots, zuccini.
Now I am completely confused. I would appreciate any comment. Thanx.
By the way some more data from the same lab test:
TC – 170 mg/dl, TG – 130 mg/dl, HDL – 45 mg/dl

Stan December 15, 2010 at 5:26 am

Forgot – age 41

NoGluten December 15, 2010 at 6:56 am

Since you are fairly new to using the meter, are you certain that your hands were clean before each check?

If you are confident that the testing is correct, then your personal peak for that meal seems to be at the 3 hour mark and it is a little high. Perhaps try sweet potatoes instead of the potatoes? Are the carrots cooked or raw?

Chris Kresser December 15, 2010 at 9:37 am

Stan: it seems you may have a delayed insulin response. Your triglycerides are quite high, especially in relation to your total cholesterol. Ideally your TG should be less than 1/2 of your TC. How long have you been following this diet?

Stress, sleep deprivation and cortisol dysregulation can also cause elevations in fasting BG and 3-4 hour post-meal readings.

Stan December 15, 2010 at 1:40 pm

Thanx for all the comments. This blog is fantastic. I guess some more info is needed.
I am 170 cm/66 kgs. Started a vegan diet 6 y ago (without packaged junk, sugar) after I was told to take pills for life for high blood pressure (140/90, “your dad had it so it should be genetic”). It helped, I lost 3 kgs (that was never a problem) and was feeling pretty good and “light”. I also did water fasts 1-2 times per year. But since I was reading a lot about nutrition I eventually introduced fish and eggs about 2 y ago, then dropped wheat, grains, legumes, potatoes (reintroduced about 6 months ago). I eat about 2 pieces of fruit during the day (mostly banana, apple, melon and other in season) and main meal in the evening, and lots of nuts (100 gr/day), regular vegetables blend. I use ev olive oil. I do not eat dairy, clarified butter was added recently (I do it at home). My nose is mucus free, I am glad and want to stay like this. Now I also eat chicken liver, vary rarely other meats (no good sources here). I do not have any major health issues. So it is obvious I made a lot of changes to my diet the last several years. Exercise – not much, avoiding elevator twice a day for 6 floors, push-ups, crunches, squats, stationary bike all at home.
BG tests today:
FBG morning – 6.2 and 5.1 from same spot
Before main meal – 4.5 and 5.9 same spot, 5.0 new spot (I will stick to one testing, just these were the last strips from the batch)
carbs – 200 gr potatoes with butter (half from yesterday), raw vegitables – carrots, zuccini
new batch of test strips
1 hr – 6.3
2 hr – 4.9
3 hr – 5.2

I am skeptical about these BG meters. They are essential for people with diabetes, showing major differences low and high. But for normal and pre-diabetes they have too big variance – 100 mg/dl may be 80 or 120. I may limit potatoes and bananas, and fruit to one piece. But my problem is that I have been eliminating foods all the time. We have driven ourselves into the position to produce very few decent foods here in Eastern Europe, people want cheap food and compromise or do not know about quality. We do not have grass-fed free-pastured meat or dairy (or it is not promoted), for example.

Sorry for the long post.

lynn December 15, 2010 at 3:21 pm

Hi Stan

Strange question, but are you SURE you don’t have grassfed meat where you are? The reason I ask is because it’s never advertised on packages here (I live in Ireland); because ALL our beef is grass fed. There is no such thing as factory farmed beef.

We do not have raw dairy here though.

Stan December 15, 2010 at 4:38 pm

Hi Lynn

Here, Bulgaria, it is mostly pork and chicken meat, beef is very small part and mostly imported. Cows are milk breeds mainly. There are eggs from open raised hens (I eat these), at least twice the price of conventional cell raised. Dairy is not raw.

lynn December 15, 2010 at 5:29 pm

Hi Stan

Where does the beef come from? If it comes from Ireland or certain other European countries, it will be grass fed.

Stan December 16, 2010 at 3:47 am

And because posting of personal experience and results is usually encouraged:
morning FBG – 4.4 mmol/l
last time, I promise

Steven Miller December 27, 2010 at 9:02 am

“I’ve seen another strange pattern a few times where the patient’s blood sugar actually decreases after the meal at the 1- and 2-hour mark, and then increases at the 3-hour mark. ”

This is actually something that seems to be happening with me. I am a “paleo” eater (no grains, low carb) and my FBG usually runs between 95-101 which i attributed to low-carb morning insulin resistance. However, today and yesterday I did a BG text 1/5 hour after breakfast (eggs, bacon, tomatoes, coffee/heavy cream” and my BG dropped both days from a FBG of 105 to 95 yesterday and 80 today. Today I monitored more carefully and at 1 hour it was 90, 2 hours 80, and three hours 104. I hour after lunch it was 95.

Do I need to worry about this?? Whatever the explanation, and they are all theoretical, my BG seems to be staying in a narrow range (80-105) without any of the post-prandial peaking; in fact no peaking at all nor is it dropping particularly low nor do I have any feeling of low BG.

I am otherwise healthy with an HDL of 88 and TG of 67 (haven’t had a VAP or NMR yet). I lost about 7/8 pounds since starting paleo/lc and now have a BMI of 20 (5:11/143 pounds). No matter how much I eat, my weight doesn’t budge more than .5 pounds either way. I am probably too thin but I don’t feeling like eating more than the 2500 calories I take in usually.

So, once again, aside from the reverse pattern I seem to have developed, is there some negative health implication in this that I am missing?

Steven Miller December 27, 2010 at 9:13 am

Actually, I have been working on the theory that my BG pattern results from the return of insulin sensitivity, particularly following the morning BREAKfast. By coincidence, I rediscovered this from Peter at Hyperlipid:

“A LC eater has a FBG of 5.5mmol/l, technically pre diabetic, but blood insulin is 3.5 IU/ml. This is VERY low. Glucose is in very short supply but blood glucose is maintained by physiological insulin resistance, ie the muscles are full of triglycerides assembled from free fatty acids (NEFA) from lipolysis. The LC eater has breakfast, with enough protein from his eggs or particularly casein from his yoghurt to raise insulin from 3.5 IU/ml to 5.0IU/ml. This inhibits lipolysis enough to reduce NEFA in the bloodstream, intramuscular triglycerides fall and muscle insulin sensitivity returns. There’s minimal glucose coming from the gut and so plasma glucose drops to between 4.0 and 5.0mmol/l, probably nearer 4.0mmol/l. It fluctuates between 4.0 and 5.0 after and between each LC meal. In the early hours of the morning there is a growth hormone surge and NEFA from lipolysis peak early morning to give insulin resistant muscles and an elevated FBG. MEAN glucose over 24h will be in 4 point somethingish, HbA1c will be between 4 and 5%. INSULIN will probably average out around 5-10 IU/ml, averaged out over 24h.

http://high-fat-nutrition.blogspot.com/search/label/Physiological%20insulin%20resistance%20(3);%20Clarification%20of%20FBG

This is me! So, I am going to retire my BG meter and give my sore old finger a rest for the time being unless somebody convinces me there is osmething wrong with this analysis.

Chris Kresser December 28, 2010 at 1:20 pm

Steven: I’ve also written about LC eaters having high FBG. However, that doesn’t diminish the importance of post-meal blood sugars as a measurement of glucose tolerance. If your FBG is high on an LC diet, but your post-meal numbers are fine, nothing to worry about. But if you have a sweet potato with a meal, for example, and your BG shoots up to 180 mg/dL an hour later, not good. That’s where post-meal measurement comes in – determining carbohydrate tolerance. It’s a moot point if you don’t eat starchy/carby foods at all.

David January 13, 2011 at 10:10 am

I used a similar process to try and get my glucose under control (25-year diabetic). There is only one drawback to the method. It is possible to have a “normal” blood sugar reading and still be producing way too much insulin to make that happen. A meter cannot tell you that. In such a case, you would be in between normal metabolic function and frank diabetes, without an idea.

Steven Miller January 18, 2011 at 8:38 am

” if you have a sweet potato with a meal, for example, and your BG shoots up to 180 mg/dL an hour later, not good. That’s where post-meal measurement comes in – determining carbohydrate tolerance. It’s a moot point if you don’t eat starchy/carby foods at all.”

Chris….thanks for responding…I haven’t checked this thread for a while.

Yes, I had been checking my post-prandials which is how I noticed that they were actually dropping after a meal but that was on pretty low-carb. I have since started experimenting with more carbs…specifically a portion of rice or sweet potato with lunch and dinner. I was thinking that perhaps I was too low on carbs given that I had dropped so much weight and, more importantly, I was waking up almost every night in the middle of the night hungry.

After a few days of this, I checked by FBG which was 87 so maybe my insulin sensitivity is returning.

Also, I just checked by BG 1 hour post-prandial after eating a lunch of beef, brussels sprouts, and half a large sweet potato mashed with butter and cream. It was 99. Two-hours post-prandial was 98. That may be a trifle on the high range of “normal” but still seems pretty ok.

So, bottom line, even with the additional carbs my BG is staying in a pretty tight range with no evidence at all of “spikes” remotely close to the 180 mg/dl range. When I started all this, I wanted to see more readings in the 70-85 area but perhaps this is just the way I am (or have become after too many years of thoughtless eating).

Anyway, I expect to have an A1c test in a couple of weeks and that should complete the picture. I realize I actually have very little reason to go through all this except to try and understand more about my own physiology but it also gives me some small appreciation of what life must be like for diabetics….what a nightmare.

Steven Miller January 20, 2011 at 4:27 am

The journey continues….

I think I am still a bit insulin resistant as my FBG remains in the high 80′s and today I did a 1 hour post-prandial following my usual high protein, high fat, low carb breakfast (eggs, bacon, avocado, a few small tomatoes). Interestingly, my BG result was 78 which is one of the lowest readings I have seen so far. Anytime my post-prandial is lower than my fasting, I am assuming it is a result of insulin resistance in the morning.

My general BG level seems to be drifting downwards following the addition of the two carb portions to lunch and dinner…..interesting. I think I will stay with the regime of doing a FBG and a 1-hour post prandial as suggested on one of the Heartscan papers. Its simple and it makes sense to me to be testing real-world eating conditions rather than the “hypothetical” pure glucose/carb tests.

I plan to get a general idea of how my normal meals are impacting BG before I retire the meter again (there really is a danger of obsession with this BG stuff!)

Dale January 22, 2011 at 6:10 am

In Canada the glucometer is free, the strips are $75 for 100 tests @ Costco and Superstore. I was reluctantly glucose tolerance tested for hypoglycemia (with migraine!) and years later after an uncle’s surgery, tested positive for diabetes type 2 and told the two had no connection, were separate diseases! Luckily the low carb diet recommended by Dr. Richard K. Berstein Diabetes Solution removed the excess weight gain and returned blood sugar to normal. If I had known about glucometers years earlier, perhaps I could have prevented my sugar addict slide.

Mirek February 7, 2011 at 2:23 pm

If one does not want to punch a finger, there is an approximate, but still a good tool for Diabetes risk assessment at http://www.diarisk.com.

KW March 10, 2011 at 11:38 pm

I know this is an old post so perhaps the comments are no longer monitored, but I wanted to share anyway. I checked out this 3-part blog series after Robb Wolf shared the link on Twitter last week, and it couldn’t have been more timely! I was scheduled to have the OGTT today at my OB’s office to screen for gestational diabetes and I was having reservations about the test. I expressed those reservations to my doctor – that it would make me sick because I don’t consume 75 grams of any kind of CHOs in a day, let alone at once, and that it would result in a false positive, which I didn’t want in my medical records. She explained that if the results were questionable, protocol was to follow up with a 4-hour GTT, where I’d consume 100 grams of glucose. Brilliant. (note the sarcasm ;)

These blog posts gave me not just the information I needed to back up my concerns, but also a viable alternative to the OGTT, to which my doctor readily agreed. As I discussed the testing protocol with her, she outlined the desired ranges for each reading, and I was pleasantly surprised to find them on target with your suggestions! I have ordered my glucometer and will start testing as soon as it arrives. Thank you for posting such easy-to-read and very well-documented information! The information is presented in such a way that it made it easy to present a well-informed argument to my doctor, and I am certain that played a huge role in the lack of opposition to skipping the OGTT. Thank you again!

Dale March 11, 2011 at 7:03 am

Re diabetes and low thyroid: I’ve just been reading Hypothyroidism: The Unsuspected Illness by Broda Barnes from 1976 (reprinted, available at the public library). I have both type II and low thyroid so I found it particularly interesting since he believed from his medical practice specialty that the two are linked and prediabetes may well be low thyroid. If only I could find a physician with that type of knowledge!

Chris Kresser March 11, 2011 at 9:39 am

KW: I’m really glad this saved you from the OGTT and put the control back in your own hands.

Ian March 12, 2011 at 3:56 pm

Hi Chris,

I just started testing my BG yesterday. After a meal of chicken curry and rice in equal proportions, along with two beers, my BG after 1 hour was 115 and 2 hours was 68. Today my fasting BG after 3 eggs, spinach and about half a banana and a half a cup of cranberry juice was 91 and my 1 hour was 62. Could this be a digestive issue? I’ve been burping a lot after eating or drinking coffee, though I don’t get the feeling of acid reflux. I do tend to feel pretty full even a few hours after eating. I have a history of GERD, which I alleviated with your GERD guide about a year ago. I just started using DGL again and eating sauerkraut. HCl seems to come out in my stool, which worries me. Is it time to get some bitters?

Thanks for your blog. The suggestion of the BG monitor has already been more educational than weeks of speculation.

Brent A Moore March 26, 2011 at 11:20 pm

This is a very interesting blog post. The comments offer lots of great supplemental information too!

Thanks everyone.

Wellness Mama April 8, 2011 at 4:27 am

Hi Chris, Not sure if you still check this thread or not, but have a question for you. I’ve been testing my blood glucose for about a week now. I’m 28 weeks pregnant, and my midwife is requiring 2 weeks of testing fasting glucose and 1 hr after every meal in place of the oral glucose test. So far, all of my numbers have been great. I’m usually back to baseline or below an hour after meals, though I haven’t tested past that. One thing I haven’t totally been able to figure out: My fasting blood glucose is usually in the 80s, though I’ve had a few in the mid-90s. This is surprising to me since this is higher than my reading after dinner the night before. I’m on a low-carb diet if that makes a difference. I’ve also been getting to bed after midnight each night and seem to remember reading something about stress hormone levels and raised blood glucose in the morning. Overall, I’m not concerned at all since my 1 hr reading is usually back to baseline, but was just curious what causes the higher fasting levels… any ideas?
Thanks!

Jackie Patti April 16, 2011 at 12:27 pm

I agree Jenny is wonderful, but… if you only read one page about bg, it should be this one:
http://www.alt-support-diabetes.org/new.php

Also, the meters can be free, that’s not relevant to your pocketbook. The strips can cost a fortune! As such, I recommend the Walmart or Walgreens storebrand meters as the strips are half the cost of namebrand meters.

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