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What is blood glucose?

Glucose (sugar) mainly comes from carbs in the food and drinks we consume and is our body’s main source of energy.

Blood transports this glucose to our cells to use for energy.

Blood glucose is simply the concentration of glucose (often measured in mg/dL) traveling through our bloodstream at a given point in time.

HbA1c Biomarker

If you’ve had bloodwork done, you might recall a biomarker called HbA1c that is used to assess metabolic health and diagnose prediabetes or diabetes.

HbA1c, or Hemoglobin A1C, measures the amount of glycosylated hemoglobin in the blood which is the amount of glucose stuck to hemoglobin molecules (the stuff that carries oxygen).

This allows us to estimate average blood glucose over the past three months.

The results of your HbA1c test can be interpreted as follows:

• Optimal = 5.1% 

• Normal = below 5.7%

• Pre-diabetic = 5.7% to 6.4% 

• Diabetic = 6.5% or above 

As blood glucose rises, more hemoglobin becomes glycosylated and the higher HbA1c rises.

An ambitious but potentially optimal HbA1c of 5.1% corresponds to an average blood glucose of 100 mg/dL whereas a diabetic HbA1c of 6.5% corresponds to 140 mg/dL, a seemingly small difference of only 40 mg/dL.

Why does blood glucose matter?

Elevated average blood glucose over a long enough period of time increases our risk for each of the Four Horsemen diseases:

• cardiovascular disease

• cancer

• neurodegenerative disease

• metabolic disease (e.g., type two diabetes)

Repeated blood glucose spikes throughout the day and the subsequent insulin spikes they generate may also produce negative outcomes.

So, the goal is to keep average blood glucose low while maintaining low blood glucose variations.

Other than reducing our risk for the Four Horsemen diseases, our focus, attention, and physical energy will benefit from reducing the hourly variations in our blood glucose.

For example, by implementing some of the practices below, we can avoid an afternoon crash resulting from a carb-heavy lunch that sends our glucose skyrocketing and then plummeting.

9 Practices for Healthier Blood Glucose

Practice #1: Focus on less processed, fibre-rich carbs.

Not all carbs are created equal.

The more refined the carb (i.e., bread rolls, potato chips), the faster and higher the glucose spike. To blunt the glucose impact, eat less processed higher fibre carbs. 

The recommended guideline for fibre intake is 25 grams for women and 38 grams for men but Dr. Peter Attia aims to eat more than 50 grams of fibre per day.

Practice #2: Be mindful of rice and oatmeal consumption.

Despite not being overly refined, rice and oatmeal are quite glycemic, meaning they cause a sharp rise in glucose levels. Brown rice is only slightly less glycemic than long-grain white rice.

On a personal note, this is sad for me to hear. Oatmeal is extremely convenient and, at the time of writing this, I am still eating it on a near daily basis. 

Practice #3: Eat lots of non-starchy vegetables.

Non-starchy veggies like spinach and broccoli have virtually zero impact on blood glucose.

Go crazy.

Practice #4: Pair protein and fat.

Foods high in protein and fat (e.g., eggs, beef short ribs) have minimal impact on blood glucose assuming they are not consumed with a caloric sauce.

But large amounts of lean protein (e.g., chicken breast) will elevate glucose slightly. Low-fat protein shakes have a more pronounced effect, particularly if they contain sugar. 

Personally, I pair my daily protein shake with 20 grams each of almonds and walnuts. However, I haven’t measured my glucose response so cannot attest to the effectiveness of this strategy.

Eating fat and protein together also helps you feel more satiated, thus minimizing overeating.

Practice #5: Front-load carb consumption earlier in the day.

Most people are more insulin sensitive in the morning than in the evening, so do your best to front-load carb consumption earlier in the day.

Practice #6: Understand the impact of exercise.

Timing, duration, and intensity of exercise all have a big impact on blood glucose.

Aerobic exercise (zone two) is best at removing glucose from circulation.

Strength training and high-intensity exercise tend to increase glucose for a short period of time because the liver is sending more glucose into circulation to fuel the muscles. 

Practice #7: Focus on high-quality sleep. 

The quality and duration of your sleep have a huge impact on your body’s glucose control.

All things equal, sleeping five to six hours (versus eight hours) is responsible for a substantial 10 to 20 mg/dL spike in peak glucose response, and about 5 to 10 mg/dL increase in average levels.

Practice #8: Manage stress.

Stress impacts blood glucose even if you are in a fasted or carb-restricted state.

The negative effect is most apparent during sleep or periods long after you finished eating.

Practice #9: Build compound interest.

Like all habits, stacking the above practices is very powerful.

Good habits in each of these areas will compound to help delay the onset of chronic disease, give you more energy, and serve as an all-around boost to your health.

But if you're sleeping poorly, stressed out, and have not exercised, try to be more careful with what you eat.

Source: Outlive: The Science & Art of Longevity by Peter Attia, MD

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Much love to you and yours,

Jack Dixon