How to control your blood sugar to increase health and longevity

Hi Friends,

I hope you’re keeping well during these challenging times. After all the distractions of the past few months, I’m excited to be posting again and plan to do so more regularly going forward. Today's is a big one! I hope you enjoy it.

Updates

I’ll begin with a couple of updates related to prior posts:

1) First, I’ve heard from a few FAT Coffee/Tea converts after my post in June – great to hear, and if you haven’t tried it yet, I suggest you do!

2) Second, some new data offers further support for the importance of Vitamin D to protecting yourself against Covid-19, and for your general health. In data drawn from a hospital in Spain, 82.2% of Covid patients were found deficient in Vitamin D, compared to 47.2% of people in the comparison group. Vitamin D was already at the top of my list of supplements that I think everyone should consider taking, and these data make me even more convinced of that. Not only because adequate Vitamin D appears to reduce Covid risk, but because a 47% deficiency rate amongst non-Covid patients underscores just how prevalent deficiency is! ( And to be clear, a lack of clinical deficiency does not mean that your levels are optimal, so it likely that an even larger % of people could benefit from increasing their levels). I discuss the importance of Vitamin D and how to supplement with it here.

Today's post

In today’s post, I want to touch on the vital topic of blood sugar – and by extension, diabetes – and its role in health and longevity.

Quick summary: Maintaining stable blood sugar is a critical determinant of lifespan, and healthspan – i.e., how long you remain healthy and capable of living a full life. Interestingly, various spices and herbs appear to be able to make a big difference in helping to correct blood sugar dysregulation, and specific forms of exercise and diet can be very helpful as well. Making some small changes now could ultimately add years of good health to your life.

Full post:

At this point, most people have heard of diabetes, a category of health conditions that entail a reduced ability to handle blood sugar effectively. Briefly, when you eat food – especially food containing carbohydrates – it is broken down into glucose (sugar), and released into your bloodstream. The hormone insulin is then released, which shuttles the glucose into your cells. People with diabetes either don’t produce enough insulin, or have become ‘insulin resistant,’ meaning that they no longer respond to insulin in the same way. The net result is that blood sugar remains elevated, which as I review below, can cause a wide range of health problems.

Diabetes is incredibly common in the world today. In 2015, the CDC reported that over 30 million Americans had diabetes, and that another 84 million had ‘pre-diabetes,’ showing signs of increased blood sugar and insulin resistance that were just not yet high enough to be officially classified as diabetes.

This latter point is critical: diabetes is not a ‘you have it or you don’t’ scenario, or something you just suddenly develop one day. Rather, individuals’ health on this dimension is continuous, and it is common for it to slowly worsen over many years. It might take decades for you to get to the point where you are classified as having Type 2 diabetes. Or, you might never get to a clinical diagnosis of diabetes, yet have chronic mildly elevated blood sugar, or be experiencing swings in blood sugar, that is still hurting your long-term health outcomes.

In other words, whether or not your current blood sugar metrics qualify you as officially ‘diabetic’, ‘pre-diabetic,’ or neither, this is an element of health that you can and should seek to improve.

Indeed, more and more evidence is accumulating for the importance of blood sugar for many aspects of health. The more glucose you have circulating around your blood stream, the more oxidative stress you experience, leading to worse long-term health outcomes. A recent meta-analysis found strong evidence for a positive association between blood sugar levels and cancer risk. Other research finds that blood sugar levels predict the onset of dementia and Alzheimer’s. And diets lower in glycemic load have been found to reduce incidence of heart disease.

What can you do?

Thankfully, there are many things you can do to maintain stable blood sugar.

Exercise: I’ll be doing a deeper dive into the various forms of exercise and their myriad benefits in future posts, but one of the biggest benefits of exercise is in keeping your blood sugar stable by improving glucose uptake (your body’s ability to shuttle blood glucose into muscle cells and thus out of the bloodstream). The existing research shows clear benefits of both resistance training (also see here) and aerobic training, and finds that doing both appears to be most beneficial for blood sugar levels.

Resistance training includes weight and bodyweight training, such as pushups, squats, curls, leg press, leg extension, pulldowns, deadlifts, etc. Importantly, even fairly light resistance training appears to improve blood sugar levels, although the benefits are greater with more intense training.

Aerobic training is commonly referred to as ‘cardio’, which focuses on increasing heart rate. Importantly, there is accumulating evidence for the benefits of ‘high intensity interval training’ – where short periods of fairly intense cardio are interspersed with rest periods – over ‘steady state cardio,’ a topic I’ll cover in more detail in the future. If you really want to get advanced, research suggests that doing aerobic exercise in a ‘fasting state’ – i.e., in the morning before breakfast – has even greater benefits for glucose utilization, and can protect against a less than optimal diet. Personally, I try do even just a few minutes of exercise before breakfast (and typically save my longer workouts for later in the day).

In conclusion, “Either aerobic or resistance training alone improves glycemic control… but the improvements are greatest with combined aerobic and resistance training.”

One more thing to try is a walk after big meals. One study found that a 20 minute walk after a meal resulted in significantly lower glucose levels.

Diet: Not surprisingly, a diet that is high in sugar and other carbohydrates can be a risk factor for blood sugar disregulation, eventually leading to full-blown diabetes.

There are a couple of important factors to note here, however. First, it appears that glycemic index is a critical factor, perhaps more important than absolute amount of carbohydrate intake. Glycemic index refers to how quickly a food is turned into glucose, and not surprisingly, the faster a food is turned into glucose, the larger of a spike in blood sugar it is apt to cause.

By contrast, a high carb meal that is more slowly turned into glucose offers the body more time to use that glucose (i.e., shuttle it into muscle cells). You can read more about glycemic index, and see a list of the foods that are high versus low in glycemic index here. Generally, you want to limit the worst offenders, which include soda, fruit juice, pasta, white bread, cereals, bagels, and white rice.

Glycemic index can also be affected by what you eat in combination with your carbohydrates. Eating simple carbohydrates by themselves is most problematic; by contrast, if you have some fat, protein, and especially fiber at the same time as carbohydrates, that will slow down the speed at which they are turned into glucose. So, have some vegetables with some olive oil or grassfed butter at the same time as your carbs, and maybe a little prebiotic fiber to boot.

Second, as I discussed above, glucose utilization is substantially improved by exercising. That is true not only in the long-term, but in the short-term. During and after exercise, your glycogen is depleted and your muscle cells are receptive to glucose – thus, glucose in your bloodstream is quickly shuttled into your liver and muscles, rather than lingering and causing damage. In other words, it can be totally fine – and even important/beneficial – to consume carbohydrates, even those with a high glycemic index, after exercise. Glucose uptake will be increased even for several hours after a workout. On the other hand, it is especially harmful to consume high glycemic index foods during periods of inactivity. The prototypical example of this is a glass of orange juice, bowl of cereal and/or a bagel for breakfast, right after waking up and right before sitting down for several hours of work. Unless you are doing significant pre-breakfast exercise, it would be much better to have a high-fat or high-protein breakfast – maybe FAT COFFEE? – and save your carbohydrates for later in the day, after you’ve ideally done some amount of exercise, even if that’s just a brisk walk.

Summary so far:

- Incorporate resistance training and cardio training. Strive for at least 20-30 minutes of each, twice a week (four total workouts per week). That said, less is still good!

- Pay attention to your consumption of high glycemic index foods. Eat them after periods of physical activity, and/or in combination with fiber and healthy fat.

Advanced blood sugar hacking

The steps that I just covered are things that I strongly believe everyone should be doing. There are a number of additional things one can do for blood sugar control beyond just exercise and diet, however.

Testing:

The first thing you will want to consider if you are serious about managing your blood sugar is getting some diagnostic tests. The two most common metrics that are used to diagnose diabetes (and pre-diabetes) are fasting blood glucose (in mg/dL) and hemoglobin A1C % (HbA1c), which is a measure of average blood sugar over the prior 2-3 months. You can get these by getting blood drawn, perhaps along with a cholesterol test. Here is how to interpret those values:

‘Normal’: fasting glucose < 99; HbA1c < 5.7%

Pre-diabetes: fasting glucose 100 - 125; HbA1 5.7 – 6.4%

Diabetes: fasting glucose > 125; HbA1c > 6.4%

However, the updated thinking in the more advanced biohacking and functional medicine circles is that optimal levels are even lower than the ‘normal’ category from the CDC:

‘Optimal’: fasting glucose < 86; HbA1c < 5.3%

So, getting these tests can give you a good idea of whether you have, or are developing, blood sugar regulation issues, which could then inform how proactive you are about implementing all of the exercise and diet recommendations above, and trying the supplementation suggestions below.

That said, these two metrics largely miss something else that is increasingly being recognized as also critical to health and a leading indicator of development of blood sugar issues: post-meal blood glucose. Ideally, after you eat a meal, especially one containing carbohydrates, your body quickly and efficiently uses the glucose contained, eliminating it from your bloodstream in a timely manner.

You can assess this by measuring your blood sugar roughly 90 minutes after eating, which is around the time when blood sugar will be at its highest following a meal (though higher glycemic index foods may cause a spike earlier, around 60 minutes after ingestion).

If your body is using glucose optimally, then your blood sugar should never spike above 140 mg/dL. You can test your blood sugar after meals with a simple blood glucose monitor and the ‘finger prick’ method, which will also allow you to test your fasting blood sugar at home (just test in the morning before eating anything), although the accuracy is not quite as good as with getting your blood drawn at a lab.

Being able to regularly test post-meal blood sugar will also help you learn about which foods are more or less healthy for you – which can vary from individual to individual depending upon your gut biome and other factors not yet fully understood – and whether any dietary, exercise, or supplementation interventions are working. And again, even if you have normal fasting glucose and HbA1c levels, regular swings in blood sugar can still be causing damage and ultimately cause those other metrics to go up.

Home blood glucose testing kits are available at drugstores everywhere, or you can buy a kit on Amazon, for $29. Using them involves making tiny prick to one of your finger pads and squeezing a small amount of blood onto a test strip. At most, you feel a small sting that goes away quickly.

An even more advanced option is a continuous blood glucose monitoring system, which is a small device that you attach to your arm and wear for a couple of weeks. These are available via prescription, generally for people who are already diabetic or pre-diabetic, although some open-minded doctors realize the benefits of preventing these issues before they develop, and will prescribe them more widely. These include the FreeStyle Libre and Dexcom systems. I have used the FreeStyle Libre system on several occasions; a $38 replacement sensor lasts for two weeks and give you a lot of insight into where you stand. There is also a brand-new company, Levels Health, that is seeking to bring real-time glucose monitoring into the mainstream given all of the potential benefits for even those without diabetes. You can submit a request to test their product for 28 days.

Herbal supplements to improve blood glucose utilization:

There are a variety of prescription medications designed to help people manage diabetes. I don't know a lot about these and you should consult with a doctor to discuss your options. I do know, however, about a range of herbs and spices that can be surprisingly effective in both helping to maintain lower and stable blood sugar levels in the short-term, and even improve your body’s glucose utilization in the long-term.

I myself have seen a substantial improvement in my blood sugar markers from trying several of the following (more details below), and I have a friend who actually reversed a diagnosis of Type 2 Diabetes from doing the same. Of course, these are not controlled studies, I am not a doctor, and if you are currently being treated for diabetes, you should consult with your physician before adding any supplements. I’ll begin with common foods that are probably familiar to everyone, and then move to some more ‘advanced’ herbal supplements.

Cinnamon. Recent research found that supplementing with cinnamon led to a significant decrease in fasting glucose levels, as well as cholesterol and triglycerides. Importantly, you want to Ceylon cinnamon (rather than Cassia). You can take between 1 and 2 teaspoons a day, mixed in a smoothie or a drink (you can literally just gulp it down in some water), or sprinkled on foods like sweet potatoes or squash. You can buy a nice organic Ceylon cinnamon powder on Amazon or on iHerb (delivers worldwide).

Vinegar. Consuming vinegar before eating carbohydrates appears to benefit blood sugar levels. One study found that post-meal glucose levels were reduced and another observed significant reductions in HbA1c in participants who consumed vinegar every day for 8 to 12 weeks. Apple Cider Vinegar (ACV) is a healthy option and you can mix ½ to 1 tablespoon in a few ounces of water and drink before meals containing significant levels of carbohydrates. You can find ACV at most grocery stores or buy it on Amazon or iHerb.

Moringa. Moringa oleifera is a plant native to northern India that has been used in Ayurvedic medicine to treat diabetes, as well as inflammatory conditions such as joint pain. A recent study found that daily supplementation with Moringa for 3 months led to a 13.5% decrease in fasting blood glucose, as well as increases in a range of antioxidants. Moringa is also high in nutrient and mineral content.

To take Moringa, mix 1-2 teaspoons into a drink or smoothie daily. You can buy organic Moringa powder in bulk on Amazon or iHerb.

Berberine. This is a plant-based compound with multiple benefits. Most notably, it is considered an 'exercise mimetic' that promotes healthy blood sugar levels. Research has found that it can reduce fasting glucose, HbA1c levels, post meal glucose levels, and trigylcerides.

To supplement with Berberine, take 1 capsule per day, or 2 (at different times) for advanced support. You can buy it on Amazon or on iHerb.

Gymnema sylvestre. Gymnema is a woody climbing shrub native to India and Africa. Gymnema has a long history of use in India's Ayurvedic medicine. The Hindi name for gymnema means "destroyer of sugar." Research suggests that supplementing with Gymnema sylvestre can help increase insulin levels, potentially reducing the insulin needs of diabetic patients, and lower fasting glucose and HbA1c levels. It is available in supplement form, on Amazon and iHerb and the suggested dose is one capsule daily, with food. Anecdotal reports suggest that it can also curb carb cravings, facilitating a healthier diet.

Bitter melon. Bitter melon, or bitter gourd, is a tropical vine that belongs to the gourd family, and is cultivated around the world for its edible fruit, which are especially common in many types of Asian cuisine. Although human clinical trial research is somewhat limited, a couple of studies have shown the benefits of bitter melon supplementation for blood sugar and HbA1c.

This is also one that I can personally vouch for. I have used the finger prick testing method extensively, and when I take bitter melon extract as a supplement before carbohydrate-rich meals, my blood glucose levels at 60 and 90 minutes are noticeably lower. To supplement with bitter melon, take 1 or 2 capsules with carbohydrate-rich meals (2 if the meal is very heavy in carbs, such as a pasta). You can buy bitter melon extract on Amazon and iHerb.

Possible risk: low blood sugar

Although it is less common than high blood sugar, it is also possible to suffer from low blood sugar. If you have only mildly-elevated blood sugar and take a lot of the supplements above, you might ‘overshoot,’ leading to low blood sugar. Low blood sugar is most likely to happen at night, and it can cause your body to release the stress hormone cortisol as a sort of ‘alarm’ that wakes you up and makes it difficult to fall back asleep. So, when experimenting with the above supplements, you should be on the lookout for this. Again, the clearest indicator will be waking up at night and feeling very alert when you do so. You can also of course track your blood sugar with the measures described above. Also, if you think you might be suffering from low blood sugar at night (some people experience this even without any blood sugar lowering supplements), you can try eating some carbohydrates an hour or so before bed, or, taking a spoonful of honey (ideally raw honey) right before bed, and see if that helps.

My experiences:

My personal deep dive into the topic of blood sugar management occurred about a year and a half ago. I read in several places about its importance to long-term health and longevity, and decided to track my metrics. Given what I thought was a healthy diet and lifestyle, I had no reason to expect that I might have any issues, and my past fasting glucose tests had never been flagged as problematic.

So, I was quite surprised to discover that I was experiencing significant blood sugar spikes after eating carbohydrates. Using the finger prick method, I discovered that eating a moderate portion of white rice or sweet potatoes would often cause blood sugar levels of more than 180 mg/dL 75-90 minutes later, and sometimes even levels above 200. Looking back at the various fasting glucose tests I had gotten over the years, there was indeed an upward trend, and my most recent test had me at 97 – just barely within the supposed ‘normal’ range, and significantly above optimal.

The root cause of these issues is a longer discussion, but my best sense is they developed as a result of my having followed a very low carbohydrate diet for an extended period of time, partly to help heal some gut issues. (I believe now that going low/zero carb, while potentially beneficial when done for short periods of time, is not advisable long-term).

In any case, I was concerned and determined to try to fix the problem. Over the next few months, I began taking:

1) 1.5 teaspoons of cinnamon and 2 teaspoons of Moringa every day in my morning smoothie

2) 2-3 teaspoons of Apple Cider Vinegar prior to carbohydrate containing meals

3) 2 tablets of bitter melon prior to my biggest carbohydrate meal of the day

With #3 in particular, I noticed an immediate effect on blood sugar spikes after carb-rich meals – when I took bitter melon prior to high carb meals, my blood sugar peaked around 150-160 rather than 180-200. And, over time, these slowly came down further. I eventually stopped taking bitter melon entirely, because things were totally in control and I was starting to see some signs of low blood sugar at night.

I am now on a consistent regimen of 1.5 teaspoons of Moringa in my morning smoothie, and .5 teaspoons of cinnamon and 2-3 teaspoons of ACV prior to meals with significant carbs. My blood sugar after carb-containing meals peaks at around 130, and my fasting glucose has come down to 87. When I tried stopping this regimen for a few days, my blood sugar spikes starting going up again, further supporting the benefits of these supplements. And, I do notice that I experience higher blood sugar readings on days when I have not exercised.

Summary – supplementation strategies:

Based on everything above, I could envision some different supplementation strategies, depending on a person’s situation. Obviously, it would be best to inform these decisions with blood glucose measurements upon waking and after carb-containing meals, but I think that even without these, it can make sense to add some of these supplements.

Basic. For those who do not have any significant blood sugar regulation issues, you might try 1 teaspoon cinnamon and 1.5 teaspoons Moringa daily, as a preventative measure. It’s generally good to give the body an occasional break from most things, so you might skip each of these once a week. And, if it’s not hard for you, taking a teaspoon of ACV prior to your heaviest carb meal could also make sense. It may also be effective to time your cinnamon to coincide with carbohydrate intake, so you could take 1/2 - 1 teaspoon mixed into water immediately prior to eating carbs. Side note: a milk frother is a great way to mix powder into water for quick consumption.

Moderate. For those who want to be even more proactive, or suspect they may have minor to moderate blood sugar issues (more likely if you are overweight and/or older), you could incorporate the basic suggestions above, perhaps increase the dosages slightly, and also add 1 capsule of berberine daily and take 1 tablet of bitter melon with any meals containing a large amount of carbohydrates.

Advanced. For those who suspect having significant blood sugar regulation issues, you might try all of the above supplementation recommendations. I would recommend phasing them in slowly, rather than all at once, however – i.e., start with the basic regimen for a couple of weeks and see how you respond, and then try sequentially adding Berberine, Bitter Melon and Gymnema and tracking the effects of each. One final supplement to look into is Biotin (aka Vitamin B7), which has also shown benefits for insulin and blood sugar management.

Again, I personally know someone who reversed his Type 2 Diabetes by following the advanced regimen, along with better diet and more exercise. That is a single case, of course, and everyone is different. But, given the evidence for the importance of blood sugar management to long-term health, and the evidence supporting the efficacy of these various measures – balanced against their relatively low risk profiles – this is an experiment worth trying!

Thank you for reading. As always, please share this with anyone who you think might find it interesting or helpful. This may be especially important information for older or overweight individuals. If you have any questions, please post them below. To your health!

Gavin