The theme that I’ve been working on and trying to get into everyone’s knowledge is that a teaspoon of sugar is all that there is in the bloodstream of an average person. If you go to two teaspoons of sugar, (in your blood) you have diabetes. That’s not a big difference; it’s a very controlled situation inside the bloodstream. Pre-diabetes and diabetes are both conditions of elevated blood glucose. When you’re checking your blood sugar, you’re really checking glucose, but I use that interchangeably on purpose – sugar and glucose – to make sure you know what I’m talking about.
There is a phenomenon called a biological reality where some foods get absorbed faster than others and more totally than others. Then there’s the individual variation – you may absorb a different amount than I do or you may absorb faster or slower, especially if you have other conditions that cause slowed gastric emptying. In general, the more refined the sugar is, like taking a teaspoon of sugar, the faster it will be absorbed. Depending on your genetics, if you have insulin resistance or not, you might actually not see any change in blood sugar after having some sugar. This gets confusing, doesn’t it? If you’re healthier or you have the genetic ability to control the sugar, your insulin goes up really fast and so you might not see much of a blip after consuming a meal of carbohydrates. As my patients say to me, “It’s not fair!”
Which foods should I avoid?
What you want to do in the big picture is reduce the total carbs – this is the simplest way of looking at it. Starches get digested into sugar and sugar gets absorbed, so total carbs gives you a combined metric of all of the sugars and fibers that are in the food. You can fine-tune every food and there are charts and charts and charts to give you an estimate of how much it might raise your blood sugar, but again, these are estimates. A lot of these foods have not been tested in people with diabetes.
What happens to your blood sugar after eating carbs?
The amount that the blood sugar goes up can be quite variable. I remember when I was in training decades ago, I was taught that a blood sugar rise after a meal was normal. This was because you were eating carbohydrates, so you would have a rise in blood sugar. Now, there’s a focus – and you can see this written in the literature – that the postprandial, meaning after the meal (“post” meaning “after” and “prandial” meaning “meal”) elevation in blood sugar is thought to be bad; you don’t want to have too high of an elevation. We’ve gone from it being normal to have a blood sugar elevation after a meal to not actually wanting to have too high of an elevation after a meal.
The elevation of blood sugar is a function that depends upon the amount of carbohydrates in the meal. Protein does raise the blood glucose a little bit and the insulin a little bit but not to the degree that carbohydrates do (especially refined carbohydrates). You can add proteins and fats to carbohydrates to slow and even reduce the uptake of the sugar to manipulate it if you’re eating a meal with lots of different foods, and different macronutrients like carbs, proteins, and fats.
Reducing carbs and altering your lifestyle will help you manage your blood sugar
It’s pretty clear now that for most people, through carbohydrate-free eating, meaning if you don’t eat any carbs, your blood glucose will be almost flat. After meals, you don’t get this elevation. That’s why for people with diabetes, if they’re on short-acting insulin, I stop that immediately because they’re not covering the carbs in the meal anymore. Remember, if you have diabetes and you’re on medicine, be sure to do medicine changing and reducing and a diet that’s potent with a doctor or healthcare practitioner who understands how potent this can be. (So that you can adjust your medication safely.) The extent to which the blood sugars go up will depend on how many carbs there are in the meal and then on your genetics.
All too often I see that doctors really don’t ask you what you’re eating, do they? When is the last time you went to a doctor and they said, “Please write out what you’re eating and drinking for me over the course of a day and I’ll look at it.” I do that every time people come to my office because my secret weapon, as an internal medicine and obesity doctor, is food. You can go to a doctor and they never ask you about what you’re eating and drinking although you might start asking, “Well, is there something I can do with my food or my lifestyle that might help or help me get off medications?” Doctors might not ask you about food but they’re quick to diagnose conditions and then give you pills for them. That’s one way to go about things. In fact, that’s the most traveled pathway as it were, that most doctors just give medications. I’m afraid that doctors coming out of Duke University today are surprised to see a clinic like mine, where people actually get off medication because in the other clinics they go to – internal medicine and family medicine – the doctors are prescribing pills all the time. It’s a tragedy that most doctors are not taught nutrition; most doctors are not taught how to help people lose weight or reverse diabetes. However, the ability to do that is real and available now by people who understand how to do that.
It’s the blood sugar and insulin rise that you want to protect against. You don’t want to have blood sugar that’s elevated all day long. The sugars in food – refined sugars and refined starches – are the most potent promoters of blood sugar elevation. You don’t have to take my word for it. I’ll do a video shortly on how to measure your own blood sugars. I don’t recommend that, I just want you to believe and trust me. It’s solid science that basically it’s the carbs that raise the blood glucose. If you want to prove that in your own body, we’ll talk about how you can actually check your blood sugar at home and see what foods raise your blood sugar. There are lots of different ways to do that today. Not that I recommend it; I just want you to think very carefully about the sugars and moderate them in your diet, as starches get digested into sugar.
Watch the full video here.