Ask most mainstream doctors: What should my blood sugars be after a meal? They will invariably respond: “As long as it is less than 200 mg/dl, you’re fine. Is this true?
No, absolutely not. Blood sugars after a meal of, say, 180 mg/dl, are destructive for long-term health. What the doctor is saying is “You don’t yet have type 2 diabetes necessitating insulin or other drugs to reduce blood sugar and I’m therefore not concerned for your near-term safety.” In conventional healthcare, not needing a drug or procedure is viewed as “health.” Of course, that is not our definition of health. What he/she is not saying is “This is a level of blood sugar consistent with optimal health.” In fact, you are going to come to understand that any blood sugar >100 mg/dl holds potential for damaging effects on health.
Let’s say your blood sugar prior to the meal is ideal at 87 mg/dl. (Ideal fasting glucose is 70-90 mg/dl). You have a breakfast of stoneground organic oatmeal in skim milk with blueberries, a teaspoon of honey, and an 8 ounce glass of orange juice. You check your blood sugar 30-60 minutes after the start of your meal 178 mg/dl—a level your doctor declares is fine. Doctors also advise you to check a blood sugar 2 hours after a meal, but this is to determine whether blood sugar returns to its baseline level for purposes of managing it with insulin or other drugs—that is NOT what we are looking for. We are looking for the peak blood sugar. Anytime blood sugar rises over 100 mg/dl, we know that:
- Repeated cycles of high blood sugar involve high blood insulin. This is the process that leads to insulin resistance that leads to weight gain (especially in inflammatory visceral fat), type 2 diabetes, hypertension, small LDL particles that lead to heart disease, fatty liver, and increased potential for conditions such as Alzheimer’s dementia (“type 3 diabetes”). In other words, that breakfast of oatmeal and orange juice sets you up for numerous chronic health problems.
- The liver converts the sugars in your breakfast to triglycerides via the process of de novo lipogenesis, the conversion of sugars to fats (triglycerides). Triglycerides are released into the bloodstream as very low-density lipoproteins, VLDL, that contribute to heart disease and cause formation of small LDL particles that also contribute to heart disease. Some triglycerides also remain in the liver and contribute to the process of fatty liver.
- A large influx of sugars (the amylopectin of oats, sugars in honey and orange juice) alters the intestinal microbiome, favoring proliferation of Proteobacteria (the species of dysbiosis and SIBO) and fungi like Candida albicans.
- A rise in blood sugar causes irreversible glycation, i.e., glucose modification of proteins. This is the fundamental process that leads to cataracts, accelerated skin aging, deterioration of joint cartilage and osteoarthritis, worsens the heart disease-causing potential of small LDL particles, and dementia.
Of course, the higher the blood sugar rise after a meal, the more these processes are set in motion. High blood sugars after a meal are therefore quite detrimental to health, contrary to conventional advice. For this reason, I advocate what I call “The No Change Rule”: blood sugar 30-60 minutes after the start of a meal should be approximately the same as blood sugar prior to the meal (accepting that finger stick blood sugars are accurate to +/- 15 mg/dl). A blood sugar pre-meal of, say, 93 mg/dl should remain at about that level 30-60 minutes after the start. You thereby do not trigger a big rise in insulin, do not create insulin resistance, do not cause liver de novo lipogenesis, do not cause formation of VLDL and small LDL particles, do not trigger adverse changes in the intestinal microbiome, and do not cause glycation—all major advantages for health.
If you have access to a continuous glucose monitor, even better—but still adhere to the No Change Rule for maximum health benefit.