How to Interpret Your CGM Data

[@sarahk802]

Thank you so much for making this video! I recently ordered the Dexcom Stelo CGM for non-diabetics. After two month of eating a very low carb/keto diet, my fasting glucose has gone down from 156 to 95. It’s amazing how stable my glucose remains throughout the day now, hovering close to 100/110 even when snacking on nuts, cheese, and beef jerky. I had a McDonald’s fish sandwich yesterday and it spiked quickly to 160! It amazes me which foods impact my glucose so drastically. I stick to the same foods right now, two eggs and two turkey bacon strips for breakfast, meatballs and cauliflower rice for lunch, steak and sauerkraut for dinner. I add avocado, MCT oil, olive oil, avocado mayonnaise, and butter for healthy fats to slow digestion and increase satiety. I wish you all the best on your healthcare journeys!

[@nourishedbyscience]

Just be careful not to think that your glucose response to carbs at this time, on your very low-carb diet, is a reflection of your actual glucose tolerance. The issue is that while you are eating low-carb, your first-phase insulin response (the amount of insulin secreted early after a meal) will be diminished. That is temporary and reversible though, so if you ever want to figure out whether your glucose tolerance has been improved (for example, because you have lost some weight), you should only judge that after about 2-3 weeks of eating carbs again (introducing carbs slowly). Hope this makes sense!? Cheers Mario

[@rsween922]

That's great, stop eating the carbs, sugar and processed food.

[@stnln2180]

​@@nourishedbyscience I have been on Keto, 18×6 feeding window, as well cardio and strength exercise twice a week for approximately 2 years. The reason to start it was insulin resistance, gallbladder sludge, and possibly fatty liver. I have no problem to maintain this diet indefinitely. However, I am thinking of starting to introduce complex carbs to keep my metabolic response flexible and healthy. What's your opinion about periodically, maybe once a week to switch my metabolism to carbs based diet to keep it healthy and flexible???🤔

[@LiveLoveLaughEveryday]

​@nourishedbyscience very helpful. I wear dexcom g7 10 days every month to correct my eating behavior so that the reading is below 140 every day. I'm none diabetic but having insulin resistance. I'm going on a transatlantic cruise next week wearing cgm. The thought of carefully choose the food I will eat on cruise is very exciting 😂

[@bradnyers]

This video was outstanding. I began wearing a CGM after a T2 diagnosis. I moved to a low carb diet and have seen my A1C drop from 9.5 to 5.2 and lost 50lbs. I continue to wear a CGM to hold myself accountable in managing glucose spikes. I have been using 160 as my definition of a spike and focus managing post meal increases to 160 or below. I really appreciate your time educating us with facts based upon science.

[@tarabooartarmy3654]

If the keto diet is working for you, that’s great. Just be aware that it will make insulin resistance worse in the background. A diet high in saturated fat is how scientists cause insulin resistance in lab rats for studies. Keto makes the numbers look better, but the only way to reverse type 2 permanently is a very low fat diet high in whole plant foods and low in animal products. Not trying to discourage you because you’ve made a ton of progress! I just want you to know the truth. The End of Diabetes by Dr. Joel Fuhrman and the book Mastering Diabetes do an amazing job explaining the science behind it if you want to learn more.

[@nourishedbyscience]

@tarabooartarmy3654, I am sorry to disagree. If you watch the video linked below, there is basically no impact of the dietary macronutrient composition on insulin resistance, once we take body weight changes out of the equation. And similarly, the science on the impact of saturated fatty acids and their impact on insulin resistance is not nearly as clear as suggested by these and other individuals. When considering the cumulative evidence, I do not hold the view that a ketogenic diet or saturated fatty acids trigger insulin resistance. And I am saying this as someone who has published one of the few papers showing negative effects of a diet rich in saturated fatty acids on insulin sensitivity. kzbin.info/www/bejne/kJS5lqGLl9amj7ssi=3zGTlJvoo2whKcvS However, a very low-carb diet such as a ketogenic diet will reduce insulin secretion, and specifically the first-phase insulin response, temporarily. That is a reversible phenomenon, and people on low-carb diets do well do eat all of their meals low-carb, and to reintroduce carbs slowly should they want to switch to a higher-carb diet. Sadly, some studies showing impacts of low-carb diets on glucose tolerance have been incorrectly interpreted by proponents of plant-based diets as suggesting that dietary fat or saturated fat trigger insulin resistance. This is, IMO, not supported by the cumulative evidence. The effect seen in these studies instead is a reduction in glucose tolerance induced by reduced insulin secretion. Best, Mario

[@gonebyrv9748]

@@tarabooartarmy3654 you are so wrong!

[@Jayla-dj2gj]

@@tarabooartarmy3654 lol

[@sandramorton5510]

@@tarabooartarmy3654 Where is the scientific data to support your claim. Look into Dr. Bikman who does scientific tests on fat in mice, no evidence animal fat causes insulin resistance.

[@2009raindrop]

I almost have no words for how impressed I was by this video. I just started using one of the new OTC CGMs and was wondering what criteria was being used for its spike notifications. I still am not sure - maybe it is the rise by 30. But thank you ever so much for the extended description of studies on normal individuals, and on what patterns correlate to chronic disease. You have just won a new subscriber!

[@nourishedbyscience]

You are welcome. Thank you for your kind feedback. Cheers Mario

[@ThomasAT86]

Great video! I despise all these fear-mongering influencers and "doctors". It's so irresponsible and partly even dangerous. And then people copy these weird and silly arguments, share them on social media and with friends and contribute. So thank you for doing what you're doing!

[@veronicaheaney3464]

My BG increases from my fasting BG by 8-10 points if I walk in the morning before breakfast. I hope to be able to get a CGM sometime soon to get a better picture of the fluctuations that occur during my day and what foods and/or activities influence the changes. Thank you for this video. It will come in handy when I get one.

[@Kat-lq8sp]

Please make more videos. I have started to wear a CGM. I’m 57 menopausal on BHRT with Hashimoto’s. I’m also a RN currently in University for my FNP. I’m wanting to see the effects of glucose on this demographic so basically I am my own research subject. I have found your videos so helpful in understanding the scientific data. I find social media “influencers” spreading inaccurate even fear mongering information. Your channel concise, to the point and easy to understanding.

[@Arugula100]

This is the best lecture I have heard about glucose tolerance and glucose spike.

[@sahomd]

Academic-level information presented in a clear, understandable way!

[@nourishedbyscience]

Thanks, Saba. Cheers Mario

[@BartBVanBockstaele]

Another top-notch presentation. Highly recommended. I really love Mario's dispassionate no-nonsense presentation style as well as the high level of the information he presents.

[@AbsenceLacksNothing]

Thanks Mario. I wish the folks at ZOE were similarly clear about what exactly we should be concerned about and what we shouldn’t. I hope they invite you to do a ZOE podcast soon and you can put them straight. Although something tells me that your message might actually cost them because their low level fear-mongering is a significant source of revenue for the ZOE brand. More power to you. Danke aus Schottland!

[@sandramorton5510]

I stopped watching Zoe for the reason you described.

[@megs4898]

Props to you!! I've been searching for a video with this information for days! Great work, thank you!

[@jadidi77]

Many thanks for these useful facts ,Mario! You remain the best educator in this field to me and many more like me . Keep it we are supportive 🙏🏼

[@nourishedbyscience]

Thank you.

[@mindyadams9041]

Much needed video!

[@Luis9876-z]

One of the best videos about this subjects I have ever seen. A lot of people are obsessed with their blood sugar and tell people 120 mg/dl is deadly.

[@bigjay1970]

So true!😊

[@trust1952]

I’ve been reading and watching stuff on diabetes for years because I have family with it so I want to prevent it for myself. I’ve never once seen someone say 120 was deadly. 120 isn’t even a diabetic fasting glucose. Not sure what you read, but it’s probably a troll trying to scare uneducated viewers.

[@Mat_Gallusman]

In a fasted state it's too high indeed.

[@Luis9876-z]

The subject is spikes not fasted blood sugar.

[@mygolfballsannoy]

No, the problem is type twos are broken. We don’t spike for 30 minutes. We spike for 2 to 3 hours sometimes and it may take days to actually get back to normal since we know we are broken. It’s better to minimize the spike as much as possible or less is, zero spike meal is better, every spike and long duration with high insulin and BG is damaging

[@lorenzoucce3903]

one of the best video on the internet, absolutely well explained and as a scientist, I appreciate all the data and very well presented data! very well done!!!

[@luisv007]

Very informative video. I will watch more. My interest is in the glycemic index and dietary management of diabetes. I have only recently commenced watching YT. Anyway, there are people that use their CGM to test the effects of food on their glucose levels. As example, he tested white potato and sweet potato for different Short videos and compared them. After the tests, he said that his blood glucose levels for the both foods were the same. However, white potato has a higher GI and sweet potato a lower GI. He also tested another food and ended up with about 3 peaks during the two hours of the test. I have noticed this with others, even one with Type 1 diabetes. You stated that CGM is not used to diagnose prediabetes or diabetes. This is similar to the GI because GI uses a protocol that blood glucose is tested every 15 minutes, after the premeal test and after the food is consumed, for 2 hours. CGM does not test blood glucose but interstitial glucose. You mentioned blood glucose throughout the video rather than interstitial glucose. I’m not sure whether the two are similar, because the CGM tests on YT could not possibly be used to calculate the area under the curve to obtain the GI. Your opinion would be help me greatly. Thanks

[@kipditlow7737]

This was very interesting and quite informative. Thank you for doing it. And thank you for mentioning that laying on a sensor can cause a low reading. I have been involved in a face group group for type twos in which it comes up regularly. Usually when someone new to cgm's is woken up by the alarm and not understanding its a fluke takes an excessively large amount of sugar with out doing a blood sugar check to confirm what was going on.

[@sherrygaley4675]

I’d like to see you do a video about the long-term 22:01 health risks of someone who has pre diabetes for say 5 plus years- An A1C of 5.7 to 6.1 for example. This person has higher fasting blood sugars - say 5.7 to 6.3 - but no spikes above 7.8.

[@ak-rx1ui]

Excellent presentation! Low carbers may note: A slower insulin response is normal (07:03) after months of carb restriction. One way to make sure is by a HOMA IR test which will quantify(?) the IR. By the way, Cortisol response due to psych. factors (fight/flight) plays havoc with blood sugar 🙄. (One solution for this is to water fast for 6~8 hours after such events.)

[@jasmines.6325]

I thought fasting with high cortisol makes it worse?

[@santarosa6676]

Thank you Mario. Helps distinguish silence from hype!

[@JulieWombacher]

Excellent video. Thank you.

[@MaryRaymond-cg3wn]

As always, Thank you Mario! You have placed definitive cutoff readings so frequently presented within an understandable context but retained an awareness of their relevance. It is not real easy to work out personal glucose tolerance but you have removed some of the angst by providing a way forward. Cheers

[@caroljohnson5724]

Extremely helpful!! The best I’ve heard. Thank you.

[@olgabaeva2087]

Thanks a lot for this valuable information! Glad that I found your channel

[@DrLeonardoAydos]

Like the new scenario! Amazing video as always

[@cbgbstew4072]

Thank you for this video! I found your videos a year ago after questioning the 30mg/dL rise being touted as “unhealthy” and subsequently changing CGM companies for this reason. I know exactly which company you’re talking about 😉

[@RaphaelChan888]

When I was diagnosed with T2D back at the end of 2022, I was literally off the charts. At the time, I didn't understand the numbers and the fuss with my blood glucose level at being over 28mmol/L (>504mg/dL!) but the doctor and nurse who tested me seemed very urgent to get me to take medication and see other specialists for treatment. Over a year later, it's now more average around 8mmol/L (144mg/dL) and currently managing spikes (usually over 10-13mmol/L after snacks and meals) by trying out a CGM

[@nourishedbyscience]

Glad you are controlling your blood glucose better these days. If I may suggest, you may find these videos here helpful, in this order: The basics of how blood sugar levels are regulated, and what goes wrong in diabetes: kzbin.info/www/bejne/j5iccoZoqMuMb7ssi=m7T23zQwMc25Hxcp To figure out if you are insulin resistant, a common cause of glucose intolerance: kzbin.info/www/bejne/hYvXqaKaprR1mNksi=NJFuxjT-mh3xj2NK If you are insulin resistant, to understand why you may be insulin resistant: kzbin.info/www/bejne/mYGYaKKDbdF1l7csi=VBUg60B2f0Y5jrLq kzbin.info/www/bejne/forXn5-IeNZradUsi=-iPi09SYz3to0ML9 To understand why insulin resistance is harmful: kzbin.info/www/bejne/fJiWn2Csnpenabssi=ljX7nTAqVj8f58b_ To avoid blood sugar spikes to 180 mg/dL or higher: kzbin.info/www/bejne/r5iTimabg7h0hMksi=gwAVoW2Ch0HRqLDI kzbin.info/www/bejne/gofaZ2OIfs2VsMksi=IiTbUkTjwdG_6Jen Best wishes, Mario

[@RaphaelChan888]

@@nourishedbyscience thankyou

[@woofinu]

Welcome back. I was sent here by a recommendation by Nutrition Made Simple.

[@Kmahersh01]

Thank you for this video. I wear a cgm and have a normal BMI of 20. I don’t eat a lot of sugar or carbs anymore but I ate some licorice mints the other day and I went above 200. When my blood sugar spikes like that, I become so tired that I immediately fall asleep for a few hours. It’s happened every time my blood sugar rapidly rises. I guess I need to see a doctor.

[@Dina-h8r]

Very nice . Mario is very knowledgeable and explain very well , and his content is evidence based.

[@hugoboggino7933]

What a good discussion, as always well thought out, with data and presented in a logical manner. congratulations for the great work you do Dr.

[@johanna-tx9oo]

Nice to hear from you, you have such a good quality content 🤗

[@nourishedbyscience]

Thank you so much 🤗

[@KittySlay1million]

Thank you for this fantastic episode. Very informative and clearly explained in a neutral manner.

[@333Susanne]

excellent video!!! I've realized I've done things wrong over the past 3 months where I tried to extend the non eating window and never have carbs on its own, so I would often have 1 treat after a meal, and if there were carbs in the meal it would overextend the spike even higher. Would be better to let the spike come down and then have the treat with a much lower glucose peak. I'm in the middle category with spikes that shortly go above 140 but then come down again, I'm somewhat compromised. For next 3 months I need to follow a different eating routine.

[@inasbriek]

Thank you so much for this informativ video. I have missed your Videos so much. You have said, that after a low carb diet, we should integrate more carbs to restore our insulin respond. Could you explain why?

[@tselski]

If you're regularly consuming carbs, the pancreas will be used to responding to them, and will actually keep some premade insulin stored so it can respond and release it right away. When you don't eat carbs it stops keeping that store because you don't need it. Then when you eat carbs unexpectedly the beta cells have to make all the insulin on the spot. So it is a slower response. But if you consume carbs for a while again the pancreas will know it needs to maintain that store again

[@nourishedbyscience]

Yes, what @tselski said! Thanks!

[@shootitamboo7553]

👏👏 best talk on this topic. Congratulations

[@asr9217]

Thanks Mario for another superb balanced video based on science. I found one study based on oggt that suggested 1hr > 155 could be predictive for diabetes ( jcem 1hr postload hyperglycaemia 2018 fiorentino ...link wont upload) would be grateful for your views on whether this could extend to food. Thank you again for all your work.

[@nourishedbyscience]

Yes, I know that paper. It's interesting, but I am not sure it holds a lot of value for the layperson, beyond what I shared in this video. First, the papers are based on OGTTs, which constitute a very different glycemic load than normal meals. Second, the paper in essence just shows that people with higher postprandial blood glucose to a standardized load have a higher risk of later developing diabetes. That is hardly surprising, right, because glucose intolerance is a continuous process, and it would seem plausible that hyperglycemia and glucose intolerance develop gradually. That said, for most people, the spike after a meal occurs around 45 min after the start of the meal. That means that glucose levels should be on a downward movement at 60 min, and if they consistently are still above 155 mg/dL, that would strike me as a sign of at least mild glucose intolerance. Again, because the data suggest that increases in blood sugar into the 140-180 mg/dL range do occur even in very glucose tolerant people, but they are infrequent and brief. Best, Mario

[@asr9217]

@@nourishedbyscience Thanks Mario for a really detailed answer ... that is what I took from the paper too (and yes not a lay person) but many are looking for optimal and like you I believe this is an area where we can get over worried so will include this paper when i present my findings... you are so good to help us all in this way.

[@ruthe3351]

Excellent video! Thank you for disseminating evidence based information!

[@admgloval]

Thanks for this video. I was looking for something that showed what a normal persons blood glucose does after eating and even though this doesn't go into super detail, its good to know that the whole "30 points is too high of a spike" thing that so many youtubers throw around is not true. It's true that you can keep any spikes below 30 by eating nothing but meat and low carb vegetables but life gets pretty boring IMO if that is all you eat. I love fruit and am not giving it up and my blood sugar will spike 40-50 points after eating some fruit but it always comes back down to around 80-85 in 3-4 hours. I have cut out pretty much all processed foods with the exception of lunchmeat and low carb bread/tortillas which I don't eat all that often. I've lowered my A1C from 6.5 to 5.3 and lost over 50 lbs so feel like I am doing pretty well.

[@nourishedbyscience]

If your glucose levels remain elevated above 100 mg/dL about 2 hours after starting a meal, this could still be a sign of insulin resistance, and there may be value in identifying and addressing any potential triggers of insulin resistance: kzbin.info/www/bejne/forXn5-IeNZradUsi=WEhaPV3nI0Va_kID Cheers Mario

[@admgloval]

@@nourishedbyscience Oh I have no doubt I am still insulin resistant. From what I understand, there is no way to really reverse that once you have become T2 diabetic. You can lower your A1C by eating low carb but you will be insulin resistant the rest of your life (unless they figure out some medical way to reverse it). I know it is fruit and the low carb bread/tortillas that raise my blood sugar but I am not giving those up. I keep the spikes below 150 for the most part even if sometimes it stays elevated for 3 or 4 hours before going back to normal. Life is too short to not enjoy some amount of sugar which I do now with fruit instead of candy or desserts. I don't over do it and have kept my A1C down to normal levels so I am happy with where I am at.

[@nourishedbyscience]

@@admgloval That assumption is incorrect. Glucose tolerance can be improved, both by improving insulin sensitivity and - in some cases - improving insulin production. The key is to figuring out WHY you are insulin resistant, and then systematically addressing that in a way that you can maintain long-term. Best wishes, Mario

[@admgloval]

@@nourishedbyscience I may have to try your suggestion of bringing carbs back into my diet and see if glucose response improves. I went low carb for about 4 or 5 months (50 carbs or under per day) and dropped my A1C from 6.5 (what it was when I was diagnosed with T2 diabetes) to 5.3 in July. Since then I have started eating small amounts of some carbs that I had cut out completely, mainly junk type food like chips or candy. Typically when I do I see my blood sugar go up from around 85-90 to 134-140 and it will stay elevated above 100 for 3-4 hours before returning down to normal. During that time it goes up and down though between 135 and 90. I was always under the impression that once you had insulin resistance that you had it forever. When I was doing 50 carbs and under, my blood sugar was always around 80-90 with low spikes up to around 120 and then back down to normal.

[@AC_2.4-10]

Thank you for another great video! So grateful for you!

[@sigigee6628]

So clear, practical and helpful - thank you.

[@MarkLowCarb]

Just one standard serving of pizza, with a calibrated CGM (Dexcom G6), I went from 4.8 mmol to 13 mmol, within 30-45 minutes. We drank water. This was typical Italian pizzeria stating 100% made onsite dough and sauce, wood oven. In this same time period, did 15 min blood pricks that confirmed what the CGM said 15-20m later, and my wife that is not pre-diabetic, she went from 5.6 mmol to a max of 8 mmol. IOW, confirming what this video says. My spike was huge and it took over 4 hours to return to "normal" 5.5 mmol, where 1.5 hr later my wife was back below 6. When fasted and not spiked from previous day, my BG is 4.2/4.4 and dawn effect brings it up to 4.8-ish. So maybe the pizza test could be used as a baseline.

[@MarykayOsoski]

Thank you! Helpful

[@rajeshtanwar2445]

Objective and scientific knowledge 🎉❤🎉❤

[@DrLaurieMarbas]

Love your videos. FYI in the US T2DM can also be diagnosed with a random blood glucose level ≥ 200 mg/dL (11.1 mmol/L) at any time of the day.

[@nourishedbyscience]

Yes, correct, but IMO, this criterion should not be applied to CGM data without further testing, as the false positive rate would be too high. I think the issue is that if a patient comes into a doctors office once, usually fasting or a while after eating, and has a glucose > 200 mg/dL, the likelihood that they indeed have diabetes is high. However, with CGM, we get data every 5 minutes, including immediately after eating, and I don't think that the relationship between sensitivity and specificity of the random glucose test hold up very well under these conditions. I am hoping that we get updated criteria on this with CGM data, and would assume that the threshold for when diabetes is suspected is going to be a bit higher than 200 mg/dL. Cheers Mario

[@sevdaboneva]

Thank you for your video! It contains valuable information!

[@stephenwestland942]

Incredibly informative - thanks

[@sunbeam9222]

Im wearing a cgm. Only for 14 days. Early on I noticed that porridge ( not instant, steel cuts oat) accompanied by Greek yoghurt made my blood sugar rise by a good 50 mg/dl. From about 80 mg/ dl to 130. So I was quite apprehensive to test 75 g glucose. But if you don't try you don't know so I did and it rose by 55 mg/dl. I expected more tbh. Or porridge and Greek yoghurt to make it rise less. I'm not diabetic nor pre diabetic and my blood sugar is able to rise from 85 to 140/ 145, easy so quite a jump. Then i it will start going down then back up again down up again for about 5 or even 6 hours hours if I consume a big meal including carbs. To reduce that length I can go for a fast walk and iit will go down quicker tho. My blood sugar rises quite a lot when I exercise. It also rises when I take a shower or do the dishes. Also when I fast. It seems whenever I need extra energy it will rise which I found strange at first but ok.. Also I tend to experience hypoglycemia ( or is that dawn syndrome or reactive hypoglycemia?) at night. But when I replace sweet snack by cheese or an avocado or don't snack at all tthen I don't go hypoglycemic. I managed to reduce this occuring from 11% to 2% so wearing a cgm has been great if only for that). Hopefully that helps give my liver a break and having to" rescue me" ;-) My BMI is 20.2 and AC1 4.7% Fascinating experience imo. It's been like a little journey within some part of my body that was so far unknown. Thank you very much for another outstanding video.

[@neorasper1]

This was very good, indeed one of the best looks at the published data deciphered for a general audience. BUT the final synthesis, by emphasizing being under 140 mg/dL “most of the time,” missed the most important metric a CGM can give: average blood glucose (ie, area under the curve). Having a healthy average blood sugar between 90 and 100 mg/dL would not result if one were at around 130 “most of the time.” It’s really down to how readily one returns to a fasting level after their meals.

[@nourishedbyscience]

I suggest that if someone meets all of the criteria, as outlined, their average blood glucose will be low. That is because there are exactly zero people who have normal glucose tolerance and who keep their blood sugar in the 70-140 mg/dL range 95%+ of the time who have stable blood glucose at 130 mg/dL for more than a few minutes. If someone can regulate their blood sugar as I outline as normal, then their blood sugar will never just hang around 130 mg/dL. Does that make sense? Best, Mario

[@sunbeam9222]

​@@nourishedbyscienceit does to me, cheers.

[@monikakress3867]

I am one of those otherwise healthy people who wore a CGM for a month. I follow a predominantly plant-based diet. My glucose levels would “spike” every time I ate anything. I could have avoided spikes by swapping my fruit and beans for beef jerky and hard boiled eggs. I’ll stick with my plants and take my chances!

[@jamato8461]

So how did ypu manage the spikes?

[@nourishedbyscience]

You could still try to front-load your high-glycemic carb meals with fiber-rich veggies, salad, and plant protein.

[@ryanneedham7466]

I have gone the other way and decided to eat massively reduced carbs. This means that I have to eat more meat and dairy. I was diagnosed with prediabetes in May and I’ve managed to reverse my blood glucose with the help of a CGM. I will honestly tell you, I’d give up all the meat for some fruit or any carbs for that matter 🤤 I miss pasta 😂 I am still very sensitive to carbs unfortunately although I have kept my intake low.

[@wellnesssecrets2014]

Excellent content & presentation

[@Daniel_Maxin]

Very useful, thank you. That being said, I am still not clear on the difference between normal and optimal. A spike to say 170 may be normal but is it optimal? Is it something to be OK with if it happens daily? More to the point, is the pancreas meant to be "exercised" once in a while with carb challenges or is it more like the liver with respect to alcohol, i.e. a healthy one can handle 4 drinks but, really, optimal is as little as possible. Between the two extremes: keto vs very high carb diet would you say moderate low and complex carb would be ideal?

[@nourishedbyscience]

I don't think we have any data to support any specific macronutrient composition as optimal for everyone. If someone is glucose intolerant, they may benefit from reducing their carb content, at least until their glucose tolerance has been normalized. My sense is that currently we do also do not have any data to link short blood sugar increases into the 140-180 mg/dL range to negative health outcomes. It is possible, as you say, that it's suboptimal, but that would be a guess and not based on any data I am aware of. Best, Mario

[@sandramorton5510]

Your deliverance is perfect for me for I am not a scientist, many videos are for fellow scientists. I am prediabetic and insulin resistant (both slightly), started on low carb(average 60 a day) 8 months ago, ordered my CGM yesterday. I believe all people are not the same so carbs can be an issue in some people and diabetes runs in my family. Additionally, removing grans cured my severe IBS.

[@tadwimmer6225]

The average glucose rise needs to be accompanied by the deviation range. But otherwise I’m pleased with your presentation. BTW, I am a Type 1 diabetic over 31 years.

[@nourishedbyscience]

If someone meets the criteria, as outlined, their SD will be low. And I beliebe that these criteria are more intuitively grasped by most people than SD. Cheers Mario

[@ElBeeEss]

Reassuring: thank you sooo much xx

[@abaadad6833]

Dear Mario, I appreciate the valuable educational content you provide. Regarding your discussion on high LDL levels, are you advocating for a reduction in the intake of foods high in saturated fats, such as full-fat dairy products and red meats? also about Visceral fat storage dysfunction is a contributing factor to diabetes. If dietary and lifestyle changes are not effective, what are the recommended safe medical intervention. Thank you in advance for your response and effort.

[@eugeniebreida1583]

Very helpful, mil grazie Mario.

[@NatarajanGanesan]

Great video. Info about 1,5 AG as a biomarker was interesting. I would have liked a bit more emphasis on the area under the curve and the convexity of the curve in the post peak. Ideally the peak should come down rapidly l and we know that. But how much should the rate of decrease be and how could it be an indicator of developing insulin resistance would be interesting to know

[@nourishedbyscience]

I would simply pay attention to the glucose concentrations two hours after beginning a meal: is it usually back to around my baseline, ideally

[@NatarajanGanesan]

@@nourishedbyscience Yes. By rapid I meant the average downward slope in healthy homeostasis of glucose levels. Any variation on either side is likely to be indicative of an imbalance for sure.

[@Manzoorali]

Awesome explaination.

[@FranciscoAcosta-q9w]

I have glucose peaks of 170 to 200 when I eat more than 30 to 70 grams of carbohydrates in a single meal, after 2 hours it drops to 80 to 70, sometimes it goes from 150 to 80 in 15 minutes. But, I just finished the keto diet 3 days ago, so I guess as the days go by I will improve. My fasting insulin at the end of the diet was 2.4 fasting, meaning I wasn't producing enough insulin I guess.

[@nourishedbyscience]

Your low fasting insulin probably means that you are very insulin sensitive. My best guess is that you have a (temporarily) diminished first-phase insulin response due to your long-term low-carb diet. The first-phase insulin response is based on pre-formed insulin that is stored in the pancreatic beta-cells and that can be secreted into the blood within seconds of consuming carbs. That first insulin secretion prevents a spike from happening. Just re-introduce carbs a bit more gradually, and eat some non-starchy veggies or salad AND some protein before you eat carbs for the next few weeks. That'll slow down your carb digestion, and the protein also stimulates insulin secretion before your carbs are absorbed. Cheers Mario

[@FranciscoAcosta-q9w]

@@nourishedbyscience Thank you

[@Roberto-cg2gr]

Better test of diabetes is measuring insulin. HOMA IR or Kraft insulin Assay Test. Early detection is better than cure. Hyperinsulinimia even if blood sugar thresholds are still normal. Definition of diabetes should change

[@dr.shadmbbsdphmasco]

Diabetes is actually insulin resistance + Relative Insulin Deficiency because pancreatic Beta cells fatigue or dysfunction= Type 2 Diabetes. Or not able to follow Insulin's Own Natural Circadian Rhythm.

[@nourishedbyscience]

Measuring insulin is not a 'better test of diabetes'. By definition, diabetes is a condition of glucose intolerance, and while related to insulin resistance, is not the same. Let's try to be clear and not muddle up things. Insulin resistance is important, and you'll find many videos on my channel about that as well, but glucose intolerance and hyperglycemia are independent risk factors for many severe chronic diseases in their own right. My position is we should normalize both insulin sensitivity and glucose tolerance, but this video was just about glucose tolerance and glycemia. Best, Mario

[@Roberto-cg2gr]

@@nourishedbyscience Science is challenging the status quo. Proving existing guidelines wrong. High insulin levels using root cause analysis and 5 why's will show that high insulin levels even if your glucose value is still low is abnormal from the acceptable fasting insulin levels or using Kraft insulin Assay Test. Catching this high insulin levels early will be the best way to cure Diabetes faster and easier with low carb or keto diet

[@Roberto-cg2gr]

@@nourishedbyscience Best to challenge the status quo of a glucose centered approach to diabetes. The only constant thing in this world is to change for the better

[@Roberto-cg2gr]

@@nourishedbyscience Interview Dr Ben Bikman expert in insulin

[@vadimesharak726]

Thanks for the video. BTW, given glucose concentration 5mmol/L and molar mass 180g/mol, the homeostatic glucose in the blood in human readable form is 0.9g/l or 4.5g for the whole 5 liters blood volume. The glucose adsorption is around 96%. There is the question: why we abuse the body with the external glucose in many times bigger concentration that body have? We know that there is no storage for glucose nowadays for sedentary population.

[@nourishedbyscience]

I feel strongly that the issue we should address is glucose intolerance, and that blaming carbs is short-sighted. If someone is glucose tolerance, they can eat all the carbs they want and not have any problems. What we should be talking about a lot more is why people are glucose intolerant, and - again - it's not carbs per se IMO. Best, Mario

[@vadimesharak726]

@@nourishedbyscience , thanks. Based on Glucose - Fatty acid cycle, historically, we rarely mixed glucose with non-glucose sources, until last 12-10k years ago. Given that, the genetic and evaluation aren't fast process, IMO, I'm still not convinced it was long enough to get humans adapted to such glucose surge every meal. BTW, Homo Paranthropus extinct.

[@chochooshoe]

"that's a pretty easy thing, you just need to eat fewer carbs" - that's actually a very hard thing to do.

[@karynstouffer3562]

No joke. They put extra carbs in everything! There's no need to do that, other than making "food" more cheaply. But then, they charge a small fortune for anything resembling real food. Beyond frustrating.

[@jean4157]

It’s really not that hard. Buy real food instead of the processed junk. And stay away from bread pasta potatoes. It’s simple. But people are literally addicted to the processed crap located mostly in the aisles of the grocery store.

[@karynstouffer3562]

@@jean4157 You are right, in a way, but also not quite correct in saying it's simple. It depends a lot of where you live, and whether you have access to those foods/ingredients. Grocery stores have caught on to the fact that more people are wanting to eat more healthfully. In some areas of the US, fresh vegetables are very expensive. Frozen vegetables are (sometimes) not pleasant to eat. Canned vegetables are loaded with extra ingredients. Fruits have all the same problems. Think about it. Someone who lives in a larger city, who does not own a car, earns Federal minimum wage - they are not going to have time and energy to shop frequently, prepare for cooking and then actually cook a lot of wholesome, healthy food. Besides, who was supposed to teach them how to cook? Their mother, who likely raised them on prepackaged, cheap, convenience food? School? The other end of the spectrum - those who live in the country literally have no feasible way to get more than a handful of groceries home from the store. They are going to look for lightweight items that they can carry easily. Not everyone has the privilege of living in Pleasantville suburbia, with easily accessible transportation, and an affordable supermarket every couple of miles.

[@ErinCummings-rz7xp]

So a few months ago my fasting BS was 77 and A1C 5.1. Since having covid, my morning sugars are 100 to 105 in my CGM..... Very frustrating. Hoping time and keto/IF will bring it down.

[@stoenchu122]

People should start making difference between acute and chronically

[@VagifZeynalov]

Thanks! It was useful.

[@nourishedbyscience]

Thank you.

[@oliverstewart834]

Thanks! Type II trying to prevent Type 1 with CGM

[@nourishedbyscience]

Thank you for your support.

[@lichanidz6502]

Many thanks very helpful

[@Marc_de_Car]

Thank you

[@intothespace.....9442]

Super....

[@joeunkong407]

The definition of the numbers like 140,180 I guess by lab results? I heard cgm or finger prick are higher than venous blood by 10-15%. Should I still aim for to stay 140 on cgm? I actually aim like 135 on my cgm though. Thank you. Great video!

[@GrampalettasCamp]

Wonderful video. I wish I saw this before I did a 2-week CGM test. Some say that glucose levels above 110 or 130 cause glycolation of proteins which accelerates aging, and this is the reason to keep your glucose peaks lower to minimize this damage. Is this correct?

[@nourishedbyscience]

Glucose can attach itself to proteins at any glucose concentration. We can see this in the HbA1c measurement, which measures exactly this: glucose attached to the hemoglobin molecule in the blood. Your HbA1c would never be zero, even if you kept your blood glucose level flat at 80 mg/dL all day. What we understand well is that chronically elevated blood glucose concentrations, as in prediabetes or diabetes, are strongly associated with an increased risk of several chronic diseases. We also know that even within the normal range for HbA1c, there is a very slightly increased risk of cardiovascular disease, for example, at the higher end of the normal range. However, I argue that this does not mean that we should be concerned about small 'bumps' in blood sugar within the 70-140 mg/dL range. Even if your blood sugar goes up to 130 mg/dL after every meal, you could well have a very low HbA1c. The main things that matters here is that you don't spike to high, to 180 mg/dL or higher, and that your levels don't remain elevated for a long time. For example, my blood sugar fluctuates within the 80-130 mg/dL range about 95% of the time, and my HbA1c is 4.6-4.7% which is on the low end of normal. Cheers Mario

[@GrampalettasCamp]

@@nourishedbyscience thank you for responding, Mario. All chemical reactions are larger with higher concentrations of the reactants, hence HbA1c increases with higher average glucose levels. If cataracts and Skin damage are a result of glucose reactions with those proteins it would follow that lower glucose levels would result in less tissue damage. Area under the glucose-time curve may be indicative of extent of glycation or tissue damage. Perhaps HbA1c is a good indicator of this. So does it follow that selective ingestion of food types (low GI) and amounts along with sequence and combinations can lead to lower glucose excursions from your fasting levels, you can minimize tissue damage from glycation and lower disease?

[@steffanrhoads1870]

but i eat no carbs and my blood sugar is high. if i eat a steak it goes up. only if i eat fat it doesn’t go up.

[@lukeanna4268]

Very good information. Thank you. I'm wondering, is glucose intolerance the same as insulin resistance? or does one precede the other?

[@TasteOfButterflies]

Insulin resistance is one possible reason of glucose intolerance. Type 1 diabetes is glucose intolerance without insulin resistance.

[@cbgbstew4072]

@@TasteOfButterfliesThat’s not entirely accurate. Type I is when they don’t produce any insulin at all, or at times, very little. But even type I patients can develop insulin resistance based on their self-administered doses.

[@nourishedbyscience]

I suggest you watch this video here on how insulin resistance relates to glucose tolerance: kzbin.info/www/bejne/j5iccoZoqMuMb7ssi=gIGcgWXuN1hwuTPR Cheers Mario

[@Levidicussed]

Thanks!

[@nourishedbyscience]

Thank you for your support.

[@user-ij8no5zw6u-]

Still.....how do we know that we're even supposed to eat the foods that raise the blood sugar that much? Also how do we know what normal is if the study's general purpose is to find exactly that with "normal" individuals?

[@nourishedbyscience]

This is an excellent question. Love this. Thanks. My view here is that from observing the normal range in which the body keeps glucose regulated, we can actually get a sense of which foods our ancestors ate as we evolved. From the data I shared, it does seem very clear that the body makes substantial efforts to keep blood glucose in the 70-180 mg/dL AT ALL TIMES. That is absolutely remarkable, because the amounts of glucose we often eat in a typical mixed meal are multiples of the total glucose content in all of our blood. And this system shows some evidence of redundancies, such that defects in one component can be compensated by another component (insulin resistance can be compensated by higher insulin secretion). So the fact that such a nuanced, robust glucose homeostatic mechanism exists seems like indirect evidence to me that humans are adapted to consume glucose-containing foods (sugar, starch). To phrase differently, our body does NOT seem to have any homeostatic mechanisms to always keep blood glucose in the 70-100 mg/dL. Admittedly, this is not strong, conclusive evidence, but to me suggests that humans evolved on diets that contained at least some carb-containing foods. Cheers Mario

[@user-ij8no5zw6u-]

@@nourishedbyscience Very interesting look....you can definitely find logic in that. But going the same route...how about blood pressure regulation? BP is also pretty tightly regulated and the body if healthy would increase it to 150/100 for example when stressed. But these days everybody is stressed overtime, numbers climb and we have new normal. Despite many people are very sick and have degenerated cardiovascular system, the body is still giving its best to keep the numbers under 200 systolic. But that's not healthy we can agree? Acute stress is better than chronic stress....but lower instances of acute stress is even better. If I eat as similar as possible to our ancestors, my glucose would absolutely never rise more that 20-25mg/dl. Also if we get even more basic - if we're close to peeing out sugat at that levels 180mg/dl.....how the hell would testing the absolute limits of the system regularly be healthy?

[@UnCoolDad]

19:40 Abbott have this data 😊

[@nourishedbyscience]

Yes, we'd just need to get them and link them to long-term health outcomes data. May happen at some point.

[@UnCoolDad]

@@nourishedbyscience I'm sure they'll do it - for a price! Selling other people's data is all the rage on Wall Street these days.

[@VagifZeynalov]

5:46 what is a definition of a “your typical meal”? There could be a meal with almost no any carbs and there won’t be any spikes, or another meal with lot of carbs, so that spike can be elevated for hours… it would be more helpful if you can provide concrete numbers, like “after a meal with about xxx grams of carbs”. Also, it is very important to mention for what kind of person size/gender/age/activity level that stats are relevant. Because for one person 75g of glucose is “full stomach” dose, for another it is not even a half…

[@VagifZeynalov]

15:56 “fasting state” is another uncertain definition. After year of experiments with CGM I realized that “fasting state” is very outdated meaning. The morning blood sugar numbers could be easily manipulated with meals taken day(s) before the measurement. And another factor is body composition and amount of physical activities before the measurement. Say a person with high muscle mass can easily consume glucose from blood with just few minutes of walk and little stretching… I’m just trying to say, that the diagnosis by measuring blood glucose with single test is outdated, it must be considered in the dynamic.

[@nourishedbyscience]

Yes, I agree that ideally a doctor would diagnose diabetes or prediabetes based on several tests. It is definitely true that morning/fasting glucose can fluctuate a little bit up and down based on a few factors. However, I had good reasons to not provide more specifics about the exact g of carbs during a meal. While the amount of carbs plays a role, the quality of these carbs (i.e., their glycemic index) matters at least as much, as does the composition of the rest of the meal. As long as we are eating some carbs, however, all of these things are dwarfed by our glucose tolerance. As I explain in the video, as long as we are regularly eating some carbs as we are wearing a CGM, we should be able to get a pretty good sense of our glucose tolerance, irrespective of what the specific amounts and GIs of these carbs are. If I had included specifics of what a optimal blood glucose response would be in response to a specific glycemic load, the video would have immediately become useless, because most people cannot or don't want to calculate the glycemic load of their meals. So, of course, this could be done in a more academically precise way, but I believe the way I have presented it here is the better balance between usefulness rigorous consideration of what is known about normal glucose homeostasis. Hope this makes sense. Best, Mario

[@sunbeam9222]

I don't know I think people who say that 30 mg/ dl rise is too much are on keto or something. Im not diabetic nor prediabetic, my AC1 is 4.7 , average blood glucose level 88 and I observe 50 mg/ dl rises .

[@bestonly7983]

my CGM (freestyle Libre) always shows my fasting blood glucose in 80's and 90's in the morning but glucometer always shows 10 points more (i.e 100 or above.)

[@bsidhom]

Am I to take the prominent placement of “the Hungry Brain” as an endorsement? I don’t see the book rated on Red Pen Reviews (possibly due to a conflict of interest), but I realize the author is a founder.

[@nourishedbyscience]

No, I am not endorsing anything. Just reading it right now. Very good book though. Cheers Mario

[@LL2024-x4h]

I have noticed that my glucose will spike very high if I eat anything with lots of carbs or sweets. I am generally low carb. WOuld that be a sign of glucose intolerance if you spike higher than 180 when eating mainly low carb

[@nourishedbyscience]

Being low-carb reduces the amount of insulin that is secreted early following a meal, which can cause a spike. We call this a diminished first-phase insulin response. If you want to know your true glucose tolerance, you would need to eat carbs regularly again for at least 2-3 weeks before assessing whether you experience similar spikes.

[@LL2024-x4h]

Thank you so much for your reply! When you say add back in carbs for 2-3 weeks, I’m curious what you mean by that exactly. How many grams of carbs per day? I currently eat low carb, but do still consume them. I didn’t start wearing a CGM until after I was low carb so I’m not sure if I’ve always been glucose intolerant or if this is new.

[@nourishedbyscience]

@@LL2024-x4h Well, that's difficult to answer. There is no need for you to ever eat carbs again, so if you are happy with your current diet and it doesn't give you any problems, you could certainly continue eating this way. If the low-carb diet isn't feasible for you long term though, for whatever reason, and you wonder if and when you could re-introduce some carbs, then all I am saying is that you cannot adequately assess your glucose tolerance while consuming a low-carb diet. Even if you were fully glucose tolerant before on a mixed diet, you would now be (temporarily) glucose intolerant while following the low-carb diet. So one approach you could use is to gradually re-introduce carbs, starting with lower glycemic index foods in small portions and using strategies to avoid or minimize blood sugar spikes. I'll post some videos for you below that you may find interesting. Then, once you are consuming carbs again in quantities exceeding about 100 g per day, you could assess whether you still experience blood sugar spikes, and if you do try to figure out why that is. Again, some of the videos linked below may be helpful for that. Cheers Mario kzbin.info/www/bejne/rGLddIl7aM6ZpJIsi=RV4gZ-LuKRQ-kXz5 kzbin.info/www/bejne/r5iTimabg7h0hMksi=BonWgCA9OOGE61zj kzbin.info/www/bejne/hYvXqaKaprR1mNksi=bqWQnJKy8gHRpOx3 kzbin.info/www/bejne/mYGYaKKDbdF1l7csi=f_xGfU06E5ISa6lU kzbin.info/www/bejne/forXn5-IeNZradUsi=gYS6HR5jvfFm0ocf

[@jenniferdimaggio7448]

Wondering... I've been in the pre-diabetic range for at least 24 years (was diagnosed with PCOS/insulin resistance in the year 2000)... have managed through diet & exercise to not test once in the Type II range, but have never been able to get out of the pre-diabetic range either. I recently started using the Dexcom Stelo biosensor and within 2 days, have managed to get my glucose levels within range (bet. 70-140) 100% of the time (over 3 wks now) through diet & exercise... I am not on any medication for my pre-diabetes... my average daily glucose is currently 106, so I am happy about that... BUT, my morning (fasting) glucose is always around 110-115. Obviously, I am victim to the dawn phenomenon... how can I correct this? Can I correct this? Is this something I need to look into correcting? Do you have any information or a video about tackling this issue specifically? Thank you so much!

[@sidebuns]

Have you already tried stopping eating earlier in the night like say stop eating (no more dinner or snacks) around 8pm is usually what people say. But I think it's usually about 3 hours before bed. Without medication, I'm not sure how to help that other than maybe some light cardio before bed and no snacks and an early dinner. Cardio goes pretty far in lowering stubborn blood sugar. Also if you are using a cgm it could be running higher than a regular blood stick, if you have a meter you trust try doing a blood stick and see if it's lower than your cgm. Cause that's also a possibility with still such a low morning number. Sorry if you've tried all that though and it's not helpful!

[@jenniferdimaggio7448]

@@sidebuns Thank you for the response and info. I have reduced my nighttime eating (I used to snack every single night before bed... sometimes right up to or very close to the time I went to bed). I eat a much smaller, much healthier (low carb/no sugar) protein snack, if I even have a snack at all... and I make sure to now have it at least 2 hrs before bedtime. I need to work on backing it up to 3 before bed and then 4 hrs... and then hopefully no more snack at all. I do light cardio almost every day... but it's usually mid/late afternoon. I could try to do it at nighttime (or just another session at night to see what that does)... good idea! I don't do a lot of cardio (and/or not intense cardio) (mostly strength/circuit training w/weights and either walking or elliptical machine). I suppose I should get back into a more cardio-based routine... or at least try it for a little while to see if that makes a difference to my fasting glucose. Sigh. ;) I do have a regular finger stick device... I hated using it as it was constantly reading errors, not enough blood, etc... the skin on my fingers just doesn't like to be poked, I guess. I was even having my husband do it to my fingers and it wasn't working well. That is why I was so excited to get a CGM so I could stop being a pin cushion... I have heard, however, on the Stelo Users Facebook page that many who are checking against finger sticks are all saying the Stelo runs quite a bit higher... so, I should probably break out the old finger stick machine and at least do it upon waking and the 1st couple hrs in the morning to see if I am truly having issues with the dawn phenomenon. Thanks for all the suggestions! :)

[@brianwong4481]

My father-in-law recently is on CMG and has been diabetic for years and have all the medications taking consistently, after meals, his glucose level is around 380. That is our worries but by the morning come, his number is below 200 which is good to me. We are very conscious about his diet too. He has low carb diet for years too like browse rice, protein and fiber. Any suggestions will be help. Thanks

[@brianwong4481]

Also, recently learning from glucose goddess hack by taking the protein intake before the starch and coffee in the breakfast, I notice the glucose results very nicely like around 220. But it is only for a few days, but then it goes back way high again. I scratch my head … His normal breakfast is like eggs, cereal/ oatmeal and a cup of those Asian instant coffee.

[@brianwong4481]

Here is example today. Before breakfast glucose 170. Then just a couple toast with peanut butter (2 tblespoon) no coffee. A couple hour later 326. So the worry is roller coasting.

[@nourishedbyscience]

Hi Brian, Fasting glucose of 170 mg/dL is way too high, and any levels as high as what you are reporting here should immediately be brought to the attention of a doctor, ideally an endocrinologist. I feel very strongly that one should always try to use nutrition and lifestyle modifications, ideally to address the root causes of glucose intolerance whenever possible. BUT: in a case like this, your dad may well need some additional antidiabetic medications or even insulin, at least for some time. Another thing to think about with your dad and his doctor: if this was me, I would immediately cut out ALL carbs, and adopt a whole foods, very-low carb or keto diet. If I had any blood glucose responses higher than 200 mg/dL, I would not have cereal, oatmeal, rice, pasta, potatoes, or bread anymore until my glucose tolerance has improved substantially. Again, before you implement any major dietary change, please discuss it with your dad's doctor, because his medication regimen (if he is already using medication) would need to be monitored and adapted if he changes his diet radically. In addition to this, if you and your dad want to educate yourselves about diabetes and its underpinnings, and what can be done about it, I recommend the following videos, in this order: kzbin.info/www/bejne/j5iccoZoqMuMb7ssi=Zg5Hv-fS8GGbFkeS kzbin.info/www/bejne/hYvXqaKaprR1mNksi=v2HTOBrmFkMHyyCH kzbin.info/www/bejne/mYGYaKKDbdF1l7csi=YiVBQ6947Z7am1cO kzbin.info/www/bejne/forXn5-IeNZradUsi=PXBjruZmdcGKyWXU kzbin.info/www/bejne/fJiWn2Csnpenabssi=kG4bHOaWY4HI-hro Warm wishes, Mario

[@jean4157]

Rice is carbs and fiber is only found in carbs. Those glucose numbers seem way too high

[@firstlast1732]

Maybe the discrepancy with normal individuals is not normal it’s because the food is so substantially changed and inferior quality worse every day that it could negatively affect the blood glucose response and evolution has certainly not caught up with our inferior food supply

[@wocket42]

What is abnormal? When becoming insulin resistant is not abnormal, but a normal physiological response. But is it a good thing to have 365 days a year? That's a different question.

[@davidsuzukiispolpot]

Why does it matter if my glucose tolerance is poor if I never ingest much glucose?

[@nourishedbyscience]

It's a good and common question. I'd argue that if you are glucose intolerant, then following a low-carb diet is a good idea. It just wouldn't be smart to continue exposing the body to a nutrient it cannot handle well. At the same time, I suggest we should also address glucose intolerance IN ADDITION to lowering our dietary glycemic load, because many of the factors that cause glucose intolerance are in and of themselves risk factors for other chronic diseases. For example, glucose intolerance could be caused by insulin resistance due to fatty liver, and a fatty liver is a risk factor for liver fibrosis, cirrhosis, and liver cancer. Insulin resistance could also be the result of low muscle mass (itself a predictor of poor health outcomes), chronic stress (same), physical inactivity (same), or a chronic inflammatory condition (same). Of course, some of the underlying problems could be addressed over the long term by a low-carb diet as well, but depending on what the specific causal factor is, not necessarily so. Best, Mario

[@davidsuzukiispolpot]

@@nourishedbyscience Makes sense. I personally have switched to a low-carb high fat (and high cholesterol) diet and my markers have improved greatly. Even my blood pressure is great now and my inflammation and joint pains are much better. I forgot that I was diagnosed with osteoarthritis more than 20 years ago after MRI. I likely am more glucose tolerant than I used to be based upon claims about triglyceride levels, but I am not going to test it. I am also doing the low seed oil thing. I was on a kitesurfing trip with people mostly 20-30 years old and only one person had more stamina than I had (I am age 59). It does appear that all of these things like joint pain and inflammation go together. I remember explaining to my doctor about 20 years ago that my problems would come at the same time (GI tract, joint pains, inflammation) so I didn't think they were unrelated. Now we now.

[@nourishedbyscience]

@@davidsuzukiispolpot If low-carb works for you, it would make sense to stick with it. In general, being low-carb has a lot of benefits; I am just not one to claim that it's the only healthy way to eat. For people who are very glucose tolerant, there are also ways to eat that include carbs, or even mostly high-carb foods. I know that 'seed oils' are considered poisonous by many in the low-carb community, against all evidence. I personally am not a fan of consuming too many n-6-PUFA, and I am also not a fan of UPF or empty calories, so I don't mind it if people eat less oils. I am not sure that cutting out seed oils is the reason people are having less inflammation and joint pain though. My best guess is that by going low-carb, low-carbers eat less of certain antinutrients in plants. I think it's a reasonable hypothesis that certain lectins or oxalates could contribute to inflammation and pain in susceptible people. And lectins and oxalates are all found only in plant foods. That's an area we have only a limited understanding of, but I'd say that it's possible. Cheers Mario

[@davidsuzukiispolpot]

@@nourishedbyscience I agree. I don't know what caused my improvements as I did not just change my macro-nutrients but all the other changes came along for the ride. I eat almost no processed food and the types of food have changed. It may or may not be low-carb that has has been the answer to all of my problems. But the reason I was asking is that it seemed the video implied the pathology (and perhaps medicine itself by virtue of the definition of diabetes to fail a glucose tolerance test) that if the glucose levels are held in check by not having carbs, does the pathology of not tolerating a glucose tolerance test even matter? I know people who are told by their doctors that their type 2 diabetes is just a function of age or genetics and also other people type 2 that just plan to take insulin along with their carbs. Even my own doctor told me that she thinks the most important thing is a "balanced" diet. I wonder if it would work for almost anyone with type 2 diabetes.

[@UnCoolDad]

My "baseline" is usually in the mid to high 6's. Is this ok or should one work on getting it to the 5's to low 6's?

[@nourishedbyscience]

The baseline and fasting should be below 100 mg/dL = 5.7 mmol/L. Cheers Mario

[@UnCoolDad]

@@nourishedbyscience I'm seeing recommendations for someone with T2 as 4-7 - is this wrong then?

[@davidsuzukiispolpot]

Is the problem glucose intolerance or excess glucose?

[@utubewillis24]

Great video but you dont have to say milligrams per deciliter every time

[@nourishedbyscience]

Thanks for the feedback.

[@SusanCoombes-v2q]

My blood sugar goes up more than 30 when I'm exercising during a fast. Seems odd.

[@4everhdt]

That happens to a lot of people, in fact during intense exercise I think it's normal to have blood glucose above 150 for many people and it's not a sign of being unhealthy. The highest my blood glucose has ever been is 160 and it was after doing a 3 mile run with five max effort sprints thrown in, all while about 15 hours fasted.

[@SusanCoombes-v2q]

Thank you. I thought so. Mine went from 77 to 107. So not out of the ordinary. I'm just getting back to exercise and probably overdoing it. Pushing myself is going to recruit stress hormones to raise blood sugar. I'm 73 but previously very fit.

[@sunbeam9222]

I'm wearing a cgm and it rises pretty high whenever I exercise. It even rises when I shower or do the dishes ;)

[@AngryDrake]

Any idea why the fasting glycemia is different for gestational diabetes?

[@nourishedbyscience]

Can you explain what you mean?

[@AngryDrake]

@@nourishedbyscience Sure. I've seen several different numbers for what constitutes "normal" fasting glycemia in pregnancy. 90, 92, 95, 105 mg/dl. Non-pregnant cutoffs are more uniformly 100 mg/dl. Why is this?

[@sheila7814]

My issue is: I have to choose between taking an aromatase inhibitor (because of my estrogen fed cancer) which causes my estrogen to drop significantly vs not taking the pill. The pill in turn causes my glucose to have wild fluctuations since estrogen is a glucose moderator. So I have to choose between cancer or diabetes. UGH!

[@asr9217]

@@sheila7814 that's tough for you ... all the best with your decision .. the pill may protect your life though and there are lots of ways to manage glucose responses to food ...you will need bone protection too ...

[@sheila7814]

@@asr9217 Yes. Thank you. I think the day I wrote that I was having a hard day. I try not to do that online….. Hugs to you, common sense tells me to keep taking the AI pill and manage the rest. I do work out with weights to help my bones, but am 61 and feeling it is sometimes hard to manage all the “stuff” needed to deal with it all - I appreciate your tips. Thanks again

[@asr9217]

It is indeed hard to juggle many health balls .. glad you've made the right choice and hope you find the strength to do the rest ...

[@nourishedbyscience]

Hi Sheila, Very sorry to hear, but usually patients need to take AI inhibitors only for a limited period of time (5 years)? It may be an option to modify your diet while taking the AI inhibitor to prevent the development of diabetes. If you look around my channel, you should find some other videos that may help you navigate this. Best wishes to you, Mario

[@sheila7814]

@@nourishedbyscience Thank you. I am now wearing a CGM and following some of the methods you have shared. It does seem to be helping. The day I posted that message I was very frustrated about the extra layer of health issue due to the AI. Plus, I want others that are on AI to know they might want to get their A1C checked in case they become one of the 33% that develop diabetes from taking this pill. I do feel blessed to have found your site, and to be able to wear a CGM now that we have identified my problem. Cancer: tackled; Diabetes: hopefully tackled! :)

[@ef9033]

What might be "good" Levels of 1,5-AG. I have red that a Level of above 12 mircogramm per mL might be OK, do you agree in that ?

[@nourishedbyscience]

The problem is that the lab assay for 1,5-AG doesn't seem to be as well standardized as for other biomarkers. As a result, the thresholds suggested by different studies can differ substantially. This means that 1,5-AG can be used to compare people within one study, as long as all blood samples were analyzed together in the same lab, but less so when comparing data from different labs. Also, we don't have a good clinical definition of what normal means. My best estimate based on most assays and most papers I have seen is that 15 ug/mL or higher, or better 20 ug/mL or higher, would be indicative of totally normal blood glucose regulation without frequent spikes to 180 mg/dL or higher. People with diabetes seem to commonly be below 10 ug/mL or even below 6 ug/mL, so we can assume that under 10 ug/mL is indicative of frequent levels above 180 mg/dL. Sorry I can't provide a fully conclusive answer at this point. It may be that individual labs that conduct this test can provide a normal range; however, I'd be worried that the lower end of that normal range includes some people who experience frequent spikes. Best, Mario

[@ef9033]

@@nourishedbyscience thanks for the explanation 👍

[@wocket42]

Let's say in a couple of years the "normal breakfast" is liquid and contains 250g of carbs and they reoeat the study. Those 20 year olds will have even higher changes in BG. Say +80 or +100. How is that proving that this is a normal response that is healthy to have? It doesn't matter if the individual is healthy, it matters if the response is detrimental to the health. I dont know how you cannot see that.

[@nourishedbyscience]

The numbers I provided in the video are not just based on sugar- and refined grain-based breakfasts. For example, Freckman and colleagues (see reference on my blog) found an average glucose increase of 44 mg/dL to a dinner of salmon, broccoli, carrots, cream, and wild rice. Sure, if you are a low-carb follower, you may still scoff at that meal, but in my book, that's a very good, nutrient-dense meal. Is it really your opinion that we should discourage people from consuming such a meal just because their blood sugar level increases by more than 30 mg/dL? Aside from that, do you honestly think that your example of a 250g carb liquid breakfast is very realistic? What do you suggest how we should figure out in which homeostatic range the body regulates blood sugar levels? Just look at the body's response to low-carb meals?

[@Edmond347]

I have been watching Mr. Kratz' videos and he clearly knows a lot about this subject, but I think Western medicine in general knows very little. All these numbers may be meaningful to an average person, but they are NOT meaningful to athletes or VERY active people, at least to some. I'm 52, and I have been an avid cyclist for years now, and cycle 90-100 miles Saturdays and 90-100 miles Sundays. I also work out Mon-Fri with weights and mix it up with 1-hr intensive Peloton rides, always on empty stomach. I also walk vigorously for about 30 minutes after each meal, and have been since I was a teen. My diet is beyond healthy with no processed foods, very little refined sugar, and no simple carbs in general. I had a fasting glucose test recently and it was 105. I then did the A1C test it was 5.8. So both pre-diabetic. I recently got a CGM (Stelo) and my fasting glucose is routinely between 110 and 120. I do have a stressful job as an attorney, but regardless, I knew these numbers did not tell the whole story. For one, my doctor didn't even look at my Triglyceride:HDL ratio or asked me about my lifestyle. My Tri:HDL ratio is 0.6, which is superb and that of an elite athlete. I then paid out of my own pocket to have a fasting insulin test. After all, I was told I was insulin resistant. My fasting insulin is 2.4 uIU/mL, which again is ridiculously low and shows that I am in fact VERY insulin sensitive. Also, my glucose level is between 90 and 120-130 for 99% of the time. Even after a big bowl of pasta, it doesn't exceed 130-135. I have "spikes" to 140 after I eat an apple or an occasional piece of chocolate that literally last minutes. I'd love to hear what Mr. Kratz has to say about my numbers.

[@girlgeekFL]

My CGM doesn't show a glucose rise after I eat until 3 to 3.5 hours later. Doing finger sticks, though, I usually see the rise 2 to 2.5 hours later. 🤷

[@nourishedbyscience]

That is highly unusual. There is a lag between changes in blood and interstitial fluid (which is what the CGM measures), but it's usually only about 15 min.

[@joecephus4151]

"Root cause" of glucose intolerance is Ultra Processed Foods, 80 percent of which contain ultra high amounts of sugars, including HFCS (in USA). UPF causes BG spikes way above 180, and when BG levels begin to fall later, hunger pangs kick in, causing us to eat "snacks", which is usually more UPF, i.e. soda and candy or crackers (very few eat a carrot, celery, or apple for snack). The snack causes another BG spike, then freewill, which triggers hunger again. The result is, we snack from wake up till bed time, and most of the day with BG >180, usually 200-300. That BG level does not mean we are diabetic, it just means we need to stop eating UPF, including during meals. Just eat real food, and for carbs just eat veggies and fruits (be careful with too many fruits). This way, we'll never develop diabetes, which can better be labeled "processed food disease". In the 1970s, junk carbs from sugar were proposed to be labeled "anti-nutrients", but Big Food lobbyist won out, and called them carbs (confusing us with what real carbs are - fruits, veggies and grains. Nowadays, UPF is lumped in with "carbs" and we're told we can maintain health by eating UPF. In short, UPF is driving the global diabetes epidemic, but it the elephant in the room nobody wants to talk about, and "research" skirts around, or simply lies about.

[@maxinef6654]

Where do I get a CGM?

[@nourishedbyscience]

Dexcom just came out with a new CGM that doesn't require a prescription in the US. Fairly affordable as well, compared to other CGM sensors: www.stelo.com/ (I have no association with Dexcom of any kind)

[@TinajaneOxnam-w3l]

I cant check my glucos levels because my nurse just gave me metformin tablets. Nothing eles.

[@nourishedbyscience]

Dexcom just came out with a new CGM that doesn't require a prescription in the US. Fairly affordable as well, compared to other CGM sensors: www.stelo.com/ (I have no association with Dexcom of any kind)

[@giovannipiazza007]

Report her immediately.