I agree. And stories like yours have convinced me that CGMs can be a great tool to figure this out, including in people who test 'normal' when their doctor looks just at fasting glucose and HbA1c. That said, blood glucose spikes to 300+ mg/dL are very concerning. I hope you had a conversation with your doctor about that? And I hope the doctor did take this seriously? I obviously cannot diagnose you here, but just know that even a single spike like that should be considered indicative of diabetes, and should be treated. Best, Mario

Have you had gastric bypass?

​@@lifelovejourney great question

Oatmeal it self is part of the problem you're sharing. We've been fed so much inaccurate information on food...especially food that's been designed to be shelf stable rather than healthy for human vitality.

That's a remarkable health turn-around story, John. Congrats, and thank you for sharing. I am familiar with Dr. Bernstein, and do think his diet is a good approach for people with diabetes who are willing to follow his protocol long term. Cheers Mario

My wife initially had a fasting sugar level below 95 and an A1C of 5.8. She adopted a low-carb diet, eliminated sugar completely, and incorporated evening walks into her routine for three months. Surprisingly, her A1C increased from 5.8 to 6. We're puzzled as we expected it to decrease. Any insights on what might have caused this

I would suggest watch Dr berg to get an idea what foods can be beneficial. All the best.

Thanks for sharing! Cheers Mario

What carbs do you eat, if you don't mind me asking?

@@adamswift1747 I don’t mid at all….Less than 20 carbs per day have been the best option for me. I have success eating tart/sour or non-starchy fruit/vegetables like green apples, tomatoes, cucumbers, broccoli, cauliflower, grapefruit. I enjoy carrots in a stew, but probably should avoid them and cabbage actually makes me gain weight over night (inflammation) but doesn’t spike my sugar too terribly, thought it does taste sweet. And finally, I have not tried eating resistant potatoes or rice, but am really curious 🤣.

Thanks for your support!

Thank you, Javed. All the best wishes for you and your family as well! Cheers Mario

Yes, regularly eating some carbs (ideally low-glycemic index carbs that also have a lot of fiber and ideally also some protein, such as lentils) do help improve glucose tolerance at the following meal. There are many other ways to improving glucose tolerance though, as we will be discussing in the very near future. Hope this content will also be useful. Cheers Mario

In large studies, CGM data reproduce those of a finger-prick and hand-held glucose meter pretty well. However, they lag blood sugar whenever sugar levels change rapidly, i.e., after a meal. Cheers Mario

My CGM reads 20 pts higher during fasting,but 20 pts lower during spikes, compared to the glucometer blood test.

When I just started this channel and blog, I wrote this here on my website: "Understanding how the food we eat affects our long-term health is surprisingly difficult to figure out. This field, unfortunately, has a history of drawing conclusions based on fairly poor evidence that later turned out to be at least partly wrong. The resulting back and forth between different diet approaches, each only weakly supported by scientific evidence, has led to confusion about how to eat. As a result, many have abandoned scientific evidence, with the argument that science hasn’t really provided the answers we need to understand how diet affects long-term health. And that abandonment has led to a rise in pseudo-scientific approaches to eating, superficial views that attribute complex diseases to a single food or dietary factor, and sales pitches for dubious diet programs or supplements. I have drawn a very different conclusion from the mistakes of the past. Yes, nutrition science is a difficult science, often forced to work with weak evidence. And yes, we have often drawn conclusions based on this weak evidence that later had to be revised. However, that does not mean that a non-scientific approach will be more likely to lead us to answers that are truly helpful for our health. It simply means that we need to apply scientific principles more rigorously. This relates to the conduct of the research, but particularly how we interpret the available data. My goal is to use this platform to raise the standard of rigor in how we read the scientific literature and the conclusions we draw from it." I still stand by that. And I do try to raise the standard of scientific communication by always presenting evidence that is based not just on one or two papers that support my argument but by looking at the totality of the evidence on any given topic. And I provide a more detailed discussion and all references in a blog post associated with each video. That is a ton of work, much more than it would be if I just filmed myself talking vaguely about some ideas, and it isn't being rewarded (yet?) because I am not good enough at making these videos concise or entertaining, but I do think this is the way to go if we want to find a way out of the confusion and misinformation pandemic. Thank you for your feedback. It's good to know this approach resonates with some people. Cheers Mario

@@nourishedbyscience excellent reply and reassuring that science is your guide. Taking anything back to basics and using science to guide one is certainly the only way. I will watch the early videos and catch up. Thanks

Thanks for sharing. Definitely commend you for considering several biomarkers of health. I am worried about this trend that I am seeing in the low-carb community that all diseases are attributed to elevated blood sugar and insulin resistance, while other established risk factors such as high serum lipids and high blood pressure are discounted.

I believe it's caused by a combination of nativity and the challenge of finding correct information online. I had near to zero understanding of what I was getting in to. I scavenged KZfaq for information and it felt all so confusing. That was until the algorithm served me a video of Gil and it felt like coming home. And when he tweeted your insulin resistance video, I found the second reliable source of information. Thanks a lot, Mario You're a hero.

@@henkwerner You are too kind. I consider myself an apprentice at the art of science communication, as I clearly have a lot to learn to make these better (i.e., more engaging, more concise). But then, I just got started, and if being in academia for 20+ years has taught me one thing, it is that any worthwhile craft requires intense learning, work, and patience. The biggest problem in this space though is that there is a very wrong incentive structure, such that creators get rewarded for making bold or contrarian statements by getting more clicks, more followers. Creating content in a scientific way, with lots of qualifiers and cautious statements about cause and effect just isn't as sexy.

It isn't sexy "yet", because most people are not aware "yet" of the difference between misinformation and life-saving information. This will change over time. The KZfaq algorithms also learn and will start promote high-quality information. Opinion leaders will mature and start promote those who share real, thus valuable, information. I have already shared the link to your channel, including motivation, with 4 people last week in personal messages. It's just a matter of time until you have pushed this snowball over the top of the hill.

@@henkwerner Let's hope that society at large will see the type of transformation you predict. Misinformation, particularly where it is used in a targeted fashion for political or for-profit reasons is, IMHO, one of the biggest obstacles to addressing our big societal and personal challenges. Also thank you for helping me reach more people. Much appreciated!

Yes, I think we are on the same page. You may know this already, but if anyone wants to understand the role of insulin resistance and the hyperinsulinemia that usually results from it in the development of hypertension, dyslipidemia, and glucose intolerance: kzfaq.info/get/bejne/fM1joZCnzpjYY40.htmlsi=1mPlIHu7LN7TioRD Cheers Mario

I am absolutely passionate about helping people bring their blood sugar levels into the normal range and avoiding real blood sugar spikes (i.e., >180 mg/dL). BUT: I am equally passionate to let people know that little bumps in blood sugar are part of normal physiology and that there is little to no evidence that fluctuations within the 70-140 mg/dL range are harmful. There are some influencers right now who claim that any increase of more than 30 mg/dL (1.7 mmol/L) are harmful and should be avoided; I disagree with this, and I know that most of my professional colleagues also disagree with this notion. To me, the anxiety you describe is not just unnecessary, but also potentially harmful, and many people will unnecessarily make radical dietary changes to avoid such tiny bumps (and these radical changes may lead to other problems or at least dietary sacrifices that are uncalled for). Warm wishes, Mario

Hi Sumit, You sound like you are disappointed, so let me first tell you that I think you have done an amazing job! Losing 40 pounds and reducing your A1c from 8.2% to 5.9% is wonderful, and 5.9% is barely above the normal range. Take a breath, and give yourself a pat on the back. You have every reason to be proud. Now, that said, there are certainly other things one could try. Pancreatic beta-cell dysfunction may still be an issue. Also consider that exercise is always helpful in helping the body regulate blood sugar, including walks after meals and also weight-bearing exercise to build up more muscle mass. And reducing carbohydrate intake can be an option. I'll publish videos on all of this in the near future. If you haven't, check out the most recent video on ways to keep blood sugar levels low and prevent spikes: kzfaq.info/get/bejne/r81gjJaWs7mlfps.html Cheers Mario P.S.: What I am sharing here is just a summary of the factors that affect glucose tolerance and blood sugar levels, not dietary or medical advice for you specifically. If you make major changes to your diet, make sure to first discuss these with a dietitian or physician.

I’m in the same boat with fasting blood sugar. Similar bmi

@@angelikaharabin3628 what I’m finding is that cutting fructose in all forms (not just sugar) is critical. My fasting sugar is down to 105

@@angelikaharabin3628 Something else for both of you to consider: are you on a very low-carb or keto diet? In some people, this can lead to an increased dawn phenomenon, i.e., substantially increased glucose upon waking up. Cheers Mario

@@nourishedbyscience my diet is lowish carb but not ketogenic . I do time restricted eating. If I eat late Or high carb or heavy protein like beef , I can be in the diabetic range . Thank you for your answer !

Yes, I don't disagree. Figuring out which foods lead to actual spikes over 180 mg/dL can be very helpful to people, including those without diabetes. At the same time, I decided to include a bit of a warning in the video because many people take it too far. I have seen numerous people on social media share their 'spike' to 130 mg/dL or so, which in my opinion really should not be called a spike. I know of no data that suggest that such small bumps in blood sugar within the normal range from 70-140 mg/dL are harmful, and driving ourself nuts over any such small increase could well have other negative health consequences. Thanks for leaving a comment. Cheers Mario

The single biggest glucose spike I've seen with myself is when a scammer stole over 2k from me. I got my money back but for me, getting angry skyrockets my blood sugar which was kind of unexpected. My blood sugar doesn't spike more than 30 points when I eat because I restrict carbs. It shot up well over 60 points mad.

@@franny5295 OMG! same thing happened to me. I had a chat on phone with someone that turned out to be very stressful. My blood sugar spiked too. Very interesting to find this out.

Triglycerides are commonly high when we have too much fat in our liver (watch my video on the personal fat threshold below if you haven't yet), but they are also commonly elevated in response to a diet too rich in refined carbs and particularly added sugars (soda, sweets, deserts etc.) These same foods would also contribute to blood sugar spikes, particularly in someone who is pre-diabetic, so what we know about your state would suggest that you would greatly benefit from cutting back on the refined, high-glycemic index carbs and particularly the added sugars. See my video about the glycemic index below as well. Best wishes, Mario kzfaq.info/get/bejne/mbZlatJ-ndKmkYk.htmlsi=c7myP142_o6LCU7q kzfaq.info/get/bejne/rJeqdrl2mM_KnmQ.htmlsi=nKt4m2VBIiA68bUy

@@nourishedbyscience hi Mario, thank you for your response! Probably sugar and refined carbs much more than fats. I purchased an accurate lipids tester years ago (ACON Mission Cholesterol 3 in 1). I never was able to get TG/HDL ratios below 3 or 4. Now something that is not rational or understandable, but it works, it also did in the past with other health issues. So, hold your fire! I occasionally visit a woman that can diagnose with "Touch for Health" or applied kinesiology. I do not claim that I understand HOW it works, but she solved issues before, also for my mother. My high TG was solved, mostly within week, with the following regime: * Chrome 'ionic drops' (a solution of chrome (III) chloride, a few hundred micrograms) * Vitamin E complex * beta 1,3 1,6 glucan * Riboflavin (vit B2) for improved methylation (homocysteine issue, MTTR gene defect). My ratio is now below 2. I absolutely understand strong doubts about this story, but I don't care because it's been solved now. 😊

Thank you for the kind feedback. One issue I see with diet tribalism is that there are certain narratives within these tribes that get perpetuated by being repeated again and again, even though in many cases there is little evidence to support them (or even evidence to the contrary). I am worried that this could be harmful to health in the long term. Cheers Mario

​​​@@nourishedbyscience diet tribalism. I live that. QUESTION: Ive recently begun keto. I think 20 carbs is too restrictive. I walk 3 miles in the evening after work and currently weigh 180. Down 4 pds in one week (probably from a 3 day fast before the keto). What do you think the range limit to go into ketosis is? I keep reading it's between 20to 50 carbs a day. That's a large range.

@@annjohnson4061 Typically, the recommendation is not to consume more than 50g of total carbs (incl. fiber) per day. I personally would find 20g per day too restrictive and hard to maintain for an extended period of time. Cheers Mario

@@nourishedbyscience so you think you can go into ketosis with 45 or so carbs? Is managing the amount your sugar spikes the same as keeping the sugar low enough for your body to burn fat instead of sugar?? Your explanations are so helpful but I'm stuck at how to understand how to understand whether it's the AMOUNT of sugar in the blood that decides whether our bodies will burn it for energy or the insulin response deciding NOT to put the sugar in our muscles and leave it in our blood to be used for sugar.

​I am not the worlds greatest keto expert, and haven't researched this recently, but traditionally, insulin regulates ketogenesis. When you eat such a small amount of total carbs, usually on keto in the form of some vegetables or other whole foods such as nuts and seeds, which also come with fiber, your absolute changes in blood glucose and insulin are not going to be all that substantial, particularly if you distribute the 45g over 2-3 meals per day. Cheers Mario

Thank you, Monica. My newest video has some information about reactive hypoglycemias: kzfaq.info/get/bejne/grynaZODrs7Gqps.html Also, the next video that will post this coming week will be an interview with an MD who has a long history of struggling with reactive hypoglycemia. That said, reactive hypoglycemias can have numerous causes, and may have nothing to do with blood sugar spikes. It's always a good idea to try to get to the bottom of what causes your specific case by working with a knowledgeable physician, which it sounds like you are doing. Warm wishes from Bonn, Germany! Mario

I agree that spikes over 180 mg/dL should clearly be minimized or - better - avoided altogether. Many people who are now sharing their CGM data suggest that these are not rare, not even among those who don't suffer from diabetes or pre-diabetes. At the same time, I am similarly concerned about health influencers who call a 30 mg/dL bump in blood sugar a spike, because that pathologizes normal physiology, and there is little evidence that any increase within the 70-140 mg/dL range has negative long-term health consequences. Cheers Mario

Sounds like you have pretty excellent glucose tolerance. If your blood sugar never exceeds 140 mg/dL in response to high-carb meals even though you are generally on a low-carb diet, that's quite remarkable (the low-carb diet should cause you to be - temporarily - more glucose intolerant, so usually I would expect some spikes in response to high-carb meals in someone a low-carb diet). Given your very low A1c, however, you may want to use your CGM to watch for hypoglycemic episodes (and if you have them often, discuss with your doctor) as well, not just high blood sugar levels. All the best, Mario

@@nourishedbyscience I have already experienced episodes of hypoglycemia for sure. I’ve had some days where it hovered in the upper 50’s and 60’s for quite a bit of the day. I even questioned whether I was having reactive hypoglycemia - I watched your video on that - but, I think I just wasn’t eating enough food, and/or the right foods all together. Probably not enough of the right carbs and protein. So, I’ve been keeping an eye on that and making sure it doesn’t get too low and stay too low. Thanks for reading my comment and responding 😊.

Forgive me that was meant as a criticism. It is inversely proportional.

What works for him may not work for you. That is just one data point, which literally has no meaning when you try to apply to many from different backgrounds. Don't listen to failed chiropractors on KZfaq for medical advice.

Thanks for sharing. It's worth noting that exercise commonly raises blood sugar levels, and low-carb high-protein meals such as your can lower blood sugar levels (because little glucose is coming into the body, while protein triggers a bit of insulin release). Cheers Mario

I think, depending on the workout intensity it is perfectly normal to have higher blood sugar because it spikes cortisol , a stress induced hormone (exercice is stress on the body). Your body gets ready to fight lol. As long as your workout doesn't last all day, it's perfectly healthy and well received by the body. I know it's been a while but if you read this, would love to hear more about your experience monitoring while on a carnivore diet.

Yes, many videos on exactly this topic coming. Thanks for commenting. Cheers Mario

I am not sure I understand your question. Could you re-phrase?

It will all have to do with the Pharmacist in Preparation of the Insulin and whether it can be converted to be inhaled and have access to the system Through the capillaries up the nasal cavity or even in the lungs.

My first response is to be careful not to place too much trust into the CGM data from one sensor. I have used 7 FreeStyle Libre sensors, and they all tended to show hypoglycemic episodes in the first few days. Also, one was faulty, and showed glucose levels that were 40-50 mg/dL lower than actual blood glucose levels measured by a finger prick and hand-held glucose meter. One morning, I woke up and the CGM (incorrectly) suggested that I must have had died overnight ... If you use a CGM for 4 weeks or longer and indeed repeatedly find these low blood glucose levels at night, it may be a good idea to discuss this with a doctor. Could be related to a medical issue, so I don't think this is something you should tackle on your own. if it's not a medical issue, it may also be a good idea to discuss this with a good nutritionist or registered dietitian. Best, Mario

An example would be lentils, or other legumes. They don't likely induce spikes, unless someone is extremely glucose intolerant. But they do lead to an increase in blood sugar levels that is greater than that in response to, say, meat, cheese, or eggs (which are not glycemic at all). So if we compared our glycemic response to a lunch of lentils to that of a lunch of meat, we would conclude that meat is clearly better. However, lentils are famous for triggering a potent second-meal effect, meaning that if you eat lentils at lunch, your glucose tolerance to DINNER will be substantially improved and you'll have a lower blood sugar response to dinner (all other things being equal). Cheers Mario

Thanks, Sean!

All I will say about your blood sugar is: congratulations! And thank you for your kind feedback.

That's a good use of a CGM. However, be careful with your sources of information. Oatmeal clearly isn't good for blood sugar. Check out the videos below: kzfaq.info/get/bejne/rJeqdrl2mM_KnmQ.htmlsi=ut25KNGPhqsoTMoR kzfaq.info/get/bejne/od6Fg5Or36ipc3U.htmlsi=Oomw06RQF9HZQIvS You may also enjoy this video here to experiment with you meals to better understand your blood sugar responses: kzfaq.info/get/bejne/r81gjJaWs7mlfps.htmlsi=M31oQfJtkhXP-Pwt Best, Mario

As I describe in the video linked below, normal blood glucose concentrations in people with normal glucose tolerance are in the 70-140 mg/dL range about 98-99% of the time, and that is the case for me, even on a high-carb diet. So no, I do not have diabetes or even pre-diabetes. In fact, with an HbA1c (measure of long-time blood sugar levels) of 4.7%, I have excellent glycemic control and excellent glucose tolerance. kzfaq.info/get/bejne/grynaZODrs7Gqps.htmlsi=5Gk6emsmvAt3ZZ_j If you say your numbers are "way off", please know that there are two different units of measurement for blood glucose: mg/dL and mmol/L, 18 mg/dL = 1 mmol/L, so if your CGM shows glucose levels in mmol/L, you need to multiply these by 18 to compare them to mine, which are in mg/dL. The ideal range in mmol/L is 3.9 - 7.8 mmol/L. Best, Mario

@@nourishedbyscience Thank you for the quick response 😊 I double check my units and it’s right mg/dl. It shows Most of the time numbers around 80-100. My doctor thinks o have mody2 diabetes.. my Numbers are most of the time above 110 for sure 😅 120 most of the day

Do you have any info about this kind of diabetes?

Keep in mind what I said in the glucose spike video: if you regularly eat low-carb, that by itself makes your body somewhat glucose intolerant, and you will then spike particularly high to any high-carb foods you do eat. Also, the very high glucose in the morning is the dawn phenomenon: it's normal that blood glucose rises in the morning, but that is known to be more pronounced an effect in people on very low-carb diets. Warm wishes, Mario

Thanks for the feedback, Jim.

Yes, all of these things could be caused by other issues. However, also pay some attention to how rapidly your blood sugar drops. There are some data suggesting that the speed at which blood sugar levels change do affect our subjective well being and our hunger.

@@nourishedbyscience Thank you for responding. I am new and learning so much from our channel.

There may be a link, but it's probably not strong enough, and there are too many other factors affecting blood glucose, to detect an allergy. Cheers Mario

Hi KoiRun, General ideas (not medical advice): - keep a diary of what you ate and roughly how much, and whenever you noted sleepiness setting in after a meal; - if you have a CGM, add the glucose levels at the key time points (when you ate, when you noticed sleepiness); - do you notice a pattern? now experiment with changing the composition of the meal. A pattern of a rapid sugar spike followed by a dip (often below baseline) could contribute to this postprandial sleepiness (also to hunger attacks about 90-150 min after the meal), so one way to address this is to eat in a way that minimizes the sugar spike. Eating something rich in protein or fiber first, and/or replacing some of the carbs with some fat or protein, should reduce the postprandial sugar spike. Or switch to lower glycemic index carbs. Whatever is feasible. Details on these strategies, the science behind it, and how to do this will be coming in future videos.

Thanks Mario, I've basically ruled rapid sugar spike/crash using my last cgm. I will get another cgm in January. I'm wondering now whether my high loading of vegetables is contributing to my sleepiness. Melatonin?? I will keep a diary now. Thanks again.

Another trick to try as soon as you feel the drowsiness starting... Stand up and do several minutes of exercise to raise your energy level. You can wave your arms, bend your knees, kick your legs etc. for 2 or 3 minutes to re-energize your body.

At baseline (right before eating) and then again 15, 30, 60, and 120 min. Initially at least, for a few meals. You will then see whether you are someone who spikes very quickly. If you don't you can probably skip the 15 min time point. It's a bit of a pain to do this with finger pricks, but you'll get a good sense of your blood sugar responses if you just do this for one meal every other day or so. Best, Mario

@@nourishedbyscience For 6 months after my pre diabetic diagnosis, I checked fasting, 1hr and 2 hr with occasionally at the 30 minute post meals. I found that I spike at the 45 to 1 hr and back to base at the two three hours. Now as my A1C is back in the normal range, I check like for two weeks every months and do an excel data control with line chart. Even though am a nurse, In the last three years, I have learned so much more about the human metabolism that school ever taught me. Most importantly, I have learned how to stay away from diabetes. It runs heavily in my family I have diabetic siblings. I have also helped my sister to manage her diabetes better and hopefully go into remission soon. This is good information and valuable education that we do not get from drs visits. Thanks,

Blood sugar spikes will produce insulin production, and insulin makes your body want to store fat. So, you will improve your chance of losing weight by keeping your blood sugar (and therefore insulin) low as much as possible. Intermittent fasting can help as well, e.g. eating within an 8-hour time period and not eating for 16 hours straight.

Most probably yes. If you fall in the majority of people, you have several signs of insulin resistance, of which increased body weight is just one. In that case, a combination of intermittent fasting and low carb diet should be quite effective. Also, try to implement some HIIT and resistance training: the more muscles, the more insulin sensitivity.

Hi Carly, Blood glucose in the range from 70-140 mg/dL (3.9-7.8 mmol/L) is normal, even with occasional excursions to the 140-180 mg/dL range (7.8-10 mmol/L). A CGM is indeed not suitable to detect insulin resistance, because your body probably compensates by producing more insulin. I suggest watching this video here to understand how this works: Regulation of Blood Sugar kzfaq.info/get/bejne/j81pdLZj2My9aY0.html I also have additional videos on how to measure whether you are insulin resistant, and what common causes of insulin resistance are. Hope this is helpful. Best, Mario

@@nourishedbyscience Thank you so much. This is very helpful indeed! I appreciate the time you took to reply. I will continue watching and learning!

Way to go!!

Not really. I used the FreeStyle Libre, but haven't compared that to any others. Cheers Mario

No, never looked into that? Have you? Cheers Mario

They expire in just six months? That’s ridiculous…

CGMs have been compared vs. finger prick and glucose meter measurements. The CGM measures lack a bit in time whenever blood glucose levels change rapidly, but generally they are pretty comparable. The bigger issue, I think, is that once in a while the GCM sensors can be bad. I had one once (out of 7 I have used) that consistently read 50 mg/dL high or low. That can give you quite a shock initially when suddenly your CGM shows a sugar value of 45 mg/dL right before you want to go to bed, even though you feel fine. And I have heard similar stories from others, so it's important to be aware of this. It's probably a good idea to have a glucose meter on hand to do an additional check if the CGM shows an implausible reading. Cheers Mario