There are so many reasons you might be wanting to get more serious about reducing your blood sugar:
- Did you just get off a zoom appointment with your doctor where you were notified that your blood sugar is "creeping up"?
- Or maybe you've been warned over the years that your hemoglobin A1C is elevated?
- Perhaps your primary care physician just keeps telling you to "watch what you eat." What does that even mean?
Keep reading to learn how to reduce high blood sugar and take control of your health.
- Why is Reducing High Blood Sugar Important?
- Strategy #1: Eat Fewer Carbs to Reduce Blood Sugar
- Strategy #2: Test Don't Guess Your Blood Sugar
- Strategy #3: Start Fasting to Reduce Blood Sugar
- Strategy #4: Get More Sleep to Reduce Blood Sugar
- Strategy #5: Walk Walk Walk to Reduce Blood Sugar
- Small Lifestyle Changes Are All That's Needed to Reduce Blood Sugar
- CityPT: Our expert clinicians can help you reduce high blood sugar
When left unchecked, chronically elevated blood sugar levels can lead to a host of other chronic diseases including:
- Insulin resistant diabetes (Type II)
- Kidney failure
- Heart disease
- Joint damage
- Inability to heal wounds
- Memory loss
Unfortunately, many doctors don't have the time to help their patients understand the ins and outs of why their blood sugar is high and how to effectively lower it.
All too often, medications are prescribed instead of in-depth education. However, even with medications such as Metformin, many patients still don't reach optimal blood sugar control and are at risk for future complications.
What is a normal blood sugar? Here is a breakdown of the various levels from The American Diabetes Association:
|Fasting||2 Hours After Eating|
|Normal||<100 mg/dL||<140 mg/dL|
|Pre-diabetic||100-126 mg/dL||140-199 mg/dL|
|Diabetec||>126 mg/dL||>200 mg/dL|
However, studies show that compared to truly healthy populations, the "normal" numbers above may still be too high.1 In particular, lifestyle changes might be warranted when fasting blood sugar levels are consistently outside of the 72 - 85mg/dL range.
Thanks to continuous glucose monitors, we now know more about blood sugar levels in healthy populations.2 Turns out, blood glucose typically does not go above 110mg/dL after a meal of unprocessed foods. However, a range of no more than +30mg/dL from pre-meal glucose levels is reasonable.
So what can you do to help lower your blood sugar, lose weight, and decrease your risk of complications?
The Atkins diet was popular in the 90s, and for several years now the Ketogenic (Keto) diet has been tried by more people.
Both diets have in common a severe restriction of carbohydrates (carbs) to 30g or less per day. While you do not need to go to this extreme to control your blood sugars, you will probably need to decrease your current intake of carbs.
The USDA recommends that 45-65% of your calories come from carbs, which equals about 225-325g of carbohydrate when following a 2000 calorie diet.3 There is no physiological need for carbohydrates, which is why people can live and thrive on ketogenic and even carnivore diets.
However, most people want more options than just eating steak and butter. So, finding your sweet spot, likely between 50-120g of carbs per day is necessary. In general, the more active you are, the more carbohydrates you may need. The less active, the less you need.
What Foods are Carbohydrates?
The following foods are carbohydrates:
- Pasta, pizza crust
- Bread, cereal, crackers, muffins
- Chips, French fries
- Cake, donuts, cookies, pie, ice cream
- Juice, soda, fancy coffee drinks, and cocktails with umbrellas
Less processed carbs from this group include all whole grains such as oatmeal, rice, quinoa as well as beans and lentils. It also includes potatoes, corn, peas, bananas and all other fruits and vegetables. Avocados and olives are exempt since they are mostly fat.
Milk and yogurt contain carbohydrates in the form of lactose or milk sugar. Other dairy foods like cheese, sour cream, whipping cream, and cream cheese are mostly fat and protein and contain very little or no lactose, and are therefore not sources of carbohydrate.
Processed foods such as those listed first (pasta, bread etc.) are not as health promoting as unprocessed foods like plain oatmeal, beans, fruits, and vegetables.
No matter where you fall in the carbohydrate intake spectrum, choosing less processed whole food sources is a great step in supporting better health.
How Carbohydrates Lead to Disease and Dysfunction
When we eat carbohydrates, they are digested and broken down into their simplest forms: glucose, fructose, and galactose. As they are absorbed and transported through the bloodstream it raises your blood sugar levels.
This is normal to an extent. But when we eat highly processed carbohydrates or we eat carbs frequently throughout the day (a.k.a. snacking) the constantly elevated glucose levels create inflammation. Over time this inflammation can lead to everything from acne, heartburn, arthritis/joint pain, memory loss, heart disease, and diabetes just to name a few.
Keeping blood sugar levels as low as possible is not my goal for patients. My goal is to keep them well-regulated and not swinging wildly up and down.
When your glucose levels are constantly high, it also means your pancreas is constantly producing insulin. One job of insulin is to take excess glucose and store it as fat. So essentially, constant insulin means constant fat storage. This is one reason why high carb diets can lead to weight gain.
Ideas for Lower Carb Meals
Take a look at these ideas low carb meals. Main carb sources in bold.
- 3 eggs + 1 cup sautéed spinach and mushrooms + 1 ounce cheese (5g carb)
- 1 cup plain full fat yogurt + ¼ cup raspberries + 2 tablespoon sliced almonds (12g carb)
- Chicken + 4 cups garden salad + low carb dressing + olives (8g carb)
- ¼ cup black beans + 1 cup cauliflower rice + 2 tbsp salsa + ¼ avocado (17g carb)
- Salmon or steak + 1 cup asparagus + butter (5g carb)
- Stir-fry tofu + 1 cup broccoli + ¼ cup cooked rice + sesame oil (14g carb)
Each person's body responds differently to sugar in food. This makes it important to test and track the blood sugar response of your body to a range of foods, especially carbohydrates.
Even when limiting your carbohydrate intake, it can be surprising how quickly certain foods can spike your blood sugar. There is also a lot of bio-individuality; what causes a blood sugar spike for one person may have no effect in someone else.
Here's an example: my husband can eat 2 hamburgers with buns as well as a milkshake and his glucose barely reaches 130 mg/dL.
In contrast, I can eat just the burger patties and a few big sips of a milkshake and my blood sugar elevates more quickly to the same level.
Additionally, I can eat 2.5 bananas or about 50g of carbohydrate in one sitting and stay below 130mg/dL, but eating the same equivalent of white bread, white rice, or white potato spikes me all the way up to 170mg/dL, leaving me needing a nap for the next two hours.
How to Measure Your Body's Response to Carbs
Follow this process to get some baseline glucose response measurements.
Get yourself a glucometer; which can be easily purchased from an online retailer such as Amazon and is much less expensive than buying from a pharmacy. Here are my rules which are borrowed and adapted from Robb Wolf's 7 Day Carb Test4 and outlined in his book, 'Wired to Eat.'
- Weigh out 50g of effective carb: Popular choices include: 1 cup of cooked rice or pasta, 3 small potatoes, 3 slices bread, 2-3 apples or bananas, or a large serving of cereal. Choose foods you actually eat. There is no point in testing bananas if you never eat them. If pasta and potatoes frequent your diet, test those. Also, your carbs are naked. No butter, sour cream, peanut butter, or sauces.
- In the morning, eat your test carb: You should eat no other food at this time. Allowable beverages are black coffee, unsweetened tea, and water. If you do have a beverage, make sure to have that same beverage each morning you are testing.
- Set a timer for 2 hours
- Test your blood glucose 2 hours later: DO NOT EAT OR DRINK anything else during this time.
- Evaluate the results: If your blood sugar goes above 115mg/dl during this time, this food or the quantity you're eating is probably inappropriate for your body. Therefore, you should avoid that food 99% of the time or cut the serving in half (25g carb) and try testing it a different morning to see how your body responds.
As you shift from eating processed foods to more real foods, you may need to eat slightly more frequently as your body adjusts. But within days to weeks, you should no longer feel ravenous or "hangry" every 2 hours. You are then ready to introduce fasting.
By skipping snacks or delaying your first meal of the day, you allow your glucagon to kick in and start burning fat for energy.
How does fasting improve blood sugar? Simple: if you aren't eating, your body doesn't have any carbs, protein, or fat coming in to use as energy. As a result, insulin stays in your pancreas, and instead it produces glucagon. Glucagon is a hormone which takes stored glucose and body fat and breaks it down to use as fuel for our brain, muscles, and organs.
What if I get hungry? Good, embrace it. Yes, it's uncomfortable in the beginning, but waiting an extra couple hours till your next meal will get easier and improve your health.
When you feel a craving coming on, ask yourself: What is it that you need? Are you truly hungry? Or, are you stressed at work or mad at your kids? Maybe that's why the chips are suddenly calling you from the cupboard. When you address what you really need, the desire for extra calories and carbs goes away.
What is the optimal amount of time for someone to fast? For someone starting out, eating after 7pm and waiting till 8am to eat breakfast (13 hours) should suffice. Once you can manage 13 hours, slowly increase your fasting window to 16 hours most days of the week.
For some people, doing a 20-24 hour fast 1 time or more per week might be right for their body. You should work with a dietitian to figure out what is best for you, especially if you take any medications to control your blood pressure or blood sugar. Extended fasting is not recommended for women who are trying to get pregnant, are pregnant, or breast feeding.
According to an article in the Journal of Clinical Sleep medicine, if you are getting less than 7 hours of sleep most nights, you can expect to see elevated fasting blood glucose numbers.5
After reviewing 72 different studies, the researchers concluded that partial sleep deprivation (6 hours or less) is associated with changes in the hormones leptin and ghrelin, which regulate appetite. These changes typically cause an increase in appetite, which may lead to increased food intake and weight gain.
Sleep deprivation also comes with impairments in glucose metabolism and chronically elevated insulin levels. Over time, simply not getting adequate sleep increases a person's chances of developing prediabetes, diabetes, and obesity.
Although it's a difficult lifestyle change to make, when patients start getting adequate sleep, they typically see big improvements in their blood surgar levels as well as energy levels, mood, and overall quality of life.
While increasing your physical activity through walking can lead to weight loss, it often takes more intense exercise to trigger significant fat loss. However, if your goal is blood sugar control, then get walking. Walk as much as you can.
Here's why: A 2012 study of 201 people with type 2 diabetes found that every 2,600 steps of walking each day was associated with a 0.2% lower A1c.6 2,600 steps is a little over a mile: just 20 minutes of walking at a normal pace.
In an interesting 2005 study, 179 patients with type 2 diabetes were tracked over a two-year period.7 Researchers found a three-mile daily walk reduced drug costs by an estimated $550 and other medical costs by $700.
The number of patients on insulin therapy also fell by 25%. That could translate into about $1200 in annual savings.
A 2007 analysis found that those who walked at least 20 minutes per day had a 30% lower risk of developing type 2 diabetes compared to those who did almost no walking at all.8
A 1999 analysis of the Nurses Health Study examined the risk of developing type 2 diabetes in over 70,000 female nurses during an eight-year period. Walking was strongly associated with a lower risk of type 2 diabetes.9
In conclusion, there are many things you can do to lower your blood sugar without medication. There are other techniques, supplements and "hacks" but I'll save those for future articles. Stay tuned!
To sum up these top 5:
- Eat mostly vegetable carbohydrates
- Measure your blood sugar response
- Shorten your eating window
- Get more sleep
- Get walking
Before you go, please read our disclaimer. This blog is intended for informational purposes only. We are not providing legal or medical advice and this blog does not create a provider-patient relationship. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Casey Means MDCR. What should your glucose levels be? Here's the ultimate guide to healthy blood sugar ranges - Levels. Levelshealth.com. Published April 15, 2020. Accessed February 26, 2021. https://www.levelshealth.com/blog/what-should-my-glucose-levels-be-ultimate-guide↩
Freckmann G, Hagenlocher S, Baumstark A, et al. Continuous glucose profiles in healthy subjects under everyday life conditions and after different meals. J Diabetes Sci Technol. 2007;1(5):695-703.https://doi.org/10.1177/193229680700100513↩
2015-2020 Dietary Guidelines. (n.d.). Retrieved February 26, 2021, from Health.gov website: https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015↩
Pautler A. 7 Day Carb Test. Robbwolf.com. Accessed February 26, 2021. https://robbwolf.com/wiredtoeat/7daycarbtest/↩
Knutson KL. Impact of sleep and sleep loss on glucose homeostasis and appetite regulation. Sleep Med Clin. 2007;2(2):187-197.https://doi.org/10.1016/j.jsmc.2007.03.004↩
Manjoo P, Joseph L, Dasgupta K. Abdominal adiposity and daily step counts as determinants of glycemic control in a cohort of patients with type 2 diabetes mellitus. Nutr Diabetes. 2012;2(1):e25.https://doi.org/10.1038/nutd.2011.22↩
Di Loreto C, Fanelli C, Lucidi P, et al. Make your diabetic patients walk: long-term impact of different amounts of physical activity on type 2 diabetes. Diabetes Care. 2005;28(6):1295-1302. https://doi.org/10.2337/diacare.28.6.1295↩
Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care. 2007;30(3):744-752.https://doi.org/10.2337/dc06-1842↩
Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: A prospective study. JAMA. 1999;282(15):1433. https://jamanetwork.com/journals/jama/fullarticle/192010↩