How to Maintain Optimal Blood Glucose Levels | Dr. Michael Snyder & Dr. Andrew Huberman
Chapters
0:0 Understanding Glucose Spikes2:24 Continuous Glucose Monitoring
4:38 Personalized Glucose Responses
6:13 Experiences of Glucose Spikes
00:00:00.400 | - How is it that what we eat impacts our glucose response?
00:00:05.400 | And maybe you could tell us a little bit
00:00:09.040 | about what a healthy glucose response looks like.
00:00:12.500 | Because by most people's view,
00:00:16.180 | any inflection in blood glucose is a quote unquote spike.
00:00:19.560 | But what are the sorts of spikes that matter for health?
00:00:21.880 | And what are the sorts of spikes in blood glucose
00:00:23.880 | or what are called the glucose excursions that,
00:00:27.120 | you know, okay, well, that's a normal response
00:00:29.200 | to eating some food.
00:00:30.040 | And then it goes back down to baseline.
00:00:31.880 | I think this is especially important nowadays
00:00:33.920 | with all the interest in metabolic health,
00:00:36.140 | in how particular types of foods like processed foods
00:00:39.980 | are indeed far worse for us and on and on.
00:00:42.360 | So if you could just give us your view
00:00:45.960 | and understanding of glucose excursions,
00:00:48.280 | what they mean, when they're good, when they're bad.
00:00:51.060 | - Well, I would say that, you know,
00:00:53.880 | high, long, prolonged spikes is obviously pretty bad.
00:00:58.400 | But certain things, like if you eat a grape,
00:01:01.020 | grape's pretty loaded with sugar,
00:01:02.720 | but it's a pretty transient spike.
00:01:04.520 | It'll go up.
00:01:05.320 | And so that would be a transient one.
00:01:09.180 | And actually, when you do strength training,
00:01:12.460 | for example, for exercise, you break down glucagon,
00:01:15.560 | which is a, you know, it's a polymer of sugar
00:01:18.280 | that you break down, gives you energy.
00:01:19.880 | That's important for when you're doing exercise and training.
00:01:23.420 | And that will give a glucose spike.
00:01:25.120 | I get a glucose spike every morning when I weight train.
00:01:27.740 | So that would be a normal, healthy one,
00:01:30.000 | but it's transient.
00:01:30.740 | It goes away pretty quickly.
00:01:32.360 | - What's quickly?
00:01:33.500 | - Within 30 minutes, maybe most 60 minutes.
00:01:38.340 | Now I'm a special case, I'm a type two diabetic.
00:01:40.740 | So my spikes go higher and longer than most people.
00:01:45.360 | So yeah, mine are not good spikes, but we can get into that.
00:01:49.900 | So what is a good spike?
00:01:51.360 | Well, the calibration people mostly uses time and range.
00:01:55.200 | It's a simple metric, meaning if you're a healthy person,
00:01:59.160 | your glucose is normally, for most people, around 90.
00:02:02.740 | And if you're off, you will go higher than that.
00:02:08.620 | For most people, you want to keep your glucose between 70 and 140.
00:02:13.240 | If you're healthy, for diabetics, they say,
00:02:15.500 | try and keep it between 70 and 180.
00:02:18.360 | And that is what people try to do.
00:02:21.780 | And most healthy people, it's pretty easy.
00:02:24.700 | And I think one of the things we've done,
00:02:26.540 | you've heard about continuous glucose monitors,
00:02:28.700 | these devices, and I'm wearing one, and some of your staff,
00:02:31.740 | I know, are wearing them as well.
00:02:33.580 | And they're over the counter now.
00:02:34.740 | You put these on your arm, and they measure your glucose
00:02:36.920 | every five minutes, so you can see exactly what's going on.
00:02:40.340 | And so we put them on so-called normal people,
00:02:44.180 | pre-diabetics, and some diabetics.
00:02:45.900 | That was already well-known.
00:02:47.040 | Diabetics will spike their glucose through the roof,
00:02:50.080 | too high for too long.
00:02:52.180 | And then the people devise, especially type 1s,
00:02:54.460 | control mechanisms for releasing insulin,
00:02:57.340 | controlling all of that.
00:02:58.880 | But for the average person, that wasn't so well-known
00:03:02.220 | at the time we were doing this.
00:03:03.580 | And it was a bit of a surprise to see that a lot of people--
00:03:07.260 | some did a very good glucose control,
00:03:09.580 | but some pre-diabetics were what we call moderate spikers.
00:03:13.100 | We came up and named glucotypes as a way of quantifying this.
00:03:17.460 | And then some people were spiking just as bad as diabetics
00:03:20.260 | and had no idea.
00:03:22.100 | And so it was a way of revealing what was going on.
00:03:25.340 | So it's recommended that you try to stay in this 71-40,
00:03:29.500 | but it is a bit arbitrary.
00:03:30.760 | But it's not a bad rule of thumb to work by for the average person.
00:03:35.260 | But again, some people have very, very good glucose control.
00:03:38.640 | Some are moderate spikers and some are severe.
00:03:41.520 | And it's pretty clear that excessive spiking, especially in diabetics,
00:03:46.460 | is associated with cardiovascular disease and other things.
00:03:49.420 | There are some pretty strong papers out there on that.
00:03:52.300 | So you do want to keep it under control.
00:03:54.840 | And there's a very strong correlation between this time and range measurement
00:03:59.340 | I mentioned and something called hemoglobin A1c.
00:04:02.300 | That's a measure of your steady-state glucose.
00:04:05.420 | And so if you have high hemoglobin A1c, that's typically how we classify people for diabetes
00:04:11.840 | and pre-diabetes.
00:04:12.720 | If you're over 6'5" or over, you're classified as diabetic.
00:04:16.140 | If you're 5'7" to 6'4", you're pre-diabetic.
00:04:19.140 | And if you're under that, you're so-called normal.
00:04:22.060 | And this time and range will actually correlate very, very well with that.
00:04:25.640 | So it's a surrogate measure for that.
00:04:28.360 | But it's actually pretty cool because you can precisely see what's going on in real time,
00:04:34.580 | unlike a hemoglobin A1c measurement, which you get periodically.
00:04:38.500 | So if you want to dig into that further, I would say that, you know, what's cool about
00:04:43.060 | these CGMs is that you wear them, like I'm wearing one now.
00:04:47.460 | You can wear them for about 14 days, depends on the particular device.
00:04:52.200 | And you see exactly what foods do what to you, and we're all different.
00:04:56.760 | So some people spike to bananas, some to potatoes, some to pasta, some to white bread, some to
00:05:01.780 | brown bread.
00:05:03.220 | And so this was shown by Aaron Siegel's lab at the Weissman, and our lab had found something
00:05:08.160 | similar.
00:05:09.160 | And it's very personal.
00:05:11.060 | And so we've been spending a lot of time trying to dig into what's behind that.
00:05:14.760 | So different people's glucose spike to different foods.
00:05:18.360 | It's hard to predict on the basis of something like a chart of glycemic index, for instance.
00:05:24.460 | So if I understand correctly, and I have glanced at those papers, you know, I might be able
00:05:30.140 | to eat mango with nothing else, and my blood glucose doesn't go out of range, or at least
00:05:36.040 | not for very long.
00:05:37.580 | Whereas somebody else might have a very big and prolonged spike in blood glucose to mango.
00:05:43.820 | But maybe there are things they can eat that I can't eat, like, I don't know, sourdough
00:05:47.660 | bread or something.
00:05:48.660 | By the way, I can eat sourdough bread.
00:05:49.920 | But just by way of example.
00:05:50.920 | A hundred percent, yeah.
00:05:51.920 | Yeah.
00:05:52.920 | And so really the only way to know, as you're pointing out, is to measure.
00:05:56.360 | I want to talk a lot about measurement today.
00:05:58.320 | All right.
00:05:59.320 | For those that are just listening, not watching, Mike is wearing many sensors.
00:06:02.920 | How many sensors?
00:06:03.920 | You have got four watches.
00:06:04.920 | And my ring and even my hearing aids are sensors, believe it or not.
00:06:08.720 | So, they are for hearing, but, uh.
00:06:10.720 | We're going to get into all of that, but maybe we could talk a little bit about some
00:06:16.140 | of the subjective experience of blood glucose excursions, both healthy and unhealthy.
00:06:21.100 | Okay.
00:06:22.100 | Most people are familiar with eating a big meal, like the, you know, the cliche is the, you
00:06:27.800 | know, the Thanksgiving meal after which you're tired, where you stuffed yourself with protein
00:06:31.160 | and carbohydrates and dessert, et cetera, maybe some alcohol too, in some cases.
00:06:35.460 | But I think people are also familiar with, you know, eating a certain food.
00:06:42.120 | Like for me lately, I'll have my bowl of oatmeal with some berries and my protein drink after
00:06:46.820 | I train.
00:06:47.820 | And I'm noticing with each successive year, I'm getting really sleepy after I eat this.
00:06:54.200 | And I've swapped out the oatmeal for a different carbohydrate recently, just some white rice,
00:07:00.020 | and I feel fine.
00:07:01.200 | And I don't think this is my imagination.
00:07:03.600 | I mean, in one case, I want to take a nap afterwards.
00:07:06.540 | In the other case, I'm good to keep going and I generally have a lot of energy.
00:07:10.340 | So, is what I just described atypical, what are some subjective effects of high glucose spikes?
00:07:16.160 | Yeah.
00:07:17.160 | Well, certainly, uh, sleepiness is one.
00:07:19.120 | I can put myself to sleep with a piece of pizza.
00:07:21.720 | Um, I'm diabetic.
00:07:22.980 | I'm a unusual diabetic.
00:07:23.980 | We can talk about that too.
00:07:25.980 | Uh, and yeah, if I eat pizza, my glucose goes through the roof and, um, I will get sleepy.
00:07:31.800 | So does that mean that you eat and you feel sleepy?
00:07:34.500 | Or there's a, uh, a period after you eat, because this is what I experienced, where I feel very
00:07:39.760 | energized for a short while, and then it's almost like my vision gets a little blurry and I feel
00:07:45.460 | kind of like, um, yeah, like I just want to curl up and take a nap, even if I slept great the night
00:07:50.160 | before.
00:07:50.660 | Is that a blood glucose response?
00:07:52.580 | I believe so.
00:07:53.300 | I mean, there are multiple things that affect sleepiness and you probably know this better than
00:07:56.700 | me since, uh, you've covered sleep more.
00:07:59.220 | But, um, yeah, like tryptothanes, things like this can help induce sleep as well, but certainly glucose,
00:08:06.400 | these large glucose spikes, uh, I can say personally make me very, very sleepy.
00:08:11.040 | Uh, and alcohol can make a lot of people sleepy too, but you're right.
00:08:15.400 | There can be a lag because that first little shot of glucose can be a stimulant, um, but,
00:08:21.160 | uh, very soon that shot can go very, very large, uh, of glucose and, at least for me, it makes
00:08:27.420 | me very, very sleepy.
00:08:28.420 | So, I think it's very normal.
00:08:30.040 | So, I think it's very normal.