Hi, I'm Christa, the new writer for Alexfergus.com! In this blog post, I'll tell you why 24/7 blood glucose monitoring can be an excellent tool for every biohacker wanting to safe-guard their health—whether you're currently in perfect health or seeking an improvement.
I bring a unique perspective to blood sugar monitoring because I've worked as a certified assistant to ophthalmologists helping clients with diabetes-caused side-effects such as worsening vision.
The issue of diabetes is closely intertwined with loss of blood sugar control and insulin levels. Insulin is a hormone that ensures sugar (glucose) is taken up by your body's cells and prevents that sugar from circulating in your bloodstream.
Who is managing your blood sugar right now? Nobody?
Your doctor usually won't start managing your blood sugar level unless it progresses to become the disease diabetes. Why? Well, if blood tests show your blood glucose level is too high, some doctors may first advise: eat right and exercise.
And if that advice fails, then oral medication is started, and diabetes eventually sets in! Next, if that first medication doesn't cut it, insulin injections and/or other oral medications are added.
When those added prescriptions can't keep the sugar levels controlled, organ damage occurs.
And who is responsible when diabetes results in:
Moral of the story? You better control your blood sugar levels. You cannot wait until blood sugar levels have become excessive because then it's very hard to reverse.
High blood sugar is a leading cause of morbidity and mortality.
You may be wondering: why isn't blood sugar simply lowered to harmless levels?
There's more than just elevated blood sugar levels. In fact, there's a second threat that slipped under the radar. High levels of insulin hormone also correspond to increased morbidity and mortality.
So both high (or unstable) blood sugar levels and high insulin levels are problematic.
Having to use exogenous insulin, however, is also damaging. Cardiff University researchers published a study titled "Insulin dosage for type 2 diabetes linked with increased death risk."
Patients with diabetes taking the highest doses of insulin had up to a 75% greater risk of death compared to those taking the lowest doses.
So greater risk of morbidity and mortality is caused by both high insulin and high sugar levels.
The worst part?
Despite gradually increasing the dosages of drug therapy, diabetes almost always worsens.
I, Christa, worked for a team of eye surgeons and optometrists as a certified ophthalmic assistant and have seen these problems first-hand!
Surprisingly, glaucoma and cataracts are twice as likely among those with diabetes.
But if you only start worrying about your blood sugar once you already have diabetes, you will miss your greatest window of opportunity to protect your health.
This blog post is important even to the seasoned biohacker because if you can control your blood sugar levels, you can dramatically improve your health!
Got you interested?
Let's look at a few very dramatic side-effects of NOT getting your blood sugar and insulin under control!
Patients never imagined it could suddenly get bad because there often aren't any warning symptoms.
Diabetics who are not receiving any treatment (such as insulin) to lower their blood sugar levels are a whopping 25 times more likely to go blind than someone without diabetes.
In a crisis of chronic damage from high sugar and insulin levels, patients are dependent on medical interventions to attempt to preserve their remaining sight necessary to read, see their loved ones, drive, enjoy their hobbies, do their job...
More than half of all diabetics (we're talking about 7,700,000 Americans) will be diagnosed with diabetic retinopathy (DR). For new cases of blindness in the United States, this diabetic eye disease is the top cause.
So if you don't control your blood glucose levels, you can develop retinopathy and a high risk of eventually going blind!
You may think, "Well, then I'll just take some prescription medicine to save my vision!" Let's explore that option further.
Here's the grim reality:
Drug therapy is one available option to try to preserve vision. While the patient is wide awake in the office, a prescription drug is injected directly into the eyeball every 4 to 6 weeks.
It is common for both eyeballs to need injections.
The second line of defense is dozens of painless laser burns to permanently coagulate non-essential blood vessels in the back of the eyeball that feeds the less-essential peripheral areas on the edges of the field of vision.
Those areas of burn spots become irreversibly non-functional after treatment. The goal of treatment is to preserve the essential central vision.
If the blood in the eye does not clear up after about a year, vitrectomy surgery has a 70% chance of improving vision to a degree.
None of these procedures are guaranteed to work.
All require signed consent-to-treat forms that list the known potential risks of treatment. I met many patients who experienced complications.
Medical procedures are intended to preserve as much vision as possible for as long as possible.
It's an uphill battle.
Bottom line: you don't want to rely on medication or surgery to counter the spiraling-out-of-control side-effects of high blood sugar and high insulin.
So let's explore much better options:
The vast majority of diabetes cases gradually worsened year after year.
A few strong-willed patients got a diagnosis of diabetes and urgently fought for their health by drastically overhauling their lifestyle habits... and succeeded!
Their stories all shared a common thread: lowering carbs to tightly control their blood sugar through diligent glucose monitoring.
(Editing note by Bart: some people will also do well on higher-carb lifestyles to prevent diabetes, but blood glucose monitoring is still essential to find whether that's true for you!)
Forks became weapons to defend their health against the morbidity and mortality of high blood levels of both sugar and insulin.
For a dozen years, I ate superfoods with every meal and was mostly vegetarian. If we eat "healthy," can we automatically assume our blood sugar levels are good?
Let me start with a background story:
My yearly fasting blood work didn't seem to raise any red flags.
But should we just assume the fasting blood glucose level on that one day sufficiently represents all the other days of the year?
Are all 365 days filled with matching meals, cookie-cutter exercise routines, the same sleep quality, perfectly stable stress levels, unchanging prescription medications, and no surprises?
Would there be any point in measuring non-fasting blood sugar levels an hour or two after a meal?
Let me ask you a simple question:
Is it easier to prevent diabetes or reverse it? Of course, prevention takes you much less effort!
So let's explore the underlying assumption of 24/7 blood glucose monitoring:
My life changes daily, and my blood sugar changes hourly.
I did a two-day fast in May of 2017. Much to my delight, it resulted in significant but temporary improvement of some nagging symptoms.
That experience opened my eyes to notice the pattern that my symptoms worsened in direct proportion to eating sweet-tasting foods or even processed starches like a bowl of cereal.
As an experiment, I tried a relatively lower-carb diet. I was eating lots of superfoods: kale, turmeric, coconut oil, blueberries, sprouted seeds, eggs, sardines, mushrooms, beans, nuts, matcha green tea... and a variety of other foods.
I imagined and assumed my blood sugar couldn't be better.
On a whim, I bought a blood sugar monitor. I thought it would keep me motivated to stick with this temporary low-carb diet if I saw objective results of excellent levels.
Much to my dismay and disbelief, my fasting blood sugar was 20 points higher than expected. Tracking the highs and lows was incredibly eye-opening!
All my life, I believed I knew when my blood sugar was low because I felt certain signs and symptoms of "hypoglycemia": hunger, my stomach growling, my fingers tingling...
What a shock when I discovered that I could have all those symptoms even when my blood sugar was plenty high enough. All those years, it was fluctuating levels of the hunger hormone, ghrelin, that I was feeling.
The low-carb diet was only intended to be a temporary experiment.
I stuck with it because I saw the effect high-carb meals vs. low-carb meals had on my objective test measurements.
This principle made me think of an often-used management quote:
"We can't manage what we don't measure. That which is measured improves" ~ Peter Drucker & Karl Pearson
How do you know when you might benefit from testing your blood sugar at home? Let's take a step back and consider why measuring blood glucose is so important:
Everyone is aware of the importance of early detection for killers like cancer and heart disease. Diabetes is #7 on the list of top causes of death.
Has anyone ever heard any mention of early detection for diabetes? Why is that unheard of? Does it happen overnight without warning?
Thankfully not! There are three effective early detection options.
The first method of early detection is an A1c blood test. It measures the percentage of red blood cells that have been damaged by elevated glucose sugar.
People with an A1c lower than 5.5% were the least likely to develop diabetes over the following five to eight years. Each 0.5% increase doubled their risk of developing diabetes.
The same researchers also found that obesity resulted in double the risk of diabetes making it a second method of early detection.
There is also a third method. The hormone insulin is elevated 6–13 years or more before adults are diagnosed with diabetes.
If only people knew their fasting insulin levels were abnormal in relation to their fasting glucose levels, they could take steps to dodge the bullet of diabetes.
How would a person know if their insulin to glucose relationship is problematic? An assessment called HOMA-IR is used to evaluate insulin resistance. (It is calculated by multiplying fasting insulin and fasting glucose then that product is divided by 22.5.)
Between 0.5 to 1.5 is a pretty good HOMA-IR score. Anything over that might be a warning of elevated risk of diabetes. Some doctors may even prescribe Metformin if insulin is elevated.
"...metformin was found to be more effective in younger, heavier patients than those who were aged 45 or more."
It's a balancing act because Metformin has side-effects. A quarter of the people taking it reported problems with digestive disturbances.
One-eighth complained of heartburn, headaches, upper respiratory infections, flu-like symptoms, sweating, flushing, heart palpitations, rashes, or nail problems.
Commonly, doctors to wait until people have elevated blood sugar levels to start drug therapy.
Good news! Insulin levels alone can predict how likely it is that a person will develop prediabetes.
Compared to women with a fasting insulin level of 5mcU/ml, women with 8mcU/ml have a greater than 200% increased risk of prediabetes. Women with 25mcU/ml have more than 500% increased risk of prediabetes.
Elevated insulin causes these problems:
So it's quite helpful to catch high insulin levels before your blood glucose levels go out of whack.
Moreover, the symptoms listed above should give you an indication as to whether you have problematic insulin levels.
So let's explore how this dynamic conventionally develops:
It's not uncommon for doctors to wait to start drug therapy until the blood sugar levels go up. It makes sense considering the possibility of unpleasant side-effects and costs of prescription medications.
At this stage of elevated insulin, before blood sugar becomes elevated, a doctor may advise a patient to lose weight because belly fat is strongly linked to high insulin, which is a proven risk factor for prediabetes.
A person's diabetes risk drops 16% for each kilogram lost. (The risk of diabetes is reduced by 16% for every 2 pounds and 3 ounces of weight loss.) Essentially, there is a 7% reduction in diabetes risk for every pound lost.
During this three year study, people lost about 4kg or 9 pounds, which equates to a 64% risk reduction for diabetes compared to their risk level at the beginning of the study.
This fat-loss advice is often frustrating for patients who may have tried every trick in the book. They may be following all the guidelines to the letter for eating right and exercising, yet nothing seems to work.
It is not surprising that it has been a losing battle despite following the experts' recommendations regarding calories in vs. calories out.
Bottom line: if you're carrying excess pounds, losing weight can dramatically lower your risk for diabetes and other health issues.
(By the way: Alex has written a great review on how to lose weight in a natural, healthy way).
So let's explore insulin a bit more:
Insulin is a hormone that moves glucose (sugar) out of the bloodstream and into storage in the liver, muscles, and fat cells.
High levels of insulin send your body a clear message to store excess fuel to have available to use in the event of a future food shortage.
It is fighting an uphill battle to try to burn fat while you have high insulin levels. The typical advice to eat less and exercise more often doesn't consider that high insulin may ensure some of the fuel you consume gets stored as fat.
What sends the strongest signal to your body to make more insulin hormone? It's mainly carbs, especially high-glycemic, sweet-tasting carbs, and alcohol.
To differing degrees, carbs trigger a spike in insulin to get that high blood sugar level lowered quickly (to prevent organ and tissue damage) by storing fuel for future use in the liver, muscles, and fat cells.
The Diabetes Association of America states,
"The main purpose of carbs in the diet is to provide energy as your body's main fuel source."
But if you have diabetes, should carbs be your main fuel source?
What quantity of carbs is even necessary? Take a look at this direct quote from chapter 6 page 275 of the Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2005):
"The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed."
How is that possible!?
Your liver can make all the glucose you need from the protein and fat you eat. There are essential fatty acids (fats), essential amino acids (proteins), and essential vitamins and minerals. If it is essential, your body cannot make it and need to consume it.
However, carbs are not essential because your body can make glucose in your liver to fuel your red blood cells, brain, and fill in elsewhere as needed.
Sure, carbs taste great, and some have beneficial nutrients. Still, if high insulin and high blood sugar are contributing to diabetes, then you wouldn't need to depend on carbs from your diet the way you need to consume all the essential fats, amino acids, vitamins, and minerals.
High insulin is very common! In one noteworthy study, 46.5% of the general population was found to have problems with their insulin levels being too high.
It is encouraging to realize that it is possible to keep your insulin from being chronically elevated due to insulin resistance. When insulin levels are optimally low because there are not more carbs coming in than the body needs, it is easier to burn fat.
(Editorial by Bart: again, how many carbs you can tolerate will depend on the individual and many circumstances. Alex can consume 250-500 grams of carbohydrates per day, for instance, while maintaining perfect health. To know what works for you, you need to test how you handle blood glucose.)
A low-carb meal plan helps restore excessive insulin levels to a healthy balance to reach fat-loss goals while preserving lean muscle mass.
Evaluating insulin resistance with the HOMA-IR calculation is also a powerful predictor of cardiovascular diseases and even mortality from any cause.
It is essential to know if your insulin levels are running excessively high. Even if your doctor does not order a HOMA-IR assessment, measuring your waist-to-height ratio will give you a good indication.
You don't even need a tape measure. Any string will do. Measure your height with the string. Then fold it in half length-wise and wrap it around the smallest part of your waist an inch or two above your navel.
If your waist is smaller than the folded string or half your height, that is a good sign. If it won't reach around your waist, that usually indicates chronically elevated insulin.
Even in children, a waistline greater than half their height correlates with activated inflammatory genes resulting in a higher risk of inflammatory conditions.
Waist circumference, waist-to-height ratio, and waist-to-hip ratio are all predictive of future cardiovascular disease and diabetes.
Here are some risk factors that have a strong correlation with insulin issues and prediabetes:
Additionally, this infographic displays some of the reasons why you might have an increased diabetes risk due to poor blood sugar regulation and how to lower your risk:
Visit the mentioned articles here:
Both articles will greatly help you manage your insulin and blood glucose. Now that you've learned a lot more about managing insulin, let's return to the topic of monitoring blood sugar levels 24/7:
If you have any of the risk factors above, you may benefit from tracking your blood sugar levels.
In a risk/reward analysis, the risk of not detecting and reversing high insulin and high blood sugar levels is high if you rely on assuming rather than objective testing.
If I had gotten excellent blood sugar results that very first day, like I had been expecting, I still wouldn't have regretted buying the testing device to know that information.
I could have saved it for the future to test a few years down the road... or sooner if I had a significant change to my lifestyle habits of sleep, stress, eating, exercising, supplements, medications, or the like.
Unfortunately, I didn't have ideal blood sugar levels at first, even though it had been a month after starting my relatively low-carb diet. It was disappointing, like getting a C on a test I expected to ace.
It was only through tracking the ups and downs that I learned what meals created blood sugar instability. Applying that personalized knowledge helped me consistently "ace the test" after a few more weeks.
I feel so informed and empowered to have these objective measurements at my fingertips to guide my choices.
You can apply that principle too. By measuring your blood glucose levels 24/7, you can attain more mastery over your health—you'll know what meals cause a healthy or unhealthy response.
Never once have I regretted investing in a blood sugar monitor. I bought the simplest device, so it was very affordable. My only regret is that I didn't buy it decades ago.
Basically, 24/7 blood glucose monitoring is inexpensive (especially compared to the cost of diabetes medications and treatments). The potential payoff of testing is priceless.
Why? The risk of not knowing your levels can be very debilitating while the cost of knowing your levels is minimal.
Knowing your glucose levels is beneficial, just like it can be helpful to track your body temperature or sleep quality.
About 15 years ago, when I was in my late 20s, I became a vegetarian. Then I became a raw-food-only vegetarian (raw produce and raw eggs). Finally, I became a fruitarian (raw-fresh-whole fruit, raw-soaked-sprouted seeds, and fresh greens like kale).
A female black-belt who I met at a national karate workshop had recommended I become a fruitarian. For six months straight, I stuck to that fruit-seeds-greens diet (The 80/10/10 Diet by Douglas N. Graham).
Back then, I used to eat half a papaya for breakfast before work. Fruit is high in fructose, a type of simple carbohydrate that can only be utilized by liver cells.
Douglas Graham suggested that it was okay to spike blood sugar levels with all that fruit as long as there wasn't excess fat in the diet to cause insulin resistance.
There are a variety of valid paths to health. Speaking from my personal experience, that diet of spiking blood sugar very high while trying to off-set all the risks by keeping protein and fat at rock bottom is one dietary intervention that would be best done under close medical supervision.
With such a limited diet, supplementing essential nutrients would be necessary since the body is not receiving all the essential fatty acids, essential amino acids, essential vitamins, and essential minerals.
Dr. Walter Kempner invented a strict fruit and rice diet for his patients who had organ damage from diabetes back in the 1950s. He warned that medical supervision was necessary because it was a dangerously incomplete diet on its own.
Why would he prescribe such an extreme program? After all, his patients had severe diabetic problems affecting their vital organs.
He was taking extreme measures in a heroic effort to reverse severe damage that had been caused by the elevated blood sugar and insulin levels in his patients with diabetes.
He took medical imaging photos demonstrating the reversal of diabetic retinopathy for patients who complied with his medically-supervised dietary intervention.
Dr. Kempner's patient, FF, a 42-year-old male with an 18-year history of diabetes mellitus. Dietary compliance for 26 months.
My 6-month fruitarian diet came to an end around age 29. I believe my highly restricted diet caused me to develop nutritional deficiencies. I was not on a medically-monitored therapeutic intervention with supplements of all the essential nutrients.
I wish I had been monitoring my blood sugar levels objectively during that self-experiment. I frequently felt hypoglycemic and assumed it meant my blood sugar was too low.
Now I realize it may have been other hormones that regulate hunger levels, making me feel intensely hungry so often. I am sure my blood sugar was cycling through highs and lows, so I was probably eating more fruit even when my blood sugar was still high.
Before buying my blood sugar monitor, I always tried my best to be open-minded and objective by having a keen interest in scientific studies.
During my dozen years or so as a vegetarian, I always focused on nutrient-dense foods such as kale smoothies with frozen fruit. I never wondered what effect those green smoothies were having on my blood sugar levels.
I took my dog on long walks almost every day. At the gym, I periodically went to yoga and Zumba classes and did some weight training and interval sprints. It seemed like my physical activity level was adequate.
I believed my "healthy habits" were enough to keep me safely following in the footsteps of those rare patients in their 80s, 90s, and 100s who I would have guessed were 20 to 30 years younger.
None of those patients who were living long, healthy lives had diabetes. Knowing the objective data about how my choices impact my blood sugar stability will increase my chances of avoiding diabetes.
I hope to live a long, happy, and healthy life like those remarkable patients were enjoying. I hope you will do the same!
Last year, I read an AlexFergus.com article by Bart called "8 Proven Reasons Vegan and Vegetarian Diets Easily Ruin Your Body."
To be honest, I felt a bit defensive last May (2019), reading it as a vegetarian. It was uncomfortable to be willing to ask myself if my dietary habits could be missing the mark.
(Bart also created a FREE Essential Supplement Guide for vegans and vegetarians who choose not to read an article that might alter their beliefs.)
That article changed my mind overnight. I used to eat one serving of animal protein a month. (It was usually eggs or salmon most months and muscle meat for months when there was a family holiday meal).
After reading that article, I started eating a meal with animal protein a couple of times a week. I gradually increased my animal protein intake to a couple of times a day once I started testing my blood sugar and lowering carbs more.
I only share the twists and turns of my unfolding journey to support you in any changes you decide to make to your diet in light of your blood sugar readings or waist-to-height ratio.
Naturally, feelings and beliefs about the foods and drinks you have always enjoyed run very deep. I can empathize! I try to make ground-breaking changes gradually. It allows my feelings to adjust and gives my body time to adapt.
Your sense of taste can evolve to accommodate new foods. A lot of the enjoyment of foods is wired into your brain by neurotransmitter signals. If you are patient and persistent, you can begin to enjoy foods aligned with any new nutritional strategy you choose.
Unfortunately, some superfoods still raise my blood sugar too much right now to consume them in the quantities I was having before.
I used to add homemade coconut water kefir to my kale smoothies with frozen muscadine grapes high in resveratrol. It no longer works for me to drink one of these smoothies if I want to keep my blood sugar stable.
Nowadays, I just have a couple of frozen muscadines, or a small-handful amount of blueberries, or raspberries. I have noticed that my body seems to be managing simple carbs like small amounts of low-sugar fruit a little better after eight months on a low-carb diet.
It may be that some of the improvement might be due to stress reduction as well. The stress hormone cortisol that our bodies produce (and even prescription corticosteroid drugs) contribute to blood-sugar instability.
Testing my blood sugar at home has helped me hop off the roller coaster of sugar-highs and lows. I hope you feel encouraged to monitor your blood glucose to find out which foods your body responds to well. It will help you customize your meal plans for blood-sugar stability, insulin sensitivity, and diabetes prevention.
In light of all that, here is what's on the horizon:
Blood sugar monitoring is one of the ideal biohacks you can perform because doing so will give you lots of control over a crucial variable in your health.
Just as you measure deep sleep or heart rate variability, blood sugar monitoring is an essential ingredient in this mix.
Once more, there's very little downside to measuring your blood glucose levels because it's very inexpensive to do. The upside, however, is massive because you'll find out what your body responds best to.
In the next article, we will discuss several options for monitoring blood glucose levels—so stay tuned!
We've recently reviewed two continuous blood glucose monitoring apps. You can view that review here, of the Levels app and Veri app.
Joe also published a YouTube video on the topic which can be watched below:
Here's a video of Alex using the Lumen breath analyzing device - that device can tell you whether you're burning carbohydrates or fats at that very moment, and what proportion:
Also, Alex has recently started a continuous blood glucose monitoring experiment, where he also uses the Freestyle Libre, Oura Ring, and Lumen:
Christa Rucker has been biohacking her own physiology for two decades now. She loves to geek-out on researching scientific studies which connect different habits to measurable health outcomes. She also has extensive clinical experience assisting patients which has fueled her passion for prevention.
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