With Dr. Peter Attia
14 June2021
In this “Ask Me Anything” (AMA) episode, Peter Attia and Bob dive deep into blood glucose and why it matters so much with respect to metabolic health and longevity. They explain the need to pay close attention to metrics like average blood glucose, glucose variability, and peak glucose numbers.
We begin by understanding that your doctor uses fasting blood glucose and HbAc1 as tests for identifying that your past diet has caused type II diabetes. You can think of diabetes as carbohydrate intolerance, or excess sugar, or as insulin resistance. Different ways of looking at the same problem.
So “Bob” on behalf of the viewers asks what a normal blood sugar level for a healthy person should be. And if the doctor says “I’m not diabetic” do I have anything to worry about?
This area of health is badly understood because we use a cheap, substitute marker for health, fasting blood glucose, rather than measure the interaction between glucose and insulin in response to a standard “meal”. The best measure is the Oral Glucose Tolerance Test. When your doctor says, “The bad news is that you have type II diabetes,” he’s reporting 10 or 20 years after the damage began to accumulate.
The Oral Glucose Tolerance Test is often called the Kraft Test, after Dr Joseph Kraft who first described the test. If you have for a long time eaten excessive carbohydrates, your body is likely to become intolerant of the amount of “sugar” you are eating. This is called insulin resistance in medical terms. Some cells, eventually most of your cells, refuse to respond to the insulin in your blood, because they are already “overflowing with sugar” as Dr Jason Fung says. In the face of “resistance” the pancreas produces more and more insulin, to force glucose into muscle cells or fat tissues. You get fat. So, it’s true; hormones do make you fat, but only if you’ve been abusing yourself with a poor diet for many years.
I can tell you in 30 seconds what the best human diet is, but that’s useless information. Even if I’m correct, you can’t eat that way, with your present knowledge and long-term food habits. You have to make your own choices.
Dr Kraft showed that insulin resistance was hidden, so long as most of the body remained responsive to insulin. Dr Kraft said that more than 60% of the people he tested were already developing insulin resistance.
Even without taking the OGTT, understanding the principle of glucose spikes allows you to avoid some of them. Try to keep your average blood glucose as low as possible. Less glucose variability is better. Your doctor might give your HbA1c a pass mark, but this traditional measure catches metabolic issues too late.
After eating quickly absorbed carbohydrates, the postprandial dip in blood glucose is interpreted as hunger and you search for food again. If you are eating enough fatty acids and protein, you won’t experience constant hunger.
Additionally, Peter explains why he encourages all his patients, even nondiabetics, to utilize a continuous glucose monitor (CGM) which gives important insights that traditional lab testing and metrics consistently miss.
It’s expensive to wear a CGM, but it can be life changing. If you can find a way to do that for a month, do it. We expect that you’ll discover that most of the manufactured foods you eat, even the one’s called “healthy” cause surprising glucose reactions.
My wife, Carolyn, last week, summed up the sort of diet we are now eating. There’s very little in the pantry, and a lot of food in the refrigerator and the freezer. “You know,” she said, “this Christmas I’ve avoided buying any processed foods, not even a Christmas Pudding.”