High blood glucose is a sign that you are eating too much or too often.
You can use your blood glucose meter as a fuel gauge to help you understand whether your hunger is real and refine your meal timing.
Delaying your next meal allows your body to use up the glucose in your blood.
Intermittent fasting will allow your blood stream to be replenished from the glycogen stores in your liver and muscle and allow energy to flow from your fat stores.
blood glucose
action
> 7 day average, well slept and low stress
delay eating and / or exercise
< 7 day average
if hungry, enjoy nutrient dense foods that align with your insulin sensitivity
< 73mg/dL (4.0 mmol/L)
eat higher insulin load foods if hungry and delay exercise
reducing insulin
Eating frequently will keep your insulin and blood glucose levels high.
Reducing meal frequency allows longer periods where when insulin is low.
Insulin keeps your fat stores locked away in storage. Reducing insulin levels allows your body fat to be released for fuel.[1]
Decreasing body fat, particularly from around the liver, pancreas and kidneys leads to improved insulin sensitivity and normalised blood glucose.[2] [3]
Eating larger meals with more carbohydrate causes your blood glucose to stay higher for longer. Conversely, having smaller meals with a lower insulin load allows your blood glucose levels will return to baseline faster. And if you’re following this protocol, you’ll be able to eat again sooner.
when to eat
You can use your blood glucose readings to help you know whether to skip a meal or two or not eat for the day. If you fast for longer you will need to fast less often to keep your insulin and blood glucose levels moving towards optimal.
If you have some level of insulin resistance then chances are your blood glucose levels will be higher in the morning due to glycogen being released into the bloodstream as your body prepares for the day (a.k.a. Dawn Phenomenon). If you are insulin resistant the insulin secreted doesn’t keep up with the increased glucose in the blood stream and hence your blood glucose will be high.
If you test your blood glucose in the morning and it’s higher than your current average then you might want to delay eating until your blood glucose comes back down. This may mean eating your first meal early afternoon followed by an early dinner (e.g. 16:8 intermittent fasting). Alternatively, you could skip dinner which would help to lower morning blood glucose and then eat breakfast and lunch.
Dr Jason Fung says that Dawn Phenomenon is your body’s way of healing itself and purging excess energy.
The Dawn Phenomenon is simply moving sugar from body stores (liver) into the blood. That’s it. If your body stores are filled to bursting, then you will expel as much of that sugar as possible. By itself it is neither good nor bad. It is simply a marker that your body has too much sugar. Solution? Simple. Either don’t put any sugar in (LCHF) or burn it off (fasting). Even better? LCHF + IF.[4]
Other people find it simplest to not eat for the whole day or even two days at a time and then resume normal eating to satiety the rest of the time. Over time you’ll find a routine that suits you and be able to reduce the frequency of testing off the testing.
tailored just for you
Many people agree that intermittent fasting is a good idea, but how do you whether you should be doing Michael Mosely’s 5:2 diet, Hugh Jackman’s 6:8, Kiefer’s Carb Back Loading and Carb Nite, Lyle McDonald’s TKD and CKD, Bert Herring’s Fast Five, Ori Hofmekler’s Warrior Diet, or Martin Berham’s Lean Gains?
There are so many fasting options out there! How do you know which one is right for you and then how do you know if it’s working? How can you refined and tweak to to reach your goals?
The advantage of using your blood glucose level as a guide versus a regimented intermittent fasting protocol or a fixed calorie intake is that it accounts for your activity level and your food intake.
Eating is not bad. In the end it is about balancing your intake with your expenditure which can be a challenge in our current environment with abundant hyperpalatable food choices.
This approach helps you to fine tune when and how much you eat to your actual requirements right now. Not so much that you’ll store fat, but not so little that you’ll downregulate your metabolism.
Your blood glucose meter can help you understand whether your hunger is real and recalibrate your appetite signals. If your blood glucose levels are lower than your average then your insulin levels will be decreasing and you’ll be using body fat. If your blood glucose levels are increasing then you’re probably eating too much, your insulin levels are high and you’re storing the excess energy as body fat.
When using this approach you’re able to eat to satiate your appetite, while still keeping in mind that when you eat next will be influenced by how much you binge at this meal.
Many people find that they are able to eat less overall when intermittent fasting compared to trying to eat numerous ‘small’ meals. Saint Augustine wisely said “Complete abstinence is easier than perfect moderation”. This also applies to our meal timing and portion sizing.
By choosing to eat only when your blood glucose is below YOUR average blood glucose level you can tailor the approach to your current situation and metabolic health.
Waiting until your blood glucose reaches optimal is not realistic for most people. It’s best to start from where you are now and work towards optimal. In the study Adherence to hunger training using blood glucose monitoring: a feasibility study[5] the researchers found that participants did much better when they set their own personalised blood glucose target rather than waiting until their blood glucose levels reached some optimal target before eating.
the end game
The ultimate goal is to achieve an optimal HbA1c of 4.5% which equates to an average blood glucose level of 83mg/dL (or 4.6mmol/L). There are lots of really good reasons to keep your blood glucose and insulin levels in check such as reducing your risk for cancer…[6]
…heart disease, stroke[7] and a whole range of western diseases.[8]
People with type 1 diabetes following Dr Bernstein’s protocol will typically try to keep their blood glucose within ten points of the optimal target level of 83mg/dL (4.6 mmol/l). This means that they will dose with insulin when their blood glucose rises above 93mg/dL (or 5.2 mmol/l) and then eat to bring their glucose levels back up when they drop below 73mg/dL (or 4.0mmol/L).
Someone who has a functioning pancreas but is struggling with insulin resistance and / or obesity can use a similar process to manage their blood glucose and insulin levels. Rather than dosing with insulin they simply delay eating until they burn through the excess blood glucose.
Eating when your blood glucose levels are below your recent average will ensure that they decrease over time. Most glucose meters will display the average glucose level for the last seven days so it is easy to tell what your current target is.
weight loss
If you are looking to lose weight you could also add a ‘fast if my weight is above my target weight’ parameter. Normalising blood glucose and insulin will often lead to achieving optimal weight, particularly if you’re insulin resistant, although some people do need to pay attention to cutting calories once blood sugar and insulin is normalised.
Below is an example system used by Rebecca Skvorc Latham using both blood glucose and weight.[9]
Rebecca will fast for the whole day if her weight is above her goal or her blood glucose is above her target of 86mg/dL. Rebecca says the fasting works better for her than calorie counting or just carb counting which tend to down-regulate her metabolism and affect her hormones.
As you can see she’s already got her blood glucose pretty well under control.
The feast / fast heat map below shows the days that she has fasted based on this system while achieving her weight loss results while only having to fast once or twice a week.
when not to use this approach
Exercise may raise your blood glucose in the short term due to the body dumping glycogen from your liver into the bloodstream. If you don’t eat as much after exercise your body will have to replenish the glycogen stores from the energy stores on your body.
There will be times when you’re really hungry or it will be appropriate to eat for social reasons (e.g. a party, family gathering etc). Periodic feasting is a normal part of our culture. This system would help you to get back on track and work around these times.
You should also keep in mind that there are other things that affect blood glucose including stress, sleep, sickness and exercise that you will need to manage and be mindful of when deciding whether to delay a meal due to your blood glucose being high. Fasting may not be ideal if you’re already stressed, not sleeping well and / or are pushing the exercise envelope. During these times it maybe better to focus on life maintenance and listen to your appetite.
Jason Fung pointed out:
Medications and insulin obviously would gum up the entire system. The other thing would be stress (cortisol) also increases blood sugars. If you could control for those two things, then this would definitely be an idea worth testing. I like the idea of varying the fasting period. I think that intermittency is a key component to success.
So if you are taking insulin or other blood glucose lowering medications you will need to make sure they are reduced so you are not having to eat to raise your blood glucose because of the medication. The more you reduce insulin (injected or produced from your own pancreas) the quicker the healing can occur. However the same time it would be prudent to reduce medications progressively to prevent your blood glucose levels from going too high.[10]
The problem with injected insulin or many other diabetes medications is that, while it may help to reduce blood glucose levels, it also drives the energy back into the cells rather than allowing the stored energy to flow out of storage.
High blood glucose levels can be a sign that you’re stressed, exhausted or your hormones are out of whack (including time of the month for females), all of which will lead to insulin resistance. You can use Heart Rate Variability to track your stress and exhaustion with an app such as Elite HRV which enables you to see when you’re exhausted and need to back off and rest.
If you just don’t feel like fasting and your blood glucose levels are high it’s probably a sign that you need to rest, relax, sleep, meditate, see some real sunlight during the day and stop gazing into the iPad before you go to bed. Using f.lux on your computer or blue blocking glasses after sunset is worth considering.
While longer therapeutic fasts can be beneficial, a shorter feast / fast cycle that brings your blood glucose level down to below your average is likely to be more useful to improve your metabolism while reducing the extreme swings in water weight or any concerns that you’re not getting adequate protein to support lean body mass.
ketones and the glucose: ketone index (GKI)
The simplest approach is to measure your blood glucose levels when you feel hungry and not eat until they drop below your target level. You could still use this approach even once you have improved your insulin sensitivity to lose weight by targeting lower and lower blood glucose levels before eating.
Monitoring your blood glucose will work whether you are insulin sensitive or insulin resistant, obese or normal weight. The body does an amazing job of replenishing your glycogen stores and stabilising your blood glucose whether it be from carbohydrates, gluconeogenesis from amino acids or even gluconeogenesis of fat once you are highly insulin sensitive.
Once you are starting to get your blood glucose levels under control you could start to track your ketones or the glucose: ketone index (GKI). Decreasing glucose along with rising ketones is a sign that your glycogen stores are being depleted and you your hunger is legitimate.[11]
If your average glucose is under 90mg/dL (5.0mmol/L) then you could start tracking the ratio between your glucose and ketones (GKI)[12] and delay eating until your GKI is under a certain level.
Alternatively you could simply not eat until your ketone levels were above a certain level. For example, start with a target ketone level of 0.4mmol/L and keep winding that up till you achieve your target results. However testing blood ketones every time you feel hungry could become expensive quickly.
While all these things are important and useful though make sure to use them as tools to help you live life rather than taking over your life and stressing you out. Your goals need to be realistic and tailored to your situation. Hopefully in time this ‘hunger training’ will help you build new habits around eating and you won’t need to rely on the testing.
fast well, feast well
Keep in mind If you are eating less food less often you will need to maximise nutrient density when you do eat, including ensuring that you are getting adequate protein to maintain lean muscle mass over the long term.
Best of luck if you chose to try this approach. I look forward to hearing how you go. Be sure to share your experience in the comments below.
references
[1] http://bja.oxfordjournals.org/content/85/1/69.long
[2] https://intensivedietarymanagement.com/fatty-pancreas-t2d-9/
[3] http://care.diabetesjournals.org/content/early/2015/11/29/dc15-0750?patientinform-links=yes&legid=diacare;dc15-0750v1
[4] https://intensivedietarymanagement.com/dawn-phenomenon-t2d-8/
[5] http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0017-2
[6] http://onlinelibrary.wiley.com/doi/10.1002/ijc.29917/epdf
[7] http://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164
[8] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19
[9] http://lowcarbbetterhealth.blogspot.com.au/2016/02/day-37-2016-weight-loss-and-blood.html
[10] http://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/
[11] http://www.nature.com/articles/ncomms10580.epdf?shared_access_token=MUKioJXu6KVY753YIDoPVNRgN0jAjWel9jnR3ZoTv0NZFUsLxRRWAKMsrNHEbSj2q0khGxVdwhqgBvlELqp6rtnjRj5ppdqpqF9VFYO_6UzYPSf3Z5ZW4kFdG4GQIZ71IGlh7tQHXrGHJ2Nz7rN5iw-9csWuhb9uHxuz_-28FyOP6Tcmjd1H9Uxq9OwlIQTy
[12] http://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/