POST PRANDIAL BLOOD SUGAR

Comparison of diabetic, prediabetic and normal responses to a meal.

Let’s talk about one of the most powerful risk generators there are for cancer, heart disease and stroke. In fact, this little discussed test can make or break you as far as preventive medicine goes. In other words if you remain ignorant of your post prandial blood sugars you will in essence be flying with blinders on. Blinders are good thing when at a nudist campground (usually) but for our InflaNATION readers we want the full frontal shot 24/7.

When I was a kid, I did plenty of daydreaming when not in the police station being questioned for yet another ridiculous reason. The only thing, my daydreaming was on my bicycle. It was so bad that I would ride my bike with my head down and eyes closed. Until I split my lip open on a parking curb. That was my wake up call, the slap across my chops, that said hey stupid wake up or die! Well, your PPBS values may be your wake up call.

Take a meal consisting of simple and complex carbs. For example, your bowl of animal feed, err, breakfast cereal that you look forward to munching down each AM. All of the simple carbs and a high percentage of the complex carbs are quickly broken down and absorbed across your bowel lining and into your bloodstream. A nice way to assess a patient’s ability to handle simple and complex carbs is to measure a PPBS level. A PPBS refers to a measurement of blood sugar at a specific time after eating. Usually 2 hours after eating a meal but it can include any time period that you wish to measure. One typically does this to find out if they have any problems with carbohydrate metabolism and to test for pre-diabetes or diabetes. Studies have confirmed that the PPBS test is a far better measurement for carbohydrate metabolism than the fasting blood sugar (FBS).

There is a more technical test called the oral glucose tolerance test (OGTT) that uses a specified amount of sugar and specified BS testing. Both tests can reveal plenty of information. Over the years we have found out that fasting glucose is not a good method of screening people for diabetes or pre-diabetes nor does it predict the magnitude of postprandial glucose surge. In other words many patients that have normal FBS may in fact be a ticking time bomb with high after-meal BS. It’s only a matter of time before the rest of the medical community catches up and realizes that after-meal glucose surges are one of the most important players in heart disease and stroke. The reason for this is because the vascular endothelium, the one cell layer lining your arteries, can be injured by excess glucose setting the stage for coronary and cerebral vascular diseases like heart attack and stroke.

We already know from a meta-analysis of seven previous long term studies that acarbose, a drug that lowers blood sugar, may reduce heart attack risk in type II diabetics by 36%, and “any cardiovascular event” including stroke by 65%. In addition the authors stated complete with their spelling of glycemic:

Glycaemic control, triglyceride levels, body weight and systolic blood pressure also improved significantly during acarbose treatment.[1]

Predictably TG and body fat were reduced along with the remarkable effects on stroke and heart attack risk by reducing blood sugar. In fact, these effects were so notable that a new clinical trial is underway studying the effects of acarbose on heart disease risk called the Acarbose Cardiovascular Evaluation Trial. It will be completed in 2016.

You’ll note that my Super Mediterranean Diet (SMD) is geared exactly toward the same BS and insulin endpoints by curbing consumption of “unsafe” carbohydrates instead of using toxic drugs. I make it super by adding fish oil, eliminating the bad fats and adding in EVOO. Yes, dear reader, you are not familiar with my SMD but you shall all in good time-as soon as I can elaborate in a future blog. I’d bet that if the trials in the meta-analysis above had included eliminating omega 6 FA (seed oils) and the other bad fats we would have seen heart attack and stroke risk shot right out of the park. We have the Lyon Heart study which eliminated omega 6 FA, and added more omega 3 FA to massively drop sudden death and heart attack risk. We now have the above studies which looked at tight glycemic control but ignored the type of fat consumed. Why not put the two together and live until you are 100? That’s what the SMD should predict based on these and other trials. Yet, to the best of my knowledge there is no trial that has had enough vision to employ the principles of my SMD. But we don’t need another trial to enjoy the benefits. I’m living proof that it works.

NOT TO MENTION THE DEMENTIA DIMENSION

Elevated blood sugar has another tooth and claw. It’s in the form of increasing your risk for neurodegeneration. As you know the Gang of Three is marching across the country like pre-senile Titans delivering dementia and crippling motor neuron diseases in the form of  Alzheimer’s (AD), Parkinson’s (PD) and ALS. Although there may be numerous causes what we see is that in non-diabetics with a glucose level of 115 mg per deciliter as compared with 100 mg per deciliter, the risk for dementia was 18% higher. Among participants with diabetes, the difference in BS between 160-190 mg per deciliter conferred a risk for dementia 40% higher for those with BS in the 190 mg/dl or higher range.[2] Recently AD has been referred to as diabetes type III.

In 2012 the Australian National University found that patients who had high-normal FBS (under 110 mg/dl) suffered a greater risk for brain atrophy in the region of the hippocampus an area responsible for memory as well as other functions. These levels of FBS were responsible for a 6-10% shrinkage of both the hippocampus and amygdala. The lead author reported that chronic exposure to high glucose levels is more likely to lead to poorer brain health and that the data was robust.[3]

MECHANISM OF AGING

Although there are at least a half-dozen “causes” of aging at the biochemical/cellular level, high BS and high fasting insulin level (FIL) will help promote some of these effects. High PPBS surges result in a metabolic cascade that causes cell damage and accelerated aging. One of the mechanisms by which diabetes type II ages people faster is by telomere shortening and mitochondrial DNA depletion.[4] How rapidly one’s telomeres shorten provides a reliable method of assessing the rate of aging.

It’s shocking to think that we are essentially eating ourselves to death. To wit: it is surprisingly common, in fact it’s the norm, for first world people to have poor glycemic control. Several studies involving a total of nearly 60,000 patients found that approximately 80% of the participants had a FBS over 85 mg/dl.[5]

CARDIOVASCULAR RISK

While many doctors won’t flinch if you have a FBS of 100 mg/dl or even 110 mg/dl, studies have shown that any FBS over 85 mg/dl may start to damage delicate cells lining arteries and glycate vulnerable proteins in the body. A study was recently published after 22 years of observation. It showed that when compared to the lowest quartile (the lowest 1/4^th) of FBS values in patients, the highest 25% suffered a 40% increase in the risk for death due to cardiovascular disease.[6] None of these patients in the highest quartile had a FBS over 110 mg/dl. After meal BS surges were even more alarming increasing the risk of CVD, retinal damage and cancer.[7] A 2013 study found that those patients who had a FBS around 110 mg/dl suffered similar risk factors as full blown diabetics (with BS at or above 126 mg/dl).[8]

Ouch! I thought you said it was painless.

I’ll cover cancer risk next and the effects of insulin on the body especially when in excess. In the mean time you can go to the nearest drugstore and purchase a glucose meter which utilizes a tiny fingerstick of blood. It’s painless, trust me I do it all the time, and they are cheap. Later we’ll go over the details.

Tags: FBS, OGTT, Post Prandial Blood Sugar, PPBS

Category: Post Prandial Blood Sugar, PREVENTIVE MEDICINE