On Glucose, Cheesecake and Health (really!)

Part 1 of 2 looking at tools for a better diet.

Today, I am going to venture into new ground with my Substack. I still think it remains true to the Quijotesco brand. What could be more in the spirit of tilting at windmills than the topic of diet and fitness?*

For the first of two parts, I would like to introduce my co-conspirator in glucose, Allison Fox. Allison is a nurse practitioner and fellow traveler on the long and winding path of fitness. Over Twitter, we hatched the plan of an experiment in the name of Science: we would wear continuous glucose monitors (CGM) to see if a greater awareness of our by-the-minute blood sugar readings would promote better eating, lower blood sugar, and, ultimately, fitness.

We proposed this idea to some fellow travelers on Twitter, and it went something like:

“We’re going to do this awesome experiment where we wear a continuous glucose monitor for three months! Who’s with us?!”

“...”

“Mmmm…okay.”

So it was just us. 

Before I turn the keyboard over to Allison, I want to preface: neither of us has diabetes, and we want to be respectful of the struggle of those who do. If I learned nothing else, it is that having my health depend so much on the ups and downs of a device would be a challenge. 

Type I diabetes, the type that usually begins in childhood, very commonly ends up requiring a CGM to manage insulin. There is no way to use diet and exercise to prevent that illness. Type II diabetes is another matter. It is exploding in incidence, and that is primarily driven by obesity and overeating generally. Type II diabetes can be improved and, in some cases, eliminated by maintaining a healthy body weight. I hope that one lesson from this experiment can be that there are things many of us can do to prevent or reverse type II diabetes.

About the CGM: It is a pretty unobtrusive device. You can wear it on your arm or along your waist, and it pairs with your phone via Bluetooth to give you a measurement of your glucose every 5 minutes, as well as an indicator of whether it is headed up or down. Here’s a photo from the manufacturer website:

Over to you, Allison.

Thank you, David.

A little of my background for reference: I’m 46, HgA1c is 5.1 (average glucose for 3 months). That correlates to an avg glucose of ~100. Not bad, but could be better. BMI isn’t a great indicator of health however mine is 20.5. I’m healthy and moderately active. I go to the gym, I rock climb, I do cardio. I try to move my body every day. I mention this because I had no idea I would see the swings in my glucose that occurred over these 3 months.

Before this experiment, I suspected I had some level of glucose resistance, but it never showed up in my labs. A1c misses the highs and lows of glucose on a day-to-day basis. 

My goals from #ExperimentCGM:

-Kick David’s ass

-Eliminate energy crashes 

-See objective evidence to face my sugar addiction

I considered wearing a continuous glucose monitor for years but they were out of reach financially for me. They’ve finally come down in price the last few years, and I was thrilled to have a buddy along for the ride.  We both ordered our devices through Levels, there was an annual charge of $200 and each month you used the CGM there was an additional charge of $200. Getting it ordered and set up was easy, even if you are low-tech. 

The first few days I was on a roll for perfection, eating foods I knew wouldn’t spike my glucose. Omelets with cheese, high protein and low carb meals. This was easy! I made it 3 days before my sweet tooth kicked in and my regular eating habits returned. My first spike was eating a high protein GF cereal with oat milk. My glucose was well under 100 and I watched it jump up to 180 over the next 30 minutes. WTF. I thought oat milk was healthy? After the spike came the crash along with an energy dip and the slightest of headaches.

Back to David

I remember that moment (mostly because up until that point Allison had been winning the CGM battle). So, when I saw that she had this big spike, I knew it was a good time to offer support. It was no big deal, and with constructive feedback she’d get back to healthy eating. As a kind and helpful CGM buddy, of course I was supportive of Allison in her effort. 

Hahahaha. Sure, that’s what exactly happened. Yes, turns out that anything measurable can be made into a competition. And you can turn any competition into an opportunity for trash talk.

But I got it out of my (admittedly juvenile) system, right?

Well….

So, yes, there were some lighter moments.  

But then I learned that she was actually not, in fact, binge-eating junk but dealing with some pretty significant stress. Not only did this demonstrate an adage that “the failure mode of clever is asshole,” it illustrated an important point that would recur: your blood sugar is influenced not just by what you eat, but by many other factors. Including stress.

I have my own demo of this phenomenon recently during travel. As per my usual, I waited until the last minute, so the journey to the airport gate was more stressful than it needed to be. Notice the rise in glucose, even though I was fasting that morning. I will return to this in the summary, but the important point is that stress doesn’t just influence our eating patterns, it affects what our bodies do with the food that we eat, and even raises blood sugar with no food involved.

Allison, here. While I know stress has an impact on health, seeing an objective change in my reading within 15 minutes of being anxious was surprising. My glucose soared nearly 100 points with barely any food. That stress reaction, or cortisol spike feels unavoidable at times. Exhaustion after adequate rest, muscle tension, headaches, GI distress and even irritability can all be consequences of high stress hormones (cortisol). The “tired but wired” feeling when we stay up late (damn you, fomo!) then can’t get to sleep. The list is pretty endless. Not surprisingly, cortisol contributes to weight gain and the inability to lose weight.

Ok, time to share some pearls I learned from wearing the CGM:

Pro Tip #1: Food pairing helps

More cheesecake, please.

I’m hedonistic. I want what I want, and I had to come up with a solution for my sweet tooth early on. Was there a way to have dessert without blowing this competition? When mango licorice bumped my glucose to 230, I decided I needed to pair my sugar with fat and protein to slow the spike. 

Would cheesecake work? 

Could I taunt David with pictures of cheesecake and maintain a glucose of 100? 

SCORE. It worked, friends. Cheesecake would occasionally spike my glucose to 115. Once I spiked to 130 when I had tons of sugary toppings on it, but overall it was fairly glucose neutral. I also experimented using a GF pancake mix that was very high in both fat and protein. Even with a ton of maple syrup on the pancakes, my glucose was stable.

Take away: if you want to indulge, consider adding a hard boiled egg or two as a snack beforehand. Or have something that won’t break down as only carbs in your system. 

Mango licorice will always be evil moving forward though. RIP, delicious.

Pro Tip #2 Exercise cures everything 

Regardless of how careless I was with my diet, a short walk was a panacea. Glucose 145? Brisk 15 minute walk would have me back at 80. 

Like most people, I don’t want to move after a meal, particularly a large meal. When I went for a walk, my glucose would normalize and stay down until my next meal. I’ve tried to stick to this habit as much as possible, even if it’s doing something around the house for 10-15 instead of sitting on the couch after a meal. If I eat chocolate or fruit, I try to do so before a walk.

Alternately, when I went to the gym to weight train, my sugar remained stable despite being fasting. Once I dipped to 65 briefly, but within 5-10 minutes my glucose stores kicked in and I was up to 85 or 90. 

Pro Tip #3 Glucose control matters, but it is not the same as weight control

David here. As opposed to Allison, my can’t-stop-won’t-stop foods tend to be salty and fatty. Hello, Mr. Peanut. So while an egg and cheese omelet with sausage is a meal that doesn’t even cause a blip on the CGM, if you overdo it, then throw down a few handfuls of nuts as a “snack”, before you know it, you’ve overeaten. Lesson: food choices matter for blood glucose, but if you eat too many fat and protein calories, regardless of what the CGM is showing, you still gain weight.

Bonus Tips: Things that make the CGM go Hmmmm.

Alcohol can have a counter-intuitive effect. Essentially, your liver treats alcohol like poison (granted, a tasty, tasty poison) and drops everything else it’s doing to get rid of it. You may notice no change or even a drop in blood glucose when consuming it.

There is device-to-device variation, actually as much as 20%. The device tends to settle after the first 24 hours, but the baseline for some monitors is higher (which prompted Allison to call one of hers an “asshole” if I recall). Of course we both believed the ones with lower values were the “accurate” ones.

They can be positional. I rolled over on mine during sleep and it stopped getting a good reading. It looked like I had flatlined. If you are not using this to manage actual diabetes, consider adjusting the alarms or turning of Bluetooth at night to avoid a 3am wake-up.

Final thoughts:

In the end, I thought this was a useful exercise that showed the benefits and the limits of wearing a monitor. If there is a way you can finagle one from your primary care, or if you can afford one as a health splurge or with expiring FSA money, I recommend doing it once as a tool for health self-education. Final advice if you do:

1. Eat your regular diet for the first thirty days. The goal is not, at least initially, to use this as a diet aid. I think the better use is to see what your regular food choices do to your glucose. There is enough person-to-person variation that I think it’s better to see for yourself what works and what doesn’t,

2. Take copious notes. In my opinion, the goal of the CGM is not to have this constantly in your life, but to learn and apply some lessons to your diet choices. 

3. If you find out you are having regular high spikes, seek care from your primary care provider. Again, my opinion, but the US healthcare system gets very interested in you once you develop diabetes, but that is downstream from most likely years of gradually worsening glucose control. Intermittent high spikes won’t necessarily show up in your annual screening, but if you wait until the diagnosis is obvious, you’ve probably already had negative health effects.

I hope this has been informative. Hit me up in the comments if you have questions.

*Disclaimer: this is for informational purposes only and may not be appropriate or applicable for your individual circumstances. The Services do not provide medical, professional, or licensed advice and are not a substitute for consultation with a health care professional. You should seek medical advice from a qualified health care professional for any questions.