About 1 in 10 Americans are diabetic (diagnosed as fasting glucose >126), and some 95% of those have Type 2, or insulin resistance diabetes. In 2020 about 38% of all adults in the United States were prediabetic, defined as fasting glucose between 100-126. Other related parameters to watch for include fasting insulin, and hemoglobin A1c.
What’s going on here?
The Standard American Diet
Of course we have to start with diet. Actual sugar consumption may be on the relative decline, but other sweeteners compensate, keeping our national intake of caloric sweeteners quite high. This study further shows that among 2-18 year olds, 40% of calories were “empty,” or simply processed macronutrients (fat and sugar) with no micronutrients.
Sugar is very addictive, of course. So that’s certainly part of the problem. White (or highly processed) carbohydrates count in this category too. They’re ubiquitous, they’re cheap, and they can help blunt unpleasant emotions, at least in the short term. Also, everybody else is doing it—“and they’re all doing fine, right?” (Well, no they’re not, but that’s hard to tell if all you’re seeing is their highlight reel on social media.) No wonder it’s a hard habit to break.
If this is you, consider a short fast or intermittent fasting to hit a reset button on your cravings, as well as to improve glycemic control, aid weight loss and decrease both insulin and hemoglobin A1c.
If the problem is emotional, a short fast may still help… but you might have some deeper work to do, too. This podcast interview is a great place to start.
Empty Calories = Low Micronutrients
Another problem with the empty calories mentioned above is the fact that they don’t contain the vitamins, minerals, antioxidants, and essential fatty acids necessary for all of your body’s physiologic functions.
A multivitamin, antioxidant, and essential fatty acid supplement are all a good choice to start, as well as a probiotic, as a healthy microbiome is also very important for blood sugar regulation. (Once upon a time, we could get all we needed from our diets, but alas, I believe that time has passed.)
Caloric Mismatch = Oxidative Stress
The food you eat and the air you breathe go through several biochemical pathways before they enter your mitochondria, where they are ultimately destined to become ATP, your body’s energy currency. But there’s a delicate balance between the ATP produced, and the amount actually required for use. Healthy mitochondria should efficiently flip a switch, as it were, to release any unneeded calories as heat (this is how brown fat works). Even the healthiest mitochondria aren’t 100% efficient at this, though—some 4% of the raw materials will leak out into the surrounding tissues, creating “endogenous” (produced inside the body) free radicals, or oxidative stress. (This is in fact where the bulk of our oxidative stress comes from, and the mitochondria take the brunt of it.) Healthy mitochondria can handle this, if there’s a close match between the calories coming in and energy needed.
But even healthy mitochondria might have a supply-and-demand problem, if there’s way more calories coming in than demand for ATP. They may not be able to “throw open the floodgates” (the uncoupling proteins, that is) for sufficient heat dissipation to compensate. This means more leakage of electrons into the surrounding tissue, increasing oxidative stress.
Among other things, this can lead to decreased insulin sensitivity (since insulin signaling requires healthy cell membranes). Ultimately this can cause elevated blood sugar, insulin resistance, and metabolic syndrome generally.
What this means is just this: don’t overeat, and move your body regularly.
But, even if you’re doing this, your mitochondria might be damaged, and thus inherently less efficient. There are a number of possible causes for this, but if you suspect it, the first thing to do is to find out if your mitochondria are compromised and go from there. My favorite test for this is the Urinary Organic Acid test, as it includes a number of mitochondrial markers.
Stress Increases Glucose Levels
Your main stress hormones are cortisol and adrenaline (norepinephrine and epinephrine). In acute stress, the latter two will trigger release of glucose from the liver, as you flee or fight for your life (or just feel like you do, as the case may be).
Then cortisol has to take over. Cortisol decreases insulin sensitivity so that blood sugar doesn’t fall too precipitously.
This isn’t a huge deal if it’s only occasional. But if it’s chronic, it can perpetuate elevated glucose levels, even if you’re eating perfectly.
How’s your stress management? I’d highly recommend identifying and cultivating strategies that work for you. Here’s a few ideas to get you started.
Keep in mind that stress isn’t always necessarily negative emotions. Positive emotions can be stressors too. So can physiological causes, such as surgery, an accident, or chronic inflammation. If you feel like your stress management is dialed in already, I’d first check with your loved ones to see if they agree (you might be surprised). If any of the physiologic causes seem likely, it might be worth checking your neurotransmitters and stress hormones to see if they’re playing a role.
It would be nice if elevated glucose had a simple, straightforward cause. Alas. If you’re “doing everything right,” and your blood sugar is still too high, it might be time to start digging deeper: looking at micronutrients, stress hormones, mitochondria, and then possibly potential toxic insults to find and eliminate.
I said simple… not easy. But you can do it!