#78 - Glucose spikes are normal physiology!!! Drs Nicola Guess and Jonathan Little
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- čas přidán 5. 08. 2024
- Dr Glenn McConell chats with Dr Nicola Guess from Oxford University, England and Professor Jonathan Little from the University of British Columbia, Canada. Nicola is a dietitian researcher with many years of expertise including the importance or otherwise of glucose “spikes” or excursions and the pros and cons of continuous glucose monitor use. Jonathan is an expert on exercise metabolism who is coming onto the podcast for the second time after speaking previously and ketone diets and exercise. This is the first time there has been a double header in the podcast. A major point that came out is the difference between having chronically elevated glucose levels such as in diabetes versus having normal increases in glucose in response to a meal. Having chronically elevated glucose is indicative of underlying pathology, while normal increases in blood glucose (spikes) after a meal is normal physiology and not of concern. Also increases in glucose before and during very intense exercise is normal physiology as well and not of concern. There was also a clear message that the use of continuous glucose monitors (CGMs) have both pros and cons and that need to be considered. A very interesting chat. Twitter: @DrJonLittle. Instagram: dr__guess. Glucose spikes are normal physiology!
0:00. Introduction and welcome to Nicola and Jonathan
3:20. What are glucose “spikes”/excursions
4:45. Hyperglycemia in diabetes is very different to “spikes”
6:20. Glucose spikes in type 2 diabetes
7:19. Why is chronically elevated glucose a problem?
12:20. Confusion about glucose levels 2hrs after a meal
15:29. Underlying insulin resistance is the problem not spikes
19:08. Fasting glucose and insulin measures and the liver
21:10. Meal tests and oral glucose tolerance tests
24:55. Being careful not to make the underlying pathology worse
26:15. Keto diets: type 2 diabetes vs weight loss vs exercise
32:10. Glucose even in diabetes is not as important as we think
35:00. Are continuous glucose monitors (CGM) useful?
38:30. Too much focus on glucose than more important things
41:00. CGMs very important for people with T1D
42:05. CGMs and anxiety
43:25. Some people on CGMs have higher cholesterol
44:00. Misunderstanding of pre-diabetes re CGMs
46:00. Metabolic flexibility in response to what eat
47:40. “Nervous normals”
49:42. Is how one loses weight important?
53:41. What about CGMs in type 1 diabetes?
54:15. Do CGMs result in favorable changes in behavior in T2D?
56:33. CGMs, diet, behaviour change and exercise
57:40. Glucose metabolism during exercise
59:55. Exercise and insulin sensitivity
1:02:15. Effect of exercise on glucose spikes from a meal
1:04:10. Intense exercise can increase blood glucose levels
1:07:10. Normal to have elevated glucose after intense exercise
1:09:50. Influencers misinterpreting data re glucose spikes etc
1:12:10. Misunderstanding glucose cut offs
1:13:10. Takeaway messages etc
1:14:00. Weight loss diet strategies
1:17:50. Amino acids and insulin secretion
1:24:40. Should everyone use CGMs?
1:26:30. Keep it simple re diet and exercise
1:27:40. Outro
Inside Exercise brings to you the who's who of research in exercise metabolism, exercise physiology and exercise’s effects on health. With scientific rigor, these researchers discuss popular exercise topics while providing practical strategies for all.
The interviewer, Emeritus Professor Glenn McConell, has an international research profile following 30 years of Exercise Metabolism research experience while at The University of Melbourne, Ball State University, Monash University, the University of Copenhagen and Victoria University.
He has published over 120 peer reviewed journal articles and recently edited an Exercise Metabolism eBook written by world experts on 17 different topics (link.springer.com/book/10.100....
Connect with Inside Exercise and Glenn McConell at:
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Not medical advice - Věda a technologie
I used a CGM for a month after a HbA1c blood test indicated pre-diabetes despite complete absence of risk factors. I made no change to diet or lifestyle and the CGM results were normal to low average glucose levels, post meal and post excercise spikes as you described (with levels retuning to normal within 30-60mm). A subsequent glucose tolerance test returned a normal result. Doctor concluded the HbA1c result should be ignored (possibly thrown off by my steroid inhaler). I wonder how often people are steered int he wrong direction by potentially erroneous HbA1c measurements?
That’s interesting. I’m not sure. Thanks.
Confused the heck out of me. When Insulin is higher and longer than other people then it is Type 2 diabetes. When the pancreas is not secreting Insulin for glucose presence meaning there is a deficiency of Insulin, it is Type 2 diabetes. Which one is really Type 2 diabetes, or is it both conditions?
From someone that used one for 14 days, I'd say make them cheap as chips and it should / would... not only benefit the end user, but could save the health care system spending millions on treatment.
Prevention is always better than the cure.
Thank you for uploading and sharing.
Dr McConell. Excellent discussion. I want to recommend someone on youtube I know you will like. His name is Mario Kratz. He holds a PhD and specializes in diabetes, I think. His channel is Nourished by Science. He's a carb guy. He discusses how to eat carbs and how to use and avoid using CGMs, and much more. BTW, I hope you are running now! I just saw your chat with Dr Davis. She is amazing! I wish she were my coach 15 years ago. I also have a chronically sore left calf. And a weak right hip. So many mistakes. So much I didn't know. So much I will never know. She had it right: keep young people out of the cushy high-heeled running shoes.
As usual grateful you do these!
A wonderful contribution with outstanding knowledge from experts. This is so important in today's world full of so-called experts! Peter Attia has now corrected himself many times (Metformin, fasting, low carb, ZONE2 etc.). On the one hand commendable, on the other hand a dangerous thing. As confidently as he proclaims everything, it is just as dangerous when he retracts a lot of things... Thank you very much!
I agree, Perter Attia and Rhonda Patrick are always saying they can make you live longer even though they do give some good advice in the videos but quoting good science to support your click bait claims is just wrong. Take it all with a grain of salt.
Strong opinions, weakly held.
Thanks, all. Another great episode, Glenn.
Thanks for doing these podcasts, really helpful and much appreciated. Interesting critique of Peter Attia too!
Excellent and informative. Both interviewees were really helpful. Thanks
There's also the "Mastering Diabetes" way of eating, where the fat (especially SFA) is reduced to under 10% of one's diet, and then carbs can be eaten in large quantities with great insulin response and sensitivity. Many people have reversed their type two , while type one have been able to substantially reduce their insulin dosage.
so are you one that practices their method ?
awesome i really liked Jonathan little on last time and Nicola Guess from other things.
I'm type one the only way to control my blood sugars is low carb/mostly carnivore. But I cringe when people who don't know what it like to have the problems of someone who been type one for 28 years and tries to say you are depriving yourself, like the lady says 'cutting out all the foods you like'. Well I would like to correct her and re-frame that as 'all the food you are addicted to' around 44:50. For me the bottom line is you either limit your diet or limit your life by going blind or having your feet cut off. There is no way to having your cake and eating it as far as I can see, and being able to see is more rewarding then pigging out on processed crap. By our very nature eating carbs inspires gluttony, and trust me it not a good look either and can lead to mental illness especially if you avoid animal fat.
I would think a CGM might be reassuring to see a normal glucose spike (if informed) and also seeing how fiber reduces spikes without trying to cut back on carbs.
I like Nicola and loved her closing comment
Tim Noakes would disagree about the need for carbs for exercise. He has done a 180 degree turn from his earlier view.
Subscribed!
Very useful👍
@@TheWolfAkella Good to hear 👍
So when you go very low carb, you are less able to controle bloodsugar when eating carbs.
But what about bloodsugar made by the liver. Is it likewise more difficult to take up by the cells. Will your fasting bloodglucose go up as a result? If so, does your fasting insulin also go up as well?
We need a summary. Confused the heck out of me. When Insulin is higher and longer than others people then it is diabetes. When the pancreas is not secreting Insulin for glucose presence meaning there is a deficiency of Insulin, it is diabetes. Which one is really diabetes, or is it both conditions?
What if healthy person starts using exagonus insulin just to prevent his beta cells from "burning"? In bodybulding this is very common practice, because of the use of HGH, but still.
Wow that’s pretty messed up. I wasn’t aware of that.
I take protein powder because I dont what to eat that many meals but I want to spread the protein intake out over the day so I have 25g first thing in the morning and believe it or not I sometimes use it as a coffee creamer with coco powder and heavy cream like a frappuccino before a 6 hr hike at 5am. It tastes REALLY GOOD.
But when i was young I could exercise on a full stomach but now I get acid reflux.
I like the keto like hacks of turning coffee into a some form of superdense food with cream and protein powder.
Layne Norton did some research protein through out the day to prove he was best with 6 meals a day as powerlifter. Then he found out it did not matter. A good example of the type of person you want testing a null hypothesis, then again only 1 study.
@@bobo-cc1xw I started spreading my protein intake out 3 times a day when Glenn McConell and one of the guests on this channel said it should be done. I don't always remember to do it but I try. I generally only eat once or twice a day.
👍👍
The assertion I hear repeated in this discussion about people reducing their intake of healthy carbs, in response to elevated glucose detected by their cgm, is so ridiculous to me. What percentage of the western population is getting their spikes from healthy carbs like veggies and fruits and pulses? Versus, what percentage is getting their spikes from flour based and refined sugars based processed foods? Let's be real.
Jessie Inchauspe (aka the Glucose goddess) could add much to this conversation. It would be interesting to hear you interview her as well.
Good discussion. Why are you whispering though? Lol
I find it amusing that when Nicola critizices Peter Attia's interpretation of a study on glucose, she so completely butchers the description of what the study did that I have no idea what she is saying. It just goes to show how easy it is to misinterpret what someone else is saying on a podcast and judging them as "utterly misguided at best". Come on, do better.
I understood what she was saying.
@@4plum Check out 1:10:57 where she describes the study Peter apparently misinterpreted. She says "they did is gave people 5 mmol/liter..." without specifying WHAT they gave. Did they inject glucose? Did they give them a carb shake to induct that glucose concentration? It's just impossible to understand what she supposedly does not agree with.
Can someone please explain is this is good or bad
I can get blood glucose spikes of 190 45 mins after eating raw honey or other things at times
My fasting insulin is 3
I was vegan for 9 years and my A1c was always 5.4
I went animal based for the last 4 months and my A1c went to 5.7
Should I be working about them blood sugar spikes if my fasting insulin stays good?
My sugar doesn’t spike like that all the time, mainly in the morning when I eat honey and raw dairy
But it has happened durithe day at times, but not often
A professor who can't pronounce etcetera is somewhat concerning.
The demonising of potatoes is probably due to the glycemic index.