Morning everyone!

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. This week I’m going to talk about a recent book I’ve been reading called “The Glucose Revolution” (a fun read suggested by one of our Tuesday night Q&A participants).  

In this book, biochemist & author Jessie Inchauspe, puts into plain words a very complex subject: how GLUCOSE and INSULIN work in the body from a biochemical aspect. Her practical carbohydrate “hacks” are easy to implement and sure to improve your metabolism, prevent illness, lift brain fog, and ultimately help you lose weight. I’ve put into practice a few of these principles and it’s already made a huge difference! 

As you know I’m always talking about sugar, insulin, and things you can do to lower your carb intake. For weight loss I also talk a lot about intermittent fasting and going on a very low carb diet. In the first part of this post, my aim is to help you better understand the various forms of carbohydrates and how glucose and insulin spikes harm your health. In the last part of this post, I’ll mention a few “hacks” that I think will be useful and allow you to eat more carbohydrates than I would normally tell you to eat. 


The Harm Of Blood Sugar Spikes 


Most doctors just check fasting blood sugar levels and Hemoglobin A1C (your average blood sugar of the past 3 months). The problem with that is these two numbers can be normal and you still have spikes in your glucose and insulin levels. 

Note: a glucose spike is a sharp, quick rise in blood sugar levels, followed by a similar decline. These spikes are what causes damage to your body. 

You can have a good average sugar, but if you’re eating the wrong foods in the wrong order you can be getting spikes. The spikes damage the endothelial cells (lining of your blood cells) and also your organs. 

In an earlier DEMO episode of The Common Sense MD, it showed me wearing a Continuous Glucose Monitor for a few weeks. This was an extremely useful exercise for me, especially now that I’ve read this book. Note: the author, Jessie Inchauspe, actually wears one continuously and she’s also not a diabetic! The CGM shows you how your blood sugars are doing. If you were to wear one, you might be amazed at how insulin resistant you are, and the glucose spikes you get after eating and drinking certain foods. If they are spiking they are doing damage, even if you’re not a diabetic. What we want to do is prevent these spikes.

Note:  You can check out my demo here: DEMO: Continuous Glucose Monitor/ Andy Rogers, PA-C/ Outside the Box


The Four Types Of Carbohydrates (From Glucose) 


Glucose is your body’s main energy source. Eighty-eight percent of Americans have dysregulated glucose metabolisms (me included), even if you’re not overweight. Glucose is made from the process of photosynthesis, i.e., when the sun hits plants, the combination of carbon dioxide and water makes glucose. 

Carbohydrates (from glucose) come in four different forms: Starches, Fiber, Fructose, and Sucrose. Starches come from plants. They are glucose molecules linked together. Think potatoes and rice. Fiber is made from trunks, branches and leaves. Think of broccoli and other vegetables. There is very little glucose spike with these. Fructose is two times sweeter than glucose. When you think fructose, think fruits. Plants transform glucose into fructose. They do this to make their fruits taste sweeter so they can spread their seeds and propagate. 

Sucrose is a combination of glucose and fructose. Think table sugar. 

Note: Glucose is necessary and essential to fuel the body. Fructose is not necessary. It cannot be burned by our muscles for fuel. There are some fruits that are good, such as the low glycemic berries. Those are really the main type of fruit I like because they don’t raise my blood glucose levels. 

Fructose turns to fat too easily, and it also doesn’t fill you up. The worst fructose is man-made, high fructose corn syrup. Of all things man-made, this is the worst (besides Covid). Fructose causes glycation, which basically means “browning” of organs and the lining of your blood vessels (endothelium). This is damaging! In fact it’s 10 times more damaging than glucose to your body. Think free radicals, oxidative stress, and inflammation, which is the root of all disease. 

The other thing about fructose is you can’t measure it. When you wear a CGM it doesn’t measure fructose, which is a lot more damaging than the glucose spike that you can actually see. You can measure insulin and glucose spikes and assume that when you get glucose spikes you’re going to get fructose spikes as well. With food, sweetness is nature’s most sought after taste. We all want sweetness. You even get a hit of dopamine (the reward hormone) when you eat sugar. 

If there was no glucose in our diets, our body would make its own glucose. It’s not photosynthesis like plants, but our liver can make it from proteins and fats. This is called Gluconeogenesis. Gluconeogenesis could also be called metabolic flexibility. That’s kind of how ketosis works. Extremely low carb intake pushes the body into burning fat. The problem is that most people can’t stay in ketosis. It also can affect the thyroid. I don’t recommend it long term. It’s also just not practical for most people. 

Note: You can survive without carbohydrates because our bodies can produce it. You would die without fat or protein. 


Insulin and Glucose 


The hormone INSULIN, secreted by the pancreas when glucose is in your bloodstream, stashes excess glucose into storage units in the body keeping it out of circulation where it causes glycation and damage to our organs and blood vessels. Insulin stores glucose in the liver (think fatty liver) and muscles (think energy and movement). 

The problem is that once it’s all stored (if you’re eating too many carbohydrates and glucose in all forms except fiber) then you have more glucose coming in and it turns to fat, plain and simple. Fat on your hips, thighs, belly, face, and in between your organs (which is visceral fat). 

Note: Visceral fat is the worst kind of fat.

You need your insulin levels to be low. If they are elevated you’re going to be hungry all the time. There are lots of things you can do for this, including some medications, which we won’t talk about in this Note. 


Carbohydrate Hacks 


Think about what sugar spikes can do to your body. It makes you feel bad when you eat sugar by itself. It makes you exhausted, gives you brain fog, cravings, stress, dizziness, sweat, nausea, and palpitations. You can get in a poor mood (think of the term hangry) because you’re craving sugars. This is because your insulin levels are spiking!

Constant hunger is a symptom of high insulin levels. It messes with your hormones that control your metabolism, like leptin, which is the hormone produced by the gut to tell you you’re full. It also affects ghrelin, the hormone that tells you you’re hungry. Those signals won’t work efficiently any more. You have dysregulation going on and you’re going to store fat. All kinds of diseases are caused by this. 

Cholesterol is not a villain. In most all diseases, Insulin and glucose are the villains. We need to focus more on that instead of cholesterol (which we know doesn’t cause heart disease). Cholesterol doesn’t cause heart disease, although certain lipid particles can cause plaque. Excess glucose is the real problem. 

Excess glucose can cause: 

  • Heart Disease
  • Cancer
  • Alzheimer’s (Type 3 Diabetes)
  • Gut problems 
  • Depression
  • PCOS in women 
  • Diabetes 

Here are some hacks to avoid these harmful glucose, insulin, and fructose spikes. You have every reason in the world to do these hacks and blunt that glucose, fructose and insulin spikes that do damage. 

HACK #1 The first hack is simple. Eat less carbs and more fiber. 

HACK #2 Change the order in which you eat things. 

You want to eat fiber first, and then protein and fats. The last thing you should eat is carbohydrates. Eating fiber first decreases the action of amylase, which breaks down your starch into glucose molecules.  It also decreases gastric emptying and creates a mesh that makes it harder for glucose to go straight into your bloodstream. 

Eat your meals in this order: 

  1. Vegetables
  2. Proteins and fats
  3. Carbohydrates  

HACK #3 Intermittent Fasting 

This is the timing in which you eat. I personally do this almost everyday. Doing this allows you to eat some carbohydrates during the window you eat and tolerate them better. I try not to eat after 7PM and I only consume black coffee and water before lunch the next day. 

HACK #4 Apple Cider Vinegar 

After reading this book, I’m understanding how apple cider vinegar works. I knew it was good for you, but just didn’t realize how good. You can use apple cider vinegar for all kinds of things, especially the gut and arthritis. It also blunts down glucose and insulin spikes. 

Here’s the hack: About 10-20 minutes before a meal, put 1 tbsp of apple cider vinegar into an 8 oz glass of water and drink it. The acidic acid in this deactivates amylase (remember amylase breaks down starch into sugar quickly). This slows down the glucose that gets into the bloodstream. It also makes your muscles work better. It actually tells your DNA to reprogram so your mitochondria burn more fat. Apple cider vinegar works well before, during, or after a meal. Ideally, take it before the meal. 

There were a few small (but interesting) studies around apple cider vinegar. In one study they took a group of people who ate exactly the same thing. One group took apple cider vinegar before they ate and the other did not. The people that consumed apple cider vinegar before lost twice the weight as the other group and also lost more inches. 

There was another very small study with women who had PCOS. When they put these women on apple cider vinegar, 4 out of 7 got regular periods back. I really wish they did a bigger study on this because I see a lot of patients in my office with PCOS. It is a tough disease.

HACK #5 After you eat a meal, MOVE. 

When you ingest glucose it can go one of two ways. If you’re sedentary it turns to fat, and if you move, it burns off. Just 10 minutes of walking after a meal can really help. You can do this up to 70 minutes after a meal and it will still help. The same thing goes for resistance exercise. This will help you burn even more fat after you eat. You can do simple body weight exercises for 10 minutes like air squats. Doesn’t have to be strenuous. 

Note: the combination of apple cider vinegar before a meal and moving after a meal is ideal. 

HACK #6 Don’t eat “naked” carbs. 

“Naked” carbs are carbs that don’t have anything else around them, like protein or fat. By themselves they are going to spike your sugar and insulin. 

Note: Adding fat to a carb does not raise insulin levels, contrary to popular belief. Remember, fats are good! They burn energy more efficiently than carbs or even protein. I like good healthy fats for the majority of your meal. 

These are some “hacks” you can do that will allow you to eat more carbs. I hope this helps you in your journey to stay fit and lean, keep your brains working well, and prevent inflammation. Till next week.