The Role of Blood Sugar
The body operates on blood sugar, especially the brain. In other words, our brain needs sugar to work. Therefore, the body is very concerned about trying to control the level of blood sugar. If the blood sugar gets too high—greater than 200 mg/dl—a patient can begin spilling sugar into the urine, and simply not feel well. If it gets too low—less than 40 mg/dl—a patient can become confused, lethargic, have a seizure, and even go into a coma.
This truth became very evident to me on my very first day of my clinical experience in the surgery floor at the VA hospital in Denver, Colorado. I was a third year medical student and definitely wet behind the ears. I had only been there for three hours when the nurses came running down the hallway yelling for me to help them give a patient some sugar intravenously. Apparently, a patient who had just come out of surgery, had been given too much insulin and his blood sugars had dropped so much that he went into a very deep coma.
As I was running down the hall, they placed a huge syringe in my hand filled with glucose, which I was supposed to give this man intravenously. This was going to be a trick, since I had never given anybody anything intravenously before. The first two years of medical school are pretty much spent in the classroom with absolutely no patient contact. This was the very first day of my training in the hospital for being with any kind of patient. Needless to say, I was not exuding much confidence.
When I arrived at the patient’s bedside, he was cold, clammy, and in a very deep coma. My hands were literally shaking as I was able to get the needle into a vein and draw some blood back into the syringe. I then began shooting some of the glucose into the vein. I had administered about 10% of the glucose into the blood stream when I decided to look up to check out the patient again. To my disbelief, the patient was looking at me eyeball-to-eyeball and said, “What in the world are you doing?” I couldn’t believe my eyes! I had barely given him any sugar at all and he was completely alert and questioning me rather directly. I will never forget that experience as long as I live and I will definitely remember that our brain needs sugar in order to work.
Insulin – Our Storage Hormone
Insulin is a hormone, which is produced in the beta cells of the pancreas. The beta cells of the pancreas release stored insulin (first phase release) and produces more insulin (second phase) if it is needed. Even the smallest rise in blood sugar following a meal stimulates the release of insulin from our pancreas. However, if our blood sugar rises rapidly, the amount of insulin that our pancreas releases is tremendous. Again, remember the body needs to control blood sugar in a very tight range. It is also known that the release of insulin is stimulated by protein in our diet but not by fat.
Insulin’s primary duty is to control this rising blood sugar by facilitating the transport of blood sugar from the blood stream into the cells that are responsive to insulin’s actions. These are primarily the muscle, liver, and fat cells. It is interesting to note that the brain does not need insulin to get the glucose it needs, since glucose readily passes into the brain on its own. Insulin attaches itself to specific receptor sites on the surface of the muscle, fat, and liver cells. Insulin then attracts glucose-transporting proteins (i.e. GLUT 4) which literally takes the glucose and transports it to the area of the cell where glucose is needed and used. In muscle, glucose may be used for glycogen production (stored as a quick source of sugar) or may be used directly for fuel.
In the liver, insulin shuts down the liver’s production of sugar. In fat cells, insulin enhances the conversion of glucose into fat (lipogenesis). This becomes a very important fact when it comes to learning why you can’t lose weight. Especially when you realize another action of insulin is to shut down the breakdown of fat (lipolysis). In other words, these higher insulin levels create an environment that not only readily changes sugar to fat but it also holds on to that stored fat like a sponge holds on to water. Remember, the body thinks and lives on blood sugar and the level of sugar in our blood stream must be maintained in a very narrow range.
Glucagon – The Fat Releasing Hormone
One thing that you learn in medicine is the fact that there are always two sides to every regulatory system. The opposite of insulin is glucagon. Glucagon is produced and secreted from the alpha cells of the pancreas. Secretion of glucagon is stimulated by the intake of protein in our diet and suppressed by the intake of carbohydrates. Therefore, when we eat a lot of high-glycemic carbohydrates in a meal, insulin levels begin to rise very rapidly and glucagon levels are suppressed. If you eat a balance of protein and low-glycemic carbohydrates in a meal, insulin levels will drop and glucagon levels will rise, which allows these two hormones to remain in balance. Fat does not have a stimulatory affect on either insulin or glucagon.
The major affect of glucagon is on the liver where it stimulates the release of glucose. However, it also stimulates the release of fat (lipolysis) so that it can be used as fuel—it is your fat-releasing hormone. Normally, it is very important to try to keep insulin and glucagon in balance or what Barry Sears has popularized “The Zone”.
Events Following a High-Glycemic Meal
You will become familiar with the terms high-glycemic and low-glycemic carbohydrates in a future training article. Remember, foods like white bread, white flour, rice, and potatoes are absorbed into our blood stream very rapidly and cause our blood sugar to spike faster than if we were slapping table sugar onto our tongue. These carbohydrates are referred to as high-glycemic. Foods like beans, legumes, apples, and cauliflower release their sugars very slowly and therefore are referred to as low-glycemic carbohydrates. We now need to look at what happens following a meal that is primarily made up of high-glycemic carbohydrates.
Events Following a High Glycemic Meal
Following the ingestion of a meal primarily made up of high-glycemic carbohydrates, our blood sugar begins to rise very rapidly. This rapid rise in blood sugar, as you have already learned, stimulates the release of a large amount of insulin and in turn significantly suppresses our glucagon level. The high levels of insulin now drive the sugar into the muscle, liver, and fat to be utilized, stored as glycogen, or stored as fat. It is important to realize that it does not take much glucose to completely fill up our glycogen stores in the liver and muscle.
This means that almost all of the glucose following a meal is stored as fat. Insulin also causes the liver to quit making glucose, since our blood sugars are already too high, and causes the fat cells to quit breaking down fat (lipolysis). The blood sugar begins to fall almost as rapidly as it increased. In fact, it will usually fall well below the fasting blood sugar level into what is known as a hypoglycemic range (low blood sugar).
The body then panics because it must get the blood sugar up to protect against the consequences of very low blood sugars. Because of the rapid rise in blood sugar our body simply overproduced insulin and now has over shot its mark and the blood sugars have actually become too low. This triggers the release of what are known as counterregulatory hormones. There is a release of glucagon, epinephrine (adrenaline), growth hormone, and cortisol. This is known as a counterregulatory response and its primary purpose is to get the blood sugar back up to acceptable levels.
These hormones stimulate the release of glucose by the liver and breakdown of fats from the adipose (fat) cells. However, even though the blood sugar eventually returns to normal and most of the time even higher; our body simply craves more and more food (hyperphagia). This entire cycle actually produces an “uncontrollable” hunger. This state of hyperphagia or desire to eat more food is actually very prolonged following an episode of hypoglycemia. Usually these people crave another high-glycemic meal and this vicious cycle starts all over again.
The rapid absorption of glucose following the consumption of a high-glycemic meal challenges the normal hormonal responses, complicating in effect the body’s transition from a fasting state to a postabsorptive (postmeal) state. The resultant high insulin-to-glucagon ratio exaggerates the insulin action and significantly more glucose is stored as fat. If this is not bad enough, when these individuals then become hypoglycemic their hunger is literally out of control and studies have shown that they eat 80% more calories during the rest of the day when compared to individuals who have eaten a normal, low-glycemic meal.
This is the main reason that sugar and high-glycemic carbohydrates are so addictive, which I refer to as “The Carbohydrate Addiction”. Your body desires to control blood sugars and when they get too low (hypoglycemia) your brain sends out these counterregulatory hormones, which slowly bring up the blood sugar. However, at the same time, these hormones create an overwhelming urge to eat more and more food (hyperphagia).
This is not a very pretty picture. Not only does eating the typical American diet cause us to store more fat but it also causes us to eat more and more calories than we should. You can easily imagine that you may feel good for 20 to 30 minutes as your blood sugar is peaking but it comes down again so quickly. Since our brain thinks on blood sugar, it is going to do everything it can to get you to eat more so you can raise this blood sugar again. This is the main reason so many people fail when they try to diet.
The low-fat, high-carbohydrate diet will spike our blood sugar, which results in our blood sugars rising quickly and then falling rapidly into these hypoglycemic ranges. You are trying to eat less and less food to lower your caloric intake only to find that you have this tremendous craving for more and more food. You quickly become discouraged because you simply feel that your will power is not strong enough. In reality, you are just being set up for failure because of the body’s natural response to this type of diet.
Events Following a Low-Glycemic Meal
It is very important to compare what transpires when an individual eats a meal that consists of low-glycemic carbohydrates, instead of a high-glycemic meal. Again, this would be eating things like fresh fruits, vegetables, and whole grains along with some good protein and good fat. Well, the blood sugar rises slowly stimulating the release of insulin and glucagon in a much more normal physiological manner. Following a meal, 85% to 90% of the glucose is taken up by the muscle and the rest by the adipose (fat) cells and liver. Because the blood insulin levels do not rise too fast or too high, there is no abnormal storing of the fat. The insulin-to-glucagon ratio is in balance so therefore, fat is still being broken down as much or more than is being made. The blood sugar slowly returns back to baseline (fasting blood sugar level) and does not drop into the hypoglycemic range. This does not set off the counterregulatory hormonal response. Your appetite and hunger response is normal.
You are much more satisfied after a meal like this. You do not have the unusual cravings for high-glycemic foods and you actually do not even feel hungry for hours after a low-glycemic meal. Obviously, you are going to eat fewer calories naturally because your body is not craving food.
Phase 1 – Reversing Glycemic Stress
Phase 1 of the Healthy for Life Program primarily focuses on trying to reverse this vicious cycle of blood sugar spikes following a meal and the resultant hypoglycemia. As you have just learned, this is the reason that the majority of people tend to overeat and have significant cravings. By eating low-glycemic meals and not spiking your blood sugar, you get yourself out of this vicious cycle. Some people may also choose to use low-glycemic meal or snack replacements, which some companies are producing. This allows the body to adjust and develop a healthy, normal pattern of slow blood sugar increases following a meal. This lowers insulin and raises glucagon levels. Your abnormal cravings will decrease and you will begin to experience life in an entirely different perspective. You will be able to focus and concentrate better. You will have an energy that you have not experienced in a long time. Your health begins to improve because you are not constantly stressing it by spiking your blood sugars producing glycemic stress.
You will be learning to eat meals and snacks that will not spike your blood sugar. Please take some time to review the Recommended Food List on this web page. When you eat a meal, you simply want to combine good proteins, good fats, and good carbohydrates together, which create a healthy, low-glycemic meal. You will also want to refer to the Phase 1 Meal Plan. Here you will find a detailed guide for the first 14 days of the Healthy for Life Program.
All you have to do is repeat this meal plan for the last 14 days of this phase. Remember, this is merely a guide and not something that has to be strictly adhered to. You just want to have two of your meals and one snack be a Macro-Optimizer Meal or Snack Replacement along with one low-glycemic meal and snack. Now, it is strictly up to you to decide which meal you would like to have as your regular meal and which you would like to be the Macro-Optimizer meals.
There are some principles that you need to understand from the beginning. There really is no calorie restriction to the Healthy for Life Program. If you are naturally hungry, you need to eat. If it is not time for your regular meal or snack, you need to eat an additional meal or snack. This could be an additional Macro-Optimizer Meal or Snack Replacement or just a regular snack or meal. The only restriction is the fact that your meal or snack does not spike your blood sugar. Over Phase 1, you will find that you naturally become less and less hungry because you are reversing glycemic stress and its role in creating “uncontrollable” hunger. Let this happen naturally and don’t worry if you are eating more than the recommended amounts.
If you are a very active person or a larger person, you are going to require more food. You don’t want to become weak. Listen to your body and if you feel you need more food at any particular meal or snack, go for it. Just be sure that you are not going to spike your blood sugar.
During Phase 1, you also need to avoid eating any sugar (you may use granulated fructose, Stevia, or Splenda), bread, rice, cereals, sodas, pasta, and potatoes. This will be hard for most of you; however, it is critical to eliminate these foods during Phase 1. Many of our clients are simply remaining in Phase 1 until they reach their goals. This is fine, since this is a healthy diet and you can stay with it as long as you would like. In Phase 2, these foods will be reintroduced into your diet with some limitations. But for Phase 1, it is critical that you eliminate them altogether. If you are involved with the Coaching Program our Healthy Lifestyle Coach will help you adjust to these restrictions.
Whenever you challenge yourself and make any kind of changes to your diet or lifestyle, you will experience some stress and anxiety. This is very natural and you should not be concerned. I teach my patients that none of these guidelines are rules that can’t be broken. It is more important for you to simply do the best you can and work through what I have labeled as the Carbohydrate Addiction.
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