- While reducing carbohydrates is the first priority, high blood glucose levels and insulin resistance can also be a sign that you are eating too much and / or too often.
- You can use your blood glucose meter as a fuel gauge to help you understand whether your hunger is real and refine your meal timing.
- Delaying your next meal allows your body to use up the glucose in your blood.
- Intermittent fasting will allow your the glucose in your blood stream to be replenished from the glycogen stores in your liver and muscle and allow energy to flow from your fat stores.
|> 7 day average, well slept and low stress||delay eating and / or exercise|
|< 7 day average||if hungry, enjoy nutrient dense foods that align with your insulin sensitivity|
|< 73mg/dL (4.0 mmol/L)||if hungry, eat higher insulin load foods and delay exercise|
This approach is NOT intended for people who do not produce enough insulin (i.e. type 1 diabetes, type 1.5, LADA and MODY) but rather for people who are insulin resistant and produce large amounts of insulin but still have high blood glucose levels (i.e. type 2 diabetes, hyperinsulinemia and most people who are obese).
Eating frequently will keep your insulin and blood glucose levels high, particularly if you eat high carbohydrate foods with a high insulin load.
Reducing meal frequency enables blood glucose and and insulin levels to decrease.
Insulin keeps fat stores locked in storage. Reducing insulin levels allows body fat to be released for fuel.
Eating larger meals with more carbohydrate causes your blood glucose to stay higher for longer. Conversely, having smaller meals with a lower insulin load allows your blood glucose levels will return to baseline faster, and if you’re following this protocol, you’ll be able to eat again sooner.
when to eat
You can use your blood glucose meter to help you know whether your hunger is real and whether or not to skip a meal or two or not eat for the day.
If you have some level of insulin resistance then chances are your blood glucose levels will be higher in the morning due to glycogen being released into the bloodstream as your body prepares for the day (a.k.a. Dawn Phenomenon). If you are insulin resistant the insulin secreted by your pancreas doesn’t keep up with the release of glucose into the blood stream and hence your blood glucose will be high.
Dr Jason Fung says that the Dawn Phenomenon is your body’s way of purging excess energy.
The Dawn Phenomenon is simply moving sugar from body stores (liver) into the blood. That’s it. If your body stores are filled to bursting, then you will expel as much of that sugar as possible.
By itself it is neither good nor bad. It is simply a marker that your body has too much sugar. Solution? Simple. Either don’t put any sugar in (LCHF) or burn it off (fasting). Even better? LCHF + IF.
If you test your blood glucose in the morning and it’s higher than your current average then you might want to delay eating until your blood glucose comes back down. This may mean eating your first meal early afternoon followed by an early dinner (e.g. 16:8 intermittent fasting). Alternatively, you could skip dinner which would help to lower morning blood glucose and then eat breakfast and lunch.
Other people find it simplest to not eat for the whole day or even two days at a time and then resume normal eating to satiety the rest of the time. As you get used to it you may want to try longer fasts which will accelerate the healing process. Over time you’ll find a routine that suits you and be able to calibrate your feeling of hunger and reduce the frequency of testing.
tailored just for you
Many people agree that intermittent fasting is a good idea, but how do you whether you should be doing Michael Mosely’s 5:2 diet, Hugh Jackman’s 6:8, Kiefer’s Carb Back Loading and Carb Nite, Lyle McDonald’s TKD and CKD, Bert Herring’s Fast Five, Ori Hofmekler’s Warrior Diet, or Martin Berham’s Lean Gains?
It can be confusing when there are so many options out there! How do you know which one is right for you and then how do you know if it’s working? How can you refine and tweak to to reach your goals? What if you just really feel hungry!?!?
The advantage of using your blood glucose level as a guide versus a regimented intermittent fasting protocol or a fixed calorie intake is that it accounts for your activity as well as your food intake.
Eating is not bad. In the end it is about balancing your intake with your expenditure which is a challenge with abundant constant hyperpalatable food choices.
This approach helps you to fine tune when and how much you eat to your actual requirements right now. Not so much that you’ll store fat, but not so little that you’ll down regulate your metabolism.
Your blood glucose meter can help you understand whether your hunger is real and re-calibrate your appetite signals. If your blood glucose levels are lower than your average then your insulin levels will be decreasing and you’ll be using body fat. If your blood glucose levels are increasing then you’re likely eating too much, your insulin levels are high and you’ll be storing the excess energy as fat on your body.
When using this approach you’re able to eat to eat to satiety while keeping in mind that when you eat next will be influenced by whether or not your binge at this meal. You could even use this approach to make sure you don’t overdo the refueling and keep the insulin load of your meals such that your blood glucose doesn’t go over say 120mg/dL (or 6.7mmol/L). A blood glucose level over this is a sure sign that your glycogen stores are full and well and truly spilling over into your blood stream.
Many people find that they are able to eat less overall when intermittent fasting compared to trying to eat numerous ‘small’ meals. Saint Augustine wisely said
“Complete abstinence is easier than perfect moderation.”
I think this also applies to our meal timing and portion sizing.
By choosing to eat only when your blood glucose is below YOUR average blood glucose level you can tailor the approach to your current situation and metabolic health.
Waiting until your blood glucose reaches optimal levels is not going to be realistic for most people. It’s best to start from where you are now and work towards optimal.
In the study Adherence to hunger training using blood glucose monitoring: a feasibility study the researchers found that participants did much better when they set their own personalised blood glucose target rather than waiting until their blood glucose levels reached some optimal target before eating. The other noteworthy observation from this study was that people who were obese lost a significant amount of weight!
Overweight participants achieved significant weight loss over the two-week period, with an average loss of 1.5 kg (95 % CI 2.2, 0.9) and a corresponding reduction in BMI of 0.6 kg/m2 (95 % CI 0.3, 0.8), p < 0.001). By contrast, lean participants maintained their weight.
the end game
The long term goal is to achieve an optimal HbA1c of 4.5% which equates to an average blood glucose level of 83mg/dL (or 4.6mmol/L). There are lots of really good reasons to keep your blood glucose and insulin levels in check such as reducing your risk for cancer…
People with Type 1 Diabetes following Dr Bernstein’s protocol try to keep their blood glucose within ten points of the optimal target level of 83mg/dL (4.6 mmol/l). This means that they will dose with insulin when their blood glucose rises above 93mg/dL (or 5.2 mmol/l) and then eat to bring their glucose levels back up when they drop below 73mg/dL (or 4.0mmol/L).
Someone who has a functioning pancreas but is struggling with insulin resistance, hyperinsulinemia and / or obesity can use a similar process to manage their blood glucose and insulin levels. But rather than dosing with insulin to bring their blood glucose down (they typically already have more than enough insulin!) they simply delay eating until they burn through the excess blood glucose.
Waiting to eat until your blood glucose levels are below your recent average will ensure that they decrease over time. Most glucose meters will display the average glucose level for the last seven, fourteen and thirty days so it is easy to tell what your current target is.
If you’re really eager you could go to the trouble of graphing your blood glucose numbers, but in the end if your seven day average is less than your fourteen day average then you’re moving in the right direction. Over time you want to see your average blood glucose levels coming down, so if you see them drifting up then you it’s a sign that you need to intensify your fasting somehow.
Normalising blood glucose and insulin will often lead to optimal weight, particularly if you’re insulin resistant. However some people will still need to pay attention to cutting calories once blood sugar and insulin is normalised.
when not to use this approach
Exercise may raise your blood glucose in the short term due to the body dumping glycogen from your liver into the bloodstream to fuel the exercise. If you don’t eat as much after exercise your body will have to replenish the glycogen stores from the energy stores on your body.
There will be times when you’re really hungry or it will be appropriate to eat for social reasons such as a party, family gathering etc. Periodic feasting is a normal part of our culture. This system would help you to get back on track and work around these times.
You should also keep in mind that there are other things that affect blood glucose including stress, sleep, sickness, hormones and exercise that you will need to manage and be mindful of when deciding whether to delay a meal due to your blood glucose being high.
Fasting may not be ideal if you’re already stressed, sick, not sleeping well and / or are pushing the exercise envelope. During these times it maybe better to focus on life maintenance and listen to your appetite.
Dr Jason Fung pointed out:
Medications and insulin obviously would gum up the entire system. The other thing would be stress (cortisol) also increases blood sugars.
If you could control for those two things, then this would definitely be an idea worth testing.
I like the idea of varying the fasting period. I think that intermittency is a key component to success.
So if you are taking insulin or other blood glucose lowering medications you will need to make sure they are reduced so you are not having to eat to raise your blood glucose because of the medication.
The problem with injected insulin or many other diabetes medications is that, while it may help to reduce blood glucose levels, it also drives the energy back into the cells rather than allowing the stored energy to flow out of storage. The more you reduce insulin (injected or produced from your own pancreas) the quicker the healing can occur. However the same time it would be prudent to reduce medications progressively to prevent your blood glucose levels from going too high.
High blood glucose levels can be a sign that you’re stressed, exhausted or your hormones are out of whack (including time of the month for females), all of which will lead to insulin resistance. You can use Heart Rate Variability to track your stress and exhaustion with an app such as Elite HRV which enables you to see when you’re exhausted and need to back off and rest.
If you just don’t feel like fasting and your blood glucose levels are high it’s probably a sign that you need to rest, relax, sleep, meditate, see some real sunlight during the day and stop gazing into the iPad before you go to bed. Using f.lux on your computer or blue blocking glasses after sunset is worth considering.
While longer therapeutic fasts can be beneficial, a shorter feast / fast cycle that brings your blood glucose level down to below your average is likely to be more useful to improve your metabolism while reducing the extreme swings in water weight or any concerns that you’re not getting adequate protein to support lean body mass.
ketones and the glucose: ketone index (GKI)
The simplest approach is just to measure your blood glucose levels when you feel hungry and not eat until they drop below your target level. You could still use this approach even once you have improved your insulin sensitivity to lose weight by targeting even lower blood glucose levels before eating.
Monitoring your blood glucose will work whether you are insulin sensitive or insulin resistant, obese or normal weight. The body does an amazing job of replenishing your glycogen stores and stabilising your blood glucose whether it be from carbohydrates, gluconeogenesis from amino acids or even gluconeogenesis of fat once you are highly insulin sensitive.
Once you are starting to get your blood glucose levels under control you could start to track your ketones or the glucose: ketone index (GKI). Decreasing glucose along with rising ketones is a sign that your glycogen stores are being depleted and you your hunger is legitimate.
Alternatively you could simply not eat until your ketone levels were greater than a certain level. You could start with a target ketone level of 0.4mmol/L and keep winding that up till you achieve your desired results. However testing blood ketones every time you feel hungry could be a costly exercise.
While all these things are important and useful, make sure to use them as tools to help you live life rather than taking over your life and stressing you out. Your goals need to be realistic and tailored to your situation. Hopefully in time this ‘hunger training’ approach will help you build new habits around eating which will mean you won’t need to rely as much on the testing.
fast well, feast well
Keep in mind If you are eating less food less often you will need to maximise nutrient density when you do eat, including ensuring that you are getting adequate protein to maintain lean muscle mass over the long term.
Best of luck if you chose to try this approach. I look forward to hearing how you go. Be sure to share your experience in the comments below.