Balancing the Sugar Seesaw

The mid-afternoon slump. The sudden need for something sweet. Feeling shaky, irritable or foggy when a meal is late. For many of us, these are just part of everyday life. But they are often signs of the same thing: blood sugar rising too high and then falling too fast, like a seesaw. Steadying that seesaw is one of the simplest ways to feel better every day, and to protect our health for years to come.

How blood sugar works

When we eat carbohydrates, such as bread, rice, potatoes, fruit or sugar, they are broken down into glucose, which passes into the blood. Glucose is the body's main fuel, and the brain in particular depends on a steady supply.

As blood sugar rises, the pancreas releases insulin, a hormone that works like a key, letting glucose into the cells to be used for energy or stored for later. When all goes well, blood sugar rises gently after a meal and settles gently back again.

But a meal or snack rich in quickly absorbed carbohydrates, such as white bread, sweets, sugary drinks or breakfast cereals, sends glucose flooding into the blood. The body releases a large wave of insulin to bring it down, and sometimes overshoots. Blood sugar dips, the body sounds the alarm with stress hormones such as adrenaline and cortisol, and we reach for something sweet to bring it back up. And so the seesaw goes on.

Signs your seesaw is out of balance

• energy dips, especially mid-morning or mid-afternoon
• strong cravings for sugar, bread or caffeine
• feeling shaky, light-headed, anxious or irritable ("hangry") when you're hungry
• brain fog and poor concentration
• waking in the night, especially in the early hours
• needing to eat every two to three hours
• weight gain around the middle that is hard to shift

Every swing up is followed by a swing down.

From seesaw to insulin resistance

When blood sugar is pushed high again and again, year after year, the cells can start to ignore insulin's message. This is called insulin resistance. The pancreas responds by making more and more insulin to keep blood sugar in range. High insulin encourages the body to store fat, especially around the middle, and feeds low-grade inflammation. (See The Quiet Fire.)

Eventually, blood sugar itself begins to rise. Diabetes UK estimates that more than five million people in the UK live with diabetes, about 90% of them with type 2, and millions more have raised blood sugar that puts them at high risk.¹ Insulin resistance is also linked with heart disease, fatty liver, polycystic ovary syndrome (PCOS) and some hormone imbalances. (See The Hormone Web.)

The hopeful news is that this path can very often be slowed or even reversed. In the UK's DiRECT trial, almost half of people with type 2 diabetes who lost weight through a structured diet were in remission a year later, no longer needing diabetes medicines.²

We all respond differently

An Israeli study gave 800 people continuous glucose monitors and recorded their blood sugar after tens of thousands of meals. People's responses to the very same food varied enormously: one person's blood sugar soared after a banana but not after a biscuit, and another's did the opposite. Their gut microbes were one of the strongest predictors of how they responded.³ (See The Master Regulator.) The principles below work for most people, but listening to your own body matters too.

Steadying the seesaw: food

• Never eat carbohydrates "naked". Pair them with protein, healthy fat and fibre, which slow down how quickly sugar enters the blood. Add nuts to your porridge, eggs to your toast, or hummus to your oatcakes.
• Eat your vegetables and protein first. In one study, people who ate their vegetables and protein before their carbohydrates had much lower blood sugar and insulin after the meal than when they ate the same food in the opposite order.⁴
• Choose slow carbohydrates. Swap white bread, white rice and sugary cereals for oats, beans, lentils, whole grains and vegetables. A major review for the World Health Organization found that people who ate the most fibre had a 15 to 30% lower risk of type 2 diabetes, heart disease and early death.⁵
• Start the day with protein. A breakfast built around eggs, Greek yoghurt, nuts or seeds sets up steadier energy for the whole day.
• Watch out for liquid sugar. Fruit juices, smoothies, fizzy drinks and sweetened coffees deliver sugar fast, without the fibre to slow it down. Eat fruit whole instead.
• Don't swap sugar for sweeteners. Sweeteners are a poor substitute for steadying blood sugar. In a controlled trial, two weeks of saccharin or sucralose changed gut bacteria and worsened blood sugar control in healthy adults,⁶ and a large French study linked higher artificial sweetener intake with a greater risk of type 2 diabetes.⁷ They also keep the taste for sweetness alive. Let your palate adjust to less sweetness instead; within a few weeks, fruit, cinnamon and naturally sweet vegetables taste sweet enough. (See Real Food, Real Health.)
• Try a little vinegar. A spoonful of vinegar with a starchy meal, perhaps in a salad dressing, has been shown to lower the rise in blood sugar afterwards.⁸
• Cook, cool and reheat. Cooling cooked potatoes, rice and pasta turns some of their starch into "resistant starch", which feeds your gut microbes and raises blood sugar less.
• Embrace bitter flavours. Bitter foods and herbs help to tame a sweet tooth. (See Bitter Is Better.)

Steadying the seesaw: life

• Walk after meals. Even a gentle 10 to 15 minute walk after eating helps the muscles soak up glucose. Breaking up long periods of sitting with short walks has been shown to lower blood sugar after meals.⁹
• Build muscle. Muscle is the body's biggest store for glucose. Strength exercises two or three times a week make a real difference.
• Protect your sleep. When healthy young men were limited to four hours' sleep for under a week, their bodies handled sugar much like those of people on the way to diabetes.¹⁰ (See The Art of Sleep.)
• Calm your stress. Stress hormones release stored sugar into the blood, ready for "fight or flight". Long-term stress keeps blood sugar higher. (See The Cortisol Clock and The Healing Breath.)
• Eat in daylight hours. The body handles sugar best earlier in the day. A lighter, earlier evening meal can help.

Herbs and spices

Many traditional herbs and spices have been studied for their effects on blood sugar:

• Cinnamon has been linked with modest improvements in fasting blood sugar in people with type 2 diabetes.¹¹ Ceylon cinnamon is the best choice for regular use, as cassia cinnamon contains more coumarin, which can harm the liver in large amounts.
• Berberine, a bright yellow compound found in barberry, goldenseal and Oregon grape, has been studied extensively, with effects on blood sugar comparable to some diabetes medicines in some trials.¹²
• Gymnema, known in Ayurveda as gurmar, "the sugar destroyer", briefly blocks the taste of sweetness when chewed, and is traditionally used to calm sugar cravings.
• Fenugreek, rich in a soluble fibre that slows the absorption of sugar, and a common ingredient in Indian cooking.

These herbs can be powerful. If you take medicines for diabetes, they may lower your blood sugar too far, so please don't add them without talking to your doctor. Berberine also interacts with a number of other medicines. (See When Plants Meet Pills.) The right herbs depend on your whole picture, so it's best to seek a practitioner's guidance rather than self-prescribe. (See The Architecture of Balance.)

At Rootwise, steady blood sugar is often one of the first things we look at. When energy, mood and appetite settle, everything else becomes easier, from sleep and hormones to simply enjoying your food again.