After Meal Glucose Spikes

Most often health professionals track fasting blood sugar to determine degree of effectiveness with the treatment regimen.  The problem with this approach is that it’s measuring the best case scenario.  What causes the most risk to the patient is the after-meal (postprandial) blood sugar spikes. After every meal, theses sudden surges in blood sugar damage delicate blood vessels in the brain, heart, kidneys and eyes.  They also accelerate the aging of cells and tissues throughout the body. diabetes-glucosespike

Numerous studies, including one published in the May 17, 2010 online issue of The Oncologist that included half the type 2 diabetics in Sweden, found that, separate from the known risks for cancer among diagnosed diabetics, the risk for some cancers escalated directly with blood sugar levels, even among those without diabetes.  Rising in lock-step with glucose levels as they edged up within the normal range were the risks for cancer of the endometrium, pancreas, colon and colorectal tumours of a more aggressive type.

Surges in blood sugar promoted a greater production of fibrous kidney tissue – which causes kidney disease – than a high but constant blood sugar level. The researchers suggested that it may be the fluctuation in glucose – more than the levels themselves- that produce the vascular complications implicated in kidney damage. Researchers also discovered that mild beta cell dysfunction in the pancreas (the beta cells produce the insulin) was already detectable in those whose glucose levels spiked two hours after eating, despite staying completely within the range considered by the medical establishment to be normal. Within any blood sugar range, reported the journal Neurology in 2003, the higher the glucose, the greater the involvement of the large nerve fibers.

Utilizing only fasting blood glucose readings does not detect the dangerous after-meal glucose spikes that increase risk of death.  New research is showing that after-meal spikes in blood sugar are potentially more damaging than elevations in fasting blood sugar.  For example, Gerstein et al (1999) in people with “normal” blood sugars and “normal’ glucose tolerance tests, the risk of heart attack increases by 58% for each point increase in after-meal blood sugar.  For a similar after-meal glucose elevation, the risk of dying from cardiovascular disease increases by 26%.

Much research has gone into determining why this occurs.  The liver stores sugar (glucose) in a form called glycogen and releases just enough to maintain a steady blood sugar level.  In a healthy person, this process of glucose release (called glycogenolysis) is suppressed after a meal to prevent blood sugar levels from rising excessively. As we age, this internal control mechanism (glycogenolysis) malfunctions, resulting in very high blood sugars.

Another factor causing elevated glucose involves excess creation of new glucose in the body.  A biochemical process called gluconeogenesis creates new glucose from other substances such as amino acids when blood sugar levels are too low.  In aging people, they often make too much glucose from all kinds of foods, even when blood glucose levels are already too high. Carbohydrates are not the only food source of blood sugar. Amino acids found in proteins reaily convert to blood glucose via gluconeogenesis. 

An enzyme involved in gluconeogenesis and glycogenolysis is glucose-6-phosphatase.  With increased age and rising blood sugar levels, control of glucose-6-phosphatase becomes impaired.  When this occurs, glucose-6-phosphatase increases the release of stored glucose from the liver and enhances glucose creation despite already sufficient after-meal blood sugar levels.  Excessive activity of glucose-6-phosphatase is why many people find it nearly impossible to achieve optimal glucose levels.

The prescription drug acarbose taken before carbohydrate-rich meals suppresses glucosidase and other enzymes involved in the breakdown and rapid absorption of sugar calories.  Chlorogenic acid found in green coffee bean extract also suppresses glucosidase activity.  It also helps to blunt the post-meal glucose surges. The prescription drug metformin inhibits gluconeogenesis, as does green coffee bean extract and berberine. Other natural supplements have been shown to help control after-meal surges. At the Heartful Wellness Centre, we work with you to establish an appropriate diet to manage the after-meal surges and we may use supplements for added control if necessary.