CGM Notes

At about 5:30 pm last Wednesday, I chanced upon a box of Sandesh crumbs lying in the office. A colleague had brought the sweets to share the previous day, and people had devoured it; but left aside the crumbs. I picked up the box and proceeded to demolish it as I reviewed a teammate’s work.

Soon the box was in the dustbin. I chanced upon a cookie box that another colleague had got. And started to demolish the cookies. This was highly atypical behaviour for me, since I’m trying to follow a low-carb diet. At the moment, I assumed it was because I was stressed that day.

Presently, I took out my phone to log this “meal” in the Ultrahuman app. There the reason for my binge was clearly visible – my blood sugar had gone down to 68 mg / dL, pretty much my lowest low in the 2 weeks I wore the last sensor.

This, I realised, was a consequence of the day’s lunch, at Sodabottleopenerwala. Maybe it was the batter (or more likely, the sauce) of the fried chicken wings. Or the batter of the onion pakoda. Something I had eaten that afternoon had spiked my blood sugar high enough to trigger a massive insulin response. And that insulin, having acted upon my lunch, had acted upon the rest of the sugars in my blood. Sending it really low. To a point where I was gorging on whatever sweets I could find.

About a year (or maybe two?) back, I had read Jason Fung’s The Obesity Code, which had talked about insulin being the hormone responsible for weight gain. High levels of insulin in the blood means you feel hungrier and you gorge more, or something like that the argument went. The answer was to not keep triggering insulin release in the blood – for that would make the body “insulin resistant” (so you need more insulin than usual to take care of a particular amount of blood sugar). Which can lead to Type 2 diabetes, high triglycerides, weight gain, etc.

And so Fung’s recommendations (paraphrasing – you should see my full blogpost based on the book ) included fasting, and eating fewer carbs. Here I was, two years later, finding evidence of the concepts in my CGM data.

I have worn a CGM a couple of times before. Those were primarily to figure out my body’s response to different kinds of foods, and find out what I should eat to maintain a healthy blood sugar level. The insights had been fairly clear. However, since it had been ten months since I last wore a CGM, I had forgotten some of the insights. I was “cheating” (eating what I wasn’t supposed to eat) too much. And my blood sugar had started going up to scary levels.

The objective of this round of the CGM was to find out “high ROI foods”. Foods that gave me a lot of “satisfaction” while not triggering much of a blood glucose response. The specific hypothesis I was trying to test was that sweets and traditional south indian lunch trigger my blood sugar in the same manner, so I might as well have dessert instead of traditional south indian lunches!

Two weeks of this CGM and I rejected this hypothesis. I had sweets enough number of times (kalakand, sandesh, corner house cake fudge, etc) to notice that the glucose response was not scary at all. The problem, each time, however, occurred later – maybe the “density of sugars” in the sweets triggered off too much of an insulin response, leading to a glucose crash (and low glucose levels at the end of it).

Traditional south indian lunch (I would start with the vegetables before I moved on to rice with sambar and then rice with curd) was something I tested multiple times. And it’s not funny how much the response varied – a couple of times, my blood glucose went up very high (160 etc.). A couple of times there was a minimal impact on my blood glucose. It was all over the place. That said, given the ease of preparation, it is something I’m not cutting out.

What I’m cutting out is pretty much anything that involves “pulverised grains”. Those just don’t work for me. Two times I had dosa – once it sent my blood sugar beyond 200, once beyond 180. One idli with vade sent my blood sugar from 80 to 140 (on the other hand, khara bath (uppit) with vaDe only sent it to 120). Paneer paratha (on the streets of Gurgaon) sent my sugar up to 200.

That some flours work for me I had established in previous iterations wearing the CGM – rice rotti hadn’t worked, jowar rotti hadn’t worked, ragi mudde had been especially bad. But that dose and idli and paratha also don’t work for me was an interesting observation this time. I guess I’ll be eating much less of these.

What did work for me was what has sort of become my usual meals when going out of late – avoiding carbs. One Wednesday, I got my team to order me an entire Paneer Butter Masala for lunch (Gurgaon again). Minimal change in glucose levels. That Friday, I had butter chicken (only; no bread or rice with it). Minimal change yet again! Omelettes simply don’t register on my blood sugar levels (even with generous amounts of cheese).

To summarise,

  • Sweets may not send my sugar very high, but in due course they send it very low (due to high insulin response). The only time this crash doesn’t happen is if I’ve had the sweets at the end of a meal. Basically, avoid.
  • Any kinds of pulverised grains (dosa, idli, rotti, paratha) is not good for me. Avoid again
  • The same food can have very different response at different times. This could be due to the pre-existing levels of insulin in the body. So any data analysis (I plan to do it) needs to be done very carefully
  • On a couple of occasions I found artificial sweeteners (like those in my whey protein) causing a glucose crash – maybe they get the body to release insulin despite not having sugars. Avoid again.
  • Again last week I met a friend for dinner and we had humongous amounts of seafood. I didn’t eat carbs with it. Minimal spike.
  • Some foods cause an immediate spike. Some cause a delayed spike. Some cause a crash.
  • Crashes in glucose levels (usually 1-2 hours after a massively insulin-triggering meal) were massively correlated with me feeling low and jittery and unable to focus. It didn’t matter how recently I had taken the last dose of my ADHD medication – glucose crash meant I was unable to focus.
  • Milk is not as good for me as I thought. It does produce a spike (and crash), especially when I’m drinking on an empty stomach
  • Speaking of drinking, minimal impact from alcohols such as whiskey or wine. I didn’t test beer (I know it’s not good)
  • Biryani (Nagarjuna) wasn’t so bad – again it was important I ate very little rice and lots of chicken (ordered sides)
  • Just omelette is great. Omelette with a slice of toast not so.

All these notes are for myself. Any benefit you get from this is only a bonus.

Diabetes, sugar and insulin

Last weekend I finished off Jason Fung’s The Complete Guide to Fasting. Like his earlier book that I read (The Obesity Code), this book makes a very compelling case to fast as a means of reversing type 2 diabetes, lose weight and generally have a much better life.

I’m compelled enough by the book to have put its message into practice immediately. Apart from days when I go to the gym early in the morning, I’ve been making it a point to not eat breakfast (this isn’t the first time I’m trying this, I must mention). And while the weighing scales haven’t moved yet, I’m pretty happy.

In any case, in both his books, one thing that Fung rails against is the conventional medical practice of telling people suffering from Type 2 Diabetes to “eat 6 meals a day”, while most medical research shows that this leads to higher insulin resistance (and thus worse diabetes), and that what is better is to eat a smaller number of meals in a day.

So a few days ago, I came across this tweetstorm by this guy who installed a continuous glucose monitor in his blood. The tweetstorm is very instructive.

And this helped explain to me why despite research showing the contrary, eating “several meals a day” has been part of the treatment manual for diabetes, even if in reality (as per Fung’s book), it hasn’t helped.

This graph from the tweetstorm is instructive:

Blood glucose spike after a meal

Look at how his blood glucose spiked immediately after a meal that he ate after a longish fast. The conventional medical wisdom has been that if a diabetic eats infrequently, every meal will spike his blood glucose, which then leads to a spike in insulin, and that is not good for the person.

Instead, the wisdom goes (I’m guessing here) that if you have several small meals, then you don’t have a single big jump in glucose levels like this. And so you don’t have single big jumps in insulin levels.

Moreover, the big risk with Type 2 diabetes is hypoglycemia – where your blood sugar drops to such a low level that you start sweating rapidly and come under the risk of a heart attack. And when you don’t eat frequently, your blood sugar can drop like crazy. And so several small meals works.

Logical right? I guess that’s what most doctors have been thinking over time.

The little problem, of course, is that if you eat too many meals (and small meals at that), your blood glucose doesn’t spike by a lot at any one point in time. However, that you haven’t given sufficient gap in your meals means that your insulin levels never drop below a point. And that means that your body becomes resistant to insulin. Which means your diabetes becomes worse.

So what do you do? How do you let your insulin level drop to an extent where your body is not resistant to it, while also making the spike in insulin when you finally eat not so much? Again, I’m NOT a medical professional, but seems like what you eat matters – fat spikes insulin much less than carbs or protein.

Maybe I should change the nature of my lunch on days I don’t eat breakfast.

PS: This entire blogpost is entirely my conjecture, and none of it is to be taken as any kind of medical opinion.


Concepts from The Obesity Code

Based on the recommendation of a friend who had once described his waistline as “changing more often than Britney Spears’s (?) bra size”, I read Jasun Fung’s The Obesity Code over the last couple of days. The book is stellar.

Here are my highlights from the book.

Anyway, fitness and nutrition is something I’ve been struggling with for a very long time in life now. I used to believe that I have my health numbers (primarily triglycerides) under control because of regular lifting of heavy weights, but a recent blood test called that assumption to question. Having got what I now think is bad advice about what to eat and what not to eat, getting better advice on food is something I’ve been fairly receptive to. And the book does a great job of it.

The basic idea is – your body weight is controlled by hormones. How much you eat and how much you exercise doesn’t really matter. Calorie counting just doesn’t work. Your body has a “natural weight”, and if you are above that the body will try to adjust it lower, and vice versa. And this “natural weight” is guided by the hormones, especially insulin. The higher the level of insulin in your blood, the more your “natural weight” will be.

So the idea is to keep the level of insulin in your blood low. The author builds up a stellar case with some rigorous presentation of research. There is NO RELATIONSHIP between the fat that you eat and risk of heart attacks. A high carb low fat diet will make you fat.

And what I liked about the book is the structuring – the first 220 pages is all about presenting the research on various topics, and not really “giving away” what you should or should not eat. And then in the last 20 pages, he puts it all together, with a broad plan on what is good to eat and what is not.

In any case, I’m not going to reproduce the book here. You can go read it (it’s very very well written), or just read my highlights. The reason I started writing this post is to document my learnings from the book. I think I’d already internalised a lot of it, but some of it is new. This is how I plan to change my diet going forward:

  • Sometimes in recent times I’ve noticed this “heady feeling” upon eating certain foods. I used to think it’s due to eating too much sweet. Now, after reading, I think it’s the feeling of an insulin spike in my head. I’m not going to have any fruit juices. Fruits need to be eaten whole
  • I’ve largely eschewed added sugars for a while now (sometimes on and off). This will continue.
  • Artificial sweeteners also cause a spike in insulin. I didn’t know this. So no more coke zero. No more Muscle Blaze Whey Energy powder as well (I now need to find a whey powder that doesn’t contain any sweet or any sweetener). No energy bars. No “no added sugar” biscuits.
  • This is maybe the most important concept in the book – NO SNACKING. Eat exactly two or three times a day (I used to eat two a day, but nowadays I go to the gym in the mornings, so breakfast is necessary). Eat as much as you want at each meal, but don’t eat in between meals. The body needs lots of periods of time when insulin levels go low – so it doesn’t adjust to a higher natural level of insulin, which means a higher natural weight.
  • Dairy products have a high “insulin index” (produce lots of insulin once eaten), but also have high satiety – they keep you full for a very long time after eating. After my last cholesterol test, after a fight with the wife, I largely gave up on cheeses. I’m reversing that now. I love cheese, and it’s good for me. Calorie counting just doesn’t work (the book does a great job of explaining this).
  • Not doing keto. It’s unsustainable. And I love my fruits too much. Oh, and I need to eat my fruits along with my meals. Not as “snacks”
  • Processed carbohydrates are not good. So no more bread for me. I need to figure out if fried eggs + milk will be enough for breakfast. Or find a decent substitute.
  • I also need to figure out how good or bad basmati rice is. Definitely makes me feel better than sona masuri (which we used to eat before). Need to figure out if this feeling is justified.
  • Peanuts are good. Peanut butter is good. Other nuts are good as well. But need to eat them for breakfast. Not as a snack.

The hardest part for me, with this new regimen I plan to start, is “no snack”. I’d gotten so used to snacking that I think I eat far less than necessary during my main meals. And that results in a vicious cycle. I’ve attempted to start breaking out of that by supplementing my chapati-paneer curry with some curd rice tonight.

So far I’ve been feeling great. Let’s see how this goes.