Dr. Koji Aoki DC - Blood Sugar Levels
Updated: Oct 2
The Blood Sugar Roller Coaster: Everything You Need to Know
As of September 2021, the average daily sugar intake for Americans was estimated to be around 17 teaspoons, which is equivalent to about 68 grams/day. The American Heart Association (AHA) recommends limiting added sugars to no more than 25 grams or 6 tsp/day for most adults. As a functional medicine practitioner it is recommended
to ingest <15 g sugar/day.
We can see the consequences of a high sugary diet because approximately 88
million adults in the United States were estimated to have prediabetes, a condition
characterized by elevated blood sugar levels. Furthermore, according to the Centers for
Disease Control and Prevention (CDC), nearly 34 million Americans have diabetes, and
approximately 90-95% of these cases are type 2 diabetes, often associated with insulin
While in the past type 2 diabetes was a disease of older people, it now affects people of all ages, including children and adolescents. In the United States one-third of children are overweight or obese. The cost of this disease to the individual and the public are enormous, with about 18% of total healthcare expenditure in Europe due to diabetes alone.
If you talk to everyone they understand that sugar is not good for them. We
understand that we should not be eating it, however we still do. Why is this? One reason
is that “you don’t know what you don’t know.” Sugar is everywhere and people do not
hesitate to eat whatever tastes good. For example, a medium sized “Snickerdoodle”
drink from Dutch Bros has 106 g of sugar! Many “morning drinks” from your favorite
coffee shop have more sugar in one drink that you should be having in a week. I know
that if people understood the gravity of the situation they may change their choices.
Secondly, not a lot of people understand why we should care. Why should I worry about
a sugary treat that is 25 grams of sugar? It is only 250 calories more? I can just skip my
other meal. The problem is we don’t see or feel immediately what a prolonged diet of
high sugar intake is going to do to our body. Then it will feel like it is too late when you
go to your annual checkup and you are diagnosed with diabetes and they just prescribe
I am going to help you understand how carbohydrates are broken down, what
high blood sugar does to your body, and what you can do to avoid high blood sugar.
What is Blood Sugar?
Blood sugar is how we as humans have energy and live each day. Our body uses sugars so that our cells can carry out every day metabolism. Millions of reactions happen every second that require this energy produced from sugars. Our body uses sugars, however it is not required for our body to survive by only ingesting sugars. This is because our body has many biological processes where we can turn fats and proteins into energy.
The Symphony of Carbohydrates
Imagine indulging in a hearty meal rich in carbohydrates. As these intricate
molecules journey through your digestive system, a remarkable transformation unfolds.
Carbohydrates are a vital source of energy for the human body and undergo a complex
process of digestion to be converted into usable forms. This process begins in the
mouth, where the enzyme salivary amylase is secreted by the salivary glands. Salivary
amylase initiates the breakdown of complex carbohydrates like starches into simpler
sugars like maltose. This enzymatic action continues as the food travels down the
esophagus and enters the stomach. However, the acidic environment of the stomach
halts the action of salivary amylase.
The majority of carbohydrate digestion occurs in the small intestine. Here, the
pancreas secretes pancreatic amylase, which further breaks down carbohydrates into
disaccharides like maltose, sucrose, and lactose. These disaccharides are then acted
upon by specific enzymes on the microvilli lining the small intestine. Maltase, sucrase, and lactase are responsible for breaking down maltose, sucrose, and lactose, respectively, into their monosaccharide components - glucose, fructose, and galactose. These monosaccharides are then absorbed through the lining of the small intestine and enter the bloodstream to be transported to cells throughout the body for energy production.
Hormones of Blood Sugar Balance
Deep within your pancreas, beta cells and alpha cells secrete insulin and
glucagon.. Beta cells release insulin in response to rising glucose levels, ushering
glucose into cells. Alpha cells, on the other hand, unleash glucagon when blood sugar
levels dip, tapping into stored glycogen in muscle and liver cells. At the same time other
hormones help regulate our actions whether we eat or feel “full.” Leptin, our satiety
hormone, signals when we're full. Ghrelin, on the other hand, encourages us to eat when
our stomachs growl.
The Cascade of Consequences
Hyperinsulinemia: Unmasking the Ramifications
Persistently high insulin levels can lead to a cascade of physiological disturbances. This
includes insulin receptor resistance, hormonal imbalances activating enzymes like aromatase and 17,20 lyase, leptin resistance, endothelial dysfunction, elevated cholesterol levels, and increased cortisol production. This leads to:
● Elevated Triglycerides while lowering your HDL cholesterol
● Elevated Total Cholesterol and LDL Cholesterol
● Increasing inflammation makes you more susceptible to oxidation of LDL which
● Endothelial dysfunction leading to Hypertension and Erectile Dysfunction
● Increased cortisol
○ The increased cortisol increases glucose and very-low-density lipoprotein (VLDL) secretion from liver while inhibiting their reuptake. This makes the pancreas secrete more insulin which perpetuates the problem of hyperinsulinemia leading to insulin resistance and storage of excessglucose into visceral and peripheral fat (adipose tissue).
○ Disturbance to the HPA axis (hypothalamic-pituitary-adrenal) increasing the cortisol which then increases immune activation
● Nitric oxide dysfunction. Nitric oxide (NO) is a chemical that our endothelial cells,
the cells that line the inside of every artery, secrete to dilate the cell.
Hyperinsulinemia prevents NO from being secreted and therefore makes
hypertension and erectile dysfunction even worse.
● Kidney Stress. Insulin resistance can affect the kidneys' ability to properly
regulate sodium levels in the body. This can lead to an increased retention of
sodium, which in turn can lead to an increase in blood volume and blood
Now do you understand the gravity of eating too much sugar day in and day out?
Testing for High Blood Sugar Levels
How do you know if you have high blood sugar? Your doctor can perform these tests:
● Fasting Glucose
● Glucose Tolerance Test
● Fasting Insulin
● Hemoglobin A1C (HgA1c)
● Waist to Hip Ratio or BMI
● Blood pressure
All of these indicators need to be looked at to see the whole picture of the
patient. I have seen patients who seem to have a normal fasting glucose but have a very
high fasting insulin. By just looking at the fasting glucose numbers many doctors would
tell you are not pre-diabetic or have a blood sugar problem. However, if you look at both
lab values a holistic doctor would be able to see that you indeed have a blood sugar
Empowering Choices for Optimal Blood Sugar Health
First and most importantly you need to be honest with yourself. Ask yourself if
you feel that you are eating too much sugar. Start to become aware of how much sugar
you are consuming. Look at the labels of the things you eat. You’ll be surprised at how
much sugar is in everything. Like my mentor told me, “what we can measure, we can
manage.” Once you have acknowledged that you need to change it allows our brain to
work with us and make more appropriate changes. Remember to go in slow. This is a
marathon not a sprint. This is going to be a huge lifestyle change for many of you. So
you don’t want to overwhelm yourself.
It all begins with what we put on our plates. Adopting a balanced diet rich in whole, unprocessed foods can be transformative. Focus on incorporating more animal protein into your diet. Also include fiber-rich fruits, vegetables, and whole grains onto your plate. Start cooking your food at home. Not only is this a good way for you to spend time with your family, but also you can control what is added to your meals. Yes there is a learning curve, but isn’t that what makes it fun?
Engaging in regular physical activity is crucial for managing blood sugar levels
and even hypertension. You don’t have to go to the gym inorder to engage in physical
activity. Move as much as you can. Park far away from the entrance to a store, take the
stairs as much as you can, take breaks at lunch to go on a walk or engage in some
sprints, take a walk after dinner with your family. You can get very creative! Remember
excess body fat, especially around the abdomen, is strongly associated with insulin
resistance and hypertension. Research published in the journal Diabetes Care highlights
that even modest weight loss can lead to significant improvements in insulin sensitivity
and blood pressure control.
Chronic stress and inadequate sleep can exacerbate both high blood sugar and hypertension. Engage in stress-reducing activities like meditation, deep breathing
exercises, or yoga. Prioritizing restful sleep is equally important. Aim for 8-9 hours of quality sleep per night, as recommended by the National Sleep Foundation. Studies have shown that adequate sleep is vital for glucose metabolism and blood pressure regulation. A study in the journal Sleep Medicine Reviews revealed that chronic sleep deprivation is linked to insulin resistance and higher blood pressure levels.
Additionally, targeted supplements like chromium, cinnamon, and probiotics can offer
support. At the office I test other herbs that can help a patient as they are on this
journey. Don’t forget that the gut, our second brain, plays a pivotal role in blood sugar
regulation. Probiotics, the friendly bacteria, can help maintain a healthy gut microbiome,
enhancing glucose control. Additionally, fish oil, rich in omega-3 fatty acids, has shown
promise in improving insulin sensitivity.
With knowledge as our compass and proactive choices as our vessel, we set sail
towards a life of vibrant health. Every meal is an opportunity to nourish our bodies and
balance our blood sugar. Together, let's embark on this exhilarating journey to radiant
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