This isn’t the first time I’ve written about the dangers of sugar in the diet and high levels of sugar in the bloodstream, and it won’t be the last. And until everybody gets a lot smarter about the stuff and world-wide metabolic disorders drop, I will continue to talk about it and bang the eliminate-the-sugar drum. Trust me though, we have a ways to go – statistics tell us that we’re eating almost ten times as much sugar per person in this country than we did a hundred years ago, and over the past several decades, the health bill for that mountain of sugar has come due. We’re in the midst of a national metabolic crisis –more than half of adult Americans are either prediabetic or diabetic, with rising rates of childhood type 2 diabetes a growing concern.

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OK, that’s the bad news. The good news is that advances in medical science have refined our understanding of how diet and lifestyle affect glucose levels (that is, the amount of sugar that circulates in the bloodstream), putting more power in your hands to ensure that sugar isn’t doing a number on your health. It’s never been easier to identify the trouble-makers so you can clean up your sugar act before real metabolic trouble begins. So what influences blood sugar? Here are a few of the biggies, and few thoughts on how to manage them smartly:

Food matters – so, dine defensively.

To keep your glucose levels under control, the art of sugar self-defense is essential. As much as possible, lose the low-fiber high-carbohydrate foods, especially processed foods and sugary drinks that digest with lightning speed, dumping too much sugar too fast, straight into the bloodstream. Those high glucose levels (and sudden surges) cause nothing but metabolic mayhem, pumping up harmful free radicals, eroding blood vessel health, and, in the process, promoting inflammatory symptoms throughout the body (skin wrinkles, fatigue, headaches, anxiety, weight-gain, you name it).

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While cutting carbs – particularly the speedy ones— to the bone is an excellent way to keep glucose levels low, you can enhance the positive effect by making sure to consume whatever carbs you do eat, with high-fiber “non- starchy” vegetables and foods that are high in fats and protein. These are all great at slowing down the digestion of carbohydrates. Not only do you get milder blood sugar spikes thanks to the slowed entry of glucose into the bloodstream, you’ll also enjoy increased satiety from the fats and protein, which can help make it easier to put the fork down and stop eating sooner. The newest research has further refined that formula. A recent pilot study out of Cornell Weill shows that the order you eat your food can have a major effect on how well (or poorly) your bloodstream can manage. What’s the secret? In a nutshell, start your meal with non-starchy veggies and protein first and get to the carbs last to help tamp down rising post-meal glucose levels by almost a third.  

Don’t just sit there – let your blood flow!

Stationary lifestyles are a major influencer of glucose levels, and it’s not a good look. Moving the body -- we’re talking any kind of physical activity here – is key to keeping your blood sugar under control. When we eat a meal and glucose gets dumped into the bloodstream, the body produces a specific hormone, insulin, to escort the excess glucose into the muscle cells for storage. When we’re regularly having to produce a lot of insulin to handle a high blood sugar load, we’re headed toward insulin resistance and all the bad things that can follow. The beauty of movement is that it eats up that glucose as fuel and it makes the muscle cells more sensitive to insulin, even after you’re stopped moving. The body gets more mileage out of less insulin which is exactly what we want. Obviously, a demanding work-out is going to burn up a lot of glucose but if that’s not your thing, not to worry. Simply going on a fifteen-minute walk after dinner has been shown to be very effective for glycemic control. The opposite of an active lifestyle is staying planted in front of a screen or behind the wheel of your car all day and, no surprise, that kind of sedentary lifestyle has been shown to be linked to inflammation and insulin resistance. My advice: break up hours work of sitting every 45 minutes or so (even more if you can!) and try these ideas on how to work more daily movement into your routine without a ton of extra effort.

De-stress your blood sugar  

Though most people probably don’t realize it, another factor that throws off your blood sugar is that old culprit lurking behind so many ills – stress. The more stressed out you are, the bigger the spike in blood sugar you’ll likely have after eating a high-carb meal – and you can thank evolution in some measure for that. Over the millennia, evolution has primed our bodies to maintain higher-than-normal glucose levels when we feel threatened. It’s the old “fight-or-flight” reflex at work: if a lion shows up, you better have energy on tap to run away. Unfortunately, in our modern world, it’s the chronic high glucose levels that are more likely to bring us down than an apex predator.  

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So, how to deflate the blood-sugar-boosting stress balloon? Studies have shown that simple deep breathing exercises can have a positive effect on blood sugar.  But any practice that chills you out is good for your (parasympathetic) nervous system and your metabolism. I’m a big fan of sitting meditation, yoga and, whenever possible, spending unstructured time outside in nature. For some of my patients, it might be a sauna or a hot bath in the evening that does the trick.

Sleep away high blood sugar.

If you’re not sleeping well or enough, you may be inadvertently driving your blood sugar to a bad place. One more reason to get your sleep act together. Good sleep is the essential ingredient that brings your nervous system and your metabolism into happy alignment. Bad sleep does the opposite. Consistently logging poor, restless nights of sleep, or trying to get by on less than 7 hours a night, has the effect of driving up cortisol, your primary stress hormone, which in turns promotes insulin resistance and cravings for carb-heavy “comfort foods.” One study made that point emphatically: a group of healthy young men were put on a 4 hours-a-night sleep “diet.” After six nights their metabolisms resembled those of type 2 diabetics! Now do that over the course of months or years and you’re looking at the express track to serious metabolic trouble. Bottom line: fix your sleep now to sidestep problems later.

People are different.

To my mind, it’s a universal truth that sugar is public health enemy number 1, it’s crap, it’s a toxin and nobody should be eating the stuff. What is interesting though is that recent research shows that different people react to different foods differently. The same baguette that sends your blood sugar soaring may be less a problem for your best friend. Complicating matters further, your body may react differently to the same food on different days. Again, here is where a continuous glucose monitor or CGM comes in handy. By tracking your body’s “glycemic response,” with a CGM, you can, over time, tailor your diet to your own unique physiology.

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Keep in mind that a lot of this variability in the way people’s bodies respond to what they eat has to do with their microbiome, the community of bacteria that lives in the gut. As a general rule, the more good-bacteria-friendly high-fiber food you eat, the more resilient your gut will be and the better able to handle the carbs without sending blood sugar soaring.

Finger pricking is so yesterday – and day-to-day, not all that helpful.

When you go to the doctor to get a read-out on your glucose levels, you’re looking at a blood sugar snapshot, a not terribly comprehensive picture of what your metabolism is doing. Researchers now appreciate that the true picture is more nuanced than that. Crucially, the spikes in glucose after you eat a high-carb, high-sugar meal can be dangerous in their own right, even if your levels are in the normal range at the particular moment in time when the doc draws your blood.  

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So how to get a more accurate take on your metabolism? For decades, the norm was to jab yourself a few times over the course of a day with a single prick glucose monitor device. It was an intrusive and sometimes unpleasant process, so much so that it was mostly people who had already been diagnosed with diabetes that monitored themselves on a regular basis. Fortunately, now we have a better, gentler and more practical way to get the job done, with a new generation of continuous glucose monitors (CGMs) -- patches that stick to the skin, measure glucose levels throughout the day and download the data to your smartphone or dedicated reader device. What’s in it for you? Virtually instant feedback on how your meals are impacting your glucose levels. For example, if you’re seeing post-meal spikes of more than 30 mg/dl higher than your pre-meal levels, it’s time to get a lot more serious about your diet and the choices you make. As my colleague Dr. Robert Lustig writes in his excellent book, Metabolical: The Truth About Processed Food and How it Poisons People and the Planet, a large percentage of people who take comfort in their “normal” annual glucose readings are becoming progressively more insulin resistant, in other words, on the path to prediabetes, or worst case, type 2 diabetes. But being able to take stock of the sugary enemy, with accurate glucose readings, is the tool you need to outsmart it.