Guide to Glucose, INSULIN RESISTANCE & Metabolic Health | Dr. Robert Lustig | Music-Free Compilation

metabolism is how your body takes stuff from the outside and makes it part of your inside that's what metabolism is there are two parts to metabolism burning and growth so stuff in the outside which we call food is consumed digested absorbed and finally metabolized if you're burning you're turning that food into energy if you're growing you're turning that food into bone muscle brain kidney liver and virtually every other organ burning occurs in a part of the cell called the mitochondria and every cell has mitochondria and cells that burn more energy need more mitochondria like for

instance the brain have the most mitochondria because it has to generate the most energy because neurotransmission is a very energy intensive effort so mitochondria determine burning what determines growth insulin insulin is a hormone hormone that is released from your pancreas from the beta cells of your pancreas in response to what you eat and how high your blood glucose goes and it drives growth it drives growth of muscle it drives growth of other organs and most importantly it drives growth of fat tissue glucose you take it in from the outside in food and it is substrate

for both growth and burning so you can use it to burn you can use it to power the little energy burning factories inside each of your cells the mitochondria to make energy for the cell in the form of ATP a denzine triphosphate which is chemical energy that your body can use to power itself or you can turn glucose into building blocks of the cell so that the cell can grow and the cell can divide so glucose can be turned into lipids for membranes it can be turned into ribos for DNA it can be turned into

proteins for structural growth glucose does both the question becomes how does a cell know which one to do at any given time what are the control mechanisms On Any Given cell at any moment insulin is a hormone it is released by the pancreas the beta cells of the pancreas which lives behind your stomach and it responds to the glucose rise in your bloodstream when you eat where does that glucose go well it goes to the various cells of the body but primarily the excess will go to fat and so insulin will drive the growth of

the fat Depot so more insulin more fat insulin is the control mechanism by which cells turn from burning and toward growth and it makes sense that that would be the case because when you have excess energy when you have excess glucose you're going to do something to turn that into growth so one of the Lynch pins between growth and burning is the level of the hormone insulin insulin is always good and bad insulin is never good or bad it's always good and bad it's good because it clears the glucose from the bloodstream because glucose in

the bloodstream does its own damage it causes endothelial cell dysfunction it causes the cells lining the inside of your arteries to be dysfunctional one of the reasons for our arteriosclerosis one of the reasons for hypertension you've got to get the glucose out of the bloodstream think of it a standard blood glucose is about 80 milligrams per deciliter that's how it's reported if you figure out your total blood volume of 6 lers that means you have about five grams of glucose in your bloodstream when you are fasting one teaspoonful when you consume an orange juice you

have consumed about nine times the amount of glucose that you have in your entire bloodstream your body has to do something to clear that before it does damage and that's the role of insulin insulin clears that glucose before it does damage the problem is that the insulin molecule itself does damage because it causes the coronary arteries to grow it causes the vascular smooth muscle in your heart and in the rest of your vascular system to grow it causes glandular tissue to grow it causes all sorts of things to grow and when they grow they risk

cancer they risk clotting and they risk uh degeneration so growth is good when you're a kid it's not so good when you're an adult so keeping that growth signal down is a primary directive and insulin is working against you as you get older when you you consume a meal you're going to overwhelm your body's blood glucose it has to be cleared so your pancreas is going to make insulin now the insulin rise is going to clear that glucose the question is how much can you make and how quick does it work the goal is don't

make so much and have it work great the problem is as you get older as you get less fit you're going to have to clear that glucose and your beta cells may not be able to make enough in which case you're not going to clear that glucose very quickly and so the blood glucose will rise so you will have a big glucose Spike and that will do damage to your vascular system and as you get less fit your insulin will work less well to drive that glucose out of your bloodstream and that will mean that

the glucose stays elevated for longer that phenomenon of insulin not working as well we call insulin resistance so two different phenomena insulin release can be compromised and that will give you a high glucose Spike or insulin resistance that will give you a long glucose Plateau both are signs of metabolic dysfunction both lead to illness and death insulin is a growth factor insulin makes cells grow and divide there is no growth without insulin now if you're a kid and you're growing if you're in puberty and you're growing if you're pregnant and you're growing you need more

insulin so the phenomenon of insulin resistance that is insulin working less well is necessary to drive all of that growth because you need a high insulin level but if you're laying down fat that's the wrong thing to be doing with your energy to be turning it into fat that's the growth you don't want but insulin is going to drive that growth so if you're consuming excess or if you're consuming things that drive in insulin like refined carbohydrate and sugar you're going to lay down more fat and the higher your insulin goes the more fat you're

going to lay down worse yet that fat then releases proteins that feed back on the liver and make your insulin work even less well and now you've got insulin resistance and you're going to drive even more insulin up and more fat gain so you get caught in this vicious cycle of more insulin more fat more insulin more fat and you can't get the fat down until you get the insulin down so fixing the insulin resistance is job one insulin is constantly pushing on your fat Cell saying store more energy store more energy we have to

turn that around we have to get the fat cell to give up energy in order to be able to lose weight but in the face of a high insulin it can't be done the only way to get a fast cell to give up its energy is to get the insulin level down any way you can the easiest way is Diet the second easiest way is exercise there is no weight loss until insulin declines you have to get your insulin down in order to be able to lose weight otherwise that insulin is just going to keep

pushing on your fat and making it grow even more insulin reduction is absolutely required ired for weight loss period And every weight loss modality that works gets insulin down inflammation is another control mechanism of the body so of course our body is our Temple but our Temple sometimes gets invaded by Foreign Invaders and the goal is to clear those foreign Invaders out we have several Pathways in our body to generate inflammation ways to stop foreign Invaders bacteria viruses fungi parasites inflammation is essential to life you can't live if you don't generate a good inflammatory response

so you need inflammation but inflammation turns your body away from growth and toward burning you increase your burning rate and the reason we know that is because you increase your body temperature how else can you generate an increased body temperature unless you're burning at a higher rate the difference is you're not making ATP out of it you're just making body heat now that's great for trying to fight off the Invader it's not great for you it's a source of aging and it's a source of early death so we have to control inflammation so the question

is where's the inflammation coming from now if you have an autoimmune disease it's coming from your immune system recognizing something is foreign but you know only about one in 10 people have an autoimmune disease yet nine out of 10 people have inflammation so where's the rest of the inflammation coming from it's coming from the gut it's coming from your intestine it's coming from where the bacteria are and the bacteria are all throughout your intestine your intestine is a sewer it's a pipe with junk in it and that junk makes inflammatory cyto kindes it makes lipopolysaccharides

it makes stuff that is bad for you and it needs to stay in the intestine so your intestine has developed three barriers to keep the junk where it belongs it has a physical barrier called the mucin layer which lines all the intestinal cells to keep the junk inside not in your bloodstream it has a biochemical barrier called tight junctions to keep each of the cells approximated so that junk can't get through and finally it has an immunological barrier to basically kill off any bacteria that might venture through the barrier and try to get into the

bloodstream all three of those barriers are under attack today and so we Americans and really pretty much anybody who eats the Western diet is inflamed because of their gut because of their diet in order to fix that inflammation in order to be able to utilize energy for either burning or growth instead of just heat we need to fix our inflammation inflammation is essential inflammation Keeps Us healthy because it clears out foreign Invaders and it allows for us to clear damage and heal that's all part of the process of inflammation you can't do without it but

mostly inflammation tends to be local so you sprain your ankle you get inflammation because you have to clear damaged tissue and you have to heal you cut yourself shaving you're going to get inflammation because you have to clear damage tissue and you have to heal wound healing is the end product of inflammation it's essential all of those are a Ute inflammatory responses and all of those are localized and that's good but there's other inflammation there's inflammation that's whole body inflammation like for instance when you get a virus the goal is raise the body temperature to

kill the bacteria or kill the virus try to activate those white blood cells to clear whatever the infection is you're doing damage but ultimately you are healing in but there is something called chronic inflammation where you don't solve the problem you don't clear the damage you don't get the healing because the inflammation is unrelenting it continues because the offending agent hasn't been dealt with because you are in constant unending exposure the only way to stop it is to stop the exposure so what is the exposure that causes chronic inflammation well many things they're all in

the environment air pollution causes chronic inflammation we know that people who live closer to freeways have more risk for diabetes and more risk for cancer than people who don't because they are breathing an inflammatory particle what about the rest of us our gut our gut is the source of the chronic inflammation and the reason is because of our diet because that intestinal barrier has been perturbed because it's not blocking the junk from getting into the bloodstream in the same way our lungs are not stopping the junk from getting into our bloodstream ultimately if you have

chronic inflammation you're going to generate cyto kindes you're going to generate uh heat you're going to generate the Aging reaction you're going to generate cortisol and you're going to generate early death that's what inflamation does and the only way we know how to stop inflammation is get rid of the exposure so you can't do very much about your air except move but you can do a whole lot about your diet so we have things in our diet that are pro-inflammatory and we have things in our diet that are anti-inflammatory pro-inflammatory foods are things that generate

an immune response like what well things that have omega-6 fatty acids okay seed oils and the reason is because Omega 6es are the precursor of a fatty acid called arachadonic acid and arachadonic acid is the precursor to all of the inflammatory molecules thromboxanes lucrin yosid basically causing inflammation where do you get seed oils from Ultra processed food because we're talking soybean oil we're talking corn oil we're talking even canola oil we're talking about the oils that the food industry specifically uses because they increase shelf life and because they're cheap now are there other pro-inflammatory Foods

absolutely sugar is a pro-inflammatory item and the reason is because of that fructose molecule glucose is not pro-inflammatory but fructose is why because fructose causes changes in the microbiome that caus the bacteria in your microbiome to chew up that mucin layer thus exposing your intestine to all of the junk that can get into your bloodstream fructose nitrates those tight junctions rendering them permeable so that stuff can get through and finally fructose knocks off those immunologic cells allowing for bacteria whole bacteria to be able to pass through into the bloodstream because we can measure them so

sugar is a pro-inflammatory substrate so seed oils sugar sounds like Ultra processed food to me all right what are anti-inflammatory foods anti-inflammatory foods are foods that suppress that immune response and I can sum that up with three items the first fiber now how can fiber be an anti-inflammatory food when we don't even digest it or absorb it because fiber is the food for your bacteria it is the food for your microbiome it's what your microbiome chews up and if you don't feed your microbiome your microbiome will feed on you that's how you lose your mucin

layer so when you consume fiber that is whole food that hasn't had the fiber stripped from it you will be actually supporting your microbiome and we know that because your microbiome will turn that fiber into a compound called short chain fatty acids acetate propionate butyrate and butyrate has very specifically been shown to reduce intestinal inflammation reduce the transit of bad stuff into the bloodstream reduce systemic inflammation reduce Alzheimer's disease bottom line fiber is the nutrient for your bacteria and you have to feed your gut and we're not second omega-3 fatty acids omega-3 fatty acids do

the opposite of omega-6 fatty acids they are the precursor to DHA dooh heex enoic acid which is necessary for neurotransmission and for immune health and also EPA iosa pentenoic acid which is ALS also necessary for good brain function and finally ala alpha linolenic acid which has cardiovascular protective effects so where do you get Omega-3s from well you can get ala from fruits and vegetables but EPA and DHA need marine life we need fish okay and it's not because the fish make the Omega-3s the fish eat the Omega-3s what makes the Omega-3s the algae the fish

eat the algae we eat the fish we get our Omega-3s thirdd hand problem is there isn't enough good wild fish to go around and so Omega-3s are a prime directive to metabolic health and then lastly the third anti-inflammatory food is vitamin D vitamin D suppresses something called the toll like receptors that keep inflammation in check and so by maintaining a check on inflammation we can keep the inflammatory Cascade from burgeoning out of control and causing all this excess damage so Omega-3s vitamin D fiber sounds like real food to me as people age the uh vicissitudes

of Life tend to catch up with you the cortisol bumps from all the chronic stress that we're all under the ultra processed food that we're all exposed to the air pollution the obesogens in our environment in the vinyl flooring in the Cosmetics I mean basically we are under constant Onslaught by various chemicals that interfere with our ability to burn and grow as that happens we're going to lose that growth signal and so muscle starts to decline as you get older one way to keep that up is of course exercise but the natural event is for

muscle mass to decrease as one gets older because of all of this Onslaught well that's one less place for glucose to go so when you eat a sizable portion up to sometimes 70 to 75% of a glucose load will end up in your muscle to power the muscles of your body if you lose that muscle where does the glucose go well it stays in your bloodstream and now your insulin has to clear it into fat so that's going to put an increased strain on your beta cells because they're going to have to make more insulin

to generate an increased storage place in your fat for all of that now excess glucose that wasn't excess before but is now and so you tend to lose muscle gain fat as you get older in in addition as you get older growth hormone decreases so growth hormone is one of the things that helps you build muscle it's one of the things that makes you grow it's growth hormone well growth hormone has a life cycle and it Peaks at around 17 to 25 and then starts to go down as you get older as you lose sex

hormones as you get older your growth hormone go goes even lower and so that stimulus to make muscle is now resolving and what takes its place is fat so basically you've got less opportunity to be able to burn the energy and more laying down of fat this of course creates even more insulin resistance that puts a greater strain on those beta cells which are also losing capacity because of all those chronic exposures and so they cannot keep up with the increased need for clearance peripherally and So eventually you'll get to the point where you just

don't have enough insulin for the way your body has changed one of the biggest issues facing women today is what to do about menopause menopause is part of life menopause is the Natural Evolution of ovaries some people earlier some people later but eventually ovaries burn out and when they burn out the estrogen that they made basically goes down to zero and that has all sorts of ramifications for metabolism throughout the body especially in the brain the drop in estrogen changes the sympathetic nervous system to generate heat and so you get these hot flashes and they

feel awful because the sympathetic nervous system what which was under suppression by estrogen is now basically released from it and so you get all sorts of you know unpleasant an unwanted side effects from the drop in estrogen now one of the other problems is that women premenopausal have low serum LDL and triglycerides but after menopause their LDL and triglycerides rise and no one's sure why that is but that puts women at increased risk for cardiovascular uh event later on in life they are protected from heart attacks prior to menopause but they catch up after menopause

so controlling that LDL and triglyceride rise that occurs after menopause is a high priority estrogen is also responsible for growth hormone release and so when estrogen declines growth hormone goes down and so women lose muscle the same as men and when it muscle is lost it is often replaced as fat so all of these phenomena are conspiring to basically destroy women's healthy metabolism as they pass through menopause the good news is that most of them are remediable with both changes in diet and improved exercise we can't get away from the fact that 93% of Americans

are metabolically ill 93% of Americans have some form of metabolic dysfunction and we can really translate that into mitochondrial dysfunction 93% of the population has something wrong with their mitochondria now ultimately we have to make mitochondria work better if we're going to fix this chronic disease pandemic that has enveloped basically the entire Western World how do you fix mitochondria well first you have to know what's wrong with them the thing that tells us that the mitochondria are dysfunctional is our fasting insulin our fasting insulin level is the closest method for determining mitochondrial dysfunction and everyone

should have a fasting insulin drawn with every yearly blood check a fasting insulin tells you whether your mitochondria are working right because if they are then your fasting insulin is low because that means that you are converting what you eat into energy and not storing it and that's what you want you want to turn it into energy not fat cell growth so keeping your fasting insulin down is job one now a fasting insulin will tell you that but in addition there's a proxy that you don't have to go to your doctor for and it is

by measuring your glucose not your fasting glucose because your body will do everything it can to keep your fasting glucose normal that is within the ranges of normality between 60 and 100 milligrams per DL it's the last thing to change your fasting glucose does not tell you about metabolic dysfunction but your glucose response to food is a proxy for for insulin so we learned earlier that high glucose causes endothelial cell dysfunction in the vasculature leads to hypertension leads to arteriosclerosis so you want to keep the spike of glucose down and also the length of time

that the glucose stays elevated is a marker of insulin resistance so the spike tells you about insulin release the length tells you about insulin resistance so by measuring your glucose in real time over time you can use that as a proxy for your metabolic Health even without a fasting insulin your glucose changes during the course of the day it's actually High when you wake up because of growth hormone and cortisol being released while you sleep it's about five to seven points higher in the morning we see this in diabetics it's called the dawn phenomenon well

the dawn phenomenon occurs in non-diabetics too because of growth hormone and cortisol release when you're waking in the morning it's part of life so measuring your blood GL glucose at 700 a.m. is not the same thing as measuring your blood glucose at 10 p.m. in addition catching the rise and fall as you eat gives you all sorts of information about your insulin Dynamics whether or not your beta cells are making enough insulin and whether that insulin is working properly and lastly something else that's super important when you you clear your blood glucose from a meal

does the insulin hang around because if it hangs around it's going to drive your blood glucose lower than Baseline and now you have something we call reactive hypoglycemia and that makes you irritable and most importantly hungry and so there's a really good chance you're going to reach for that chocolate chip cookie knowing that that happens to you is enormously important in terms of metabolic health and weight loss glucose is the energy of Life glucose is part of sugar it's part of starch it's everywhere around us because every cell on the planet Burns glucose for energy

now you eat a meal you get a glucose load that glucose gets absorbed from your intestine and goes straight to the liver the liver takes about 20% of that glucose load and imports it into the liver directly that leaves about 80% of the glucose out in the bloodstream to circulate and that raises the serum glucose you can measure that you can measure it with finger sticks you can measure it with a CGM the point is that glucose load is supplying substrate for either growth or burning to the rest of the body 20% is going to

your brain and the rest is going to your heart your kidneys your muscles any other organ that needs energy which is all of them that will raise your serum glucose which you can measure the cells will extract the glucose they need the only cell that needs insulin to import that glucose is your fat cell so so whatever's left over the insulin will clear and put into the fat cell for storage because the rest of the body doesn't need the insulin to extract the glucose from the bloodstream so a glucose spike in essence is your body's

attempt to clear your meal and every organ in your body will take what it needs and only the fat cell will get the rest and it gets that from insulin the higher the spike the more your rest of your body didn't get it so the goal is keep the spikes low so that the rest of the body doesn't need the insulin in order to clear it the glucose Spike is due to your food air pollution doesn't cause a glucose Spike but the kind of food will determine the degree of the spike and there are two

reasons one is the kind of glucose and the other is the amount of fiber so let's take each one individually the kind of gluc glucose I just told you glucose is glucose but in fact polymerized glucose called starch has two forms one is bread rice pasta potatoes called Amal optin and the other one is beans lentils other legumes called amalo amalo pcin amalo they are not the same amalo the brown food if you will is a string of glucoses one end one end and the string is put together by bonds between the glucose molecules called

alpha1 14 bonds alpha1 14 bonds they end up giving you a glucose response that is lower and slower Amal optin is Branched it's not a string it's got branches it's got Alpha one4 bonds but it also has Alpha One six bonds it looks like a Christmas tree and so enzymes can basically digest different glucoses off the tree and so you can generate a much bigger and more rapid glucose response in your intestine and therefore you will absorb more glucose faster it will give you a bigger rise well a bigger glucose rise ultimately means a bigger

insulin rise too so amalo has been shown to have beneficial effects in terms of keeping your insulin down amalo pectin has been shown to increase the risk for an insulin rise now this is captured through a phenomenon which we in nutrition call glycemic index glycemic index tells us how high will your blood glucose rise in that Spike when you consume 50 gram of carbohydrate in a given food so if you consume 50 gram of carbohydrate and bread your glucose is going to go a lot higher than if you consume 50 gr of carbohydrate in beans

so bread high glycemic index beans low glycemic index okay now the second thing fiber the amount of fiber translates into slowing of that glucose absorption so even if it's Amal optin the presence of fiber in the food will act as a barrier it forms a gel on the inside of your intestine preventing glucose from actually being able to get into your bloodstream so you will actually reduce the size of the spike by the presence of fiber this concept of using fiber to reduce the size of the spike has a name also it's called glycemic load

an example of this would be carrots so carrots have a high glycemic index if you eat 50 gram of carbohydrate in carrots your blood glucose will go pretty high but the question is not what is the glycemic index of carrots the question is what is the glycemic load of carrots because in order to get 50 grams of carbohydrate and carrots you have to eat 700 gram of carrots you have to eat 1.4 pounds of carrots now aside from Bug's bunny who's doing that nobody and that's the point so even though carrots have a high glycemic

index it has a low glycemic load so amalo fiber both of them control the size of the glucose Spike and when you control the glucose Spike you're controlling the insulin Spike and when you control both of those you are contributing to metabolic health when you exercise you activate the sympathetic nervous system now the sympathetic nervous system is the part of your nervous system that is the fight ORF flight response in the process the sympathetic nervous system will activate and will send nervous impulses to the liver the liver will then release all of the stored up

glucose that it has in the form of glycogen glycogen is what you make in response to eating a meal especially a high carbohydrate meal glucose for a rainy day this is why marathoners carad before a race because they're trying to build up their liver glycogen stores so that they can release them during the during the race so when you start exercising your liver will take that glycogen and turn it into glucose and release it into the bloodstream that will lead to a rise in your serum glucose that will lead to a glucose Spike and then

that glucose is now available for muscles for the brain for the kidneys to be able to metabolize energy while you are exercising and it will stay up until either the liver runs out of glycogen which takes about 3 hours or until you stop exercising in either case your glucose will then fall precipitously so if you stop exercising you will clear that glucose Spike very rapidly if you are on the football grd iron and exercising like crazy your glucose will start falling precipitously and you will all of a sudden become very tired because you have run

out of readily available glucose this is one reason why the sports drink companies put fructose into the sports drinks because that's another way to generate glucose when you're exercising and it's true if you are a you know grd Iron athlete an elite athlete that fructose in that sports drink will ultimately get converted back into glucose and will help replete the glycogen that your liver has lost no one else needs the fructose for anything else but the bottom line is you will clear the glucose Spike rapidly because you have stopped exercising cortisol is the stress hormone

it is made by the adrenal gland and it circulates in the bloodstream and what it does is it raises the serum glucose in order to provide more energy for the brain so that the brain can still run even when there's no glucose available and also it will start actually taking away from muscle it will actually cause the dissolution of muscle in order to keep the brain Fed so chronic stress is the opposite of acute stress in terms of the physiology and in terms of the glucose requirement the goal of chronic stress is to feed the

brain because the brain is the highest glucose demander it requires the most glucose all the time because it doesn't have a place to store glucose so cortisol lifts energy from the rest of the body and makes sure that the brain gets it well that has negative effects on the brain and it also has negative effects on that glucose Excursion because glucocorticoids actually interfere with mitochondria and interfere with the ability to produce ATP in many of those organs and so cortisol dissociates the energy availability from the energy utilization it actually inhibits mitochondrial function and so the

higher the cortisol the bigger the glucose rise but the less well you're going to clear it because glucose interferes with mitochondria you see the effect as insulin resistance in fact the more stressed you are the higher you're fasting insulin because the less well your mitochondria are working and the only way to fix that is fix the stress now that's pretty hard to do there's different information in the different components of the spike it's not that the spike is worse than the plateau it's not that the plateau is worse than the spike they're telling you different

things the size the amplitude of the initial spike is telling you what your insulin Reserve is so people with reduced insulin secretory capacity are going to have a bigger Spike than people who can muster up a a bigger in insulin response the plateau is going to tell you how insulin resistant are you and that's going to tell you about your risk for all the other diseases of high insulin term metabolic syndrome so not just diabetes but fatty liver disease um hypertension uh dyslipidemia uh cardiovascular disease cancer dementia uh polycystic ovarian disease are all dependent on

that plateau and what we've learned is that the Spike as the um resistance gets worse and your beta cell starts running out of insulin then the spike goes up so in a sense the plateau tends to precede the spike in terms of the evolution of the disease so it's not really a question of which is worse it's a more of a question of what comes first eventually if you've got a defective Plateau because you're not clearing insulin that means your beta cell is under strain and ultimately it will show up as a big spike at

the beginning and both are bad mitochondrial dysfunction transl Ates into insulin resistance insulin resistance translates into hyperinsulinemia hyperinsulinemia translates into chronic metabolic disease so you can draw a direct line between the mitochondria and your health insulin resistance is the first sign of the problem that's telling you that you've got a problem you can see it in the plateau eventually you'll see it in the fasting insulin so without question a continuous glucose monitor will pick up metabolic dysfunction before any of our other laboratory biomarkers do one of the reasons for choosing and wearing a continuous glucose

monitor is to look at that insulin Plateau because that is the first sign that your metabolism has a problem that things are going south insulin drives defective cell uh growth uh it causes cells to grow when they shouldn't certainly it causes fat cells to grow but it also causes vascular smooth muscle to grow it causes glandular tissue to grow it causes changes in the brain that prevent utilization of glucose because of insulin resistance which ultimately lead to defective ATP generation that's one of the reasons why Alzheimer's disease has been called Diabetes Type 3 but you

know we know that insulin resistance is a primary driver of defective CNS glucose utilization so getting your insulin down is job one it is the most important thing to improve your metabolic health and continuous glucose monitoring will pick up the first signs of that metabolic dysfunction before any of our other biomarkers can so that's where the rubber hits the road fiber is the stealth nutrient fiber is your friend fiber is probably the most important nutrient you don't absorb okay for years fiber wasn't even a nutrient because you didn't absorb it the FDA finally made a

change and said yes we do need fiber in our diet and they set a minimum amount of 25 gram per day the median for America right now is 12 G per day we all probably should be getting about 50 g per day all right that gives you some idea about where we are we're getting about one quarter of what we need and about 1 half of what is at least rational now why is fiber so important fiber does six things that all improve metabolic Health the first thing it does it gives some bulk it gives

a mechanical stretching to the stomach which gives you a feeling of fullness reducing total food intake number two the insoluble fiber the cellulose forms a lattice work like a fishnet on the inside of your intestine the soluble fiber the pectins the inulin like what holds jelly together or globular they plug the holes in the fish net and together they form a gel a whitish gel and you can see it on electron microscopy coating the inside of your small intestine and generating a secondary barrier and that secondary barrier prevents the transport of glucose and fructose and

sucrose and starches from the intestine into the bloodstream thus keeping your blood glucose down which you measure in your CGM well that keeps your insulin down and so that's good for your metabolic health because it's all about getting that insulin down third thing The food doesn't get absorbed early so it moves through the intestine where the microbiome lives and it will chew it up for its own purposes so you are feeding the gut and when you feed the gut then your intestine bacteria don't have to chew on the uh mucin layer that's protecting it number

four it greases the skids and moves the food through the intestine faster this is why fiber laxitives exist is to prevent constipation because it carries water with it and moves the food through the intestine faster well that generates the satiety signal at the end of the intestine sooner so you won't eat that second portion number five the soluble fiber in what you eat serves as food for the colonic bacteria which will turn that into short chain fatty acids acetate propionate butyrate which are anti-inflammatory help prevent irritable bowel syndrome and prevent Alzheimer's disease and finally the

insoluble fiber acts like little scrubbies on the inside of the colon basically sloughing off C colon cancer cells so that you don't get colon cancer so the amount of fiber you consume is inversely correlated with your risk for colon cancer so every single thing fiber does improves your metabolic health and the way it shows up is in the reduction in the glucose response on CGM in fact a high fiber diet will give you the glucose response of a ketogenic diet and a ketogenic diet is the one that suppresses insulin the most any food that came

out of the ground has fiber because that's what allows the food to get out of the ground so fiber is in fruits yes fructose is in fruits too but the fiber reduces the absorption and so it makes that fructose less of a burden and safe fiber is in vegetables stringy vegetables not as much for starchy vegetables uh green vegetables and of course if you eat green vegetables you're going to get all those antioxidants also which are good for you as well because they're going to take care of the reactive oxygen species we spoke about earlier

animal products do not have fiber contrary to popular opinion so you have to basically restrict yourself to produce now does bread have fiber in the answer answer is very few some breads do because they're made from grain and wheat has fiber until the mill takes it away so if you take a wheat berry and you measure the weight of the husk which is the fiber against the weight of the endosperm which is the starch in the center turns out the fiber is 25% of the kernel 25% so in order to find a high fiber bread

you have to look at the total carbohydrate to dietary fiber ratio on the side of the package and you have to do the calculation yourself because they're not going to do it for you if the total carbohydrate to fiber ratio is 3:1 to 5:1 then that is a high fiber bread and that is a bread worth eating for its metabolic benefits anything above that means that the fiber has been stripped out and even if they call it a high-fiber bread it's not even if they call it a whole grain bread it's not because they can

call it whole grain if they started with whole grain before they did the pulverization and got rid of the husk so just because it's brown doesn't make it good you actually have to look at the fiber content of the bread so what breads are high-fiber breads you can go to Whole Foods or to specialty grocery stores and look for German Fitness bread as an example so this is bread that is a pound but it is like a brick it's thin and it's small and it is dense it has very high fiber it's cut very thin

and it makes a really lousy sandwich and the reason is because there's not that much gluten in it to hold it together if you go to the grocery store the breads are twice or to four times the size they're all puffed up those are high gluten breads they make a terrific sandwich but they have all had their fiber stripped out and they all have carbohydrate to fiber ratios of 8:1 to 10:1 those are the breads that are not metabolic worth eating now there's protein so protein is the macronutrient of the moment everybody's really excited about

protein and the reason that they're excited about protein is because of new data that shows that muscle loss leads to metabolic syndrome declining health and early death no question sarcopenia is a bad guy in the story and as we said aging is a driver of sarcopenia and without question protein is necessary to mitigate that risk but it's not just protein it's Protein Plus exercise you cannot turn protein into muscle unless you exercise as well so what if you just consume Protein that's all the answer answer is protein will lower the glucose rise one reason it

will lower the glucose rise is because protein is mixed in all the other food and so it presents a competitor to glucose absorption so it keeps the glucose in the Lumen longer because of the Gish of the uh various nutrients within the U uh within the Kim within the the the digested food as opposed to say a soft drink where it gets uh absorbed super easy and super rapidly so it will keep the glucose rise down for that reason but it'll also keep the glucose rise down for a different reason which is maybe not so

good so protein as you may know have 20 amino acids that compose the different proteins that we consume nine of those amino acids are called essential amino acids you have to consume them your body can't make them and you have to get those nine essential amino acids one of those amino acids That's essential is called Lucine Lucine is very high in milk and it's very high in corn and Lucine of all the other amino acids is the one that goes to the beta cell and stimulates insulin by itself without glucose so we always talk about

glucose being the stimulus to insulin release yes but Lucine is a stimulator of insulin release as well so when you consume high doses of Lucine in the form of cornfed beef chicken and fish or in the form of milk you will generate a greater insulin response which will keep your GL glucose Spike lower because after all insulin's clearing glucose from the circulation so that sounds like a good thing but as we've talked about that insulin rise is part of the problem because it's driving growth when you want burning and so in a sense it's making

your cell be dis synchronous with the food load that it is uh uh dealing with so while keeping the glucose down is essential and the whole reason for wearing a CGM the goal is to keep the insulin down and loosing makes the insulin go up and then finally there's fat dietary fat and that's really complicated and the reason is because there are seven different fats and they all do different things and three of them are good for you and three of them are a little less good for you and one of them is downright poison

so we have to discuss each one because people want to know all right what are the good for you ones Omega-3s Omega-3s are the single best thing you can put in your body Omega-3s as we've talked about you can find in certain vegetables and in marine life Omega-3s are heart health anti-inflammatory anti-alzheimer's and our current omega-3 consumption is way low number two monounsaturated fatty acids oleic acid this is what's an olive oil olive oil is a winner and the reason is because olive oil stimulates the liver to produce a transcription factor which helps total body

metabolism and that's a good thing the only bad thing about olive oil is if you heat it too high because the double bond in olive oil that makes it a monounsaturated fatty acid can flip and if when you put heat across it and if it flips now you have a trans fat which is the worst number three polyunsaturated fatty acids you know Walnut oils and various other nut oils or polyunsaturated they are also good they also will keep your LDL down they will keep your membranes intact in good ways but like olive oil if you

put enough heat across those uh double bonds they will flip and you will get trans fats and because there are more double bonds more risk for it number four saturated fat now everybody thinks saturated fat is bad because they've been told for 50 years that saturated fat is the bad guy no saturated fat is cardiovascularly neutral it's neither good nor bad it doesn't have any double bonds so you can heat it to any level you want and it won't change its structure because there's no double bond to break or to flip um it is not

necessarily good for you but Dairy saturated fats have a phospholipid signature which actually is associated with metabolic Health prevention of cardiovascular disease and diabetes so Dairy saturated fat and red meat saturated fat aren't even the same number five medium chain triglycerides now they're also very uh hot because number one the vegans love it because they're not animal fat things like coconut oil and the Paleo uh people love it because it you know fits within the paleo diet and for the most part they tend to be reasonably good too unless you mix them with a whole

lot of saturated fat in which case you end up with a whole lot of triglyceride being uh manufactured in the liver which is not so good number six omega-6 fatty acids these are the seed oils the um soybean oil the uh uh ConEd oil the uh corn oil Etc and those are the precursors of arachadonic acid and uh therefore uh the precursors to inflammation and so they Drive inflammation and you want to try to keep those down and they are in virtually every ultr processed food and then finally number seven trans fats which are the

devil incarnate and the reason is because we don't have the uh enzyme to break that trans double bond well the reason they were put into the food in the in the first place was because the bacteria don't have that enzyme either they can't chew them up they can't make trans fat Laden food rancid Visa the 10-year-old Twinkie and so virtually every baked good prior to 2000 had a multitude of trans fats well they were lining Our arteries and our livers and causing metabolic syndrome and early demise so what does dietary fat do to your CGM

reading well it depends depends on what exactly you're eating if you are eating straight fat like a ketogenic diet your serum glucose should vary almost not at all and the reason is because fat does not stimulate glucose it does not stimulate insulin however what fat does is it primes the beta cell to release more insulin in response to glucose so if you eat fat and glucose together I e uh Cinnabon the Fat's going to Prime the beta cell to release more insulin in response to that glucose rise than it would have otherwise so even though

it didn't change the glucose response it's sure as hell changed the insulin response and you will get a bigger insulin response because the fat was paired with sugar and that's pretty much true for fat and virtually any carbohydrate so in and of itself fat is not a stimulator of glucose rise or insulin rise but because it primes the beta cell it generates an increased insulin response which is not good from a metabolic standpoint how many spikes are acceptable per day and the answer is however many meals you eat that's how many are acceptable because you're

going to get a spike every time you put food in your stomach the question is to what extent the goal is to mitigate that Spike as much as possible if you eat foods that are low in refined carbohydrate high in fiber and low and lucing then you should be able to keep your glucose Spike and therefore your insulin Spike relatively low optimally you should probably only eat two meals a day maybe three meals a day if you've got a family and you know you need it but probably two meals a day will do it we

in America tend to eat three and is that part of the reason we have metabolic dysfunction I don't think so but some people are postulated that we don't need that third meal maybe we don't need that third glucose Spike hard to know we don't have good controls to answer the question ultimately I don't care how many spikes you have as long as you do whatever you can to mitigate the amplitude of the spike and the duration of the plateau in other words improve insulin release and improve insulin sensitivity get the insulin down any way you

can so remember there are two parts to the insulin Excursion there's the initial rise or the spike and then there's the second phase or the plateau that rise can be mitigated by reducing total carbohydrate and increasing fiber the plateau can be mitigated by improving insulin sensitivity that is reducing refined carbohydrate and sugar so either way fixing your diet will fix the insulin Excursion both parts of it the spike and the plateau get the suar down get the carbohydrate down get the insulin down and you will improve metabolic Health you will improve mitochondrial functioning you will

improve your health and your longevity we now have a fair amount of data and what we've learned is that in response to a mixed meal because that's what people eat they don't just consume glucose what we've seen is that the rise will occur within the first 30 to 45 minutes depending and it should fall again around 75 to 90 minutes if your blood glucose has returned to Baseline by 90 minutes you are doing pretty well if on the other hand it is still high at 120 Minutes you are not doing as well and the other

thing you need to watch for is this reactive hypoglycemia and that tends to center around 75 minutes so if your blood glucose goes below Baseline at 75 minutes check to see how you feel when that when you get that number and see if that is below Baseline and see if you feel irritable tired hungry because if that's the case that means that your insulin response is greater than your need because it is sticking around and driving your glucose lower which means you probably need a change in the carbohydrate or the fiber you're eating when you

eat your blood glucose Rises when the blood glucose clears if your blood glucose goes below Baseline you kick out three hormones hores in order to raise your blood glucose back again you kick out glucagon you kick out epinephrine and you kick out cortisol all to make your blood glucose come back to Baseline the problem is you also got irritable and hungry and so you eat on top of that and so you've got these three hormones generate a glucose rise at the same time you're trying to fix it with food and so you get a bigger

response which then the insulin will come and knock back down and you may yet get another reactive hypoglycemia again and so you may kick your glucagon your epinephrine and your cortisol back in a second time and so now you have a glucose roller coaster poter because of the counterregulatory hormones that your body made in response to your glucose going down below Baseline all because of the food you ate what happens to your glucose when you enter sauna the heat is a stress the stress activates the sympathetic nervous system the sympathetic nervous system goes to your

liver and causes glycogen to be released and so it will generate a glucose Spike all by itself with having eaten nothing just from the epinephrine being released it will cause a glucose rise that glucose will clear quickly because your insulin will come up to meet it and it will go away it will have caused no damage and will be gone very quickly but that's all also one of the reasons why after you've been in the sauna you want to go take a nap afterwards is because you have actually depleted some of your glucose stores and

you need time to replete them so enjoy your nap we've gotten sick in the last 50 years because of the changes in our environment and our environment has changed in multitudinous ways our diet changed our sleep cycle changed our capacity and opportunities for exercise have changed our stress has changed our exposure to toxins has changed bottom line in order to achieve optimal metabolic Health we have to work in every single one of those venues how do we do that well we can't we can't fix them all but there are certain ones that we can okay

and the one that's immediately available and the one you can fix today is your diet and the data show that if you fix your diet your improvement in cardiovascular mortality risk is dropped by 35 to 40% now compare that to if all of a sudden you started exercising now that's also good but the data show that if you start exercising your improvement in cardiometabolic mortality risk reduces by a total of 25% which is better 35 to 40% or 25% both good do both but if you had to do one thing make it diet because number

one you have complete control and number two you can make your own food and number three it works best how quickly can you fix your metabolism if you start adopting sensible dietary and exercise practices we did a study at UCSF where we took 43 children with metabolic syndrome and we took the sugar out of their diet and replaced it with an identical amount of starch and we were able to show in nine days an improvement in every metabolic marker my colleagues at San Francisco General did the same Essential Study in adults and they were able

to document the same improvements in two weeks we could see change ches in Sugar turning into fat in the liver we could see changes in fasting insulin in 10 days to 2 weeks it doesn't take that long so within a month you should be able to see significant changes in your metabolic parameters and you should be able to tell within even a week to two weeks that you feel metabolically better now the question is how durable is it how long will the effect last the answer is if you stop doing it within two weeks things

will have gone back right to where you were at Baseline that's how quickly things can revert but if you maintain that diet if you maintain that exercise regimen you should be able to see benefits 3 months 6 months a whole year out and those will accumulate and extend life significantly we have data to show that even 15 minutes of walking each day will extend lifespan by three years and 30 minutes of exercise every other day will extend lifespan by five years it's not a shocker that adults and children today are getting less sleep than they

did before in fact 35% of adults get less than 7 hours of sleep per night and 23% of adults are chronic insomniacs the question is what does that do to your metabolic health and the answer is it does two things both bad the first is it's a stress it raises your cortisol and we've already talked about cortisol being a mitochondrial dissociator it basically creates heat instead of creating ATP that's bad for your metabolic health because now your cells are basically Running on Empty no wonder you feel lousy second sleep deprivation increases a hormone that is

responsible for Hunger which comes from the stomach called Gin Gin is released in response to sleep deprivation circulates in the bloodstream goes to your brain and says I'm hungry feed me and so you end up eating more which will only raise your glucose excursions and your insulin response and generate increased fat and of course chronic metabolic disease so chronic sleep deprivation affects cortisol driving metabolic dysfunction and gin driving increased eating everyone thinks that oh I'm eating more CU I'm up longer no you're eating more because your gin is dysfunctional so how do you fix sleep

deprivation well one way is cut the caffeine because caffeine is exactly what's wrong with sleep but that's not the only thing the other thing to do is take the screens out of your bedroom studies show that children who sleep with their phones charging in their bedroom get 28 minutes less sleep per night than children whose screens are charging outside their bedroom the blue light by itself Alters the uh dial rhythms of the brain ultimately leading to metabolic dysfunction so sleep deprivation stress reduction all part and parcel of the same metabolic toxic mix so does sleep

affect your CGM and the answer is at levels we've shown that the more sleep people get the more time in range and the lower the glucose excursions that we see more sleep more better from a glucose standpoint some people see that their blood glucose is lower in the morning and higher in the evening you'd expect it to be the other way around that may be due to changes in Dalal rhythms it may be due to the food if you are eating a high carbohydrate diet then there's a very good chance that you are priming your

beta cell as the day goes on and so you're getting a bigger glucose Spike and because you're eating late instead of early you should there should be at least four hours between the time you eat dinner and the time you go to sleep if you're eating with less time between dinner and bedtime then your glucose is going to be high and that's going to end up driving uh energy into fat while you're sleeping because the glucose still has to be cleared and that's going to generate more insulin resistance and that's going to show up throughout

the entire day as a higher Baseline but in particular because of the high carboh hydrate meals you will see a higher uh glucose at the uh end of the day there are 262 names for sugar 262 and the reason is because the food industry likes it that way because they can use a different name for sugar on the side of the package and a different sugar can be number five number six number seven number eight number nine and when you add it up it's number one they hide it in plain sight but virtually every one

of those 262 it's because of the fructose that's the problem so what is glucose and what is fructose and while we're at it what is sucrose and high fructose corn syrup too glucose is what plants make in starch fructose is what plants make in Sugar starch not sweet sugar sweet glucose not very sweet fructose very sweet fructose is addictive because fructose stimulates the reward center of the brain and tells you this feels good I want more in the same way cocaine heroin nicotine and alcohol do and it makes sense because fructose and alcohol po metabolize

the same way do the same things metabolically in the body and also centrally in the brain fructose and alcohol both lead to Alzheimer's disease fructose is half of sucrose half of dietary sugar half of high fructose corn syrup half of maple syrup honey Agave if it's sweet and it's quote natural it's fructose that's the way it works fructose has metabolic detents that glucose does not glucose stimulates mitochondria to work better fructose inhibits mitochondria from working better fructose inhibits three enzymes involved in mitochondrial function I'll name them real quick amp kyes aadl and cpt1 bottom line

fructose inhibits mitochondrial function fructose inhibits ATP generation fructose inhibits energy metabolism fructose makes you sick the goal is keep the fructose down how do you do that well get rid of the dietary sugar the problem is there are 262 names for them and the food industry uses them all so until we have policies that address this issue in Washington and London and throughout the world you have to be on your guard another problem with fructose is it's not measured by the CGM so glucose is monitored by the CGM fructose is not so when you consume

something with a lot of sugar your CGM will r eyes because of the glucose but you won't even see the contribution of the fructose because it's not being picked up by the CGM but because fructose does all of these things that glucose doesn't it's seven times worse and you don't even measure it on the CGM so absolutely essential to try to keep your dietary sugar consumption low how low well how about zero no one needs it there is no biochemical reaction in any vertebrate organism that requires dietary fructose how's that now we can tolerate a

certain amount up to about 25 grams of sugar therefore 12 gram of fructose per day that would be six teaspoons of added sugar per day an orange juice is 11 teaspoons a Milky Way bar is s teaspoons a bowl of fruit loops is four teaspoons so you can see it adds up pretty fast bottom line is if you want dessert have dessert just don't eat dessert for breakfast lunch dinner and snacks fructose is a metabolic toxin in the same way alcohol is a metabolic Toxin and it makes sense that it should be because after all

where do we get alcohol from fermentation of fructose it's called wine we do it in nap and syoma every day the big difference between the two is that for alcohol the yeast does the first step of metabolism which is called glycolysis for fructose we do our own first step after that they're virtually identical in the same way that alcohol uh causes metabolic damage fructose causes metabolic damage one of those ways is through a compound made in the liver called uric acid now uric acid is a bad guy in the story uric acid is one cause

not the only but one cause of hypertension high blood pressure uric acid blocks an enzyme in your your blood vessels that relax your blood vessels called nitric oxide uric acid reduces nitric oxide well fructose metabolism leads to uric acid and uric acid is a bad guy in The Story So uric acid also inhibits mitochondrial function it also generates increased fat in the liver and it increases blood pressure fructose is a driver of metabolic syndrome in part through uric acid keep the uric acid down keep the fructose down by the way while you're at it keep

the purines down that's red meat because that also raises uric acid too cholesterol is a funny thing cholesterol is necessary everybody thinks cholesterol is bad because they've heard it causes heart disease cholesterol is absolutely necessary if you need cholesterol you need cholesterol for membranes you need cholesterol for steroids cholesterol is so essential that our body has a method for manufacturing it out of nothing out of glucose for that matter so cholesterol gets a bad WP and the reason is because there are actually mult multiple cholesterols there's LDL there's HDL and then there's this other one

that's not really uh a LDL at all it's called triglyceride but it goes along with it because it's vldl it's got some cholesterol in it it's not the one that matters it's the pattern of all of them together that matter and this is where doctors need to basically go back to med school because all the stuff has changed really in the last 10 years and your doctor may not know it LDL has always been thought of as the bad guy high LDL oh you need a Statin well there are two ldls there's not one there's

two one's called large buoyant and one's called small dense they are not the same except that the LDL assay measures both at the same time so the lab test says they're the same but they're not the same large buoyant LDL is cardiovascularly neutral and it's the one that dietary fat raises so dietary fat turns out to not be very important in terms of cardiovascular disease small dense on the other hand is very important small dense turn turns out to be the atherogenic particle or at least an evolution of the atherogenic particle called Remnant cholesterol and

small dents can get under the surface of the endothelial cell in the arteries and start the foam cell formation process that leads to the plaque that leads to the heart disease and it's more easily oxidized because it's smaller and so it's the bad guy in the story and what raises your small dense LDL well the same thing that raises your triglyceride because that's the thing that gets turned into the small dense LDL that's sugar so sugar is the driver of the LDL fraction that generates the heart disease dietary fat is not then we have HDL

and HDL for the most part is good the higher the HDL the better off it is and the reason is because that's also an evolutionary output of LDL once the cholesterol is offloaded and then that comes back to the liver to be reloaded so basically the HDL is a shuttle mechanism and so the higher the HDL the better the shuttle mechanisms working if you eat a low carb diet whether it's a ketogenic diet or a paleo diet or just an Atkins diet okay what it means is you're reducing your total total carbohydrate and hopefully sugar

and you are raising your dietary fat so you will generate a higher LDL but it's going to be that large buoyant LDL which again is cardiovascularly neutral that's not the bad guy on the lab slip it looks like the bad guy because of these reference ranges that make no sense but ultimately the goal is get the small dense LDL down and Statin don't touch those the other issue about statins is that 20% of people who go on statins either end up with uh inflammation of their muscles called rabdom myolysis or because statins are actually a

mitochondrial toxin by themselves end up with hypoglycemia actually Frank diabetes so the question is to lower the LDL that's not important but to put yourself at risk for hypoglycemia which is important is that a good trade low carb diets are invogue ketogenic diets are commonplace now okay ketofriendly stuff in the grocery store first of all is it really keto friendly how do you know you think it's been tested don't be so sure just because it says it's keto friendly doesn't mean it is but let's say you're doing your own ketogenic diet at home you're actually

making the food yourself and you know what you're eating what's going on is that that fat is priming that insulin response but because there's no carbohydrate you don't release it it's there but it's saved up for a rainy day and then you have that slice of pizza and you break your diet what's going to happen well you're going to get this big glucose response because your liver is not going to basically uh absorb any of the glucose because it the Transporters have gone down so it's all going to flood your uh bloodstream your beta cell

is going to see a higher glucose response because your the rest of your body has learned to run on ketones instead of glucose so you're not even going to be shoveling glucose into cells and so you're going to get a bigger glucose response therefore you're going to get a bigger insulin response because your beta cells have all of this insulin stored up waiting to go because it hasn't been cold on in weeks and weeks and so you're going to get this glucose insulin explosion just because you broke the diet and that is going to drive

virtually all that glucose into fat and it's going to undo that ketogenic diet in one meal and people who fall out of the ketogenic diet now are not getting the benefits of low carbohydrate anymore the reason is because their insulin's gone up now they're on a high-fat medium carbohydrate diet with insulin which is about the worst diet you can be on so if you're going to do a ketogenic diet you have to actually be pretty fastidious about it I'm for it I'm not against it but you can't just play ketogenic you have to do it

so what should your average glucose level be the fact is there is no average level glucose because it's in constant fluctuation because you're always either pre-prandial or postprandial except when you're asleep now when you're asleep your average glucose should be somewhere between 60 and 80 when you're awake it kind of depends on what you're doing and it also depends on what you're eating and it depends on how insulin sensitive you are and it depends on how much stress you're under and it depends on the last cup of coffee you drank so it's actually kind of

hard to get specific numbers having said that the American Diabetes Association says that if your fasting blood glucose is over 90 it's an issue if it's over a 100 you have pre-diabetes and if it's over 125 you actually have type two diabetes if your postprandial 2hour postprandial blood sugar is over 140 you have pre-diabetes and if your blood postprandial blood sugar is over 200 you have Frank type 2 diabetes what I care about is you getting your blood glucose as low as possible because you got your insulin as low as possible if you become insulin

sensitive your glucose will take care of itself that's where you start and to be honest with you that's where you finish but how do you get there CGM is the best way today to get there so what should your fasting glucose be well it should be probably between 70 and 85 optimally maybe 70 to 90 [Music] suboptimally how high should it go after you've eaten probably shouldn't go above 110 if it goes above 120 and turns around quickly not so bad ultimately the goal is to get back to Baseline within 90 minutes that's more important

than how high it goes because that's the plateau if you're seeing it Go fur further than that that's the sign of insulin resistance that tells you you've got metabolic dysfunction