What you're not worrying about, but should be

Unless you have diabetes, you probably don't think about your blood glucose levels very often. If you're young, you proabably never think about it. If you're older, you might think about it once a year when you get your annual physical and get your fasting glucose levels checked. Physicians don't make a big deal out of blood sugar, so you probably assume it's no big deal. Sometimes a nutritionist might say something about certain foods being good because they "stabilize blood sugar," but the benefits of that stabilization still probab ly seem a little vague to you. Perhaps you've heard that if you prevent your blood sugar from spiking, you'll also prevent the mood swings, fatigue, and ravenous hunger that can result when you "crash" back down from a glucose peak. If you are particularly well-read you may also have heard something about insulin promoting fat storage when blood sugar is high.

While the term "fat storage" can incite fear well enough on its own, there are even more severe consequences to blood sugar levels that are higher than they should be- even if they are not, by clinical definition, abnormal.

First, a little background information, so we're all on the same page. Below are the fasting blood glucose (FBG) and 2-hour oral glucost tolerance test (OGTT) cut-offs for diabetes mellitus and impaired glucose tolerance (AKA pre-diabetes).

Normal: FBG < or =" 99;">OGTT < or =" 139

Impaired Glucose Tolerance: FBG 100-125; OGTT 140-199

Diabetes: FBG 126 and above; OGTT 200 and above

The problem with these cut-offs is that they are somewhat arbitrary. They seem to give the impression that any blood glucose value in the normal range is, well, normal, and that pre-diabetic levels are only a warning of possible future problems if left uncontrolled. What your physician won't tell you is that even within the normal range, lower is better, and that having impaired glucose tolerance can increase your risk for cardiovascular diseases and death, even if you never become diabetic.

The truth is, even a glucose level of 140 can cause damage to blood vessels and to the cells of the pancreas that produce insulin. Blood vessel damage can lead to artery plaques, which can ultimately cause heart attacks. A glucose level of 140 is not what any doctor would call "high," and yet it appears to be an important threshold. Just to be clear, glucose in the blood is dangerous no matter when it happens. So, if your glucose is high after a meal, but normal when you are fasting, you are still going to be at higher risk than someone who has normal glucose levels all the time. In fact, risk of cardiovascular disease increases with OGTT values as low as 80!! Lower really is (nearly) always better in this case. The problem is, most people have no idea what their blood sugar is after a meal. The average person only receives fasting blood glucose tests regularly, not OGTTs. Unfortunately, FBG will start to rise only after post-meal glucose has been elevated for quite some time. This means that by the time a person has a high FBG, a lot of damage has already been done.

So what are you supposed to about this?? Here are my recommendations:

1. If you have any of the following risk factors, talk to your doctor about whether you should have an OGTT: overweight with mostly belly fat, obese, polycystic ovary syndrome (PCOS), first-degree relative with type 2 diabetes (parent, sibling)

2. Be on the look out for free glucose screenings in your area and plan to go about an 1- 1.5 hours after a meal to catch your peak level.

3. Regardless of what your glucose levels are after eating, virtually everyone could benefit from reducing that level. So, think about making dietary choices that will maintain a stable blood sugar.

Some suggestions:

Reduce your portions of starches

Choose whole grains over refined grains

Increase your portion of vegetables

Choose whole fresh fruits over fruit juices or canned fruits

Eat lean protein and healthy fats (olive oil, canola oil, etc.) with starchy foods

Swap out artificial sweeteners (like Splenda) for sugar wherever you can

Switch from regular to diet soda, or no soda

Snack on nuts and fruit rather than high-carb granola bars or candy

Start your day with eggs and/or a high-fiber cereal

Also, physical activity can help your body to use the glucose in your blood, so if you must have dessert, go for a walk afterwards!

References

Ceriello A. Impaired glucose tolerance and cardiovascular disease: the potential role of post-prandial hyperglycemia. Am Heart J. 2004

MedScape article

Peter R, Okoseime OE, Rees A, Owens DR. Postprandial glucose- a potential therapeutic target to reduce cardiovascular mortality. Curr Vasc Pharmacol. 2009

I heart Chobani

If you haven't jumped on the Greek yogurt bandwagon yet, you need to get on it. And the best brand (in my not-so-humble opinion) is Chobani. What makes Greek yogurt so special? It's super thick and creamy, which makes it ideal as a substitute for sour cream or as a decadent sweet treat. Another reason why I love it is that it is nutritionally superior to other yogurts. It is much higher in protein than other yogurts, which means more nutrient bang for your calorie buck, and probably a lower glycemic index as well (though I can't be sure of that; I don't think it's been tested).

For example, 6 oz. dannon nonfat plain yogurt has 80 calories, 12g sugar, and 8g protein. This is pretty good!

But Greek yogurt has even better stats: a few more calories (100), but only 7g of sugar and a whopping 18 grams of protein!!

For people who aren't into plain yogurt, Chobani makes some great flavored yogurts, too. I had the pleasure of trying two of their new flavors: 2% strawberry-banana and 0% raspberry. They were both delicious! I hadn't ever tried the 2% yogurt before, but that could be a special indulgence because it was SO creamy and rich. Both of the yogurts had the fruit on the bottom that reminded me of the yogurt I ate as a child, before I cared about calories.

But even the sweetened yogurts are well within a reasonable range of calories for a snack. The flavored 0% yogurts have 140-150 calories, 20g sugar, and still pack 14-16g of protein. The 2% pineapple yogurt has 160 calories, 21g sugar, and 13g of protein.

In comparison, Yoplait light yogurt has fewer calories (100) but about the same number of carbs (19) and only about a third of the protein (5g). Original Yoplait's nutritional value is abysmal with 170 calories, 27g sugar and still only 5g of protein! You might save a couple of calories eating the light version, but the Chobani yogurt will be more filling (so you'll be apt to eat less later on) and will probably have a smaller impact on your blood sugar, which is more important than you know. I will be dedicating a post to this topic in the near future, so keep an eye out for it.

And if the superior nutrient profile isn't enough to convince you to switch to Greek yogurt, it just tastes a whole lot better! I know Yoplait has this "thick and creamy" line out, but that just tastes like yogurt mixed with jello, and essentially, that is what it is. The yogurt is thickened artificially with gelatin. Chobani, on the other hand, is naturally thick and creamy, and way better than anything else out there.

My only complaint about Chobani is that they don't have any truly "light" yogurts, sweetened with sugar substitutes. Although the flavored yogurts aren't very high in calories, I just can't bring myself to eat that much added sugar. I don't care if it's "natural" sugar, it's still sugar. As a result, as good as the new flavors are, I am going to stick with what I've been eating almost daily these days: Chobani nonfat plain yogurt, to which I add splenda and thawed, frozen blueberries. I don't think anything they could make could trump this combination in taste, but it would be nice to be able to have a no-sugar-added but still sweet version of this to take on the go when it's not so convenient to mix it myself.

Chobani, if you're listening, what are you waiting for?!! So many weight-conscious yogurt-eaters out there are currently gobbling up that watery, chalky tasting excuse for a "light" yogurt that's being pushed by that OTHER yogurt company (you know which one I'm talking about) simply because it's the lowest calorie option available. This is a travesty! With a few simple adjustments, Chobani could make the best-tasting AND most nutritious low-calorie yogurt on the market. I get that they're committed to "all-natural" ingredients and don't want to use artificial sweeteners, but even that's not an excuse anymore, what with Truvia and other erythritol-containing natural non-nutritive sweeteners now widely available. Time to get on the ball, people!

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