Glucose hacks: Gimmick or guidance?

I’m not a big social media person. Think of me as more favourable towards Cal Newport and less towards Tik Tok. So when I was asked to review the science and ideas behind the Glucose Goddess Instagram account, I prepared myself for a creatively scathing review. However, I can’t do this. While the science of these posts are a little thin, there is some truth behind them. There is nothing really new here in terms of diabetes care. What is new is the format that is being used to reach people (she has 1.9 million followers and counting). For this reason, it is certainly worth taking a look. The author/creator is Jessie Inchauspé (@glucosegoddess on Instagram) and her book is called Glucose Revolution. I love health books like this and I have read quite a few. It has all the points you would expect. A smart person who is searching for answers, check. They overcome a significant health crisis, check. This “success” story causes them to modify their life in some way to solve a big problem, check. Their research/ career reveals a solution that can help people (ie. you), check. This author’s overall premise is that spikes in blood glucose levels are bad for us. Nothing new here— diabetes educators have been saying this for years. The book provides a very basic scientific description, aimed at the general public, as to why glucose spikes are bad. Increased glucose levels lead to free radical production and insulin spikes, and insulin is inflammatory. Increased glucose levels can lead to human protein glycosylation. I don’t really agree with the author’s analogy of this protein-glucose interaction being similar to ‘your internal organs going brown like toast’ with a Maillard reaction. However, there was a reference1 provided. And it does sound simpler to understand than ‘age-related advanced glycation end products can lead to cartilage stiffening and potential health complications.’2 So how does the author propose you solve this problem? I’m glad you asked. The author advises readers to follow the protocol in studies which showed that the specific order in which you consume your macronutrients at meals can lead to a reduction in postprandial glucose and insulin levels.3,4 I don’t think these studies with 11 and 8 subjects (respectively) should be considered “seminal” nor “startling.” But who am I to ruin an engaging author’s creativity with a scathing criticism? Nonetheless, these studies are rather interesting. When a standardized meal was eaten in a certain order (protein, veggies and fats before carbohydrates), the post-meal glucose levels were up to 36.7% lower than if the carbs were eaten first. The exact amount of carbohydrates were only provided as 68g from orange juice and ciabatta bread. While my knowledge of clinical human nutrition is rather limited, I have no doubt that slugging back 68gm of carbs from orange juice and white bread (same carbs as 1.5 cans of cola) would do wonders for your blood glucose levels. Again, nothing new here. Diabetes educators have been stating that increased dietary fiber leads to better glucose control.5 Increasing your dietary fiber can be hard for most people, but using this meal “hack” can help reduce glucose spikes. Did I forget to mention that the author provides several “hacks”? Well, let’s get into those. There are 10 of them, so I won’t cover them all. I’m sure if you follow the author’s Instagram they will all show up. It is safe to say that if one followed all these hacks it would have a positive impact on their glucose control. My first favourite hack is #5: all carbs are the same. Agave, honey, brown sugar and white sugar all produce the same glucose spikes. Apparently dried mangos and Medjool dates can produce significant increases in blood glucose and are not the best snacks. Another hack #4: flatten your breakfast (glucose) curve. It highlights several excellent nutritional ideas for breakfast. Savory is better than sweet: Yay! avocado toast and boo! pastries. An orange is better than orange juice. Fruit smoothies are just carbs like hot chocolate. Read: Blood glucose monitoring: update on terms and recommendations Oh, and did I mention that this author likes apple cider vinegar as a way to reduce postprandial glucose. I rolled my eyes at this one too, until I read the science. The primary study cited was one where 175 obese Japanese subjects consumed 15ml of vinegar daily (½ dose after breakfast and supper).6 These subjects showed favourable improvements in body weight, BMI, serum triglycerides and other health measurements. The mechanism of action was thought to be due to inhibition of alpha-amylase (remember acarbose?) and various gene expressions associated with lipogenesis. Another meta-analysis also reported favourable improvements on blood glucose, but based on a paucity of studies.7 The Glucose Goddess was very specific about how the vinegar was to be consumed. Capsules might not work and gummies certainly don’t. You must sip 15ml of apple cider vinegar diluted in a glass of water. This is mainly to reduce the risk of damage to teeth enamel and to improve the vinegar’s flavour, but plain vinegar will also work. Throughout this book and on the author’s Instagram account are several rough graphs depicting blood glucose spikes after various dietary meals. These graphs look very positive. If you eat a bowl of rice your blood glucose spikes, but if you eat that same bowl with black beans the glucose spike is much less. Certainly these graphs are drawn from rigorous clinical trials? Well, not really. On page 7-8 of the book it is very briefly disclosed where these graphs come from. They are from the author’s personal dietary reaction while wearing a CBG monitor, or occasionally from an online follower. Testimonials do not constitute science. That being said, if this testimonial graph convinces someone to go for a walk after eating, then I suppose this is a good thing. Incidentally this is hack #8: after you eat, move. So overall, would I recommend my patients follow the advice of this Instagram health influencer? Certainly. While the science within the message might not stand up to pharmacy journal standards, the message and the way it’s delivered would be very helpful in reducing a patient's risks of complications from abnormal glucose control. References Dyer DG, Blackledge JA, Katz BM, Hull CJ, Adkisson HD, Thorpe SR, Lyons TJ, Baynes JW. The Maillard reaction in vivo. Z Ernahrungswiss. 1991 Feb;30(1):29-45. doi: 10.1007/BF01910730. PMID: 1858426. Verzijl N, DeGroot J, Oldehinkel E, Bank RA, Thorpe SR, Baynes JW, Bayliss MT, Bijlsma JW, Lafeber FP, Tekoppele JM. Age-related accumulation of Maillard reaction products in human articular cartilage collagen. Biochem J. 2000 Sep 1;350 Pt 2(Pt 2):381-7. PMID: 10947951; PMCID: PMC1221264. Shukla AP, Iliescu RG, Thomas CE, Aronne LJ. Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care. 2015 Jul;38(7):e98-9. doi: 10.2337/dc15-0429. PMID: 26106234; PMCID: PMC4876745. Nishino K, Sakurai M, Takeshita Y, Takamura T. Consuming Carbohydrates after Meat or Vegetables Lowers Postprandial Excursions of Glucose and Insulin in Nondiabetic Subjects. J Nutr Sci Vitaminol (Tokyo). 2018;64(5):316-320. doi: 10.3177/jnsv.64.316. PMID: 30381620. Giacco R, Parillo M, Rivellese AA, Lasorella G, Giacco A, D'Episcopo L, Riccardi G. Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care. 2000 Oct;23(10):1461-6. doi: 10.2337/diacare.23.10.1461. PMID: 11023137. Kondo T, Kishi M, Fushimi T, Ugajin S, Kaga T. Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Biosci Biotechnol Biochem. 2009 Aug;73(8):1837-43. doi: 10.1271/bbb.90231. Epub 2009 Aug 7. PMID: 19661687. Santos HO, de Moraes WMAM, da Silva GAR, Prestes J, Schoenfeld BJ. Vinegar (acetic acid) intake on glucose metabolism: A narrative review. Clin Nutr ESPEN. 2019 Aug;32:1-7. doi: 10.1016/j.clnesp.2019.05.008. Epub 2019 May 31. PMID: 31221273.