If you remember the recent video that we looked at by strength coach Brian Williams, he mentioned that he got his knowledge from Dr. Bryan Walsh, and I said that Dr. Walsh does have some videos out there of his own. So today we will look at one of those, and he does have several good ones by the way that we’ll look at later, this one if called “Glucose.”
So this is a topic near and dear to our hearts, by the way these videos are directed at practitioners although they don’t presume any real knowledge of the subjects and Bryan does guide us through the topics pretty well.
The approach here is a general one, in other words not specifically directed at diabetes, but since glucose dysregulation is at the forefront of diabetes, this is stuff we need to be looking at.
Some new people think of glucose as sugar, we usually mean sucrose here, which is comprised of both glucose and fructose, and some diabetics think, well I need to watch my sugar intake but I don’t need to worry about starches. Starches are pure glucose actually, although in this case many glucose molecules are bound together, and broken down by digestion. So not only are starches glucose, they have twice the amount as table sugar, although getting too much fructose from sugar isn’t healthy either.
The first place ingested glucose goes to is the liver, where it can combine glucose molecules into glycogen, reassembling it so to speak, where it can be stored and later broken down into individual glucose molecules to be used as energy.
The liver also releases a portion of ingested glucose into the bloodstream to be used. In the cells, insulin promotes glucose uptake by binding to insulin receptors and causing glucose transporters to be activated to allow for glucose to enter the cell.
What happens with insulin resistance by the way is that insulin is less effective in activating these receptors. Even in the presence of no insulin though, there are some receptors active, he does mention that this is the case in muscle cells but it is also the case generally.
Even with insulin resistance though, there is some action here, I love the analogy of these glucose transporters sticking their straws through the cell membrane, and he doesn’t mention this but with less transporters active, we need a higher glucose concentration in the blood to uptake enough glucose, so elevated blood sugar is a compensatory mechanism for less receptor activity.
Of course insulin can also be increased, and with more insulin, there does tend to be more activation of these transporters, however higher insulin levels do cause the process to be downregulated over time, and this is why more and more insulin is required, or in the alternative, higher blood sugar, for sufficient glucose uptake.
So once glucose gets into the cells, it gets converted to energy by the body, making ATP, so we need enough ATP, although we can use fat to create this as well. The body’s preferred fuel is glucose though, and will always use glucose first if it is available, and only turn to fat for energy when it is not in sufficient supply.
So we have ingested glucose that gets used for energy directly, we also have glycogen which is stored glucose which we rely on since we don’t eat continually, and we also create glucose from non glucose sources, a process called gluconeogenesis. In diabetes in fact, we have way too much of this going on in our body’s efforts to maintain higher blood sugar, and this is where a lot of our extra, unneeded blood sugar comes from, where the liver converts things like pyruvate and lactate, by products of metabolism, glycerol, a component of triglycerides, and some amino acids.
He mentions that the brain is particularly vulnerable to low glucose, and thus relies more heavily on our ability to make our own glucose, and there are mechanisms that it exerts to ensure that we do get enough, mechanisms that tend to be overexpressed in diabetes.
So the brain is actually the main regulator of hormones, and there are 4 that play a role in raising blood glucose, which are glucagon, cortisol, adrenaline, and growth hormone, which does its work actually by raising glucagon levels. Glucagon, cortisol, and adrenaline act upon the liver directly to first release glycogen but mostly to increase gluconeogenesis, which isn’t dependent on diet at all. This is how diabetics can run very high in spite of not even eating, because this mechanism tends to break down and we secrete too much of this extra glucose.
As far as measuring glucose, it’s important to monitor blood glucose levels but it is also important to measure A1C levels, which measure the level of glycation of the hemoglobin of red blood cells, so it doesn’t really measure average blood sugar levels per se, but the effects of a certain average blood sugar level, and this is also dependent on our levels of glycation, which does differ among individuals and can be improved by taking certain things.
Stress definitely elevates glucose levels though, and it’s quite important to look to manage stress and cortisol levels to control high blood sugar.
So Bryan mentions main mechanisms that break down when we have high blood sugar, and he does mention that we may just be making too much, in addition to being deficient in insulin and have insulin resistance. This tends to be overlooked a lot, we assume that the body will only put a healthy amount of glucose in our blood and we know that often is not the case with diabetes, so when we ignore this and just look to increase glucose metabolism that tends to ignore the main issue here which is just too much glucose in the first place.
He mentions exercise as being helpful since exercise will increase glucose uptake independent of insulin, with muscle contraction, and given that it is muscle contraction that is doing this, this is why we see better results from resistance training than we do from aerobics for instance.
He does tend to put too much stock in exercise though and it’s more complicated than just looking to clear the blood of excess glucose, exercise also increases stress hormones and you can actually go up from exercise depending on several factors, but that’s a discussion for another day.
He claims that hypoglycemia involves the state of not having the hormones that elevate blood sugar high enough, but this is all relative to normal amounts of insulin, and you can simply overwhelm them with too much insulin, like medications can do.
In early insulin resistance, people can at least have symptoms of low blood sugar, whether it is actually hypoglycemia or not, and often it actually isn’t low enough for a diagnosis, but this is caused by excessively high insulin levels, and he mentions that over time, this high insulin will cause more and more insulin resistance, and blood sugar will eventually rise.
He goes on to talk about A1C in more detail and this is definitely an important test for diabetics but it should be done a lot more often in people not diagnosed with diabetes, in addition to measuring insulin levels by the way, which is even more important.
He also mentions the importance of various supplements to improve various functions important in proper glucose regulation, and there are a lot of things that have been shown to be helpful, although we do focus so much on prescriptions and supplements are a more natural and safe way to accomplish these objectives.
Overall, a good general discussion of glucose, at a level that everyone can understand, which is the best part of Dr. Walsh’s videos.