Dr Rupy: These apply to everyone. What I talk about is not another type of diet. These are just fundamental principles regarding how to eat to keep your body in an optimal space. So that's really important to me to point out. This applies to everyone. Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests while we discuss the multiple determinants of what allows you to lead your best life. Today we are talking all about why the most important molecule in your body, glucose, is a double-edged sword and how flattening sugar levels in your bloodstream is key to less cravings, improved mood, better weight control and less risk of cardiovascular disease, dementia and depression. My guest today is Jessie Inchauspé who is on a mission to translate cutting-edge science into easy advice to help people improve their physical and mental health by knowing more about their glucose levels. Jessie holds a degree in mathematics from King's College London, a degree in biochemistry and her first book, Glucose Revolution, shares her discovery about the essential role of blood sugar and the surprising hacks to optimise it, which we will talk about today. Her book and her Instagram account, Glucose Goddess, are just brilliant. The science is communicated super well and it's just a really nice visual illustration of how and why we need to learn a lot more about our glucose. And I think there are caveats to wearing a continuous glucose monitor that we will talk about a lot today. But overall, knowing about one's metabolic flexibility, I think is super important. And we're going to be doing a few more deep dives into this on the newsletter that you can find at thedoctorskitchen.com and sign up for free there. So today we talk about the importance of adequate glucose, but also why blood glucose variability and the velocity of change in your blood glucose is also important to know. We talk about what excess sugar does to your mitochondria, the energy powerhouses of your cells, your DNA, inflammation, oxidative stress and something called glycation and the impact of high glycation levels. We talk about insulin and why insulin levels as steady as glucose levels is super important because of the anabolic actions of insulin. Then Jessie introduces some of her glucose flattening hacks and these are pretty incredible and they're underpinned not only by the evidence base, but also Jessie's personal experience of using them and monitoring her glucose responses using her continuous glucose monitor. And I think it's also important to note that one's individual response to different foods is very personalised and that actually came out of a study that we didn't make reference to on the podcast, but Jessie certainly makes reference to in her book. That's the predict study and that demonstrated that we have individual responses to different foods and that can be based on a combination of genetics, baseline glucose levels, baseline insulin levels. So it's important to take everything today with a pinch of salt. However, these hacks tend to be pretty universal when it comes to the glucose flattening effect, regardless of whether one has a particular high glucose response to a piece of chocolate or ice cream. The order of food consumption impacts your blood sugar levels. I was pretty amazed at this. Why savoury breakfasts are beneficial and I personally have a curry for breakfast every now and then and I absolutely love it. Vinegar before meals. This is pretty amazing again, the acetic acid component of vinegars and why that would flatten your sugar levels. Something that I've always been told to do is a post-dinner walk and we talk about why that could be good for sleep and cravings. A bit of housekeeping, we discuss normal ranges of glucose in millimoles per litre as four to seven fasted and under eight two hours after eating. But your individual target range for your blood sugars may be different, especially if you have a metabolic condition and your healthcare team will agree with you what that should be. So do not use this podcast episode or any other material for that matter from the Doctor's Kitchen as a replacement for medical advice. It's also important to remember that glucose isn't everything. And as we say at the end of the podcast, just because your glucose level is flat does not necessarily mean that you are eating the healthiest diet. And it should be seen as just one of those many levers that we can use to optimise our behaviour and positively impact our physiology. I'm doing a new thing which is our podcast recipe of the week and a recipe that reflects the topic of conversation this week on the pod is my easy sweet potato chickpea salad with sumac and tahini dressing. And yes, you can eat the different elements of that meal in whatever order you prefer to optimise your sugar levels. And that's something I'm going to be trying with my glucose monitor that I've been wearing for a few days now and see what impact that has. You can download the Doctor's Kitchen app for free to get access to all of those recipes. There's a seven-day free trial too that we're actually increasing to 14 days and Android users, please bear with me. We are going to be making one, but it'll be later on in the year. And I hope you enjoy this podcast with Jessie Inchauspé. Jessie, the book, honestly, the book is like a textbook example of how scientists should communicate. It's so well written. I smashed through it in like six hours because you've got a real lovely way of telling a story, using visuals and making it super personal. I felt like you were just talking to me as I was reading the book.
Jessie: I'm so glad. Thank you so much, Rupy. Thank you.
Dr Rupy: Thanks a lot. No, no. And I can tell, I mean, you've been on social for a little while now, so you've really developed that skill. But I want to know a bit more about your background before we go into the crux of what you're writing about. So what was your relationship with food when you were growing up and as a young woman and how did that lead to where you are today?
Jessie: Well, when I was a kid, we didn't know much about food in my family. So I had a Nutella crepe every morning for breakfast. My mom had orange juice, Special K with a bunch of sugar on it every morning. And then what happened is that my mother met my stepdad and he had a brother called David Servan-Schreiber, who was one of the leading French doctors who started educating people on the importance of food for health. And back then, I mean, nobody believed that the food you ate could have any impact on your health. So it was quite groundbreaking. But thanks to him, we discovered this whole world, sugar, processed foods versus whole foods, fibre, omega-3s. It was like a, it was really a revelation. So as a teenager, I started discovering this world and I really had an affinity for it. I thought it was very interesting. And then what really cemented my interest in health and the body was this freak accident I had when I was 19. And you mentioned you read my book and in it there's an x-ray of the hardware I now have in my spine from that accident. It was really terrible. I mean, physically and mentally, I suffered a lot, but it taught me at that young age that nothing is more important than health. And so I went on this quest, this journey to try to figure out how do I feel good? Because I felt like absolute crap every single day. And over the years, it led me to glucose. And now here I am. I feel great and I share the science with other people so they can feel good too.
Dr Rupy: Yeah, no, absolutely. Tell me about the, the, uh, the accident. Obviously, I know about it for the listeners, what exactly happened to you?
Jessie: So I was on vacation with some friends in Hawaii and they were like, hey, let's go jump off this waterfall. So I was like, okay, cool. So I jump off of the waterfall and instead of landing with my feet first, I kind of land sitting down. So one of my vertebrae exploded under the pressure just by hitting the water. And so I was walking around with this broken spine, so I had to have surgery where they went in, took the broken vertebrae out, fused it with the top and the bottom ones. And I was in a lot of pain for a very long time. But then physically, I actually recovered really well because I was 19, so when you're that age, your body can heal quite quickly. So in a matter of months, I was totally fine physically. But mentally, all the stress from the surgery, from the accident, the unprocessed trauma, I think, led to this really intense mental health condition called depersonalisation is the clinical name they gave me for the condition, which is just like very deep anxiety about existing. Depression, brain fog, dissociation, impossible to be alone because I was so scared of just being. And that's what started me on this journey to try to understand my body. And that's why I went on to study biochemistry in grad school. Then I worked in genetics because I really wanted to figure out how do I heal? It was my number one priority in life.
Dr Rupy: Yeah, yeah, yeah. And so you did biochemistry first and then you did math. Is that right? Is that was that part of your masters?
Jessie: Math was before. So when I broke my back, I was in my second year of undergrad studying math in London.
Dr Rupy: Right. Okay, got you. And so after that, you went to work at a very famous genomics company. What was that experience like?
Jessie: 23andMe. Oh, it was incredible. So I wanted to work in the field of genetics because I thought if I can understand my DNA, then I can understand my body and I can figure out how to feel good. The experience was amazing. I mean, the best company, the best people, I had the best job. It was really one of the happiest times of my life. But it did not help me figure out how to feel good because while your genetics are interesting, they can't tell you what you need to do to wake up in the morning feeling good. And that was a difficult realisation I had while I was there.
Dr Rupy: Yeah, yeah. And one of the things that you got experience of was the continuous glucose monitor. That was one of the, you put yourself up for being one of the guinea pigs. And you very casually mentioned this in the book, but you built your own app to better visualise what was going on with your continuous glucose measurements. And as someone who's just finished completing building their own app, I know that it's no mean feat to build an app. And you did this, did you do that on your own? Was that something you just spun up?
Jessie: So let me tell you the backstory. So while I was at 23andMe, there was this opportunity to try, as you mentioned, these devices, continuous glucose monitors that you need a prescription for in the US. And so I put one on and it completely changed my life forever because finally I was able to see the inside of my body and communicate with my biology in a way that I had been completely incapable of before. And so I learned about glucose and I saw that glucose spikes were bad, that we had to keep our glucose levels steady. And then I wanted to share the science that I had learned with my friends and my family. I was like, guys, look, this study shows us that if we have vinegar before our meals, we can avoid glucose spikes and feel better. But my friends didn't react to me just printing the studies and showing them the printed pieces of paper. Like nobody really connects to that. So I thought, how am I going to communicate this important information? So I had this idea of taking data from my glucose monitor and turning it into these graphs that I could show people to illustrate the science. But the problem is the app that the device comes with, it's a medical app. It's not something you can just turn into easy to understand graphics. It's just raw data and nothing else. So I had to figure out how to extract the data from that app and then to make my own little illustrations. So yeah, I built this piece of software that did it. I took lots of different pieces from the internet. So the concept was I had to take a screenshot of my daily glucose curve on the app that the device came with. And then I would put this image through a digitizer online that would extract the data points. And then I wrote this software in this program called R, which I had learned when I was in grad school. And this program then took the data in and made these graphs. And the evolution of that is what you see on my Instagram today. So then I worked with some engineers to make it into a proper app. But at the beginning, it was running just on my laptop for a year. Just importing my data and running it. Really startup mode, you know, really Silicon Valley vibes from my living room. So yeah, I did do that.
Dr Rupy: That's fab. I have so much respect for that because I know how difficult it is to do this on your own as well. And the fact that you're able to spin it up on your by yourself is amazing. So and it's a really cool app.
Jessie: Thank you. And when you really want to do something, personally, if I really want something to happen, like nothing can get in my way, I will make it happen. And so I spent countless hours building this piece of software to make it work. But I was so determined to doing this because I knew this would change the game. I knew this would help people visualise the science, understand it, become interested in it. And that was my objective because the stuff I had discovered was so life-changing and needed to find a way to make it sexy so I could share it and people could then apply it to their own lives.
Dr Rupy: Absolutely. Yeah. Well, let's dive into that. So why is sugar so important? Maybe we could talk about the different names, the relationship between starches, sugars and fibre and yeah, just give us a primer on that.
Jessie: Sure. So the word I use is glucose. And as you know, glucose is your body's preferred energy source. And we get glucose from the foods we eat. So every time we eat something starchy, like bread, pasta, rice, potatoes, or every time we eat something sweet, so this could be fruit, this could be cookies, this could be cakes, whatever. Every time you eat something starchy or sweet, they break down into glucose in your body. Special mention for the sweet foods also break down to fructose. That's a separate issue. But if you eat something sweet or starchy, glucose is going to land in your bloodstream. And glucose is very important. We need it to be able to function properly. But the problem arises when we deliver too much glucose too quickly to our body. It's like if you give a plant too much water and it drowns, or a human too much oxygen and they pass out, too much glucose creates these glucose spikes and these glucose spikes have lots of consequences.
Dr Rupy: Yeah, you're really good at creating analogies, just like you just did there with the plant, for example, because I think it's really important to communicate that it's not glucose per se or sugars per se that are the issue. It's the excess of them as well as what you describe in the book as the velocity and the spiking of them and the degree of change as well. Because, you know, as people who are listening to this podcast will likely understand, glucose is an essential molecule for life. You know, it's how we provide energy to our cells, whether it be brain cells, liver cells, etc. So with that in mind, let's talk about what those ranges should be for glucose and why a CGM or knowledge about your sugar levels would help with maintaining those those sugar ranges.
Jessie: Absolutely. And you might be able to help me because I know the units in milligrams really well. I'll try to remember the ones in millimole, which are the British units. So, uh, we're going to do, you're going to help me. So fasting, which means first thing in the morning, a level of glucose should per the NHS be underneath 100 milligrams per deciliter, which I believe is 5.5 millimoles. Is that correct?
Dr Rupy: Yeah, it's about 5.5 millimoles per litre.
Jessie: 5.5 millimoles. Anything above that as your fasting, so first thing in the morning level, signals pre-diabetes and then diabetes, which is a big issue. However, while these are the numbers the NHS publicly, you know, recommends, the fact that if your blood glucose level first thing in the morning is under 5.5 millimoles, might mean that you're normal, but it doesn't necessarily mean that your blood sugar levels are optimal. So the science shows us that actually it's probably ideal for your body to have fasting glucose levels under 4.5 millimoles or 85 milligrams per deciliter. So that's just fasting. And then we also know that after a meal, when the concentration of glucose level is most likely to increase, most rapidly because it's after eating that glucose gets into the bloodstream, we have to think about the spike that the meal creates. And from the studies, it appears that it is ideal to try to keep that spike to under 1.7 millimoles per litre after eating. And again, this is from, you know, early studies done in non-diabetics. So in my work, in my book and in on Instagram, I define a spike as anything above 1.7 millimoles per litre increase after a meal. And the objective is to try to avoid these spikes because they have all these consequences on our physical and mental health.
Dr Rupy: Yeah, yeah. I think this speaks to a wider issue that we have in medicine with regards to reference ranges and how we actually come up with reference ranges. We usually look at like the average and then two standard deviations either side. And that's why we have like pretty large ones for things like liver function tests, for example, where it doesn't demonstrate optimal values, it just demonstrates what they should be to be quote unquote normal. And so I think what you and the book is getting at is, okay, what is an optimal level of glucose that we should try and aim for to prevent any of these issues rather than something that just signals when something is going wrong. Because a lot of the times, particularly during my experience as a medic, is we catch people too late. We catch people in that pre-diabetes stage or even type two diabetes stage as per an OGT and an oral glucose tolerance test, rather than getting it before then, where we have a lot more time to make some changes to ensure that it's reversible. And I think, yeah, we have to really look into that rather than the arbitrary amounts that we currently have within NHS and other healthcare systems.
Jessie: Yeah, because right now, if you go to the doctor and your fasting is like 5.3, they'll say, oh, it's normal, it's not pre-diabetic, you can go home. When actually, if you're at 5.3, it means you've probably slowly been inching towards pre-diabetes for a decade. And actually, you should try to, you know, change a little bit of your lifestyle, use my easy hacks to get that number down. But right now, yeah, I mean, as you know, doctors are there to diagnose and treat diseases. And so unless you have a pre-diabetes diagnosis, not much is recommended to you. When really, we can all benefit from keeping our glucose levels steady, not just to avoid pre-diabetes, but to sleep better, to have better mental health, to avoid cravings, to avoid wrinkles, hormonal issues. I mean, it's much wider than just diabetes.
Dr Rupy: Yeah, yeah, absolutely. And I've got a number of personal stories of family members that have just missed that cut off of HBA1C. And we know about the inaccuracies of HBA1C anyway, because, you know, it doesn't catch those glucose spikes and it's just an average over a month period or a couple of months period. So, so that that again speaks to the potential utility of a CGM and more sort of rigorous understanding and monitoring of glucose.
Jessie: And what's happened to your family members?
Dr Rupy: Oh, I mean, they've got me, so I've changed their diet quite a bit. And they are much lower and the and their personal docs are quite pleased with how their HBA1C is looking. So yeah. But, you know, we're trying to make this information as freely available as possible. So, you know, teaching people about those thriving ranges of glucose is super important. So, so we've established the reference ranges, why there might be some inherent inaccuracies and the velocity of glucose and the changes that we might see in your bloodstream. What happens when we see those big changes? Let's say, you know, you have a cinnamon bun. I love cinnamon buns. I know you like your chocolate as well. So what happens? Why are these so bad? Why is a glucose spike going to be damaging to a whole bunch of issues within the body?
Jessie: So the two main things that happen in your body when you spike have to do one with your mitochondria and two with toasting. So I will explain both. So every time you have this big increase in concentration of your blood sugar levels, so this glucose spike, glucose, when it arrives in your bloodstream, its primary objective is to go to your cells, to go to your mitochondria, so your mitochondria can transform it into energy. And every cell in your body needs these mitochondria to make energy in order to see for your eye cells, think for your brain cells, you know, move for your feet cells so you can dance. Every cell in your body wants this glucose to arrive so it can make energy. Unfortunately, in the case of a spike, too much glucose arrives too quickly to your mitochondria. And your mitochondria do not like this very intense delivery of glucose. They kind of get overwhelmed and they shut down. They go on strike. They're like, no, I can't, I just can't, it's too much, I cannot. And so they just shut down and they stop being able to turn glucose into energy. And as your mitochondria shut down, by the way, poor mitochondria, they produce these molecules called free radicals. And free radicals are these stress molecules that your mitochondria make. Free radicals are really damaging to our body because everything they touch, they hurt. So if a free radical bumps into your DNA, it can cause a mutation in your DNA that might lead to cancer. If a free radical bumps into the membrane of one of your cells, it will cut the membrane open and your cell will get damaged. So your body tries to protect you against these free radicals by increasing inflammation levels. So that's one of the things that happen. Mitochondria get overwhelmed, that leads to free radical production, oxidative stress and inflammation. First bad thing. Second bad thing has to do with toasting. So this was news to me when I learned about it. From the moment we're born, we are slowly cooking. Like literally, the inside of a human body cooks like a piece of toast in the toaster or a chicken in the oven. And then when you're fully cooked, you die. For real. And this cooking process is called glycation. And literally your insides brown from the moment you're born until you die. With every glucose spike, you cook a little bit faster. Because glucose, when it's running around in your body, when it bumps into another molecule, it glycates it, it cooks it essentially. So with every glucose spike, you're aging faster. And this shows on your face, you get wrinkles quicker, and it also damages your organs and eventually they shut down and you die. So your body knows these two terrible things are happening. Your mitochondria are suffering and you're cooking too fast. So it tries to protect you against this glucose, this excess glucose that is causing these issues. And to protect you, it sends out insulin, insulin, the hormone from your pancreas. And insulin takes glucose, as much glucose as it can, and it ushers it away into these storage units. So your muscles, your liver and your fat cells. And that's one of the ways that we gain weight. And over time, when this happens a lot, your body has to produce more and more insulin to try to prevent too much glucose from floating around. And this then leads to pre-diabetes and diabetes. So those are the main mechanisms that happen. It's not so, not so rosy.
Dr Rupy: Yeah, yeah. I know it's almost like we have to talk about these things as as tough as it is to talk about the fact that we are all toasting inside and those glycation products can lead to these issues whether it's wrinkles, whether it's energy crashes, whether it's issues with our immune system. You know, you can look at this through so many different lenses and how metabolism affects, I mean, immunometabolism is a really big thing. And I think a lot more people are thinking about it considering what we've gone through and still going through with the pandemic as well and about how those who have worsening weight issues and obesity have worsening outcomes when it comes to any infection, let alone the pandemic.
Jessie: Yeah, I think in the studies, so if you are pre-diabetic, so if you have fasting glucose levels that are high, you're twice as likely to die from a COVID infection. And more and more studies have been coming out showing this very clear connection. And this is not, you know, the only space in which having too much glucose for too long or glucose dysregulation causes issues. I mean, also a big one that I hear a lot about in my community is female hormones and how too much glucose and too much insulin causes problems like infertility, can be one of the reasons you develop polycystic ovarian syndrome. It really is fundamental. And I have this image that I like using. Imagine your body is a plane and you're sitting in the cockpit and your job is to try to keep your plane flying in the air, to keep your body healthy essentially. But the problem is you have no idea how the plane works. Like I used to have no idea how my body worked. Yet I was the pilot trying to make myself feel good, trying to keep myself healthy. Well, my whole philosophy is there's one lever in the cockpit that if you learn about it, it's going to give you the biggest bang for its buck. You're going to be able to keep your plane flying and start improving all aspects of your health. And that lever is understanding your glucose levels and avoiding these glucose spikes. And so many things fall into place when we do.
Dr Rupy: Yeah, yeah, absolutely. And I love the way you describe insulin, even though it's responsible as an anabolic hormone for putting on weight, we should be thankful for it because it is protecting us against the issues of excess glucose in our bloodstream causing glycation and inflammation and oxidative stress. So I think having that sort of knowledge and that thankful attitude to what's normal in our body is really important to recognise.
Jessie: Yeah, because actually, you know, genetically, if you're not able to put on weight, to put on fat, your glucose levels are going to be higher much quicker and you're going to be more likely to develop diabetes faster than somebody who can put on a lot of fat. So when we gain weight, we have to actually thank our body for creating this fat to protect us against the development of diabetes too quickly. It's a whole mental shift, but I think it's really important to do. You know, we have to thank our body. Our body is just trying to keep us alive, guys. Like it's working for us, but we just don't understand its language. So we tend to blame it or to blame ourselves or to be confused or to antagonize it. But actually, everything your body does is to try to help you.
Dr Rupy: Yeah, yeah, absolutely. And using that analogy that you just used of the the lever that gives us most bang for our buck, you've included a couple of studies in the book about glucose flattening diets as the most effective way to reduce or to reverse, sorry, type two diabetes and prevent type two diabetes. I wonder if we could speak about that slightly.
Jessie: Yeah, absolutely. So, you know, for a long time, and I'm going to speak about American studies because those are the ones that have been the biggest. So for a long time, the American Diabetes Association did not recommend essentially a low glucose spiking diet or a low carb diet, if you will, to prevent diabetes. We used to think it was just a matter of reducing calories or focusing on fat reduction. And while those can also work, so for example, you know, a lot of really cool studies have been shown on the benefits of fasting for reversing type two diabetes, they also work. But one of the most effective ways to put your diabetes in remission is just to stop what's causing it in the first place, which is this excess insulin that gets triggered after each glucose spike. So now the American Diabetes Association does recommend a low glucose spike diet because, you know, just faced with the mounting evidence that shows that this is beneficial, it's become very clear that it's one of the best ways to do it. And if you focus on reducing your glucose spikes, you can put your diabetes in remission without having excessive hunger, without suffering from cravings. While a low fat or a low calorie diet also work, they can be much harder to deal with because you're hungry all the time. But when you flatten your glucose curves, your cravings start dissipating. So things just are much easier. But what's your experience, Rupy, with this?
Dr Rupy: Well, I was going to say this is probably a lovely way of thinking about it because it means that you're agnostic about the type of diet one might want. And I always refer back to this study, the A to Z study by Gardner at Stanford University where they demonstrated that regardless of the diet that you chose, whether it was low calorie, low carb, paleo, everyone could lose weight. The kicker was your ability to maintain said diet. And so if you choose, you know, one that has an omnivorous diet or a vegan diet or a low carb diet, I think the best way to look at this is using glucose as a lens. So looking at actually what the impact is on your glucose. Not at the expense of everything else. And I think one of the first things you say in your book is glucose isn't everything. And I think that's a really good primer for a lot of people because it can become a bit obsessive and we'll talk about that a bit later. But looking at any diet or any way of eating that you want through the lens of glucose and its impact on insulin, I think is a really good way of describing how people can maintain a diet like that and actually lead to the benefits of which there are many.
Jessie: Absolutely. And you know, the hacks I share, they can be applied to anybody's dietary preferences. So whether you're vegan or you're keto or you're whatever, the hacks, like eating your food in the right order, having a savoury breakfast, putting clothes on your carbs, these apply to everyone. What I talk about is not another type of diet. These are just fundamental principles regarding how to eat to keep your body in an optimal space. So that's really important to me to point out. This applies to everyone.
Dr Rupy: Well, let's talk about some of these hacks because that's what people are listening for. So let's let's talk about these hacks that are used to flatten your glucose. You mentioned a couple of them there. The order of your food. I want to start off there because I think this is an easy one to start off with and the explanation behind it, I think is is brilliant. Like the the potential mechanisms as to why this might work.
Jessie: Sure. So let's say you have your next meal in front of you and your meal has different components. Maybe it has some fish, some rice, some broccoli, and then a dessert. If you eat the elements of that meal in a specific order, you can reduce the glucose spike of the meal by up to 75%.
Dr Rupy: 75?
Jessie: Yeah. And the insulin spike by up to 40%. So you can eat the exact same meal, but if you eat the food in your meal in the right order, my gosh, a lot of things get better. And so the right order is vegetables first. So in our case, the broccoli, proteins and fats second, so the fish and whatever fat you also have on your plate, then starches, so the rice, then sugars, so the dessert, which that one's an obvious one.
Dr Rupy: Yeah, yeah, yeah, of course. And the reason why?
Jessie: The reason why is because the fibre in the vegetables has this magical superpower. If you eat your vegetables first, the fibre lands in your stomach first, then it arrives in your small intestine, and there it deploys its superpowers. The fibre essentially turns into this viscous mesh that coats the inside of your intestinal walls. And this viscous mesh is now protecting you from any glucose coming down afterwards and preventing your body from absorbing too much of that glucose too quickly into your bloodstream. So it's protecting you from this rapid rise in glucose in your blood. So it's preventing the glucose spike. That's the first reason the order is really effective. The second reason has to do with the protein and the fat. So there's this mechanism called gastric emptying, which is the process of your food moving from your stomach to your intestine. And protein and fat, when they're in your stomach, they slow down gastric emptying. So if you eat the proteins and fats first, before the carbs, any carbs arriving afterwards will just make it to your small intestine at a slower pace. And then once they're there, the fibrous mesh is even preventing too much glucose from getting through anyway. So you have these two very powerful mechanisms.
Dr Rupy: That's brilliant. I mean, I always like to think of things through the lens of traditional diets, right? And my question to you was going to be, do we see any clues in how our ancestors may have already figured this out when we look at diets from across the world, maybe Middle Eastern diets, Korean diets, Japanese, etc?
Jessie: Absolutely. So, you know, in the Middle East, most meals start with herbs eaten by the bunch. In Italy, you start with antipasti, which is literally grilled vegetables as a starter. In France, you start with crudités, which are just raw vegetables. So you see all these ways in which we've known this stuff for a really long time. And only now do we understand why it works. But yes, there are many examples of glucose science sort of showing us why cultural ways of eating are good for our glucose levels.
Dr Rupy: Yeah, yeah. I always love finding these patterns and like, oh, this is now supported by the science. I mean, the whole science around the gut microbiota and the importance of introducing live microbes into your diet is sort of being vindicated, was vindicated in like Ayurvedic practices, traditional Chinese practices. So it's a lot of stuff that we see there as well. And I love that that idea of the fibre creating that mesh and preventing the quick absorption of the glucose through into the bloodstream, which is pretty amazing if you think about it, because you're not changing the total glucose content of your meal at all. You're not changing anything to do with calories or anything like that. You're literally just changing the order that has a physiological difference.
Jessie: Yeah, because if you did it the other way around, if you ate your carbs first, they would land in your stomach and then make it to your small intestine completely uninterrupted, very quickly. Your small intestine with no fibrous mesh would just let everything go through and bam, big glucose spike. And even if you ate your broccoli afterwards, it no longer has an effect on that glucose spike. It's basically too late. And people often ask me, well, don't all the foods, you know, mix in your stomach? Does it even matter? And I actually thought that too before, but the science shows us that it's not that simple. If you eat the fibre first, it really has an impact. If you then follow with the protein and fat, it makes the overall glucose spike smaller. And you don't have to wait between each element of the meal. So you can just eat them in order. Yeah. It's really cool.
Dr Rupy: Yeah, no, that's a that's a really cool tip. And talking about the order of food, let's talk about breakfast. So there is that saying, you know, breakfast is the most important meal of the day. And you say that is true, but not for the reasons that we have been taught historically. So what tell us about glucose, tell us about glucose and and breakfast and why this is so important.
Jessie: Totally. So this is coming from someone, I will repeat it, who used to have the Nutella crepe or two every morning when I was a kid until, you know, I was 15 years old or something. And I would then go to school and then by 10:30, I was famished. Like my stomach would hurt from the hunger I felt. And I just thought that was normal. I just thought this is what normal feels like. It's normal to have this pain all morning and to be this starving. It turns out that actually your breakfast and the glucose spike it creates or does not create in your body first thing in the morning has a humongous impact on your hunger levels and your cravings for the rest of the day. So in the scientific studies, they gave people two different breakfasts. Both had the exact same number of calories. So it's not about calories. One created a big glucose spike. The other one did not. In the group that had a big glucose spike for breakfast, they became hungry again after two hours, just like it would happen to me. In the group that did not have a glucose spike, they were hungry at like 2 p.m., 3 p.m. They didn't even have this crazy craving for food until mid-afternoon. Yeah. And so actually, you know, the scientists discovered that the shape of your breakfast glucose spike really impacts how you're going to feel, how hungry you're going to get, because of its effect on your insulin levels, on the craving center in your brain and on your hunger hormones. So big hack, number one hack, eat a savoury breakfast because that's the simplest way to get yourself somewhere where your breakfast will not create a glucose spike. So center your breakfast around protein, fat, fibre, then you can add a bit of starch and sugar for taste. But in the sugar realm, only have whole fruit if you want something sweet in the morning. Cut out cereal, muesli, oats, fruit juices, like all that stuff. But you can have those as dessert after your lunch or your dinner if you really want to. So I'm not about like cutting things out really, just I'm about rearranging and reorganizing when and how you eat your food. So you still get the same pleasure, but you're not harming your body in the process.
Dr Rupy: Yeah, yeah, absolutely. And I really do appreciate that philosophy actually. It's not about restricting or saying you can't have something or other. It's just about the order or the order is being one of the hacks. And actually, from my own clinical practice of discussing this with patients, particularly those who have, you know, certain cereal brands in the morning, they're hungry by 11 and they're asking me for like, you know, snack options and that kind of stuff. I'm like, well, we need to really look at the glucose content of your meal at the start of the day because that will send you on a rollercoaster that will dictate your hunger levels, your your fatigue levels, what you're craving in the in the afternoon in terms of a coffee for more energy and that kind of stuff. So it's a yeah, it's a really important hack.
Jessie: And I want to say something about these cravings and how your patients are then asking you, how do I like suppress these cravings or how do I cater to them? And actually, what's really happening is that these cravings are just a symptom of the deregulated glucose levels. And so it's important to zoom out and as you do really well, to ask, you know, why are they there in the first place? It's like, if you have a bunch of pimples on your face, sure, you can buy makeup and take medication to get the pimples to go away or do a bunch of stuff to cover it up or try to placate the situation. But actually, if you zoom out, it's like, hmm, this is just a symptom of this underlying thing happening in my body, very often, just too many glucose spikes. And all these symptoms, the cravings, the acne, the poor energy, the poor sleep, I like to think of them as your body trying to speak to you. That's your body trying to be like, hey, Rupy, like, there's some stuff going on in here. Can you please like try to get these glucose spikes under control? And your body tries to speak to you, but often we don't know how to listen and we suppress the symptoms or we medicate them or we feel guilty about them, when actually we just need to listen.
Dr Rupy: Yeah, yeah, definitely. And I think, you know, having more data on what's going on inside combined with intentional listening, i.e. being more intuitive about what your body's saying to you, I think is a really good way of ensuring that we start and maintain habits that we can that will put us in good stead. And I think, yeah, that's why I'm a really big fan of really listening to what's going on in your body and actually having monitors like that because it can, it can, yeah, give you a lot of insight into that. I did have a question about this chapter. What is brigadeiro?
Jessie: Oh my god, it's the most delicious thing in the whole world. So I think it's a chapter in which I explain all the delicious chocolatey stuff I like to eat. And so brigadeiro, it's so my step-grandmother is Brazilian and she, it's a Brazilian dessert. And so the way it's made, so you get condensed milk and butter and you heat it up in a pan. And then you add a bunch of powdered chocolate that also has sugar in it. So you make this sort of caramel chocolate thing. And then you let it cool down and you can either eat it with a spoon or you can turn it into little balls and put chocolate sprinkles around them or powdered sugar. It is so good, Rupy. It's so good. And in the book, I explain that, of course, I eat this stuff because it's delicious. But I don't eat it on an empty stomach. I'll have it for dessert after a meal, maybe after some vinegar too. And then I'll go for a walk, you know, and use my muscles so I can still enjoy this delicious decadent dessert, but with fewer consequences on my body. So I don't feel guilty about it. I'm like, it's cool. I'm using all my hacks so that I can eat this and help my body process it as well. But you have to try this.
Dr Rupy: I know, I definitely will try that. You have to send me the recipe for sure. I mean, a lot of people are in disbelief when I tell them about what the kind of things that I like to eat. Obviously, in moderation, I don't have it every single day or whatever. But I think indulgence is a really important part of living. And food is such an important pleasure. And you know, you just described to me right there with this being a recipe from your family lineage, you know, it's a Brazilian, there's history there. So you want to be able to enjoy food with that knowledge and, you know, minimize the impact on your physiology too. So, yeah, I think it's a really important part.
Jessie: And also, when you get your glucose levels steady, what happens is that this break takes place. The things that you used to crave just because your glucose levels was deregulated, like really crappy tasting cookies at the corner store or just anything sweet you try at the airport, those go away. So now when you eat something sweet, it's because you really love it and it's really good. It's no longer out of this just very intense feeling of, oh my God, I need sugar right now. So as a result, your relationship to, you know, delicious brigadeiro or chocolate cake or chocolate ice cream or all the chocolate things I like, changes. You're much more in an enjoyment mode because you're no longer controlled by them. You're being intentional and happy about it and it brings you joy and no more guilt and no more pain. So it's such a beautiful thing to experience to go to that side of the mirror.
Dr Rupy: Yeah, no, absolutely. I'm just trying to think of other cuisines that might have that sort of vinegary element at the start of the meal. And what I've traditionally thought it was because of is because it enhances sort of your digestive enzymes and it starts that whole process, which it does. Yeah, which kind of makes sense, you know, like you're going to break down the molecules, you're going to activate your muscles to take on the glucose and convert it into glycogen and so that yeah, that makes a lot of sense. And I'm just trying to think of like other examples of of diets that might do this. Have you heard of Washoku, the Japanese sort of order? I believe they have ferments at the start of their meal. Would that be the same thing or is that slightly different?
Jessie: That's different. So there's no acetic acid specifically in fermented foods, although vinegar is a fermented food. But, you know, eating fermented foods are fermented foods are really good for lots of other reasons, notably your microbiome. Tim Spector talks about this a lot, the the lead scientist on this team at King's College, which is where I studied, that studies glucose levels and they have a bunch of cool papers on this, yeah.
Dr Rupy: Yeah, no, definitely. Yeah, he's been on the pod a couple of months ago and he's actually got me as a guinea pig for Zoe at the moment. I'm actually wearing the the CGM. I'm doing another one at the moment as well. It's the Dexcom, just to see what the difference is and I'm calibrating it as well to see to make sure that it's accurate. And I think what I'm seeing is like the great trends, particularly for the next thing I was going to ask you about, which is postprandial exercise. So after eating, if I go for a walk, my glucose level is steady, regardless of whatever I've eaten. It's pretty amazing to see that actually. And if, I mean, I'm using a standing desk at the moment, but if I eat something in the afternoon that has like some rice or, you know, I haven't done any of the order hacks, I certainly haven't had any vinegar or anything like that, I can see that rise, you know, I can see that bump in the middle of the day. Tell us about the postprandial exercise. I think this is super interesting and something that everyone can do.
Jessie: Well, your muscles, every time they contract, they need energy to do it. And the first place they look for this energy is in glucose in your bloodstream. And so this is information that can really help us understand why it's useful because after you eat a meal, you have two options. You either sit in your couch, the glucose from the meal makes it through your digestive system, then into your bloodstream and big glucose spike. Then your body with the help of insulin brings that glucose back down. Or if after you eat, within an hour after the end of your meal, if you start using your muscles, so you can go for a walk, you can dance to your favorite song, you can do the dishes, you can fold your laundry, you can play with your kids, you can go do a really intense workout at the gym, whatever, your muscles, as they contract, will be soaking in the glucose from your bloodstream to be used for energy. And as a result, the spike is just naturally smaller. And what's really cool is that when you're exercising, your muscles do not need insulin to uptake glucose. So moving your body, using your muscles after eating reduces the glucose and the insulin spike. Super powerful, especially powerful if you're somebody who suffers from being sleepy after your meals, which is often a side effect of the glucose crashing back down. It's really helped me completely get rid of that. So I'm no longer sleepy after my meals because I get up and I move for 10 minutes and then I feel great and energized and I don't have that slump and I don't have the cravings a couple hours after eating. Yeah. So that's another one of the hacks in Glucose Revolution. And it's easy stuff and it really is life-changing.
Dr Rupy: Yeah, no, that that's a that's almost like the holy grail, isn't it? It's stable glucose with stable insulin levels as well. That's like the ultimate hack that we all need to sort of try and get into the habit of doing, right? Because the insulin...
Jessie: Because you could, you know, one of the ways to keep your glucose levels down or steady is to inject a bunch of insulin because the more insulin there is, the more your glucose will be put away into the storage units in your body. But the issue is, you know, doing that doesn't actually solve the problem. And over time, all this insulin leads to insulin resistance, which is the precursor to type two diabetes. So it's really important to think about hacks that lower your glucose levels while also lowering your insulin. And vinegar does this, eating your food in the right order does this, moving after you eat does this, and all the other hacks in my book also do this.
Dr Rupy: Yeah, yeah, absolutely. And I think it's important to note that this isn't just for people who are at risk of type two diabetes or might have a metabolic inflexibility issue like PCOS or, you know, this is for everyone, including type one diabetics actually, obviously with the advice of a health professional and a nutritionist if you have one, because you need to be monitoring your insulin requirements. But reducing one's insulin requirements is a massive win. And I don't think we fully appreciate the ability to do this with some simple lifestyle hacks that you've just described here on the pod and you also do in the book as well.
Jessie: Absolutely. And, you know, for a long time, we thought that only people who had diabetes, so type one or type two, had to worry about their glucose levels. But now we know, Rupy, that 90% of people without diabetes experience glucose spikes every day without knowing it, but while being very familiar with the consequences, the cravings and the fatigue and the needing to eat every 90 minutes, the poor sleep, the hormonal issues, the weight gain, the acne, the everything. So this is really a revolution in our understanding of health and of the importance of glucose. And that's who the book is for. The book is for anybody who doesn't wake up in the morning feeling amazing. It's for everybody because keeping your glucose levels steady helps you in so many ways, physical and mental, everybody.
Dr Rupy: Yeah, absolutely. And I think, you know, there's been some criticism of CGM for non-diabetics in the past over the last couple of years. You know, some doctors on Twitter and my response to that is, even though when I work on the NHS, we don't have access to these monitors for those who do not have type two diabetes and it is kind of hard to get them even for those people as well. It's what you just described there. It's the understanding of why you're having these reactive hypoglycemic episodes that lead to a rollercoaster of your emotions and how you're feeling in terms of your energy levels that can also have impact on you craving and then in the context of an obesogenic environment, you're then grabbing whatever is in front of you, which unfortunately in our environment is a lot of sugary snacks, a lot of high salt snacks, a lot of things that are going to rapidly change your glucose levels, right?
Jessie: Yes, yes, absolutely. And, you know, for those who don't have access to or can't afford glucose monitors because they're still quite expensive or in the US, you need a prescription to get them, you know, it's not like you can just buy them anywhere. The glucose hacks I share, you don't need a glucose monitor to use them. In fact, I would say maybe 98% of the people who are following my glucose goddess Instagram account, they don't have a glucose monitor. They're just using the hacks and starting to feel better very quickly, physically and mentally without needing to monitor themselves. But I do think that wearing a glucose monitor is very interesting and very cool and can help you reconnect with your body in a way. How has your experience been?
Dr Rupy: My experience has been really positive, I think. I'm the kind of person that loves analytics and I'm also the kind of person that won't get too anxious about it either. And I think I've described my experience to a few other people, including people who would not like and would not benefit from say like an aura ring or some other sleep device because they'd get pretty anxious in the mornings about how they haven't slept properly, etc, etc. And I don't think it would be appropriate for those types of people because it's almost a bit too much information and it can spiral into an unhealthy obsession with eating to maintain your glucose levels. So I think for certain people, it would be brilliant. I actually think a CGM would be useful in short bouts, like for seven days to see what your response is like. And then maybe in the same way you would do a blood test every six or 12 months, you see what your metabolic flexibility is like on the basis of some of your lifestyle hacks. So when it comes to like encouraging people to adopt a lifestyle that is super healthy, I think it could be a really good thing to try.
Jessie: Absolutely. But definitely, if you're somebody who tends to, you know, get quite disordered when it comes to tracking yourself, so whether it's weight, whether it's steps, like if you're that kind of person where you know this is triggering to you, don't use a glucose monitor because it's giving you constant feedback every 30 seconds on what's happening. And yes, for some people, it can be very overwhelming. I think as long as there's enough education around it, it's easy to understand what's happening. But what I see often is that people will try one and then they get very hung up on the exact numbers. They're like, oh, I was at 87, now I'm at 84. Am I okay? Is this bad? Is this reactive hypoglycemia? So if you're going to wear a glucose monitor, read my book so you can get the context and not get too freaked out about small things and understand what actually matters. That's my recommendation because I get a lot of messages from stressed out people and it breaks my heart because they're fine. Yeah, because it's there's very little education so far. People don't really know how to interpret the data. So really, and if you don't want to buy my book, that's fine. Just look on my Instagram and try to get a bit of context before you use it just for your own sake because I don't want you to be stressed out when you're probably totally fine.
Dr Rupy: Yeah, I have the exact same sort of relationship with some of my followers as well and people who listen by the pod and the newsletter and all the rest of it because sometimes it can be really easy to get hung up on exactly every element of your lifestyle to try and optimize it. And if you're not doing that, am I bringing myself to harm? If I have a bit of sunflower oil, is this inflammatory? Is this going to lead me to have cancer? You know, all these different things that you can understand to certain people would spiral into an unhealthy obsession. So I think that's really important. But I think you've done a really good job. Like I said right at the start of this pod, the fact that you've communicated the science really responsibly, super clear. And right at the start, you say, look, glucose isn't everything because if you just eat for your glucose monitor, you'll just eat bacon all day long. You know, that's not going to do anything to your glucose, but it's not going to be healthy. So, yeah, I I I appreciate that and I think you're doing a great job.
Jessie: Thank you, Rupy. It's very important to me to, you know, be as nuanced as I possibly can to explain that there are many other things in your life. Yes, glucose and keeping your glucose levels steady will help you feel better and it's going to heal a lot of stuff. But, you know, sleep is important, stress is important, not eating unhealthy fat is important, having human connections is important, medical care is important. So many things also exist. And I don't want people to become, you know, too focused on just glucose, especially while wearing a glucose monitor, because as you mentioned, you can just eat bacon all day and have flat glucose levels, but that's not the answer. And in the hacks that I share, I'm very cautious about that. And the hacks will help you feel better, will help you flatten your glucose curves while avoiding those pitfalls. And that's very, very important.
Dr Rupy: Yeah, yeah, absolutely. And looking at the evidence base behind what a flat glucose level can help you achieve, whether you have symptoms or whether you're aware of them or not, I think is super interesting. So there's a lot more, I think we're going to learn about this field and I think you're early to the game and well done. It's a great book and I'm so glad you had some time to chat to us today.
Jessie: Thank you so much, Rupy. It's been an absolute pleasure and I'm really touched and glad you like the book. And I hope to meet you in person soon so you can we can I can make some brigadeiro for you.
Dr Rupy: I would love that. I would love that.
