Blood Sugar Problems: Its Role in Gut Health and How to Improve It

Often, when a patient presents with a complaint such as fatigue, a healthcare provider will order some blood work along with doing a physical exam. These blood tests tend to be basic measurements which likely include a glucose or blood sugar level and even a hemoglobin A1c.

A glucose level measures the amount of glucose that has been released into the bloodstream. To get a better picture, the test is done when you haven't had anything to eat in the prior 8-12 hours, or at least not anything that will spike your blood sugar, like carbohydrates or protein. The test will show the lingering glucose in your blood.

Glucose is intended to be used for energy. In a healthy metabolic system, your pancreas releases insulin in response to your glucose to escort it into your cells for energy and there is not an elevation in your blood glucose level at this time. This is an example of metabolic stability and your body utilizing glucose for energy, effectively. Unfortunately, for the vast majority of Americans, effective glucose management is the exception rather than the rule and, increasingly, children are impacted by this negative trend as well.

Nine out of ten people in the US are metabolically unstable. This is an astounding number. This means they experience blood sugar and insulin imbalances daily - typically high levels but low levels happen as well, especially as this dynamic progresses. Many of these people are officially labeled diabetic or pre-diabetic but many are not. 

Don't think for a second that they are immune to the consequences of this instability because they do not have an official diagnosis. This imbalance begins long before, typically years, an official diagnosis is made. These imbalances make optimal functioning impossible which means an unhealthy you. While insulin imbalance impacts our entire system, effects on the gut are widely seen which creates a cascade of dis-ease dynamics of its own accord.

Here are some ways blood sugar imbalances affect gut health:

• Gut microbiome: The gut is home to trillions of bacteria and other microorganisms collectively known as the gut microbiota. Blood sugar imbalances can disrupt the delicate balance of the gut microbiota because these organisms respond to our glucose level. Elevated blood sugar levels create an environment that favors the growth of harmful bacteria, yeast, and fungi while beneficial bacteria may dwindle leading to dysbiosis. This imbalance in gut bacteria can contribute to gastrointestinal symptoms such as digestive problems, nutrient deficiencies, inflammation, and compromised gut health. These microorganisms play a crucial role in maintaining gut health, digestion, nutrient absorption, and immune function. Imbalances in the gut microbiota, known as dysbiosis, can contribute to various health issues.

• Inflammation and gut permeability: Chronic high blood sugar levels can lead to increased systemic inflammation, which can directly affect the gut. Inflammation can damage the intestinal lining and disrupt the tight junctions between the gut cells, leading to increased gut permeability or leaky gut. This allows toxins, undigested food particles (which become food sensitivities), and bacteria to leak into the bloodstream, triggering immune responses and further inflammation. This all leads to disease.

• Nutrient absorption and gut integrity: Elevated blood sugar levels can impair nutrient absorption in the gut. The excess glucose circulating in the bloodstream can interfere with the absorption of certain nutrients, such as vitamins and minerals, which are vital for maintaining gut health. Additionally, chronic high blood sugar can compromise the integrity of the gut lining, affecting its ability to function optimally and absorb nutrients efficiently. This is a result of damage to the blood vessels that innervate our gut lining.

Optimizing blood sugar regulation is a key factor to promoting a healthy lifespan. 

The first order of business is recognizing that this could be, and likely is, an issue for you - even if you do not have any official diagnoses such as diabetes or even pre-diabetes!

Here are some actionable tasks for you to consider to begin regulating your blood sugar.

Surprise, surprise they are mostly lifestyle choices. When we know better, we do better...

• Ask your provider for a fasting insulin level: Even if your glucose and Hemoglobin A1c markers are “normal”, chances are they are not and not optimal. Fasting insulin as a marker will give you a better view of your insulin functioning which is really important. This is a marker that shifts much earlier than glucose (glucose level at the time of blood draw) or hemoglobin A1c (average glucose level over a 3 month period). Insulin resistance, a condition where cells become less responsive to the effects of insulin, is closely associated with elevated blood sugar levels and metabolic dysfunction. Insulin resistance can contribute to gut dysbiosis and inflammation, as well as affect the production and balance of gut hormones that regulate digestion, satiety, and overall gut health.
• Follow a balanced diet: Focus on consuming whole, unprocessed foods that are rich in fiber, healthy fats, and lean protein. Include plenty of vegetables, fruits,  legumes, and nuts. Avoid or minimize refined carbohydrates, sugary foods, and beverages, as they can cause rapid spikes in blood sugar levels. Sugary beverages are especially linked to metabolic dysfunction including fatty liver.
• Choose low glycemic index (GI) foods: Foods with a low glycemic index have a slower impact on blood sugar levels. Incorporate foods like legumes, non-starchy vegetables, and berries into your meals. These foods release glucose more gradually, helping to maintain stable blood sugar levels.
• Include protein with each meal: Protein-rich foods, such as lean meats, poultry, fish, eggs, and plant-based sources like legumes and tofu, can help stabilize blood sugar levels. Protein slows down the absorption of carbohydrates and promotes satiety, preventing sharp blood sugar spikes.
• Healthy fats: Incorporate healthy fats into your diet, such as avocados, nuts, seeds, olive oil, and fatty fish. Healthy fats aid in slowing down digestion and the release of glucose into the bloodstream, helping to regulate blood sugar levels.
• Regular physical activity: Engage in regular exercise as it helps improve insulin sensitivity and glucose metabolism. Aim for a combination of aerobic exercises, strength training, and activities that promote flexibility and mobility. Walking for 10-20 minutes after eating significantly improves insulin sensitivity and blood sugar regulation.
• Manage stress: Chronic stress can contribute to elevated blood sugar levels. Practice stress management techniques such as mindfulness, meditation, deep breathing exercises, yoga, or engaging in hobbies and activities that you enjoy.
• Get sufficient sleep: Aim for 7-9 hours of quality sleep each night. Lack of sleep can disrupt hormonal balance, including insulin and glucose regulation. Establish a consistent sleep routine and create a sleep-friendly environment to support optimal rest.
• Stay hydrated: Drink plenty of water throughout the day. Proper hydration helps maintain healthy blood sugar levels and supports overall metabolic function.
• Monitor carbohydrate intake: Pay attention to portion sizes and the type of carbohydrates you consume. Balancing carbohydrates with proteins, healthy fats, and fiber can help prevent spikes in blood sugar levels.
• Consider intermittent fasting: Intermittent fasting is an eating pattern that involves cycling between periods of fasting and eating. It can help improve insulin sensitivity and promote more balanced blood sugar levels. Consult with a healthcare professional before starting any fasting regimen.

Functional medicine approaches for addressing elevated blood sugar levels and supporting gut health may include dietary modifications, such as adopting a low-glycemic or anti-inflammatory diet, managing stress levels, regular physical activity, optimizing sleep patterns, and targeted supplementation. Working with a qualified functional medicine practitioner can help identify individualized strategies to restore blood sugar balance, support gut health, and address the underlying causes contributing to dysregulation.