If you do not have diabetes, is it worth managing your glucose spikes?

Nicola GuessPhD, MPH, RD · academic dietitian, type 2 diabetes

No. Normal post-meal glucose rises are not a risk factor, and the attention costs more than the practice buys.

What it rests onGlycation is a normal metabolic process which becomes pathogenic only under prolonged hyperglycaemia, that is, in diabetes. She adds a second-order objection: people who cut carbohydrate to flatten spikes tend to eat more meat and dairy, which carry the highest dietary advanced glycation end product content while grains carry among the lowest, so following the advice works against its own stated goal. And a third: normal post-prandial glucose rises are a non-existent risk factor while cholesterol and blood pressure are the ones that kill people prematurely.

Jessie InchauspéMSc biochemistry · science communicator and founder; not a clinician, dietitian or nutrition scientist

Yes. Glucose variability damages cells and raises long-term risk even below the diabetic range, and it also drives cravings and hunger today.

What it rests onHer science page states that higher glucose levels damage cells, that 'The variations, the spiking, are damaging the cells in our blood vessels, which could increase our risk of having a heart problem', that 'People with higher variability between their glucose measurements were at a higher risk of death', that 'The risk of death increased with average glucose levels even below the diabetic range', that midlife fasting glucose predicts Alzheimer's risk, and that 'When you spike high during a meal and then you drop low, this will create more cravings and more hunger'. The sources are observational.