Why bariatric patients should care about their blood sugar balance.  Diabetes is not permanently in remission after surgery. Check out the audio transcript.

Introduction of bariatric patients and there care about their blood sugar

Dawn (00:00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell and we are here today to discuss blood sugar balance and why it should be important and why bariatric patients should care about blood sugar balance. So we are going to dig in to many aspects of blood sugar balance and what influences and why you should even care and why it matters. So let’s get started and just kind of, I’ll give you a highlight, some overview and then explain what happens after bariatric surgery and what we see years and years later. Our cells run on glucose or your sugar and it works. Your, your body works really hard at maintaining a an adequate level throughout the body 24/7, 365 days. I mean, you want, your body really tries to make sure that that blood glucose or that blood sugar is stable all the time.

Dawn (00:01:16):

And it’s probably no surprise that many of you are fully aware that high blood glucose levels or high blood sugar is associated with weight issues and diabetes and when they become chronic so maybe not the short term rise, but as that continues and continues, that accelerates aging, it causes chronic inflammation, and we know at the root of all chronic illness, inflammation is there. So another thing to consider is your insulin is manufactured in the body and is used to regulate your blood glucose or your blood sugar. So this is also important to consider. Not only do you have to care about blood sugar, you also have to consider insulin because it’s what used, it’s what regulates glu.. your blood sugar. In my opinion blood sugar balance is really one of the most important things you can do for your overall health.

Dawn (00:02:29):

But also for your weight. As many of you are aware, type two diabetes is just a disease where your blood sugars are consistently elevated, and that’s where your body either doesn’t produce enough insulin or it resists insulin. And unfortunately, over 462 million people worldwide are affected by blood sugar imbalances. But what about after bariatric surgery? Many people experience you know, a significant shift in their blood sugar balance positively after bariatric surgery. And in fact, some patients leave the hospital in full remission of their diabetes. Pretty cool. In fact early on it was kind of touted as the cure for diabetes. And this was the solution that is going to reverse diabetes. You know, like many things when it comes to health the reoccurrence rate for blood sugar imbalances are a problem after a bariatric surgery.

Diabetes Outcomes of bariatric patients because of blood sugar 

Dawn (00:03:53):

And an example is a study published in 2020. It was titled Comparing the Five Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass. And it’s a cohort study in 34 US health systems on 9,710 patients. And they found that the reoccurrence rate was different between surgeries. Not a huge difference, but different. In the first year, they found that the roux-en-y gastric bypass the recurrence of diabetes was 8.4%, and in the sleeve gastrectomy it was 11.0%. And then five years after roux-en-y gastric bypass, they found that 33.1% of patients had a recurrence of diabetes. And 41.6% of sleeve gastrectomy patients experienced a reoccurrence of blood sugar imbalances or diabetes.

Dawn (00:04:37):

So how do you wanna look at this? Regardless of the reoccurrence rate, the fact does remain that 60 to 70% of bariatric patients still maintain their blood sugar balance five years later. But if you are in that 30 to 40% that have to restart blood sugar medications again you might be quite disappointed and you might be frustrated with the fact that you did something to help yourself and it didn’t maintain it. And this is what I want to help show you that there’s, there are options. There are choices, there are things you can do to put the odds in your favor to get your blood sugar in better control. And there are tools and resources that you can use that will

Genetic components to blood sugar balance

Dawn (00:05:57):

Provide you the outcomes you’re hoping for, even after bariatric surgery with the reoccurrence. So say you are in that 30 to 40% where you did have to restart blood sugar medications, just consider where you’re at and start applying. These strategies that I give you and find what works. And it may take several of them to get your body to go back the other direction. So we’ll dig into this so you get the full picture, but I just want you to see that there are options.

Dawn (00:06:27):

And just because it didn’t solve the problem permanently and it quote unquote didn’t cure it it, you may have benefited for a period of time and you were thankful for that. And right now, whatever has occurred that has made this re you know, return your blood sugar balance is off. Let’s find something that works so that you can get it back under control and get off of those diabetic medications again and get in a better place.

Dawn (00:07:09):

The reality is, there is no one set formula that’s probably gonna work for every bariatric patient. I mean we are all different and there are genetic components to blood sugar balance, and each of us may respond differently to the same food. So you can’t just assume one way is the only way to make it work. You might need to, you, for example, you may find that you may not be able to handle certain types of carbohydrates, or you might need to do a little bit longer types of workouts, or you might have to add you know, different strategies and tools that maybe someone else, you know, that has diabetes, doesn’t need all that. And that’s where the genetic piece kind of drives that and influences and your gut bacteria, all that will influence your body’s ability to maintain a normal blood sugar level.

Diabetic medications to balance the blood glucose

Dawn (00:08:20):

So so first things first, you know, first you need to understand where you’re at. So you need to do blood work. You need to get some levels evaluated so that you have kind of a baseline you can make decisions off of that information you get from the test. So you know what to do or how much you have to do. So the simple tests that you can ask your provider to draw, there’s also direct to consumer labs that you can order yourself and check these.

Dawn (00:08:50):

But most typically your, your primary care physician or your family doctor is more than happy to monitor these. And maybe more quickly if, if you walked into their office and said, I want to get off of these diabetic medications, and maybe they just put you on them, I don’t know. But if you walk in with a mission and a plan and kind of an experimental attitude, like I’m on a mission to find what works best for my body, cause obviously something has happened to shift me out of this remission and I wanna figure out what it is.

Dawn (00:09:38):

So most doctors are gonna be super happy that you’re raising your hand and saying, Hey, I want to, I want to take the lead on this and I want you to support me. So I promise you, you ask any family doctor, and they would be thrilled to have those words come out of your mouth. They need you to be engaged and they need you to be a participant in your own health. They can’t do it all for you. These things are controlled by us, by you.

Diagnosis of diabetes and blood glucose

Dawn (00:10:00):

The, your choices, your behaviors, your lifestyle, your body’s genetics, your body’s gut microbiome, everything influencing it is connected. And you know, the more you participate, the quicker the results you get. So your hemoglobin a1c, this is a test that kind of gives us a rough, a rough estimate of what your glucose levels have been over the last three months.

Dawn (00:10:44):

So if you said, Okay, I wanna see you every three months until we get me off of this medication, then they could check your A1C every three months. And ideally, you you want get it at a, a good level to put the odds in your favor so that you don’t it’s kind of, again, in remission. So how would that look? So anything between 5.7 to 6.4 is considered pre-diabetes. And anything above 6.5 is consistent with a diagnosis of diabetes.

Dawn (00:11:28):

But a healthier range can be between 4.6 to 5.3. So if you’re anywhere between those numbers you’re in a good place and you just monitor it and then stay on top of it and then observe, okay, it’s shifting or it’s migrating up to 5.4 and 5.5 And why is that? So that’s where you can reflect and observe, okay, what’s happened over the last, last three months that maybe has influenced this.

Glucose levels in bariatric patients 

Dawn (00:11:56):

The next is your fasting glucose. And this is just this measures the amount of glucose in your bloodstream after an eight to 12 hour fast. And any value between 99 to 126 is indicative of pre-diabetes. Then anything above 126 is diabetes. Optimally you want your blood sugar level to be less than 100, but more ideally between 70 and 80. Aain, your blood test will kind of guide you on where you’re landing on that.

Dawn (00:12:38):

And again, if you’re noticing that, hey, these are creeping up and your doctor’s saying, Oh, well, let’s just wait and see, let’s just wait and see. That’s where you have to be the participant and you have to say, Nope, I’m going to lead this, and I don’t like those numbers and I want them to be lower because I know that it’s going to create a cascade of events to occur when these numbers keep creeping up.

Dawn (00:13:09):

So that’s where you can change that whole dynamic just by taking charge of it. Then the, the last one is your fasting insulin. And this can help you detect early signs of insulin resistance that could be contributing to your disre dysregulated blood sugar. And research shows that a fasting insulin over 7 is associated with a significant increase in future risk of metabolic syndrome and type two diabetes.

Insulin level and blood glucose

Dawn (00:13:58):

keeping your insulin level below 6 is ideal, but you may find that you do even better when it’s between 2 to 5. So if your insulin, and again, your doctor can order this, it’s just a blood test a fasting insulin, and you, you want to keep it between 2 to 5 to give you that optimal results and management, I should say, of your blood sugar. Maintaining these healthy levels takes effort and for most people they don’t just happen naturally and as we age, we naturally all become more insulin resistant.

Dawn (00:14:36):

And so that makes it a big deal if everyone kind of migrates to that. And you start, you know, you know, gaining weight more in your midsection and holding it there, and that again, it just perpetuates a, a cascade of events that occurs with your hormones and you know, your weight all of that stuff gets impacted very quickly. Let’s discuss the things that can influence your blood sugar balance after bariatric surgery.

Dawn (00:15:08):

And you know, as you can realize there are many factors that can influence your actual blood sugar level and they’ll typically fall in a couple of categories. This is your diet, your inactivity, your gut bacteria, your hormones and genetics. I am not even talking about stress and sleep this time which I could, but they definitely influence it. But I’m not digging into those today.

Diet influences for blood sugar balance after bariatric surgery?

Dawn (00:15:41):

I’m just kind of sticking with these five core areas so that you can see the how impactful this truly is. So how does your diet influence blood sugar balance after bariatric surgery? Now most of you are aware of the connection between food choices and your blood sugar control. And most of you realize that consuming foods with added sugar or refined carbohydrate or basically foods that have no fiber or very little fiber can increase the risk for elevated blood sugar levels.

Dawn (00:16:28):

But something to kind of get you thinking out of the box is that it’s not always linear. A study published in 2018 found a protective effect from honey against metabolic syndrome. And although, you know, honey is a sugar, but as you can see, not all added sugar provides the same blood sugar response. And I would guess if you, through the genetic piece, the gut bacteria piece kind of interwoven with that each of us would probably respond even differently from that.

Dawn (00:17:07):

So some of you, you may have a increase in your blood sugar when you have honey, whereas someone else, it may not cause that same spike. Most of you know that carbohydrates turn into sugar so you can understand why they would alter your blood sugar. A study published in 2022 found that those following a low carb high protein diet had better blood sugar balance and overall weight loss. So being intentional about the types of carbohydrates you choose matters.

How inactivity impacts blood sugar balance after bariatric surgery?

Dawn (00:17:58):

And just to kind of clarify, low carb doesn’t mean no carb, so don’t misinterpret these claims that you need a high protein, low carb diet. It’s really, you have to be more specific with your, your what your body needs and your body needs fiber filled carbohydrates daily, not the non fiber filled carbohydrates. And we’ll get into a little more detail of how, what, what level of low carb do you need to do because that gets us into ketogenic diets and you know, extreme low carb.

Dawn (00:18:35):

So I’m gonna clarify you that with you so that you have that understanding and know that, hey, you know, I, I don’t have to be, or I may not need to be as strict. So, so now let’s talk about how inactivity impacts blood sugar balance after bariatric surgery. Physical activity can help lower your blood sugar for up to 24 hours or more after a workout. Making your body more sensitive to insulin. So you want more insulin sensitivity so that it can respond to excess sugar. So not moving your body consistently will set you up for higher blood sugar levels.

Dawn (00:19:18):

And doesn’t matter if you had bariatric surgery or not, it’s really just a human thing. So the more you move your body, the better control you have of your blood sugar. Now it doesn’t mean you have to run a marathon, it’s really just being intentional about moving your body several times a day and not being sedentary.

Dawn (00:19:48):

I mean, studies show walking after a meal can blunt the glucose spike. So it can blunt your blood sugar from going way high. And so the key is, you know, being intentional about your movement more importantly than you know, enlisting in this really rigorous workout that you maybe only maintain for a month or two. So it’s, you know, really, you know, being, setting yourself up for success. So you want to be successful long term, not short term.

Dawn (00:20:21):

It’s all about setting up routines that can help you keep your blood sugar in check long term and not just in the short term. Now I want to dig in next to an area that will influence your blood sugar, whether you control it or not. So you may be exercising and you may be eating a low carb high protein diet, but yet your blood sugar is still increasing.

2020 publish of blood sugar control

Dawn (00:20:59):

And why would that be? And that would, a potential would be your gut bacteria and your gut bacteria have the ability to influence your blood sugar control. A study found published in 2020 found gut bacteria actually regulate glucose balance. And then another study published in 2020 also reports that glucose alters the symbiotic relationship between gut bacteria and the human host, the person. So for example, people with diabetes have dysbiosis and dysbiosis increases the lipopolysaccharide levels and gut permeability.

Dawn (00:21:43):

And you can think of that as like leaky gut. And lipopolysaccharides are, or LPS, those are kind of damaging byproducts that occur in our in intestines. This results in inflammation, endotoxemia, systemic inflammation and insulin resistance and poor glucose control. So anytime you have a gut imbalance or dysbiosis you have these issues. So you’re going to have issues with inflammation and insulin resistance and glucose control.

Dawn (00:22:38):

So you’ve got to correct your gut bacteria before you’re going to improve your blood sugar balance with or without bariatric surgery. In reality. So this can be found in pre surgery, pre bariatric patients and post bariatric patients. So if you have gut dysbiosis after bariatric surgery the odds are over time the longer that occurs, then you have more inflammation and your blood sugars are going to be less in control, they’re gonna be more out of control and insulin resistance may become an issue. Again, it’s kind of like that snowball effect that occurs.

Gut microbiome to improve health and blood glucose

Dawn (00:23:11):

There’s a, another study that found a positive and negative relationship exists between the types of gut bacteria and type two diabetes. And this includes the bifidobacterium, bacteroidetes, faecalibacterium. Akkermansia and roseburia were negatively associated with type two diabetes, whereas Ruminococcus, fusobacterium and Blautia were positively associated with type two diabetes.

Dawn (00:23:57):

So there are indicators that when these levels are out of balance it it could be the reason why you’re experiencing blood sugar control issues. There is also a study on 3,400 participants and it was able to demonstrate the potential of using dietary interventions to influence a gut microbiome to improve health and blood sugar balance was one of the ways that it was improved.

Dawn (00:24:31):

So that’s the good news. So just because you maybe have gut dysbiosis or you have a gut bacteria imbalance there are solutions you can turn that around and reverse it. Now let’s move into how hormones influence your blood sugar balance after bariatric surgery. This one I would say is, is quite interesting to me and I wish that was thought about more for females especially. cause there’s, you know, a lot of evidence that’s showing with your estrogen level and its impact on your metabolic system.

Estrogen maintenance and insulin resistance

Dawn (00:25:23):

So when estrogen is low, or kind of think of in the menopause perimenopause area, when your blood sugar, your when your estrogen is kind of going up and down and then once you go through menopause, then it’s lower, it maintains a lower level. And what they find is that postmenopausal women the estrogen that low estrogen accelerates the development of insulin resistance and type two diabetes. And that’s kind of what I was meaning, you know, as we get older, we all are prone to becoming more insulin resistant. Our..

Dawn (00:25:41):

Our body doesn’t respond the same because these hormones aren’t there to protect us. So if you are a female going through menopause or have gone through menopause you may have noticed that your fasting blood sugar and your hemoglobin a1c has been slowly increasing during this time. So, you know, that’s when you know, I’m encouraging you to pause and just take control.

Your hormones and healthy response with your blood sugars

Dawn (00:26:36):

Just tell your provider that, Hey, I want to turn this around. I want to do what I can to get this going back in the right direction. Because you can, even if your est estrogen levels are lower there are solutions that can help put you in a better place with your blood sugar control. So, you know, knowledge is power when it comes to this. And understanding the different seasons of life and how it may require, you know, a different approach to kind of negate the effects of, you know, hormone changes that are happening.

Dawn (00:27:11):

Yeah, why wouldn’t we, why wouldn’t we apply these strategies so that we can get a better handle of our health? And that may require, you know, making different carbohydrate to choices or, you know, different exercises you may have to get your gut bacteria back in balance or you might even have to optimize your liver function because that plays your liver plays a role in how well your hormones are utilized and metabolized. So all of this you can change and get a healthy response with your blood sugars.

Dawn (00:27:58):

Next I wanna talk about genetics and how they influence blood sugar balance after bariatric surgery. And the way insulin and glucose do their job is determined by certain genes as well as by other factors like we’ve discussed your diet lifestyle got bacteria hormones and then, you know, sleep and stress that I didn’t even address those. Also influence you know, your blood sugar balance. But there are at least if not more 17 genetic SNPs either directly or indirectly are associated with blood sugar balance. And one example is the genetic SNP ADIPOQ, which is an adiponectin C1Q and collagen domain. And what they find is the GG genotype was associated with high insulin and triglyceride levels compared to the A allele carriers and is associated with a higher risk of insulin resistance and metabolic syndrome.

The melatonin receptor and blood sugar balance

Dawn (00:29:11):

So as you can see, it can be directly or indirectly influencing that blood sugar balance. There was actually a study published in 2022 on how the timing of dinner and genetics affect individuals blood sugar control. And in this study they found eating dinner close to bedtime when melatonin levels are high disturbs blood sugar control. And especially in individuals with the genetic variant in the melatonin receptor, the MTNR1B which has been linked with an elevated risk of type two diabetes.

Dawn (00:29:51):

And what they found was the high melatonin levels and food intake associated with late eating impairs blood sugar control in the carriers of this genetic SNP MTNR1B through a defect in insulin secretion. But you can see that your genes can make you more susceptible to more imbalances in your blood sugar. But here’s the thing having genetic SNPs that predispose you to imbalanced blood sugars or insulin is not a death sentence or a guarantee that they’ll be expressed.

Dawn (00:30:35):

So just because you have that genetic SNP doesn’t mean that it’s going to be activated. In fact, and if you’ve followed me long enough, you’ve heard me say this, your genes load the gun, but your epigenetics pull the trigger. And that just means that you’ll, you have the ability to influence it. You can influence your genes positively and negatively by your behaviors and your choices and the tools you use to maintain health. So that doesn’t mean that you have to you know, have a genetic test. It just means that if you’re struggling with controlling your blood sugar and you’ve worked on everything else, it could be your genetics are driving this and you, you know, you might benefit from a genetic test to kind of dial that in a little bit tighter so you know how to influence it if your strategies haven’t worked.

Five areas that can influence or cause a blood sugar imbalance

Dawn (00:31:34):

So now that we’ve talked about these five areas that can influence or cause a blood sugar imbalance, let’s talk about how you can I influence it positively. How you can improve blood sugar regulation after bariatric surgery. And I’m gonna list nine of them and they are.. Stay low carb. Consume quality carbs. Get adequate omega-3 fatty acids, magnesium and vitamin D. Move your body consistently. Consume a higher protein diet. Add apple cider vinegar with meals. Restore gut bacteria balance to increase short chain fatty acid production. Consider berberine.

Dawn (00:32:34):

And consider a continuous glucose monitor. So each of these I’m gonna cover separately so that you have the details. So most of you are aware of a low carb diet for managing your blood sugar control. Not everyone realizes this because I would say that once you get into you know, once you’ve been diagnosed with diabetes you type two diabetes, you are, you know, kind of given medications and given a dose of carbs that you have to eat at each meal to manage that medication.

Dawn (00:33:08):

So I’m wanting you to think out of the box of how can I do this differently so that I don’t need medication or help get off of medication. So these are the, these are the things that you can enlist yourself so that you are, so you are partnering with your provider in saying, I’m going to do my part. I am going to show up and I am going to get this back in control. And I promise you your provider will be thrilled.

Dawn (00:33:44):

So let’s talk about what qualifies as low carb. cause I feel like this is where in the bariatric community it gets super confusing. And mainly because of the explosion of the ketogenic diet. And , a keto diet where you consume, 20 grams or less of carbohydrates. Then over time you can kind of bounce between 20 to 50 grams and still stay in ketosis for a lot of people.

Ketogenic diet after bariatric surgery for blood sugar balance

Dawn (00:34:13):

But I find that a lot of bariatric patients feel like that’s where their carbs should be 20 to 50 grams. Or or less than 20 grams is where they should be. And that’s, that’s not necessarily true. You know, I I would say I remain pretty neutral on a keto diet. There are health conditions that it, it is beneficial for. But let’s, let’s talk about sustainability for bariatric patients. Most of you do not need to be following a ketogenic diet and you can listen to a podcast that I recorded a while back on ketogenic diets and how it really is not a good fit for a lot of people. So that’s, you know, something that you have to consider that just because it’s popular doesn’t mean it’s the right thing for you. So for me, I want, I want your choices to become sustainable.

Dawn (00:35:19):

I want you to be able to manage your health in a sustainable way. And I just find that people struggle to do that with, you know, 20 grams of carbs. They, they can’t get enough fiber in their diet when they only consume 20 grams of carbohydrates. So, but you know what’s considered a low carb? You know, what is considered low carb when it comes to the big picture and technically anything below 150 grams of carbohydrates is considered low carb.

Dawn (00:35:54):

So usually what I find that people do better with and depending on, you know, your activity and your gut bacteria and your hormones and just, you know, your stress and your sleep that will influence where this range lands. But somewhere between 75 to 125 grams of carbohydrates is more sustainable and allows you to get adequate fiber in so that you can keep the gut bacteria piece in a good place.

Dawn (00:36:35):

And, and you still have great blood sugar control because it’s still low carb. So I think, you know, I want your choices to be lifelong. I don’t want to do something that is, you know, not sustainable forever because once you go off of doing that or you know, something derails you and you’re off of it, then you know the pounds come on and the blood sugar goes up and, you know, all the cascade of events occur.

Dawn (00:37:04):

So you want that carbohydrate to be at a sustainable number that you can manage it. And, and if you’ve worked with me before, you know that I’m not a big pusher of numbers. So you know, I don’t even have you track, I just have you focus more on the quality of the food you’re eating and the colors so that you’re actually getting in what your body needs.

Dawn (00:37:30):

So you may find that you feel best at 75 grams, but yet someone else might feel better at a hundred. So it’s, it just is individual and I think you just have to play around with those numbers and experiment and, and that’s going to help you dial that in so that you get the most out of the carbs that you’re eating and get the, the biggest bang for your buck with you know, improving your gut bacteria and maintaining that.

Dawn (00:38:14):

Cause you can’t maintain that gut bacteria balance with diversity and you know, beneficial good bacteria with 20 grams of carbs. There’s just not enough room for fiber to get adequate fiber with that for short chain fatty acids. So, so now let’s talk about the quality of carbs. So we know if we go 75 to a hundred, 125 grams of carbs that would be easy for you.

Dawn (00:38:37):

Counters out there who are tracking carbs. Easy for you to get at the end of the day and say, Oh, I still have 25 grams of carbs, so guess what? I’m going to have these crackers or I’m going to have, I don’t know, whatever junk that you get excited about. So that’s why I don’t love numbers. I’m more about the quality of the food and focusing on colors because if you put the right properties in, everything kind of works itself out.

The carbohydrates that contains fiber

Dawn (00:38:59):

So that’s, you know, don’t get hung up on the numbers is really what I’m trying to say. But when it comes to carbohydrates it’s kind of broken in two categories, a simple and complex carbohydrates. And the simple carbohydrates break down quickly and the complex breakdown at a slower rate. And the complex carbohydrates is the carbohydrates that contain fiber.

Dawn (00:39:33):

So that’s where you’re going, you know, complex carbohydrates are super important to include and you’ll of course, you know, fruits and vegetables are also going to contain some of those fibers as well to help you meet all those goals. Consuming fiber filled carbohydrates actually improves blood sugar regulation. Including foods that contain soluble, insoluble and resistant starch positively impact your blood sugar.

Dawn (00:40:12):

In fact, a study published in the Journal of Nutrition found the replacement of digestible starch with resistant starch. So think of a, a simple carbohydrate with a resistant starch. Resulted in significant reductions in blood sugar after a meal and and the insulin level. So it improved blood sugar and insulin response. So that’s a positive way to impact it. And to manage your blood sugar better is by utilizing resistant starch as opposed to a refined starch.

Vitamins for blood sugar control after bariatric surgery

Dawn (00:40:50):

The next one is adequate omega-3, magnesium and vitamin D for blood sugar control after bariatric surgery. This is why choosing nutrient dense foods is so important. Your body needs nutrients from the foods we eat because it, it gives it in the, this balanced approach, this balanced blend from the food. So it has everything kind of mixed in it naturally that, you know, kind of prevents things from getting out of balance.

Dawn (00:41:30):

Cause again, you know, our body wants balance and it’s, it’s striving for balance and when we make it difficult for it to do that by our choices, that’s when it, it really gets you know, those blood sugars really get out of balance. There was a meta-analysis in the Journal of Metabolites in 2021, found that omega-3 supplementation can improve blood sugar balance and lipid profiles of patients with type two diabetes.

Dawn (00:41:57):

And then another study found that omega-3 polyunsaturated fatty acids had an effective role in improving lipid and hormonal profiles, reducing blood glucose, weight gain in PCOS rats. So again, it’s, you know, those omega three s come from those fatty fish. So you want to make sure you’re including those on a regular basis. And your body can’t make omega-3. We have to get it from our diet.

Dawn (00:42:35):

So you have to learn to incorporate these as you are you know, building your, your meals throughout the week. It’s learning to add those in. And of course you could always add in supplementation if you needed to of some omega-3 fish oils. And that also could be a thing. Magnesium insufficiency is associated with an increased risk of type two diabetes. And then magnesium supplementation was found in another study to improve insulin sensitivity and blood sugar control.

Dawn (00:43:09):

So again, this comes to, you know, making sure that you’re getting a balance and a variety of different foods so that you can maintain your magnesium level and your omega-3 levels. So you can, you know, stabilize your blood sugar better. And then vitamin D a study published in the Journal of North American Menopause Society found when the 25, when the 25 OH vitamin D was less than 30.

Dawn (00:43:50):

So when your vitamin D level is less than 30 blood glucose level levels were greater than a hundred, which if you recall at the beginning when I talked about normal reference ranges for blood glucose over a hundred would be.. Anything over 99 is, you know, you’re talking pre-diabetes, anything over 126 is is diabetes. So lower for, you know, whenever you have a lower vitamin D it appears to be associated with a high blood glucose level.

Dawn (00:44:22):

So the lower the vitamin D goes, the higher your blood glucose goes. So that’s why it’s important to get those blood blood levels checked and monitor your vitamin D on an annual basis with your family doctor or your bariatric team. Someone should be monitoring that every year and it should be the 25 OH not the 1, 25. So, and that will help give you insight into where you are.

Your vitamin D level for blood sugar control

Dawn (00:45:00):

And that reference range is 30 to 100 and on vitamin D and kind of the sweet spot is between 50 to 75. So, you know, being just in the thirties isn’t isn’t awful, but it’s really not going to help protect you. I’m, I’m more about prevention and protection. And once you get it into that 50 to 75 kind of sweet spot. That really helps get you in a better place with your vitamin D level so that you don’t have issues like with blood sugar control.

Dawn (00:45:25):

It will help keep your blood sugar you know, balanced in a better way. So, you know what, if you check your vitamin D and you are at a 50, then you know that your vitamin D isn’t driving this, It’s not the one that is causing you to have imbalanced blood sugars. So again, think of these as these are check boxes.

Dawn (00:45:50):

How is my vitamin D level and you know, am I getting 75 to 125 grams of carbs? You know, what am I doing regularly? Am I moving my body? Am I doing these things to help myself? And then, you know, kind of do the check boxes and see where you can improve. And then when it comes to activity. So moving your body consistently is important. And again, I kind of mentioned this earlier, it’s, it’s, it’s not, you can’t have that all or nothing approach this.

High protein diets brings the blood sugar balance in bariatric patients

Dawn (00:46:21):

You, this is forever. We need you to move your body forever. And, you know, guess what? If when I get older, I want to be able to go to the bathroom by myself. I I don’t want to need help. I want to be able to get out of my chair when I get older. And I want to be able to go and do things. And that requires effort on my part. I need to use my muscles. And I need to move my body. In order for that to happen 40 years from now.

Dawn (00:47:00):

I, I’ve gotta do my part now cause I can’t wait until I’m in that position because that’s, you’re making the tasks so much harder. Whereas if you work on it now when you get to be 70 and 80 and 90, then you know, you’re already in a good place and you have the, those you know, routines in a a good area that it’s, it’s not hard for you to manage.

Dawn (00:47:23):

Actually there was a study published in 2016 found that just walking 30 minutes a day reduces the risk of type two diabetes by approximately 50%. So consistency is key when it comes to moving your body. You know, enlisting in some type of intense routine may seem like a great idea, but the key thing is, is that you just are consistently moving your body, you know, lifelong. It’s not about a few months of being intense.

Dawn (00:47:55):

It’s about what you do over the long haul. The next one is consume high protein diet. And this I think is pretty intuitive for most bariatric patients. And most of you already consume a high protein diet. This, you know, decades ago was, you know, pretty unfamiliar and it was kind of touted that we shouldn’t do high protein diets, hard on your kidney and they’ve just, there really is no evidence to continue backing that up.

Dawn (00:48:28):

High protein diets are helpful with weight loss and blood sugar balance. So, and it keeps you more satiated. So, you know, making sure that you you know, continue that lifelong and check in with yourself. Evaluate how you are doing with your protein intake. Make sure you’re hitting those grams of protein that your body needs and work with your dietitian on finding that sweet spot that works best for your lifestyle.

Nutrition and protein diet to balance blood sugar levels for bariatric patients

Dawn (00:49:10):

There was a study published in the Journal of Nutrition and they found that a protein intake of 20 to 30% of total calories is best for optimizing type two diabetes management. So again, that falls right in line with where bariatric patients typically are with their protein intake. So just maintain that consistency and that piece of it will be taken care of. That doesn’t mean if you follow a high protein diet and that you won’t have any issues with your blood sugar balance, nope.

Dawn (00:49:31):

You could still could. So that’s where, you know, evaluating these other areas may be what you need to do to find what’s causing this imbalance. One surprising area that may help some people with managing their blood sugar better is apple cider vinegar. And more and more studies are discovering the impact of apple cider vinegar and its beneficial effects on blood sugar balance. A study published in 2020 found the results to clearly show that the daily consumption of vinegar can reduce the rise of blood sugar and your lipid profiles induced by a high calorie diet in rats.

Dawn (00:50:10):

And then an additional study in the Journal of Clinical Nutrition in 2019 reported daily vinegar in the, the amount of two to six tablespoons a day appear to improve the glucose response to a a carbohydrate rich meal. So what they’re saying is when you have a higher carb meal taking apple cider vinegar with it will blunt the glucose response so your blood sugar won’t spike as high when you include the apple cider vinegar.

Dawn (00:50:55):

So pretty cool especially if you’ve never tried it. What there’s no harm in trying you know, apple cider vinegar as an option. You know, I just, you know, it’s an acid. So if you notice that you get heartburn from it, you know, the key would be you probably do. It in a small amount of water and you do it with the meal. And you know, cause it can increase stomach acid for some people. But diluting in a water will help. And that is, you know, a great consideration. It may not work for all of you, but again. What a simple strategy to contribute if it is effective for you. For me personally taking it. I just to do it in water, I don’t prefer it, but I could do it in sparkling water.

Gut bacteria influence blood sugar regulation for bariatric patients

Dawn (00:51:50):

So with more of like the Pellegrino water, it’s more of like a mineral water that has some car, a little bit of carbonation in it. And to me it tastes better in that. Now being a bariatric patient, you may find that that carbonation is too much for you. And you could pick some other lower carbonated type of fluid if you wanted to mix it in. But it’s an option, it’s a consideration that has been shown to be effective. So definitely a way to trial and experiment.

Dawn (00:52:24):

The next is restore gut bacteria balance. There are several studies showing how gut bacteria influence blood sugar regulation. Then there are many ways to approach this. Working with a provider like myself that can help you get to the root of your gut health. Probably the most effective way because we’re gonna help kind of weed out and sort through your symptoms.

Dawn (00:52:59):

We’ll do a more focused approach and give you strategies to kind of rebuild and recondition. Your gut and just restore it back to its normal balance. So that it can help improve your blood sugar control. The good news is gut bacteria can be influenced and you just have to discover. What’s causing the imbalance and correct it. You may find value in just starting with boosting your beneficial gut bacteria and that be a good starting point.

Growing your good bacteria after bariatric surgery balances blood sugar

Dawn (00:53:34):

 I have a blog post and a podcast that I did and a YouTube video on this. That you can see on and. I’ll put the links so that you have that. But that’s definitely a consideration so that you have options when you can. You’re just at home and you’re trying to implement strategies. You know, focusing on just growing your good bacteria is a great place to start.

Dawn (00:54:07):

The next one is berberine. berberine is just an herbal supplement that is a bioactive compound found in various plants. And several animal studies. Kind of have figured out that berberine may lower blood sugar levels in a variety of ways. One is it increases insulin sensitivity. It promotes insulin production. Regulates metabolism. Reduces glucose production in the liver. And it slows the carbohydrate absorption from the gut. So, you know, although it is a natural strategy, it has actually been kind of touted as a very close equivalent to metformin. And this is something, it’s just a natural alternative and you get great results. Now, Metformin can cause some digestive issues and same with berberine. It can cause digestive issues for some people. So it’s, you know, kind of contraindicated for some and some people they’ve, they feel nothing with either.

Dawn (00:55:19):

So it really depends on the person. And just because you have digestive issues doesn’t mean you wouldn’t tolerate berberine. It would just be kind of a trial and error and see. So just because you experienced digestive issues with metformin doesn’t mean you’ll experience them with berberine or vice versa. But a study in 2019 found that berberine and metformin can modulate the com composition of the gut microbiome. And reduce body weight. Blood glucose levels and intestinal inflammation in mice.

Dawn (00:55:54):

Then another study found that berberine was effective in lowering glucose at various doses and it also improved weight loss. So again, it’s just another tool in your toolbox to use and. If you are having blood sugar issues working with a provider like myself. To help you work through the appropriate dosing and. Make sure that’s a right fit for you is a great way to start.

Dawn (00:56:24):

And lastly consider a continuous glucose monitor. This is kind of, you know, one of those things that if you are really struggling and. You’ve really put effort in applying some of these strategies. But it’s, it’s moving very slowly and you’re just not seeing the results that you really need to see cause.  You know, you’re trying to not go on insulin or you’re trying to get off of it cause you. Just keep gaining weight and you just find yourself in a bad place.

Gut bacteria to maintain a healthy blood sugar balance for bariatric patients

Dawn (00:57:14):

You know? Continuous glucose monitors are a great option and it could be super helpful in kind of dialing in . How you react to food. Because again, you know, we’re all going to respond differently to a carbohydrate. So some people who have, you know, real sugar don’t have the issues with their blood sugar managing it well. Whereas someone else, they can’t really have any without it managing it without it influencing your blood sugar negatively.

Dawn (00:57:40):

There are a few direct to consumer options. These are Nutrisense, Signos and Levels. Those are the three that I’m familiar with. I have not used it myself but. I am considering that as an option to do as a group with people. Do have an interest in doing this with a group of you to kind of help kind of dial it . And just kinda work through a glucose monitor and just really be intentional about your foods. Understanding your body as best as possible. And how, how it’s influenced. Because again, you know, we’re, we’re not alike. Our genetics do play a role. Gut bacteria do play a role. Stress, our sleep, all those things really do influence our ability to maintain a healthy blood sugar balance.

A balanced blood sugar after bariatric surgery

Dawn (00:58:44):

So, and it’s no different after bariatric surgery. And that’s what I want you to see. Hopefully you’ve seen the importance of maintaining a, you know, a balanced blood sugar after bariatric surgery. And that although bariatric surgery does an awesome job, it it’s not a permanent thing. There’s no guarantee that, you know, diabetes won’t return. And we see that, you know, in the original study, the 30 to 40% of you may have diabetes return. So that’s where you have to again, take control and you have to be proactive in your own health and be a participant. And experiment and try new things. Don’t be afraid to try something different. Of course, you know, always talk to your healthcare provider or work with someone like myself. Who can help you navigate these health things. And, you know, utilizing things like berberine, is that right for everyone?

Dawn (00:59:51):

No, it’s not. That’s where you need to work with somebody who can help you decide is this a good fit for me? You can definitely consider the omega-3s and vitamin D and magnesium with just foods. And then your, your bariatric team or your family doctor should be testing your vitamin D. So that one seems pretty simple. But glucose monitors, that is a direct to consumer, you can do that on your own. You can go to these testing companies and the purchase, the, the the monitor, the glucose monitor and do it on your own. So that is definitely something that is doable. You’re probably going to spend at least probably three to $400 to get. The monitor and then to get the data might require additional fees. It just depends on what they offer and if they have some, you know, deals or anything.

Dawn (01:00:54):

But you know, apple cider vinegar restoring your gut bacteria balance. All of those things are important to consider and are ways that you can go beyond. A diet and exercise option or consideration. So I hope this has helped. And anytime, you know, blood sugar start increasing, don’t wait. Don’t let your doctor just say let’s watch it. That’s when you say, Nope, I’m concerned now because I don’t want to go back there.

Dawn (01:30:54):

I don’t want that to get out of control because then when it gets out of control. They’re just going to offer, your only options are going to be insulin. And although awesome and life saving and necessary, if you can prevent yourself from getting there why not? Why not? Try these options to get your blood sugar back in balance and in a controlled state even after bariatric surgery. So you guys have a great week and we will see you next time. Bye-Bye.

Your future health awaits…