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CGM Experiment Part 2

I used to eat oatmeal every single morning. For years. Steel cut oats, soaked overnight (to reduce phytic acid levels and improve digestibility and mineral absorption), with butter or cream, nuts/nut butter, sometimes an egg cracked in, and usually berries to “sweeten” (who was I kidding, it wasn’t sweet!).

I did it the “right” way. No naked carbs. I’d be stuffed and bloated for about 30-60 minutes, then not long after, starving. I could never get through the morning without a snack. Never.

I know now that I lived for years with reactive hypoglycemia (blood sugar dropping too low). I’d joke that I’d have “emergency snacks” in my purse because I often couldn’t make it until the next meal.

CGM Experiment Part 2: Once you “fix your breakfast,” you never go back

Until I “fixed my breakfast,” I had no idea that people could go more than 2-3 hrs without a snack. And by “fixing my breakfast,” I mean that I now consciously choose to eat a sufficient portion of protein and fat, paired with a moderate portion of slow-digesting carbs. This avoids both a major blood sugar spike and the inevitable crash.

I ditched oatmeal years ago in place of higher protein breakfasts (you’ll see dozens of examples if you scroll my Instagram feed), but it wasn’t until 2018 when I first wore a continuous glucose monitor (CGM) that I understood why I felt so awful after eating oatmeal.

At that time, I tested a “dietitian-approved” breakfast of oatmeal, milk, berries, and a measly teaspoon of honey (not even enough to make it sweet or palatable) and had a massive 104 point spike in my blood sugar.

Oatmeal, my old frenemy

Many have asked me to repeat this experiment, but with added fat/protein and no honey. Well, here it is folks (see image below). I added an unsweetened beef protein powder (added 12 grams of complete protein — approximately 2 eggs worth), some heavy cream for fat, and cinnamon for flavor (and a possible glycemic benefit).

Despite this, I spiked 60mg/dl. Yes, SIXTY points.

A 60 point spike is better than 104, yes. But I still got all the icky feelings that I experienced DAILY for years when eating oatmeal (Yes, even when I added fiber, like chia or flax. Yes, even when I have added eggs. Believe me, I’ve tried #allthethings.)

I didn’t go hypoglycemic this particular day, but I felt awful relative to my usual breakfast. Even my husband, who’s highly active and incredibly insulin sensitive, didn’t feel well after the oatmeal (even though he didn’t spike as much as me; we both did a CGM experiment at the same time).

Oatmeal with “all the things” might work well for you. If you truly feel well, carry on! But DO pay close attention. My husband commented that if he hadn’t been with me for nearly 2 decades (and therefore, mostly eating similarly to me, at least when he’s at home), he probably wouldn’t have noticed that he felt “off” with oatmeal.

Most people don’t actually feel that well on a day-to-day basis. We do. And we notice, even when it’s subtle, that something is off.

No, neither of us had a blood sugar spike into the prediabetic range, but the rapid change in our levels clearly sent off some emergency signals in our body. We both felt our pulse/heart rate rise, felt a bit jittery, and then felt slightly lethargic as our blood sugar dropped. He didn’t spike as much, but he crashed faster and lower than me.

Are you sure your blood sugar didn’t spike? Or did you miss the spike?

The other point that needs to be made here is that, if I had only checked in with a 1 or 2-hour post meal blood sugar check (as many diabetes educators advise), I would have had no concerns over my readings. At 1 hour, my blood sugar was at a totally healthy and normal 103 mg/dl. At 2 hours, my blood sugar was 86 mg/dl. Again, perfectly healthy and normal.

If this was a client presenting me with only a single 1 or 2-hour post-meal blood sugar reading, I may have even congratulated them on a “blood sugar balanced” meal; however, in this case, my blood sugar peaked at 30 minutes after the meal. This is a good sign that my body has the capacity to handle blood sugar spikes by pumping out a large bolus of insulin, yes. For that, I am thankful. 

But when this system gets “used and abused” for years on end, eventually the pancreatic cells that produce insulin get worn out. We call this beta cell burnout. And eventually, the body becomes less and less responsive to insulin, because insulin levels are almost constantly high. (Imagine a nosey neighbor constantly knocking at your door; eventually, you tune out their incessant knocking and stop opening the door as often.) 

That is the very beginning of prediabetes, which, over the course of many many years, eventually can lead to type 2 diabetes.

Even, if you want to argue that I should not be concerned over a “normal” blood sugar spike and insulin response, at the end of the day, I did not feel well after this meal. I felt excellent after the other breakfast of eggs, asparagus, sourdough, and butter. Or on another day, a breakfast of 3 eggs, sausage, and a small side of hash browns. I would still choose — solely from a well-being standpoint — to opt for the egg breakfast over oatmeal any day. 

Interestingly, both meals have nearly identical amounts of protein, but the oatmeal breakfast had more carbohydrates. Also, the carbohydrates in the egg-based breakfast was my homemade sourdough. Sourdough is known to have a dramatically lower glycemic index compared to other bread (or unfermented grains, though make note that I did soak the oatmeal overnight prior to cooking).

To be clear, I am not anti-oats. And I have no plans to ‘ban” them from my diet entirely. I still like the flavor and texture of oats in certain things, like the topping on an apple crisp or in oatmeal raisin cookies. I will still eat those from time to time with zero qualms. They simply won’t be a daily food choice around here.

I also acknowledge that some people do tolerate oatmeal with less of a blood sugar spike than me. That’s the beauty of using a CGM. You can identify which foods uniquely spike your blood sugar and adjust accordingly.

Higher protein, low glycemic breakfasts just work

Overall, CGM experiment #2 reaffirmed the importance of a protein-sufficient, low glycemic breakfast. 

Although you may want to write off my assessment as an N of 1 anecdote, there’s actually quite a bit of data showing that higher protein, low glycemic breakfasts are beneficial. 

Whether the study is on children, adolescents, adults (male or female), and people with (or without) diabetes, overwhelmingly the data shows better blood sugar regulation, better satiety, easier time maintaining a healthy weight, and overall better nutrient intake when people eat a lower glycemic, protein-sufficient breakfast. This includes the studies looking at eating a protein-rich breakfast versus skipping breakfast, by the way. A number of such studies are listed in the references at the end of this article.

When you fix your breakfast, your whole day is better

Ultimately, “fixing breakfast” remains priority number 1 for me, as it has for virtually my entire career as a dietitian. When you “fix breakfast,” everything else falls into place. Well, maybe not *everything,* but chances are you’ll have better energy and focus, stay full longer between meals (so you’re naturally less snack-y or prone to reach for sugar/caffeine as a pick-me-up), and be less prone to overeat the rest of the day.

To give you one example, a study compared two breakfasts of equivalent calories on overall energy intake and satiety. The participants were given either a breakfast of eggs and toast OR a breakfast of cereal, milk, and orange juice. Again, calories were equal.

Compared to the cereal group, the egg and toast group were: 

  • More satisfied after eating eggs (longer time until hunger returned)
  • Ate less at and all-you-can-eat lunch 4 hours following breakfast
  • Were less hungry for the rest of the day (ate fewer total calories, spontaneously)

This is simply what happens when you are better nourished and your blood sugar stays balanced. Try it for yourself and report back in the comments below. If you check out this post on IG, you’ll see just how many people commented on the dramatic difference they’ve observed after “fixing their breakfast.” What have you got to lose? Give it a go for even 2-3 days.

Balanced breakfast ideas (including non-egg options)

If you need some ideas for a more balanced breakfast, check out my (very old, but still relevant) article “the healthy breakfast mistake” on my site. It’s almost 10 years old, but I still stand by every word!

I am personally a big fan of eggs for breakfast, but maybe they’re not for you (or you just want some alternatives).

Many people ask me what they can do for breakfast that has protein if they don’t like or can’t eat eggs. There are many, many options, so think outside the box. 

  • Breakfast hash with sausage, leftover veggies and potatoes or sweet potatoes
  • Greek yogurt or cottage cheese with berries/fruit
  • Grain-free granola (recipe in Real Food for Pregnancy) eaten alone or with milk or yogurt
  • High protein smoothie – try adding collagen protein or a beef protein isolate (such as the Be Well By Kelly protein powder, code LILY to save *affiliate). Non-protein powder options include adding Greek yogurt, cottage cheese, or nut butter.
  • Dinner/lunch leftovers for breakfast – think meatloaf, shepherd’s pie, leftover pulled pork, etc.
  • Avocado toast (ideally, on sourdough or sprouted grain bread) with ham/turkey, bacon, or canned sardines for extra protein
  • Snack plate of cheese, salami, fruit, nuts, and sliced veggies
  • Quesadilla with cheese, leftover chicken/beef/pork/shrimp, avocado, salsa, sour cream

Want to try your own CGM experiment? Here’s how to get a CGM

If you want to try a CGM for yourself, in most countries, you can get them OTC at a pharmacy. In the US, you either need a prescription or you need to go through a service, such as Levels. Use this link to cut the 150k+ waitlist (affiliate link).

In my first CGM article, I go through more of the basics on procuring a CGM and how they work. You can read that here.

By the way, the cool black graphs you’ll see in this article came from the Levels app. If you’re new to understanding blood sugar, it can be really helpful to interpret the response.

For me, I have 10+ years as a certified diabetes educator under my belt, so I have no trouble interpreting readings and putting them into context relative to someone who has diabetes verus someone like myself who has a functional pancreas and good insulin sensitivity. Their app makes it much easier for the average consumer compared to the standard app provided by Libre.

Now I’d like to hear from you. 

  • Have you worn a CGM or tested your blood sugar routinely? 
  • Have you experimented with different types of breakfasts
  • Which ones keep you the most satisfied and prevents a mid-morning snack attack?
  • Which ones give you the most stable blood sugar response? 

Tell us below!

Until next time,
Lily

 

PS — By popular demand, I tested out the consumption of dates (the dried fruit of the date palm) to see my blood sugar response while wearing this CGM. Many women consume dates, particularly toward the end of pregnancy, in hopes that it helps improve labor outcomes. 

If you haven’t yet read my article on eating dates, what are you waiting for? In addition to covering the research on the consumption of dates in pregnancy, I also share my blood sugar responses (CGM graphs) to the various date combinations. I was able to find ONE way of eating dates that avoided a spike, much to my surprise.

 

References

  •  Toh, Darel Wee Kiat, et al. “Lowering breakfast glycemic index and glycemic load attenuates postprandial glycemic response: a systematically searched meta-analysis of randomized controlled trials.” Nutrition 71 (2020): 110634.
  • Chang, Courtney R., et al. “Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability.” The American journal of clinical nutrition 109.5 (2019): 1302-1309.
  • Leidy, Heather J., et al. “Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese,“breakfast-skipping,” late-adolescent girls.” The American journal of clinical nutrition 97.4 (2013): 677-688.
  • Leidy, Heather J., et al. “Neural responses to visual food stimuli after a normal vs. higher protein breakfast in breakfast-skipping teens: a pilot fMRI study.” Obesity 19.10 (2011): 2019-2025.
  • Ratliff, Joseph, et al. “Consuming eggs for breakfast influences plasma glucose and ghrelin, while reducing energy intake during the next 24 hours in adult men.” Nutrition Research 30.2 (2010): 96-103.
  • Hoertel, Heather A., Matthew J. Will, and Heather J. Leidy. “A randomized crossover, pilot study examining the effects of a normal protein vs. high protein breakfast on food cravings and reward signals in overweight/obese “breakfast skipping”, late-adolescent girls.” Nutrition journal 13.1 (2014): 1-8.
  • Ma, Zhili, et al. “Daily intake of up to two eggs for 11 weeks does not affect the cholesterol balance of Chinese young adults.” Food Science & Nutrition (2022).
  • Bellissimo, Nick, et al. “Effect of increasing the dietary protein content of breakfast on subjective appetite, short-term food intake and diet-induced thermogenesis in children.” Nutrients 12.10 (2020): 3025.
  • Keogh, JB and Clifton, PM. “Energy intake and satiety responses of eggs for breakfast in overweight and obese adults—a crossover study.” International Journal of Environmental Research and Public Health 17.15 (2020): 5583.
  • Park, Young-Min, et al. “A high-protein breakfast induces greater insulin and glucose-dependent insulinotropic peptide responses to a subsequent lunch meal in individuals with type 2 diabetes.” The Journal of nutrition 145.3 (2015): 452-458.

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Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Her work is known for being research-focused, thorough, and unapologetically critical of outdated dietary guidelines. She is the author of two bestselling books, Real Food for Pregnancy and Real Food for Gestational Diabetes.

15 Comments

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  1. This article makes so much sense and validates what I have experienced for so long. Thanks for articulating all of this so clearly!

  2. I feel the same way after oatmeal and it did spike me when I had GD. My toddler however only wants to eat oatmeal in the morning. I crack an egg in and cook it together to add protein.
    Do you worry about it spiking the sugars of children or can they handle/need more carbs in the morning.

    • I’m of the opinion that kids can handle more carbs (proportional to their diet) than adults given that they’re rapidly growing and constantly active. I do try to prioritize protein and nutrient-dense foods with toddlers (ala “no naked carbs” to help blunt the blood sugar spike), but I don’t personally restrict carbohydrates. More of my thoughts on feeding young kids here: Real Food for Toddlers: Mindful Eating Starts Young

  3. Super enlightening article, thank you for sharing your knowledge! I’ve been eating oatmeal almost every morning since having my 11 month old daughter to help with milk supply but I am interested in switching it up. Is there any concern with eating eggs every morning? I know it’s kind of old school advice to avoid them for cholesterol but for some reason I was still under the impression that they shouldn’t be a daily thing. Thanks!

    • The cholesterol part is a non-concern (dietary cholesterol does not increase blood cholesterol, unlike what we were taught for decades). There are some people who can develop sensitivities to foods when eaten too often (i.e. eggs every single morning), but that’s not universal. Play it by ear and if they start giving you symptoms, switch to another breakfast or rotate between breakfast options.

  4. Great information, Lily!

    I would love to know what your MRT results say about oats and various foods. Would love to have you get an MRT test done, 25% off, and do some observations there. MRT reactive versus low reactive foods and insulin.
    I’ve been hearing that many people have found that the MRT reactive foods, even some non-or low carb, tend to spike their sugars.

  5. Yes to all of this!! For years I ate buckwheat cereal for breakfast… soaked overnight, with almond meal, or and egg, or both. I feel SO MUCH BETTER now eating my daily breakfast of a chicken liver frittata (1/2 chicken liver chopped up fine and cooked in 2 eggs), a small salad and one slice of sourdough bread. Two days ago, instead of my one slice of bread I made pancakes, which were still sourdough but had twice the carbs overall. That day, I ended up seriously dragging for most of the day. I really believe blood sugar and gut health (ie managing yeast overgrowth) are the two keys to having plenty of energy and feeling good all day long. : )

    • It’s a dramatic difference!

  6. What I find very interesting about oatmeal was that I could never tolerate it (huge blood sugar spike, feel horrible) before and during pregnancy. But in the first several months of breastfeeding, oatmeal with nut butter and chia was like the best thing for my body, I barely got a blood sugar spike at all and it helped me feel much better. (I’m type 1 with an A1c of 4.7 and use a CGM) Now, 7 months post partum and still breastfeeding I cant handle it again!

    • Insulin sensitivity improves dramatically in early postpartum in breastfeeding moms. I know many women with type 1 diabetes who had to drastically reduce their insulin and had much better insulin sensitivity for months when they were nursing. Sounds like the case for you too!

  7. I’ve used a CGM too and did an oatmeal experiment with steel cut oats + nut butter + berries + chopped nuts. I never had a drastic rise, but I didn’t go below 100mg/dl for 7hr!!! And I too felt just very full or kinda bloated, generally not well. Eggs as my first meal don’t make me feel great, but a high fiber protein smoothie seems to be working. I need to order another CGM to double check what’s actually happening.

    • How interesting. Thanks for sharing!

  8. What’s your take on higher fat diets decreasing insulin sensitivity & reducing carbohydrate tolerance due to deposition of intramyocellular fat & intrahepatic fat?

  9. Interesting enough I failed my 1 hour glucose test. The drink made me sick and shaky so I asked if I can just log blood sugar instead of taking another test. I eat according to your guidelines except I find my body can tolerate a little more carbs since I typically get 5 miles in everyday including a 30 minute weight training workout. Still my numbers were TOO LOW. She suggested I add more carbs to my diet because a 63mg/dl was too low even though I mentioned I got in a one hour walk before logging my blood sugar. I added in a small bowl of oatmeal with my fatty breakfast and a bit more carbs every meal and I’m still at 70-80 mg/dl. Hoping I can stop logging next week and I don’t have to log again for it being TOO LOW.

  10. Excellent information, I’m so encouraged by this. As a 66 yr old, who hadfour home birthed babies with no medication I’m thrilled for this generation that you and others like you are out there teaching better nutritional lessons than I got. One doc told me I would “die without carbohydrates” and a doc who diagnosed me with gestational diabetes with my second child was lacking any knowledge to share. When I asked her what that meant for me she replied, “Just cut back on the cookies.” Had she asked, I would have told her I did not consume cookies. I am type 2 today, but as my own advocate for better health I’m learning. Thank you so much!

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