If you are reading this article, then I think it is relatively safe to assume that you definitely give a f*ck about your health to enough of an extent to be proactive about addressing potential detrimental health threats by deploying the first line of defence possible - actioning changes in your life through better decision making.
In this article it is my goal to impart on you the skill-set required in order to see a measurable improvement in your blood markers and overall quality of life.
So let’s quit playing with ourselves and cut to the chase…
In essence, there are three (3) routes of intervention which can be taken before resorting to what I consider to be the last resort intervention - pharmacological intervention:
In order to prevent this article from dragging out far too long, I am going to keep this one concise and look to cover (address and improve) three different health metrics:
Disclaimer: Now although I am not the biggest fan of measuring daily fasting glucose and using it as a conclusive means of determining good insulin sensitivity, it can serve as a good place to begin. If the results present themselves as being concerning then you can proceed with a more reliable means of checking blood glucose by doing a hbA1C blood test, which will essentially measure an average reading of your blood glucose from over the past 3 months and as we know; averages over a longer time frame are far more reliable when leaning on data to make decisions.
A good example of this would be monitoring changes in body weight during a fat-loss phase; it is far more reliable to measure and to compare the weekly average body weights seeing as day to day body weight can fluctuate in quite a volatile manner.
Depending on your location (part of the world) the unit of measurement used to measure blood glucose can vary however in Australia we use mmol/L.
A healthy fasting glucose reading will usually sit between 4.0mmol/L - 6.0mmol/L
Below 4.0 is considered to be ‘low’ and respectively so, above 6.0 is considered to be ‘high’
Now before we go onto covering how to improve / manage fasting blood glucose levels, I do want to touch on one particular medical phenomenon that can sometimes affect this reading and provide you with a ‘false positive’ for high blood sugar - an unjustified scare for high blood sugar / pre-diabetes and that is the…
‘Dawn Phenomenon’ or ‘Dawn Effect’
Now despite this usually being an indicator of pre-diabetes or something often seen in the diabetic population, it can also occur in individuals who are not diabetic.
Essentially, what initiates this spike in morning glucose (typically between 3am-8am) is an elevation in cortisol and GH, which subsequently signals to the beta cells of the pancreas to liberate insulin as an attempt to sustain sufficient blood glucose levels.
So depending on when you test your glucose levels in relation to this shift of hormones, as a result you could easily see a low, normal or high blood sugar reading.
Therefore, before worrying about one blood glucose value, I’d recommend measuring it for a number of consecutive days at slightly different times in the morning before jumping to any further conclusions and thinking that you either have pre-diabetes/diabetes thus requiring medical intervention.
If it comes back high only some times at certain hours of the morning and normal during other periods of the morning then it is most likely the dawn effect. However IF the results consistently come back high, despite testing it at a handful of different times during the morning, then I would suggest getting a hbA1C blood test and then pending the result of that test, potentially consult your physician / GP.
Regardless of the cause (genuine hyperglycemia or the dawn phenomenon) before resorting to exogenous insulin / an insulin pump, there are measures you can put into action immediately to see a complete resolution, or at the least an improvement in the severity of high blood sugar.
First point of attack would be to reduce carbohydrate intake leading up to bed time, or opting for higher fibre carbohydrate sources to slow the gastric emptying rate and so your body has a sustained supply of sugar throughout the night. This will prevent a crash and lessen the spike in the early hours of the morning.
Second point of attack when it comes to intervening with nutritional strategies would be to ensure you are in a Calorie deficit (or around maintenance Calories at least) and avoid being in an excessive Calorie surplus.
If you are dieting though and if you are doing it right, then this will be a given / non-negotiable and you would already be doing this seeing as in order to lose body weight and body fat one must be in a hypocaloric state (consume less Calories than what is required to maintain one's current weight).
When it comes to this means of intervention there are two big factors that will help immensely if not already being done:
Daily cardio - any time is fine, although I personally prefer AM fasted cardio as it sets my day up and improves morning energy before even reaching for that first coffee. This is due to the dopaminergic response following physical exertion and the increased oxygenation from the deeper and more consistent breathing that takes place while doing cardio.
Resistance training - any time of the day is fine, however if you want to reduce the negative impact that cardiovascular exercise could have on your performance and progress in your resistance training sessions.
If they must be done back to back in the one single visit to the gym due to schedule constraints, then I would advise to do your weight training first and then cardio.
Alternatively, if your schedule permits, in an ideal scenario I would separate cardio from weight training by at least 4-6 hours and do cardio first thing in the morning to get a headstart on your day. Thiswill boost energy levels and only takes a fraction of the time a weight training session often takes.
Personally, I prefer to view this means of intervention as one that is complementary to the other two seeing as despite supplementation (in isolation) still positively influencing and helping to manage blood glucose levels, a greater level of effectiveness is seen when supplementation of the following products is paired alongside regular cardio and / nutritional intervention.
The first of the dietary or ‘health’ supplement that is effective at helping to manage/improve blood glucose levels (fasted and non-fasted) is:
1. Berberine HCL - 500mg up to 1,500mg/day split into 250-500mg relatively evenly spaced doses throughout the day with higher carbohydrate meals.
It is worth noting that in light of some recent literature there seems to be a substantially increased rate of absorption of berberine when it is paired with 1-Nonanecarboxylic Acid
Not only does 1-Nonanecarboxylic Acid appear to improve berberines bioavailability but it also appears to extend its half life, allowing for a less frequent dosing schedule when compared to berberine HCL without 1-Nonanecarboxylic Acid.
The second dietary supplement that also carries some effectiveness is:
2. R-Alpha Lipoic Acid (R-ALA) - 200-300mg/day evenly split/taken throughout the day alongside berberine.
R-ALA is actually a naturally occurring antioxidant found within virtually every tissue of the cells and in addition to providing defence against free radicals within the body it also appears to aid in improving blood sugar levels.
I would like to make a clear distinction in that the R form of ALA at this point in time appears to be far more bioavailable than the non-r-type.
Now when it comes to cholesterol we are mainly looking at three separate values:
There is a fourth value often measured in blood work panels; non-HDL, although we will not go into that one seeing as it is nothing more than the sum of your total cholesterol minus your HDL.
Total Cholesterol is the summation of your HDL, your LDL as well as 20% of your triglycerides.
In isolation, this value isn’t that useful however when used in conjunction with the other values listed above it can be useful.
LDL is by far without a doubt the largest needle mover when it comes to cholesterol's impact on all cause mortality rates and overall health.
LDL also happens to be largely diet influenced… I hate to break it to you.
So if your LDL is elevated then it is likely your diet sucks and could do with some ‘spring cleaning.’
When it comes to HDL it is actually really common for men receiving trt to have chronically low HDL or ‘good cholesterol.’
Despite LDL being the bigger player, it is still a risk factor when it comes to cardiovascular disease (CVD) to be walking around with subpar HDL levels and so it is still desirable to bring it within range and maintain it there.
So what can be done to increase my HDL levels and to lower my LDL levels…?
First step or point of intervention would involve Increasing your dietary fibre intake.
Whenever I audit the diet of someone enquiring about coaching with me, this is oftentimes the first pitfall I notice - inadequate fibre consumption.
In order for cholesterol to be able to leave the body, it must be detoxified by the liver - into the bile acid and pass through the intestinal tract where the cholesterol can then bind to the fibre and be excreted from the body via your stool.
An insufficient fibre intake will retard this process, which can allow a slow accumulation / build up of cholesterol in your system over time, resulting in elevated total cholesterol levels and LDL cholesterol levels.
As per the Australian guidelines it is advised as a general recommendation to aim to consume 15-18g fibre per day for every 1,000 Calories.
Example: A 100kg male who is consuming 3,000 Calories/day should be aiming for a daily fibre intake of 45g to 45g per day.
Sure, it sounds like a lot, however I can assure you it is relatively effortless to meet these requirements IF you do not eat the diet of a teenage boy.
The source of the fibre also matters too though and so if you are getting the majority of your fibre from protein bars then it is highly probable that is not sufficient. A large portion of your daily fibre should be coming from vegetables, whole-grains etc.
As I always say; if you need to shoot, pick or dig up your food source, then what you are consuming is likely great for you and your health.
I would say aiming to get at least ⅔ of your daily fibre requirements from vegetables, fruits and whole grains alone is a good place.
Cardiovascular (aerobic) exercise, is a fantastic first line of defence to deploy in my opinion and the research seems to agree.
Now although aerobic exercise does appear to assist in lowering LDL cholesterol, the body of evidence suggests that it is more impactful and effective at increasing HDL cholesterol.
Given its low-cost, low-risk and non-drug intervention profile, I would have to say that aerobic exercise would appear to be one of the best (most benign) preventative measures to combat atherosclerosis.
At the end of the day, the only thing this form of intervention will cost you is your time - 20 to 30 minutes each day which I reckon is a small price to pay, all things considered.
Including or increasing one's essential fatty acid intake (EFA’s) via fish oil / krill oil has to be one of the most affordable ways to address skewed lipids and cholesterol values when it comes to dietary supplementation.
Not only does fish oil / krill oil carry ‘natural’ blood thinning properties, it also appears to have some promising prophylactic effects in terms of lowering triglyceride levels and improving one's overall cholesterol profile by improving HDL and lowering LDL.
Now, regarding the mechanism of action by which omega 3 EFAs improve cholesterol values and lower triglycerides, we do not have a concrete answer - it is still speculatory / debated to this day.
However, regardless of the mechanism of action, it is definitely certain that through an adequate intake of EFA’s - particularly omega 3’s ones cholesterol markers do improve (a lowering of circulating triglycerides and an improved ratio of HDL:LDL ratio) as well as aiding in reducing total systemic inflammation within the body.
So out of the two, which is more effective; is one better than the other?
Based on the current literature available it appears that krill oil might have a slight advantage when it specifically comes to increasing HDL cholesterol.
Red Yeast Rice (RYR) is a pretty viable ‘natural’ alternative to test out before resorting to an expensive statin in a situation where a more potent level of cholesterol management is required… especially if you are running supraphysiologic (above natural/replacement) levels of androgens.
RYR achieves this by inhibiting one of the essential steps in the synthesis of cholesterol within the liver, adrenal glands and testes. As a result of this a dose dependent decrease in total cholesterol and LDL cholesterol levels takes place.
Supplementing with Niacin is also another effective way at improving your HDL cholesterol value.
According to the current consensus and our current understanding of how niacin works, it helps improve cholesterol markers in a number of different ways, however one of the more predominant ones being that niacin directly and non-competitively inhibits hepatocyte DGAT2 - a crucial enzyme involved in the process of triglyceride synthesis.
As a result of this inhibition, VLDL (very low density lipoprotein) and LDL are lowered.
Citrus Bergamot is an interesting one out of this list of supplements. It can be viewed as a ‘Jack of all trades’ in that not only does it help to increase HDL levels, but the literature also shows its effectiveness at lowering LDL and total cholesterol values.
Blood pressure or more importantly high blood pressure (hypertension) is without a doubt as they say a ‘silent killer.’
It is something that often goes completely unnoticed, flying under the radar and if not addressed at a certain point can cause some irreversible damage and increase one's mortality rates quite significantly.
During the early stages of high blood pressure, certain markers in blood work will start getting skewed - namely increased creatinine levels and impaired kidney function (high cystatin-c, reduced GFR etc).
So why is this such a major deal in comparison to something like impaired liver function? Well, the liver is incredibly self-regenerative, so much so that part of it can be surgically removed, and if given enough time, a healthy liver will grow that severed part of itself back.
However the kidneys and the heart do not possess such a capability and are the furthest thing away from self-regenerative.
So bottom line: MAKE SURE YOU CONTROL YOUR BLOOD PRESSURE!
Now given the serious nature of high blood pressure, what measures can be taken (outside of pharmacological intervention with ancillary medication like: ARB’s, ACE inhibitors etc)?
Well thankfully there are a few…
Standardising your sodium/potassium intake. This does not necessarily mean lower one or increase the other, rather to standardise them - keep them as consistent and constant as possible on a da- to-day basis.
The easiest way to achieve this is to salt your meals the same amount each time, to drink a similar amount of water each day and to either;
A. follow a structured nutrition plan that includes your daily fruit/vegetable/fibre requirements
B. eat similar foods on a consistent basis to help standardise the sodium/potassium/fibre content of your daily food intake without necessarily having the full rigidity of a set meal plan.
Another means of nutritional intervention that can be employed is to limit saturated fat intake. Sure, some saturated fat is fine and arguably beneficial in some instances, however as is true with many things; the devil is in the details.
Some saturated fat is good, however more is not necessarily better.
I’d suggest not letting your saturated fat intake exceed 30% of your total daily fat intake.
So if you consume 100g of fat a day, then try and cap or limit your daily saturated fat intake to no more than 30g of saturated fat a day.
Similar to how cardio helps with lowering and managing cholesterol and overall triglycerides, it also plays a major role in helping to lower and manage blood pressure.
Better cardiovascular endurance as a result of aerobic exercise (i.e. cardio) will translate over to a stronger heart. This means it will have greater ability to pump blood around, delivering the much needed oxygen and other nutrients to the extremities of the body.
If a heart can pump the same amount of blood around with less effort, this will in turn reduce the amount of arterial force which in turn helps to lower blood pressure.
Even more surprising is some recent research suggesting that isometric grip training might be even more effective at lowering blood pressure - specifically lowering one's systolic resting blood pressure.
So this might shed some light upon one of the handful of mechanisms by which weight training is beneficial at helping to improve blood pressure.
When it comes to supplements, assuming that you are not on any prescription medication seeing as there can be some negative interactions between OTC (over the counter) supplements and prescription drugs, the following list supplements seem to provide some benefit when it comes to assisting in blood pressure given the current body of evidence…
Ubiquinol, a far more bioavailable alternative to the more commonly seen CO-Q10 supplement (especially as one gets older and as the body loses its ability to convert CO-Q10 to ubiquinol).
In addition to improving overall cardiac health in addition to providing a second hand in managing blood glucose and combating oxidative stress present in the body.
The effective dose appears to be somewhere around the 100-200mg/day mark.
Although I am not completely sold on garlic extract having a significantly noticeable benefit in lowering blood pressure, there are findings which point towards garlics ability to lower something called angiotensin II. This would suggest it has a similar but much more mild effect to an angiotensin II receptor blocker ‘Micardis’ (telmisartan), which is a prescription blood pressure medication commonly prescribed to help with managing blood pressure.
As it stands currently, the studies looking into magnesium do show mixed results in terms of its potential to positively impact and improve blood pressure.owever due to its low risk profile, it can’t hurt to try it when taken at its supposed effective dose of 500-1,000mg/day. I think in most cases there is more to gain and less to lose by trying it.
Some studies report improvements by as much as 3-5 points in both systolic and diastolic values, whereas others report no improvements - so take this as you will.
In addition to Arjuna bark extract possessing antioxidant, anti-inflammatory and antimicrobial properties, it might also help to reduce the risk of heart disease due to its high concentrations of coenzyme Q-10.
500-1,000mg per day seems to be pretty consistent across the various studies looking into it as being an effective dose.
So, to conclude everything, below is a list or ‘cheat sheet’ of sorts for you if you are looking to manage the three health markers discussed:
As you can see, the solution is no quick fix, magic pill bio-hack, it's simply an equation of good old fashioned hard work and minor long-term lifestyle changes.
Disclaimer: The information provided in this article is intended for informational and educational purposes only, and should not be used as a substitute for advice from a qualified healthcare professional. It is not intended to diagnose, treat, cure, or prevent any health problem. Always consult with your healthcare provider before making any changes to your diet, exercise, medication regimen, or any other health-related behaviors. Your personal health situation should always be overseen by a healthcare provider who can provide you with tailored health advice.