Published on March 23, 2023
Rice, pasta, bread, and potatoes, all of these are affordable, convenient comfort foods that form the backbone of most people’s diets.
But there is concern that eating these high-carb foods may cause blood sugar levels to spike. And sending your blood sugar levels on a roller coaster ride all day is almost certainly not ideal for long-term health.
In this blog post, I will discuss 6 strategies you can use to avoid spikes in blood sugar without reducing your carbohydrate intake.
What is a Blood Sugar Spike?
In a previous blog post, I suggested that an increase in blood sugar levels to 180 mg/dL or higher should be considered a blood sugar spike. (By the way, 180 mg/dL is equal to 10 mmol/L).
This is based on the observation that healthy, young, and lean men and women usually have blood sugar levels in the 70-140 mg/dL range most of the time, suggesting that a healthy body strongly defends against higher blood sugar levels. This is consistent with evidence that elevated blood sugar levels and frequent blood sugar spikes are associated with negative health consequences
Now, given that perfect glucose tolerance seems to protect young, healthy and lean people against any major increase in blood glucose levels, these individuals are also not likely to ever experience a blood sugar spike to 180 mg/dL or more, no matter what they eat.
However, most of the people on this planet are not young, healthy, and lean. If you have diabetes or prediabetes, you are likely to experience blood sugar spikes frequently. And newer data suggest that even if you are among those who don’t have diabetes or prediabetes, your blood sugar may spike in response to some foods, particularly if you are older or overweight. And if you don’t know about this and eat these foods regularly, this would almost certainly not be ideal for your health.
I don’t want to scare you though. The good news is that blood sugar spikes are preventable in most cases, and you don’t necessarily have to limit your carbohydrate intake for that. My intent with this blog post is to give you the knowledge and the tools that will enable you to keep your average blood sugar levels as low as possible while also avoiding spikes.
So let’s get started with a look at my blood sugar levels. At 51, I am certainly in the ‘older’ age category, and I know that I have a high genetic risk for both obesity and type 2 diabetes. However, my HbA1c is 4.8%, which is equivalent to an average blood sugar of 91 mg/dL. And that is reflected in data from the continuous glucose monitor I have been wearing for the last 2-3 months. Unless I am experimenting wildly, my blood sugar is between 80 and 140 mg/dL all of the time, and actually below 120 mg/dL most of the time.
How do I do this? Do I follow a low-carb diet?
No, I usually eat plenty of bread, rice, potatoes, fruit, and starchy vegetables, but there are a few key things I pay attention to so that all of these high-glycemic index foods don’t send my blood sugar on a wild roller coaster ride.
Let’s take a look at the six evidence-based strategies that help me prevent excessive blood sugar spikes.
1. Minimize Foods With a High Glycemic Index
As we discussed in a prior blog post, the glycemic index is a measure of the blood sugar response to 50g of available carbohydrates. What the glycemic index tells us is that the blood sugar response to eating foods with a high glycemic index, such as white rice, cornflakes, white flour bread, potatoes, soda, or beer is similar to eating pure sugar.
If most of your meals throughout the day consist of high glycemic index foods, for example, cornflakes with milk for breakfast, a sandwich made from white wheat bread for lunch, and white rice or boiled potatoes for dinner, your blood sugar curve throughout the day could very well look like a roller coaster.
So staying away from such foods with a high glycemic index of more than about 60 will be a good first step to minimizing blood sugar responses after a meal. To revise our example from above, if you replaced the cornflakes with a porridge made from steel-cut oats, used sourdough rye bread instead of white wheat bread to make your sandwich for lunch, and a boiled sweet potato for dinner rather than white rice or white potatoes, you could easily lower your blood sugar levels throughout the day by 20-30% without reducing your total carbohydrate intake at all.
I am not super religious about this, though, as I do eat bread, rice, and potatoes pretty regularly. However, I do think that whenever we eat such high-glycemic index foods, that’s when it’s particularly important to use one of the other strategies discussed later in this post to prevent blood sugar levels from rising too much.
By the way, If you’d like a poster with the glycemic index and glycemic load values of a few common foods, please click here.
2. Eat Starchy Foods After Retrogradation
Retrogradation, that’s a very big word.
What it means is this: starchy foods such as potatoes or rice, when you cook them and eat them right away, almost all of the starch is easily broken down to glucose by our digestive enzymes, and all of the glucose enters our bloodstream quickly. That is why these foods make blood sugar rise so much.
However, if you cook rice or potatoes or any other starchy food, and then cool them overnight, ideally in a fridge, some of the starch will adopt a different structure. It will become what we call resistant starch. And we call it resistant starch because this starch is now resistant to digestion. Our digestive enzymes cannot break it down, and the glucose is kind of trapped within the starch and cannot be taken up into our bloodstream.
In other words, some of the highly digestible starch becomes a fiber that stays inside the gastrointestinal tract and will serve as food for the gut bacteria. That may have some additional benefits, but the main thing we are looking at here is that starchy foods that have undergone this process of retrogradation and therefore have some resistant starch raise blood sugar levels much less than starch that has not undergone retrogradation. The glycemic response to starchy foods that have been cooled can be 20 to 40% lower than that of the same food eaten right after cooking.
With a little bit of planning, this is a strategy you can easily take advantage of: for example, when I cook potatoes, I almost always cook a few extra, keep them in the fridge overnight, and then make potato salad or hash browns the next day. Same with rice, which can be nicely used for a stir fry the next day. Give it a try.
3. Don’t Eat ‘Naked’ Carbs
We call carbs ‘naked’ if they are eaten without much protein, fat, or fiber. For example, cornflakes with milk, instant oatmeal, white bread with jam, or risotto. Sure, some of these may contain a small amount of protein, fat, or fiber, but in all cases, the meal consists almost entirely of easily digestible starch or sugar.
There is a rich scientific literature showing clearly that if you add protein to a meal rich in carbs, the blood sugar response is strongly reduced. To a lesser degree, adding some fat or fiber from foods such as vegetables may also help. So what the scientific data suggest is this:
If you eat a meal with a high-carb food such as rice, bread, pasta, cornflakes, oatmeal, etc., think about whether you can add a source of protein to the meal. The higher the glycemic index of the food is, the more important it is to add some protein. Meat, fish or shellfish, eggs, greek yogurt, beans, lentils, or tofu would all be good options. Some of these also contain fat. Other sources of fat you could consider adding are nuts and seeds, avocado or olives, or a bit of olive oil.
It would also be a good idea to always pair high-glycemic index foods with a solid serving of non-starchy vegetables, such as onions, leeks, fennel, celery, leafy greens such as spinach or chard, and cruciferous vegetables including broccoli, cabbage, cauliflower, and brussels sprouts.
Your blood sugar response will be lower if you eat the protein, fat, and fiber-rich vegetables with the high-carb food, in one meal. You may have heard the suggestion that protein, fats and a source of fiber should be eaten first, and the high-carb food last. It’s true that this may lower the blood sugar response even more than eating all the foods together, in one meal. Personally, I find this impractical most of the time, though, and the additional benefit is probably not huge. Few studies have directly compared eating protein, fat, or vegetables before or with the high-carb food (usually, the comparison is before vs. after the high-carb food, and in that case, before leads to a lower blood sugar response), and the few that have suggest that it doesn’t make enough of a difference to justify the additional effort.
Let’s take the example high-glycemic index breakfast of white bread with jam. Now, my first suggestion would be to eat something different for breakfast entirely, because aside from its high glycemic index, this is not really nutritious food. But, let’s ignore that for now. Let’s assume you want a lovely Sunday morning breakfast with coffee, the paper, and a nice toast with jam. What you could easily do is add a couple of boiled or scrambled eggs to this meal. Or replace the white bread with, say, whole grain sourdough rye bread with peanut butter or cheese, maybe also with an egg or two. Still a nice Sunday breakfast, and you probably cut your blood sugar response in half.
Let me show you an example from my own diet. The left figure below shows my blood sugar response to a dinner of bread, ham, and cheese. This is one of the biggest increases in blood sugar I have experienced in 3 months of wearing a continuous glucose monitor. My blood sugar increased to about 170 mg/dL, started coming down, and then I ate some potato chips and that explains this little additional bump here. Note how this meal isn’t even totally ‘naked’ carbs. The ham and cheese do provide some protein and fat, but because the meal is still mostly carbs from the bread, the blood sugar increase was pretty substantial. Just imagine what this would look like if this was white wheat bread with jam!
The figure on the right shows my blood sugar response to eating the same bread, again with ham and cheese, and the same amount (4 slices of bread), but this time I also had two boiled eggs. Barely any increase in my blood sugar here. It’s not a perfect comparison, as one time was in the evening, the other in the morning, but in my opinion, the factor that explains most of this very different response in my blood sugar was that one meal had a lot more protein and also some additional fat from the eggs, and the other meal didn’t.
Another example is shown in the figure above, showing my blood sugar responses to a traditional German dish of mashed potatoes, sauerkraut, and a kind of smoked pork. Mashed potatoes have a pretty high glycemic index, but in this complex meal with a good amount of protein, some fat, and a large serving of a non-starchy vegetable, my blood sugar response was pretty minimal, topping out at around 120 mg/dL.
So, your key take-home message: don’t eat ‘naked’ carbs. Particularly if a typical serving of the food has a glycemic load of 10 or more, see if you can serve it with some protein, fat, and a large serving of non-starchy vegetables.
4. Add Some Vinegar
There is a lot of research showing that having vinegar with or before a high-carb meal will pretty substantially lower the blood sugar response to that meal. In most of these studies, because it’s a research setting where we want to standardize what we are testing, the participants had about two tablespoons of vinegar diluted in water a few minutes before eating a high-carb meal. Now, do I recommend that?
No, I don’t. Vinegar, even diluted, is a strong acid. I personally don’t like it, and just wouldn’t do this regularly. But even if you like it, drinking an acid like that could have negative effects on your dental health or your mucus membranes in the mouth, the esophagus, or the stomach. That’s because using vinegar this way will only have a meaningful impact on your blood sugar levels and your health if you do it regularly, over an extended period of time. And in that case, the negative effects of direct repeated exposure to a strong acid like that may not be ideal.
My suggestion is you do what many cultures do: have a small salad with a vinaigrette before eating a high-carb meal, or with the meal. Or have some pickles with your sandwich. Make it pleasant, and that way you’ll be able to make it into a regular habit. Plus, you’ll almost certainly reap some additional benefits from the salad or the pickled vegetables you’ll eat with the vinegar.
Most research studies used apple cider vinegar, so you could use that, but really any vinegar will do. And it probably doesn’t matter too much whether you have the vinegar before the high-carb meal or with it.
Let me show you an example from my own diet. The figure below shows my blood sugar response to a lunch of leftover mashed potatoes with caramelized onions and sauerkraut. We didn’t have any of the pork left that we had served with this dish the night before, so I had a small salad with vinaigrette before eating the mashed potatoes and the sauerkraut. The blood sugar response was again pretty minimal.
There are at least three things going on here that could explain why my blood sugar didn’t rise more than 20 mg/dL: for one, the salad with the vinegar could have helped, but also the large serving of sauerkraut that was part of the meal, and the mashed potatoes had been in the fridge overnight, and some of the starch had converted to resistant starch. Remember, strategy number 2, retrogradation?
5. Use the Second Meal Effect to Your Advantage
The second meal effect is when whatever we eat for breakfast affects our blood sugar response to our lunch. Or when whatever we eat for lunch affects our blood sugar response to our dinner.
The most important research finding worth knowing about is that the carbs you eat at one meal actually lower your blood sugar response at the next meal, particularly if the carbs are from a high-fiber low-glycemic index food. Let me give you an example:
Assume someone eats a specific high-carb dinner containing rice and vegetables two days in a row. On the first day, he eats a high-carb lunch. Let’s say some salmon and potatoes. On the second day, he eats a low-carb lunch, let’s say a steak with butter and a salad with olive oil. Then the second meal effect would predict that his blood sugar response to the identical dinner would be higher on the day he had the low-carb steak lunch.
One way to think about this is that if you eat carbs, your body gets ready to handle more carbs. Or vice versa, if you don’t eat carbs, even just for one meal, your body tends to have a slightly diminished ability to handle carbs.
What this suggests is that if you go low-carb, you should eat all of your meals low-carb and not switch back and forth between low-carb and high-carb meals all of the time.
There is another aspect to the second meal effect: if one meal is rich in protein or fiber, then this also lowers the blood sugar response at the next meal somewhat. So if you eat a high-protein high-fiber breakfast, then this will help keep your blood sugar response low at that breakfast and also at the following lunch.
Taken together, the second meal effect is another reason why we may want to incorporate a serving of protein, and also some source of fiber such as vegetables or legumes (beans, lentils) into every meal. And try not to eat large portions of high-glycemic index foods such as white rice, potatoes, or baked goods if the previous meal was low in carbs.
6. Go on a Walk After the Meal
In my blog post on the regulation of blood sugar, I talked about the role of the hormone insulin in clearing glucose from the blood after a meal. Remember, when blood sugar levels rise after a meal, it triggers an increase in the hormone insulin. Insulin does many things, but in muscle, it binds to the insulin receptor, which then leads to a change inside the cell that causes glucose transporters called GLUT-4 to be transported to the cell membrane. Glucose can then enter the muscle cells from the blood through GLUT-4, and blood sugar levels drop.
This may not work perfectly in someone who is insulin resistant though. So here is the good news: muscle cells can also take up glucose from the blood in a way that is independent of insulin.
Imagine if muscle cells could take up sugar from the blood only after a meal, and only with the help of insulin. Our species would have long died out because we probably wouldn’t have had the time to first unwrap a sandwich and take a bite when that saber-toothed tiger attacked …
So, in short, muscle cells that are being exercised take up glucose from the blood in a way that doesn’t require any insulin. And so it’s not surprising that there are a lot of scientific data showing that any muscle contraction after a meal will pretty substantially lower the increase in blood sugar levels.
What the data suggest is that exercise should be initiated within about 30 minutes after completing a meal. I guess most people would not want to exercise vigorously after a meal, but even if you just walk around the block for 10 or 15 minutes, that’s better than nothing. For larger meals rich in high-glycemic index foods, I’d say the longer the better.
To show you the impact of walking on blood sugar levels using my own data, I took one for the team. This past Christmas, my mother-in-law baked a special gluten-free cake for me, because I have celiac disease. Because a whole cake is not enough in the eyes of mothers and mothers–in–law, she also got several packages of gluten-free Christmas cookies, just for me.
Well, I thought this would be a good opportunity for an experiment for this blog post. In Germany, we do all the gift-giving on Christmas eve, so I knew I’d be sitting around for hours while we were unwrapping gifts. So right before the gift-giving started when coffee, cake, and cookies were served, I had four slices of cake and about 20 cookies. I basically munched cake and cookies for about an hour.
The figure below, left side, shows what happened to my blood sugar levels. Predictably, a perfect example of a blood sugar spike, all the way up to 190 mg/dL. Now, I have very good glucose tolerance. Let me assure you that in someone with prediabetes, levels could easily go to 250 mg/dL with this type of ‘meal’, and in someone with diabetes, possibly to 300 or 400 mg/dL. It’s actually a little bit insane to eat this much refined flour and sugar in a single sitting, so let me reiterate that I do not recommend eating this way regularly.
But, for you, I did it again the next day. Except now, I had a hardboiled egg a few minutes before I started the cake and cookies feast, and then went on a 60-minute walk right afterward. Have a guess at what my blood sugar levels looked like.
As the figure on the right shows, there is still an increase to about 140 mg/dL, but that increase is 50 mg/dL less pronounced than the day before. 50 mg/dL less!! From having a pretty substantial blood sugar spike, my sugar remained in the normal homeostatic range between 70 and 140 mg/dL even with this huge amount of cake and cookies.
Ok, so this was not just a walk, but also some added protein, so let me show you what just a walk does.
The figure on the left side below shows my blood sugar response after I ate some bread and some potato chips. I know for sure that I wasn’t moving the entire time, because I was driving our car for about 4 hours as we were returning from a trip. As a result, my blood sugar went all the way to 170 mg/dL. So obviously, the mistake I made there was that I should not have eaten something with such a high glycemic index when I knew I couldn’t move for four hours afterward. Or at least I should have used one of the other strategies discussed in this blog post.
But at least, I wanted to use these data, and re-create this ‘meal’ a little bit later. Again, I had the same bread and the same potato chips, but then went on a walk right afterward. As you can see in the figure above on the right, the meal started at 1:50 PM.
When do you think did I stop walking? Yes, exactly at 2:45 PM I arrived back home and sat down in the office again. And with such a large meal, there was apparently still a lot of glucose coming into the blood, and my blood sugar still increased to about 150 mg/dL. Certainly better than before, but in this case, it would probably have been better to walk for another half hour or so, or use one of the other strategies from this blog post because the meal contained a lot of high-glycemic index carbohydrates.
However, I do think the initially flat blood sugar response is pretty nice evidence of how powerful a walk can be in helping your body keep your blood sugar levels in the normal range.
In summary, even without reducing our overall consumption of carbohydrates, we can avoid blood sugar spikes by using one or several of these six strategies:
Strategy number 1: Minimize foods with a high glycemic index. If you have a food with a glycemic index of 60 or more, use one of the other strategies to lower its impact on your blood sugar levels.
Strategy number 2: Eat starchy foods after they have undergone retrogradation, that is cooling in the fridge.
Strategy number 3: Don’t eat ‘naked’ carbs. Have some protein and ideally some fat and non-starchy vegetables with a high-carb meal, or as an appetizer or first course prior to the high-carb meal.
Strategy number 4. Add some vinegar to high-carb meals, for example in the form of a small salad with vinaigrette prior to the main course, or with the meal.
Strategy number 5: Use the second meal effect to your advantage. So if you’re planning a big high-carb dinner, make sure to have some carbs and maybe also some protein and fiber with lunch. And mostly make sure to not constantly switch back and forth between low-carb and high-carb meals.
And strategy number 6. Go on a walk after the meal.
To make it easier to remember and use these strategies, I have summarized them on a poster that you can download for free here.
How I Use this information
I like to eat, and I want to have a positive, uncomplicated attitude when it comes to my meals, so I don’t constantly plan out exactly how I can keep my blood sugar low. And I don’t think that would be necessary.
I just try to be aware of the high-glycemic index foods that raise blood sugar the most, and whenever I have a meal with these, I use one or several of the strategies discussed here, whichever is most convenient. For example, my family sometimes likes to have a Sunday morning breakfast together with toasted bread and different cheese and spreads. I just make sure to have some boiled eggs with that; it fits well with this kind of meal, and everyone likes it. Or if we ever have a dish with rice or potatoes that doesn’t include any protein, such as a rice-vegetable stir fry, I use rice that was cooked the day before, pair the rice with a lot of vegetables, prepare a little appetizer salad with vinaigrette, or go for a walk after the meal.
I invite you to experiment with these strategies. Which of these could easily fit into the way you and your family eats, so that you can adopt a new long-term habit or two? If you don’t like vinegar or salad, well, just ignore that tip, but maybe you would enjoy a walk after a large dinner. Or if you really feel like sitting down to read after dinner, OK, then just make sure to have some protein with your lunch and dinner.
The Root Cause of Blood Sugar Spikes: Glucose Intolerance
Now, let’s wrap up this blog post with a brief discussion of the root cause of blood sugar spikes: glucose intolerance.
First, if the term glucose tolerance is foreign to you, please check out my blog post about the regulation of blood sugar.
Now, all of the strategies we discussed in this post are based on scientific evidence, and they all work to lower the blood sugar response to eating carbohydrates.
But these strategies alone may not be sufficient to bring your blood sugar levels into the normal range. If you experience frequent blood sugar spikes, it is likely that you are glucose intolerant to some degree. To totally normalize your blood sugar levels, you may need to also improve your glucose tolerance.
For example, if you currently have diabetes, with an HbA1c of 7.5%, that means your average blood sugar level is about 170 mg/dL. Your fasting blood sugar may be 130 mg/dL, and if you don’t use any of the strategies we discussed in this blog post, meaning you eat “naked” high-glycemic index carbs with every meal, you don’t go on walks, you never eat any salad or vegetables, etc., your blood sugar will likely shoot up to over 200 mg/dL after every meal.
Let’s assume that after you read this blog post, you start to eat more low-glycemic index foods, and you eat them with some protein and a large plate of non-starchy vegetables, you always have a small salad with vinaigrette before big meals, or go on a walk after a meal. With these changes, you can almost certainly avoid these spikes and your HbA1c may come down to, say, 7%. That’s better than before, much better, but your blood sugar levels are still too high, and you still have diabetes. To lower your blood sugar levels more, ideally into the non-diabetic range, you would need to improve your glucose tolerance, that is, your body’s intrinsic ability to keep blood sugar in the normal range.
Discussing what causes glucose intolerance and how to reverse it is beyond the scope of this post. I just wanted to be very clear that we can tackle elevated blood sugar levels in a variety of ways, and it’s my goal to introduce you to all of these. Rest assured that this blog post here is just the beginning, just providing the first set of tools for your toolbelt, so to speak. I have a lot more content planned about the causes of glucose intolerance, and interventions that improve glucose intolerance as well as the different dietary approaches to prevent or treat diabetes. So please make sure to subscribe to my newsletter below if this is of interest to you, so that I can let you know whenever I publish new content.
Elevated blood sugars are a major contributor to many chronic diseases, and in many cases totally preventable or treatable by dietary and lifestyle change, and it’s one of my primary goals with this website to help people get high-quality evidence-based information so that they can take action themselves to – ideally – keep their blood sugar levels in the normal range. If you know of anyone who may be interested in this topic, please share this content with them. I’d be very grateful if you helped me spread the word.
Finally, let me remind you that the information in this blog post was a summary of the scientific evidence on this topic, and does not constitute medical or dietary advice. As always, I recommend strongly that you consult with a qualified healthcare professional such as a physician or dietitian before making any major changes to your diet. For our full disclaimer, please refer to this page.
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