#82

Thanks @RapAdmin .

Has anyone tried the probiotic blend he says he takes and that is formulated to modulate glucose control?

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#83

For that price I can buy canagliflozin, acarbose and metformin. The price seems high to me, but for some it might be worth it.

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#84

Could be that it is enough to take it for a while to change oneā€™s microbiome vs the drugs that have to be taken continuously

#85

yes - and more generally Iā€™d prefer to take a probiotic if it achieves the same thing, as it would seem to offer much lower risk of side effects.

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#86

Iā€™m surprised that Attia needs help with his blood sugar control. Now that he doesnā€™t do fasting, perhaps his blood sugar is not where he wants it.

#87

I think he said that he is testing it. And he is all about optimal markers and poorer glucose control seems is inevitable connected with agingā€¦ I myself also think that this is the most important part of metabolic health and I am not happy my HbA1c went from 4.8 to 4.9 on rapamycin for sure. And I am using acarbose. :sweat_smile:

ps. I find this probiotic just ridiculously pricedā€¦ WTF is this?

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#88

My HbA1c goes all over the place on a weekly basis. I really do not think a movement from 4.8-4.9 or vice versa can be seen as being significant. It would have to move perhaps 0.5 to be a reliable movement.

HbA1c changes with metabolism and there are different versions of the test and I think probably daily movements as well.

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#89

@scta123 Itā€™s hard to see if blood sugar will improve if blood sugar is already low (too low is unpleasant). As a counter point, I have higher blood sugar. I am currently testing a number of interventions to get it lower: metformin / berberine (I rotate them), ALA, SGLT2. Blood test soon to see results.
Last test: fasted glucose 87. HbA1c 5.7.

I will not be paying $150/month for probiotics.

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#90

I believe this probiotic should be flattening the spikes after meal. This could be detected via CGM I guessā€¦

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#91

Hereā€™s an example. On 11/10/23 using Randox my HbA1c was 24.9 mmol/l which I estimate to be around 4.4%, on 16/10/23 using Medichecks it was 30 mmol/l which I estimate to be 4.9%. I am not sure there was a material change in the underlying biomarker. I hazard a guess that the time metabolising with Medichecks is longer than Randox. Creatinine with Randox was 82.3 and 98 with Medichecks which underpins the metabolism hypothesis - because Creatinine also metabolises (goes up in untested blood already drawn). Cystatin-C with Randox was 0.73 which gives an eGFR of 95.

AFAIK the metabolism error with Cystatin-C is less than with Creatinine also having more muscles is less of an issue with Creatinine. However, I know a nephrologist whose view was that Cystatin-C was too variable.

Oddly enough, however, MCV which was 94.9 with Randox was 94.7 with with Medichecks. When I stick to my only one drinking day a week routine (which I donā€™t do when there are parties to go to) I think MCV comes down, however. MCV also metabolises.

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#92

@scta123 thanks. Iā€™m still wondering about ā€œflatteningā€ the glucose curve. I donā€™t think a flat glucose level is a reasonable goal. Less AUC is measured by HbA1c. But there is some predictive information contained in the shape of glucose curves for sure. But does a short spike matter for health now? I donā€™t know. Not $150 per month worth, anyway.

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#93

Best to keep glucose below 8mmol/L. It shifts into a worse pathway when it goes over that I think the US value is 140 (rather than 144).

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#94

I understand the polyol pathway can lead to depletion of NAD+ and formation of AGEs for people with chronically high blood sugar but not metabolically healthy people. Perhaps that is the reason and the people who should be wary.

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#95

I am not myself certain that this is the full story. I donā€™t have the references to hand, but my understanding is that it is best not to go above 8. Even if you would otherwise be considered to be metabolically health. I think it is because you start metabolising fructose and that moves the metabolism into a hibernation mode.

However, I donā€™t have the references on this.

I think I have managed to sort that, however, as can be seen from the charts here:

https://twitter.com/johnhemming4mp/status/1650480078424244230

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#96

Looks good, John. My own use of a CGM showed very good glucose control after meals. I got spikes before and during exercise (I guess I get excited). And actually low during sleep. This information is hard to reconcile with my higher HbA1c (5.6-5.8 range consistently). Iā€™m not sure what to make of it. I just keep working on getting the HbA1c lower. Perhaps my red blood cells live longer than normal. My next blood test will tell me if I can get my HbA1c down to <5 (my goal) without extraordinary measures.

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#97

Do you know what your insulin levels are? Sometimes glucose control comes at the cost of high insulin which I think we want to avoid from a longevity perspective also.

Might be worth considering doing an organ glucose tolerance test (OGTT) - where youā€™d get a plot over time for both glucose AND insulin after a glucose challenge

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#98

Itā€™s a good question. I have assumed I have high insulin but have no data. My next blood test will include fasting insulin. A glucose tolerance test is the right test but I am already acting on the assumption that I have high insulinā€¦on my way to t2d if I donā€™t solve it.

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#99

Looked at it a bit more - part of why it may be costly is that they seem to have taken a rigorous path including a placebo controlled trial.

The data seems quite powerful

Glucose Control clinical efficacy

We conducted a double-blind, placebo-controlled nutrition study that demonstrated:

A1C REDUCTION 1

-0.6%

POST PRANDIAL GLUCOSE SPIKE REDUCTION 2

-32.5%

ā€¢ Glucose Controlā€™s safety

ā€¢ Glucose Control has a significant statistical and clinical impact on A1C and post-meal blood-glucose spikes

Clinical trial included participants taking metformin, compared to placebo. 1. Regarding the decreased A1C level, there was a reduction in mean A1C compared to placebo. 2. Regarding the Post Prandial Glucose Spike Reduction, the observed reduction in glucose AUC would be expected to increase the time spent within the healthy glucose range (TIR70-180) during continuous glucose monitoring. Increases in TIR70-180 strongly correlate to both reductions in A1C and reduction in risk for complications in T2D patients (see details here).

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Akkermansia mucciniphila improves healthspan and lifespan in old female mice
#100

Those who know about microbiome things.

Seems that the effects are achieved in <3 months. Given that, how likely is that doing this for 3 months and then stopping will have remodeled oneā€™s gut biome / added these flora in a sustainable/somewhat permanent way? Where perhaps no further supplementation is needed or perhaps limiting supplementation to say just 2 times a week would be enough to sustain it?

Or would maintaining perhaps be better achieved by coming back and do say one week every month, with three weeks with no supplementation?

#101

With vinegar indictions are you get a 20 - 30 % reduction in glucose spike. IsnĀ“t this a better deal, if you factor in cost, than the 32.5 % reduction from that probiotic? Unless there is that possible effect you refer to on remodeling oneĀ“s gut biome from the probiotic.

Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight | Nutrition Reviews | Oxford Academic (oup.com)

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