How Flattening my Glucose Curve reduced my Long Covid Symptoms by >70%
The summer of 2022 was one of the lowest points for me over the past three years. I couldn’t walk much more than 10 minutes at a time without fearing a relapse. I had to take the bus or an electric scooter to get to the grocery store, which was only a 13-minute walk from my apartment. I had near-consistent sleep apnea, which would flare with the slightest provocation, such as a 15-minute walk or 20 minutes in the sun. The apnea left me constantly fatigued and barely able to do my work.
During this time I was consuming a lot of coconut water and fruit. Low in akkermansia, I knew that watermelon would increase it, and I was drinking coconut water for the potassium (a cofactor for the thiamine supplementation and cyanocobalamin shots which seemed to keep my neuropathy at bay). I will note that I was not consuming any of the foods that are commonly understood to be unhealthy, such as refined grains, refined sugars, or processed foods. As I was on a fairly strict diet which consisted entirely of whole, unprocessed foods, I thought I was eating the healthiest I possibly could. None of the doctors or nutritionists I met with during this time suggested I was doing anything wrong. Little did I know how much harm I was doing to myself.
In September, I began reducing my fruit intake to one serving of berries per day and eliminated the watermelon and coconut water. Almost immediately, my symptoms began to improve. It wasn’t until several months later that I began to understand why.
Glycemic Variability’s Effect on our Health
While I couldn’t pinpoint why I had so much underlying oxidative stress that summer, I could tell that it was part of what I was experiencing. What was causing all of the oxidative stress?
I later learned that all of the fruit that I was consuming was resulting in a great deal of glycemic variability. Each time I consumed a serving of fruit, it was resulting in glucose spike. This resulted in glycation, or the interaction of glucose with proteins. Glycation within the body results in a number of end products referred to as advanced glycation end products, or AGEs. “Increased rates of formation of AGEs in tissue proteins during hyperglycemia and oxidative stress or inflammation are implicated in the pathophysiology of aging, and diabetes and other chronic diseases” (link).
Most conventional practitioners will give the guidance that glycemic variability isn’t a problem as long as blood tests don’t show signs of pre-diabetes. The tests commonly used to measure metabolic health, such as fasting glucose and A1C, don’t provide insight into glycemic variability.
In reality, it is not only fasting glucose or mean glucose that are important: the frequency and amplitude of the oscillations of blood glucose have been found to have an undeniable impact on our health as well. A study by Stanford University in 2018 (link) found that even “normal” individuals had more extreme glucose swings than previously understood. These swings can impact our health in the following ways:
Endothelial function and oxidative stress: A 2008 study showed that oscillating glucose has a “deleterious” effect on endothelial function and oxidative stress, two key areas of focus and concern to long covid patients (link).
Immune function: Glucose spikes have also been shown to inhibit the innate immune system (link). A 2021 study specifically focused on Covid-19 found that elevated glucose was linked to “each major step of the life-cycle of the virus, progression of the disease, and presentation of symptoms. Specifically, elevations of glucose provide ideal conditions for the virus to evade and weaken the first level of the immune defense system in the lungs, gain access to deep alveolar cells, bind to the ACE2 receptor and enter the pulmonary cells, accelerate replication of the virus within cells increasing cell death and inducing an pulmonary inflammatory response, which overwhelms an already weakened innate immune system to trigger an avalanche of systemic infections, inflammation and cell damage, a cytokine storm and thrombotic events.“ (link). Hyperglycemia was found to be a predictor of mortality in Covid-19 patients, regardless of diabetes status (link).
Chart: Visualization of glucose variability. Solid line: a given excursion. Dashed line: higher glucose variability due to a higher frequency of oscillation. Dotted line: higher glucose variability due to a larger amplitude. Note that the mean and area under the curve are identical in the three situations.
Initial Improvements
Upon unknowingly reducing my glucose variability that September, I experienced the following improvements:
Better sleep. My apnea became less frequent, and my fatigue (which I had tracked on a scale of 1-5) reduced by 20%. Given how much the apnea had been impacting my ability to function, this improvement alone was significant.
Ability to walk longer distances and a reduced need to rest. Despite the fact that summer would be the time when I would be naturally out doing things more, my average daily step count nearly doubled between July and November, without placing any specific focus or emphasis on it.
I didn’t necessarily understand the reasons for these improvements. I also still had plenty of fatigue.
Although I had reduced my fruit intake overall, I was still starting my day with a bowl of blueberries.
The next stage of improvement: Continuous Glucose Monitoring
In January of 2023, after learning about how continuous glucose monitors can be helpful for fasting, I purchased a subscription to continuous glucose monitoring from Levels. What I found was quite surprising.
The way I was eating, which I had previously thought to be healthy, was resulting in multiple glucose spikes per day. Starting my day with blueberries and plain yogurt? A 55 mg/dL spike. Snack of one quarter of an apple with raw carrot and avocado? 40 mg/dL spike.
What’s more, because my glucose was consistently spiking, my insulin swings were pushing me into a state of reactive hypoglycemia on almost a regular basis.
Image: A post-breakfast spike
Post-breakfast spike of 55 mg/dL on the first day of wearing my CGM. Source: Levels
Image: A post-snack spike
Post-snack spike of 40 mg/dL. Source: Levels
Levels provided some guidance on what healthy glucose levels were (tl;dr: no spikes), but at the time, I couldn’t find much additional conversation on the web. Most searches for “CGM” led to information for individuals with diabetes. Regardless, I immediately began to learn what food ordering would lead to greater stability and began to implement these changes.
These changes led to another step-change in improvement. In March of 2023, I was able to attend a conference in San Francisco and manage full days of meetings, presentations, team happy hours, and meetups with friends interspersed with >12,000 steps per day to get to and from activities. I was able to do so without any significant mid-day rest periods, which would have been unimaginable less than a year prior.
The Final Stage: Glucose Revolution
In May of 2023, I randomly stumbled upon Jessie Inchauspé. I purchased her book, which offers clear, science-driven explanations as to why my high glycemic variability was resulting in such extreme levels of fatigue and oxidative stress.
As always, my sample size is n=1 and there may be more variables at play, but it is my belief that flattening my glucose curve played a huge part in my improvements over the past several months. I’m still not 100% perfect at avoiding spikes and am looking forward to seeing what additional benefits I might gain by flattening it further.
