Dietitian-Approved Lower-Carb Breakfasts (Yes, they exist, and No, it’s not just eggs!)

Breakfast is the golden meal for many Americans, but one of the biggest complaints I hear is that our iconic breakfast foods are packed with carbohydrates. It’s a valid point: pancakes, waffles, cinnamon buns, croissants, coffee extra light and extra sweet, sugary cereals, grab-and-go granola bars… Your morning meal can easily turn into a landslide of sugar.

But let’s take a step back – don’t get frustrated and skip breakfast!  The word breakfast comes from breaking fast — it is a chance for your body to get some actual external energy to help fuel your day. Without it, your body will rely on your energy stores from the night before and, if those run too low, you may be sluggish and sleepy.

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Kodiak pancakes (they’re made with extra protein and whole grains) plus fresh berries and a drizzle of syrup (about 1 tsp) – my go-to weekend breakfast

Research stands behind breakfast as an important part of your routine (check out the links throughout this article for the original studies). Consistent breakfast intake has been linked to maintaining weight loss and higher levels of a hormone called Peptide YY which helps decrease appetite and intake.

Skipping breakfast, however, may lead to higher blood sugar spikes at your next meal, insulin resistance, and larger intake later in the day- which major implications for anyone with diabetes!

The actual foods that you eat for breakfast also play a big role in how hungry you are later as well as how high your blood sugar will go:

Higher protein / lower carbohydrate breakfasts have also linked to lower blood sugar after breakfast). Choosing lower Glycemic Index (GI) foods — foods that impact your blood sugar less drastically — can help you predict your blood sugar response even more than the just carbohydrates counting alone (study here), which supports the choice of whole grains and high-fiber foods rather than refined sugars.  A clinical trial also supported Low Glycemic Index / High Fiber breakfast combinations as they led to lower blood sugar spikes and less required insulin than High Glycemic Index / Low Fiber breakfasts (think high in refined grains and sugar). For more info on glycemic index, check out my break down.

Okay- so what can I eat?!

I generally recommend around 30 grams of carbohydrates with breakfast, which should provide you with some wonderful energy without spiking your blood sugar too much.

Try any of these combinations to get a moderate amount of carbohydrates, adequate protein, and healthy fats:

  • 1 slice whole grain toast + 1 tablespoon almond / peanut / sunflower seed butter + 1/2 cup fresh berries
  • 1 cup cooked plain oatmeal + 1 tsp maple syrup + 1 tsp cinnamon + 2 Tablespoons of walnuts or almonds
  • 1 whole wheat pancake + 1 tsp light butter + 1 tsp maple syrup + 2 links turkey bacon or sausage (~1 oz)
  • 1 piece whole wheat toast + scrambled egg mix (Mix 1 egg + 3 egg whites together, or 1/4 cup liquid whites alone) scrambled with 1/2 cup chopped veggies.
  • 1 whole wheat mini bagel + 2 tablespoons whipped cream cheese + 1 piece of fruit
  • 1 6-oz flavored Greek yogurt + 1 tsp of flax seeds + 1 Tablespoon sliced almonds
  • 3/4 cup bran flakes + 1 cup skim milk + 2 tablespoons of diced prunes or raisins
  • 3/4 cup cooked grits + 1/2 oz low fat cheese mixed in + 1 egg
  • 6 ounces plain yogurt + 1 tsp honey + 1/2 cup berries + 4 oz almond milk – blend for smoothie
  • 1 slice whole wheat toast + 1/2 sliced avocado (trendy but also healthy!)
  • 1/2 cup part skim ricotta + 1 tsp honey drizzled + 1/4 cup berries + 1 Tablespoon sliced almonds
  • 1 small apple + 1.5 Tablespoon almond butter 

If you have diabetes, you may want to substitute sugar-free syrup to minimize blood sugar spikes. For others, though, small portions of these items can still fit into a well rounded diet.

Bonus Round: Frozen Breakfasts

Are you used to grabbing something from your freezer before you hit the road each morning? Sometimes convenience is king, so I’d rather see you stock your freezer with healthy breakfast options than grab something high fat and high calorie from a fast food joint on the go. These are some of my top healthy options from the freezer aisle:

My main caution with frozen items is that they tend to have a ton of added sodium, so you may want to avoid these options if you are prone to hypertension. It’s also wise to eat lower sodium foods during the rest of the day if you rely on these quick and convenient breakfasts.  When looking at other options, I recommend avoiding anything with a croissant, biscuit, or texas toast (they tend to be both high fat and high carb). Anything made with whole grains, egg whites, and veggies is usually a decent option. If you’re choosing something with a breakfast meat, turkey bacon and sausage are leaner but higher in salt; bacon and regular sausage are higher in saturated fat.

Whichever breakfast option works best for you, remember to try to combine high quality carbohydrates from fruits, grains, and veggies along with lean protein and you’ll be setting yourself up for success! Choose one option here and make it your mission to try it out this week.

If you’re looking for more personalized nutrition advice, contact me for an appointment!

Always read the ingredients!

Are your foods what you THINk they are?

Healthy Way recently published a great piece about foods that aren’t quite what we think. From pancake syrup to wasabi to bacon bits, the food industry often brands products based on how we perceive them rather than the actual ingredients.

The best way to keep yourself informed is to read ingredient lists as much as possible. This will show you if you’re eating maple syrup or maple flavored corn syrup (yes, that’s what many generic ‘table syrups’ really are).

Our owner Kelsey is quoted discussing some of the secrets of instant oatmeal so take a look at the article on Healthy Way!

A new study links the Mediterranean Diet to lower risk of Macular Degeneration

A new article in the journal Ophthalmology examined the diets and health outcomes of almost 5,000 participants who recorded their eating habits and wellness outcomes over several years. After analyzing the group’s food frequency questionnaires (which help paint a picture of what foods people tend to eat frequently or avoid), the researchers found that those following a Mediterranean-style diet had a 41% lower chance of developing macular degeneration.

The most interesting finding that that no single element of the Mediterranean diet correlated strongly to risk of macular degeneration, which implies that the protection came from the diet as a whole rather than any one portion. The Mediterranean diet is rich in fruits and vegetables, high in fiber with whole grains and legume consumption, and full of healthy unsaturated fats from plant oils, nuts, and fatty fish, while meat can be consumed in small amounts. These elements combine to help fuel your body and protect you from cellular damage. Adhering to this diet has been linked to cardiovascular health and lower risk of cancer, as well. To learn more about the components of a Mediterranean diet, check out these sources:

Bonus reading: Visit this summary from The Olive Oil Times to see The Peoples Plate featured as a nutrition professional commentator on the study’s findings!

Fall Flavors: Acorn Squash

Fall weather calls for fall flavors! Here in New Jersey, the temperature has dropped and it’s officially time for comfort foods. Instead of making a heavy high-fat dish, try to capitalize on fresher fall flavors that pair well with other seasonal flavors. I recently made a sweet spaghetti squash and wanted to try a savory spin on a different autumn classic: Acorn squash.

I have to admit that this was a first for me! I love eating squash, but it wasn’t a kitchen staple for me until this year. I am a busy, health-conscious home cook, so I look for three things when food shopping:

  1. It has to be easy! If there are too many steps, the odds of me making it after a long day at work drop significantly. If I know I can throw it together in under 15 or 20 minutes, it makes the cut.
  2. It has to be healthy! My body and wellness matter to me, so I want to know that my meals are nourishing.
  3. It has to be delicious! I am a foodie through and through, so if it doesn’t taste good, why bother making it? Sure, I want my food to be nutritious, but I also want to crave it again and again.

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This recipe hits all of the sweet spots and brings fall to your table:

  1. Cut the squash in half and pierce the skin a few times. You can cut piece off of the bottom to create a flat surface so the squash can rest steadily when placed open-face up
  2. Scoop out the inner seeds and pulp.
  3. Coat with olive oil, pepper, and a little salt. You can also try other herbs like garlic or onion powder, thyme, sage, or rosemary.
  4. Roast at 350 degrees F for about 45 minutes, or until fork tender.

My favorite thing about squash is that it is high in fiber (5 grams per half cup) which not only keeps you full but is linked to lower blood sugar spikes and to intestinal health, has healthy complex carbs (a half cup has about 15 grams, which is equal to one carb exchange for carb counters), and is filling with very little calories (about 60 for a half-cup serving).

Feeling fancy? The shape of an acorn squash is perfect for stuffing! Try adding any of the following to elevate this squash from a side to a main feature:

  • Quinoa cooked with orange juice, topped with toasted almonds
  • Farro tossed with olive oil and craisins
  • 2 oz of crumbled lean turkey sausage with sauteed onions
  • Top with sliced pork medallions

Remember to follow The Peoples Plate for more recipes or for personalized nutrition counseling! What is your favorite fall ingredient?

Is the Glycemic Index the secret to better blood sugar control?

“Glycemic Index” and “Glycemic Load” have become buzzwords for the carbohydrate-conscious public, but the burning question remains: What exactly is Glycemic Index?  Is it worth learning in an effort to control your blood sugar? How is it even different than counting carbs?

Counting carbohydrates will tell you just how many grams of carbs you are getting with each meal, but not all carbs break down in our body the same; some are made of longer-chain molecules or are higher in fiber and take longer for your body to break down. Simpler sugars tend to be digested and absorbed much more quickly, which leads to a more rapid blood sugar spike. Carbohydrate counting along does not provide that kind of information, but Glycemic Index does.

Glycemic Index (GI) measures how a 50 gram serving of a specific food will impact your blood sugar overall. It takes into account both how high your blood sugar will spike as well as how how long it takes for it to return to normal, and it summarizes this overall glycemic effect as a number on a scale from 0 to 100. Pure glucose has a GI score of 100, as a reference point, so lower scores mean a lower blood sugar response:

Low GI: 55 or less
Medium GI: 56-69
High GI: 70 or higher

The mortal flaw of GI, however, is that is is so incredibly variable that it is difficult to actually trust any specific number. Just take a look at the extensive table (over 55 pages long) found in the journal Diabetes Cares, which lists GI data for items based on a huge range of sources. Brown rice is listed multiple times with the GI ranging from 50 to 87— which obviously complicates the idea that we can quantify exactly how your blood sugar will react to 50 grams of brown rice.  Tufts University recently studied glycemic response within individuals by measuring people’s unique blood sugar response to doses of glucose and white bread, and they found that a person’s blood sugar response varied by 20-25% at different times. This study is important in showing that Glycemic Index isn’t as precise as we’d like, though it provides a good ballpark for you.

Reference this abbreviated table from Harvard University which is based on an American Diabetes Association article that looked at GI as an average of multiple valid studies – this average is likely the most accurate you’ll find.

One major issue is that eating a large volume of a low-GI item can be worse than eating a little bit of a high-GI food. This is because GI measures the impact of 50 grams of an item, so you can only compare the GI of (for example) table sugar (GI 60) and watermelon (GI 72) if you assume you are eating 50 grams of each. Hopefully, you don’t actually eat the same amount of straight sugar and watermelon, so the GI comparison is deceitful. This is where Glycemic Load (GL) comes into play. The GL applies GI concepts to actual realistic portion sizes to help you gauge how your intake will really impact your blood sugar, so you can see that the glycemic load of ~2 teaspoons of sugar (approximately 6) is higher than that of a 4 ounce portion of watermelon (GL of approximately 4).

Again, all Glycemic Load data is based on Glycemic Index, so you need to keep some flexibility in mind when using this information for food choice.

Glycemic Index also varies based on a number of different food qualities; the GI will be higher in foods that are riper, cooked longer, or processed into a finer / easier to digest product (like quick oats as opposed to rolled oats). Even once you have a good estimate of an accurate GI score, the combination of foods in a meal will change how your body responds because fat, protein, and fiber all slow digestion and therefore blood sugar spikes.

So what’s the verdict?

There is mixed research about Glycemic Index (GI) and Glycemic Load (GL) in terms of how helpful it can be for actual blood sugar control. Some studies have found no link to improved blood sugar at all, but a Cochrane Review of glycemic index examined the literature and found that lower-GI diets are linked to better blood sugar control when you consider all of the data together.

My takeaway is that understanding the glycemic impact of food can be a helpful reference tool but is too variable to rely on entirely. It may help you understand how different types of foods might impact your blood sugar, and it’s great for comparing similar items and to see which types of foods lead to a better glycemic response. The result will likely be that you’ll see the benefit of foods that are higher in fiber, less processed, lower in simple sugars, and higher in protein – which is the same generally healthy carbohydrate-consistent diet I would recommend in the first place.

Here is a summary of some major Glycemic Index numbers to consider.
Remember, this is Glycemic Index, so it does not take portion size into account, and these numbers have a big error range so assume they can be about 10 points higher or lower.  This information tells you how these items MIGHT impact your blood sugar ON AVERAGE if you consumed IDENTICAL PORTIONS of each.  Use this more for reference between similar items with a fixed portion. Should you necessarily avoid high GI foods like watermelon and potatoes all together? No! Just monitor your portion sizes and eat them with higher protein / fiber / fat foods to help slow digestion.

  • High GI: 70 or higher
    • Corn flakes (~81)
    • Puffed rice cereal (~82)
    • Instant potatoes (~80)
    • Instant oats (~79)
    • Potato, boiled (~78)
    • Watermelon (~76)
    • White bread (~75)
    • Cheerios (~74)
    • White Rice (~73)
    • Bagel (~72)
  • Medium GI: 56-69
    • Brown Rice (~68)
    • Popcorn (~65)
    • Table sugar (~65)
    • Sweet potato (~63)
    • Honey (~61)
    • Pineapple (~59)
    • Muesli (~57)
    • Plantain (~55)
  • Low GI: 55 or less
    • Sourdough bread (~54)
    • Rice noodles (~53)
    • Stone ground or pumpernickel bread (<55 per the American Diabetes Association)
    • Rolled oats (~55)
    • Corn (~52)
    • Banana (~51)
    • Spaghetti (~49)
    • Corn tortilla (~46)
    • Canned peaches (~43)
    • Oranges (~43)
    • Grapes (~43)
    • Fruited Yogurt (~51)
    • Milk (~39)
    • Apple (~36)
    • Lentils (~32)
    • Chickpeas (~29)
    • Under 20: Eggplant, broccoli, raw carrots, cauliflower, mushrooms, lettuce, red peppers, onions,  tomatoes

There are several Glycemic Index apps to help you keep this information in your pocket if you’re interested in learning more, though keep in mind that the numbers will always be estimates and you may find very different guidelines based on what the app references.

I also recommend the following resources and articles:

 

If you’d like to pursue more personalized counseling, contact us for information about in-person or virtual sessions!

Share your thoughts on Glycemic Index below – I’d love to hear your experience with this, whether you found it helpful, confusing, interesting, too restrictive, or otherwise!

Why It’s Totally Acceptable (and Nutritious) to be Obsessed with Pumpkin

The air is getting cooler, the days are getting shorter– this can only mean one thing: Pumpkin Season is here!

Whether you love to pick ’em, paint ’em, carve ’em, or just admire ’em, pumpkins are the quintessential fall crop. Pumpkin spice has become the wildest autumn food trend, originally dominating our latte orders and muffin choices but now popping up in everything from cereal to twinkies to cheese (yes, pumpkin spice cheese).

The spice blend itself is a combination of cinnamon, ginger, cloves, nutmeg, and allspice, which can be mixed into anything for a healthier autumn celebration. Try these tricks:

  • Mix 1 tsp pumpkin spice mix into your oatmeal with 1/2 tsp of maple syrup
  • Add 1 Tablespoon pumpkin spice mix directly into your coffee grounds when brewing your next cup – the flavor will infuse into the coffee– for the pumpkin flavor without the calories and sugar of a traditional latte flavor syrup.
  • Mix 1 teaspoon of pumpkin spice, 1/2 tsp honey, and 2 Tablespoons part-skim ricotta cheese or low-fat cream cheese for a dessert-like topping for toast or graham crackers

Pumpkin itself is a wonderful ingredient and is packed with beta-carotene, the antioxidant that gets converted to vitamin A in our bodies– so much, in fact, that a cup of cooked pumpkin provides twice your daily need for vitamin A. This helps protect your vision (a lack of A in the diet is linked to night blindness) and directs cell growth throughout your body. They’re also a great source of potassium, which essentially every cell in your body needs to function as it goes hand-in-hand with sodium. You’ll get a nice dose of vitamin C for immune function and antioxidation, too. Pumpkin is definitely deserving of the superfood title.

Pumpkin is not just for pie! You can add it into a huge range of foods with the goal of either rich pumpkin flavor or subtle vegetable addition. Since it’s incredibly low fat yet moist, it often replaces part or all of the fat in a recipe as well as eggs. You’ll often get a different consistency than you’re used to so I would play around your recipes to see the result, but you’ll get a much more nutritious baked good.

  • Have pancake mix on hand and canned pumpkin in the cabinet? Then you can make pumpkin pancakes easily! Try 1 cup mix + 1 cup water + 1/3 cup pumpkin, plus pumpkin spice if desired. For a Food Network semi-homemade version, check out Sandra Lee’s recipe.
  • For a sneakier pumpkin addition, take boxed brownie mix (to make fudgy brownies) or any cake mix (for a fluffier muffin consistency) and add 1 cup of pumpkin. For a family-sized mix (18 ounces or larger), use a full can of pumpkin. You’ll get a fun twist on dessert with less fat and more nutrients!
  • I will tell you that my personal favorite pumpkin recipe is these pumpkin breakfast cookies (check it out here) by Leealicious – I highly recommend them!

 

What is your favorite pumpkin recipe? Share in the comments!

Oats: “the best balanced food in existence” -1918

If you lived in the early 1900s, what would you be eating for breakfast?

Food history is a phenomenal niche field that preserves proof of our human relationship with food and how it’s shifted over time, from what we valued to how and why we served it.

I bought this 1918 original Quaker Oats advertisement a few years ago and have been waiting to frame and hang it in my office (it will be going up tomorrow now that I’m in my new counseling space!)

My favorite elements:

  • Calories are defined as “the unit if nutrition”
  • The main point is to show how oats have more calories per pound than steak, eggs, and chicken
  • Other major selling points: more lime! Also more phosphorous which is very true of most whole grains
  • Oats are called “the ideal food for growth” and “the best-balanced food in existence”
  • The dietitian (nurse? sales girl?) Is lovely in her fabulous outfit of authority

Spaghetti Squash

 

Spaghetti squash is the trendiest new squash (sorry, butternut- we still love you) and is definitely worth adding to your fall dish repertoire. The first time I tried spaghetti squash was actually at my work cafeteria, and I absolutely loved the consistency and subtle flavor but didn’t quite understand how it came to be (Did the squash just have little strings inside? Did you have to press it through a grater?). If you’ve never tried it, imagine a truly spaghetti-shaped zucchini noodle that holds its bite a bit better but has the taste of a mild butternut squash.

img_20180923_1844294391312110323.jpgI bought one myself and cut it open only to see that it looked like a yellow cantaloupe, and my first instinct was that I bought the wrong squash. Trusty Google showed me that I had in fact bought a spaghetti squash and that it would be just as stringy as I hoped once I was through – and it did not disappoint!

I love anything that can increase the volume of a meal without adding too many calories, and this is where spaghetti squash shines; you can have a whole cup with only about 40 calories but good fiber and micronutrients including potassium, vitamin C, and B vitamins.

Making spaghetti squash is incredibly easy (almost unbelievably so):

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    Squash immediately post-baking but before spaghetti-ing.

    Cut squash in half vertically (like you’re splitting the stem).

  2. Remove the seeds and the pulp attached to them.
  3. Brush with 1-2 T olive oil and sprinkle with sea salt for a savory dish. Alternatively, brush with 1-2 T butter, 1 tsp cinnamon, and 1 tsp syrup for a sweeter version.
  4. Place face-up on a baking sheet and cook at 380F for 60 minutes. It should be incredibly tender.
  5. Take a fork and use it to rake the flesh of the squash. The strings will naturally separate and pull away (I took a video below for you to visualize). Continue until you have pulled out all of the strings and you’ll have your ‘spaghetti’!

I’ve seen savory versions topped with parmesan and herbs, but I love the sweet version for a fall side dish. Either way, you’ll get a lot of volume and flavor without a ton of calories!

 

 

What exactly is an RDN, and why should I trust one?

Everybody eats. All day long, no matter what you do from sun up to sun down, at some point your body needs food and you will eat. You’ll repeat that every day for the rest of your life, and so you will naturally form opinions about your food and perhaps which ones are ‘good’ or ‘bad.’ Your mother and your grandmother will tell you what to do to stay healthy; the fittest guy at the gym will swear he knows how to shred fat; catchy headlines and Google searches and talk show hosts will all offer ‘the key to weight loss!’ The enemy is fat! No, gluten! No, sugar!

I’ll give you a hint: if there was one key to overall health or weight loss, one simple meal plan to solve it all, whomever discovered it would be a trillionaire and you wouldn’t be reading this article. However, nutrition is much more complex than that. 

If you feel like there is an overwhelming amount of conflicting information out there, you’re right! That’s because there isn’t really one clearcut ‘healthy diet’ for everyone. Certain people DO need to cut out gluten, or watch how much potassium they eat, or strictly cut their sodium, or follow a medically-prescribed ketogenic diet to prevent seizures. However, deep Google dives will yield a lot of discordant information if you don’t know exactly what kind of nutrition information is a) pertinent to you, b) scientifically sound, and c) safe.

That’s why we need Registered Dietitian Nutritionists (RDN). Most people don’t know that an RDN is different than a ‘nutritionist’ or a ‘health coach.’ I myself didn’t know the difference until I pursued this path professionally, but those three little letters — RDN — hold a lot of meaning about the quality of nutrition education and counseling my colleagues and I provide. To become an RDN, you must:

  1. Complete an undergraduate degree including about 90 semester hours (more than a standard major) of in-depth science and nutrition-focused curriculum
  2. Complete over 1200 hours of supervised professional practice internship working under dietitians in clinical settings (hospitals, nursing homes, rehabilitation centers, dialysis centers), community locations (like WIC, Head Start, or Meals and Wheels programming for food security), and food service roles (implementing food safety standards and learning the managerial functions of food service directors)
  3. Pass a credentialing exam that covers principles of nutrition and food science, human anatomy and physiology, educational theory and application, counseling techniques, research techniques and interpretation, medical nutrition therapy for individuals in all stages of life and with varying diseases, employee and financial management skills, and menu creation and implementation just to name a few topics.
  4. Soon all RDNs will be required to hold Master’s degrees, though many dietitians (including myself) already hold a Master’s in areas like clinical nutrition, nutrition and food science, business, health care administration, or public health.

Other nutrition professions like ‘health coach’ or ‘nutritionist’ do not require the same degree of formal training (some have quick online courses that cover overall healthy eating without any explanation as to the scientific foundation of these principles or the medical implications). You may find some non-dietitian individuals who do have formal health education and experience, but you can’t be certain of the wealth of training your practitioner has completed unless he or she is a dietitian.

The New Jersey Academy of Nutrition and Dietetics has launched a campaign to support Registered Dietitian Nutritionists as the nutrition expert– and I highly suggest you check out the launch video here!

The Numbers Game: Understanding Your Blood Sugar Levels

So your blood sugar runs high- but what is considered ‘high’? Are they slightly elevated, or are they far above your target range? Are they improving with time or do they keep climbing? The first step to blood sugar control for people with diabetes is understanding your numbers, which can help you identify personal patterns and track your progress over time. There are three main blood sugar measures to take into account: Fasting blood sugar, Post-prandial blood sugar, and Hemoglobin A1c.

Fasting blood sugar refers to the glucose level measured after several hours without food, like when you test first thing in the morning.

At this point, your body has already utilized whatever carbohydrates you consumed the night before and is now running off of stored carbohydrates which means it is trying to be very efficient; you should have enough glucose in your blood to help your cells run but not much more than that. Any elevated levels are a sign that something is off and your body is not able to move glucose into your cells optimally. Whether this is due to a lack of insulin (generally type I diabetes or progressed type II) or because your cells are not as sensitive to the insulin as they should be (generally type II), a high fasting glucose at a physical exam is often a first warning sign of diabetes for patients. A normal range is 70-100 mg/dL, with levels under 70 considered abnormally low and requiring intervention to bring them back up. Levels between 100 and 125 mg/dL fall within the prediabetic range, meaning you are at risk for diabetes and have some impairment of your glucose utilization, and levels over 125 mg/dL qualify as one sign of possible diabetes.

Post-prandial blood sugar simply translates to levels ‘after eating.’ This test is usually taken two hours after your last meal, and the numbers will generally be higher because you have just introduced a large volume of glucose into your system. Some degree of a blood sugar spike is normal after eating; your body digests whatever carbohydrate you consumed, breaks it down into small glucose molecules that enter your bloodstream, and insulin helps to move that glucose into the cells where it’s needed. Two hours after eating, a normal blood sugar level would return to under 140 mg/dL. For people with diabetes, that number is often over 180 mg/dL, which shows that your body is having a difficult time transporting the glucose from your blood stream into your cells. Your doctor may formally test this with an Oral Glucose Tolerance Test where you consume a controlled amount of glucose followed by blood testing two hours later, and levels over 200 mg/dL are considered within the diabetic range.

Hemoglobin A1c (often shortened to ‘A1c’) is a bit different than the other two tests because it reflects your average blood sugar over the last 90 days rather than at a set period of time. Your result is given as a percentage that shows how much residual glucose is stuck to your red blood cells, and a higher percentage means higher overall circulating levels of glucose. A normal A1c is under 5.7%, with the prediabetes range falling from 5.7% to 6.4%. An A1c of 6.5% or higher is a major sign of possible diabetes as it shows that your blood sugar tends to run much higher than the desired range.

Once a person is diagnosed with diabetes, there are similar goals that indicate good control: Fasting blood glucose should be under 130 mg/dL; 2-hour postprandial levels should be under 180 mg/dL, and Hemoglobin A1c should be under 7%.

For your reference, here’s how all of these numbers compare to each other:

Fasting Glucose (mg/dL)

Postprandial Glucose (mg/dL)

Hemoglobin A1c

Normal levels

70 to under 100

Under 140

Under 5.7%

Prediabetes

100 to 125

140 to under 180

5.8% to 6.4%

Diabetes

126 or higher

180 or higher

6.5% or higher

Goal for people
with diabetes
(after diagnosis)

70-130*

Under 180

Under 7%

*Some doctors may prefer fasting blood sugars of 80 or over to minimize risk of hypoglycemia, which is often the case for elderly patients. All of these numbers can also be impacted by other medical factors including medications, chronic diseases, and inflammation, so the results alone may not constitute a diagnosis – always speak with your physician if you are concerned.

These ranges are also slightly different for pregnant women as they have a larger volume of blood and therefore will have automatically lower concentrations of glucose. Imagine diluting 4 ounces of iced tea with 4 ounces of water – it may taste be less sweet as it is less concentrated, but the entire glass will still have the same amount of sugar as the 4 ounces of iced tea alone, so the low concentration is somewhat deceitful. Instead, physicians generally test for gestational diabetes (the onset of new diabetes symptoms during pregnancy) with an Oral Glucose Tolerance Test where they test their blood sugar response to a concentrated high-glucose drink.

Nutrition is a major influencer of blood sugar control. The carbohydrates you consume correlate directly to your increase in blood sugar, though the magnitude of change is different for each individual. I’m familiar with the tendency of many patients to start medication and believe it negates any need for dietary intervention, but combining a carbohydrate-consistent diet with medications will optimize your results. There is solid research that diet modification can help to decrease your A1c while also helping you better understand how your food choices impact your blood sugars, and many endocrinologists routinely refer patients to dietitians for medical nutrition therapy.

For more information on understanding your numbers, check out these trustworthy websites: