Blood sugar levels are already routinely monitored in patients with diabetes or those at risk of developing diabetes, but the importance of maintaining stable blood sugar levels for overall health is becoming more widely recognized. Elevated blood sugar levels, even if not high enough to indicate diabetes, may be associated with an increased risk of cardiovascular disease, kidney disease, and other health problems.

As a result, tracking blood sugar levels without diabetes or pre-diabetes may become a tool for managing both disease and wellness. Or perhaps, availability of broader data sets can foster research examine blood glucose levels and trajectory to offer new insights into the pathophysiology of related diseases at earlier points in time.

Digital health has often offered monitoring solutions that reside in the consumers hands (or wrists). And this has certainly been a mixed blessing.  Some tools have provided valuable insights into health.  Yet some have become merely a source of arbitrary information that cannot be translated into clinical value.  Further, this added burden to healthcare providers may further preclude adoption.  But as innovation has taught us, the next big thing can often be close at hand.  The emergence of continuous blood glucose monitoring (CGM) has been transformative for patients.  And the new data sets have given scientists powerful insights into glucose kinetics and insulin administration.   And these insights maybe game-changing with the global concerns of obesity and metabolic syndrome.

Your watch is becoming a value tool in wellness and disease management.  And that value is only beginning to be realized and implemented.

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The Environmental Working Group is a non-profit organization that aims to improve the environment and human health. Each year, the group gives us a “dirty dozen” list of fruits and vegetables. It also releases a “Clean 15” produce list.

First, I want to put a disclosure front and center. Several prominent organic marketers fund the Environmental Working Group.

The “dirty dozen” fruits and vegetables

The Environmental Working Group’s annual Dirty Dozen report exclaims strawberries, spinach, and nectarines have the most pesticide residues. Here is the complete 2022 rundown:

1. Strawberries
2. Spinach
3. Kale, collard, and mustard greens
4. Nectarines
5. Apples
6. Grapes
7. Bell and hot peppers
8. Cherries
9. Peaches
10. Pears
11. Celery
12. Tomatoes

The EWG notes that a small amount of papaya, summer squash, and sweet corn sold in the United States is made from genetically modified seeds. Consider buying organic varieties of these crops if you want to dodge genetically modified produce.

The “dirty dozen” fruits and vegetables — testing

The US Department of Agriculture and the Food and Drug Administration (FDA) do the testing. They found 245 different pesticides and pesticide breakdown products on over 70 percent of non-organic produce.

Before performing a test, the USDA washes, scrubs, and peels them as a typical consumer would. It seems clear from the report that simple washing is not enough to remove all pesticides.

The “dirty dozen” fruits and vegetables — Criticism

An industry group for growers of produce (both organic and non-organic) and some dieticians offer objections to the report, noting that the annual report raises an unnecessary alarm and may discourage folks from eating enough fruits and vegetables.

Listen to Teresa Thorne, Executive Director of the Alliance for Food and Farming:

“Ignore or discount the list.” Like others, she fears that if an organic fruit or vegetable costs more, as they often do, consumers will bypass produce altogether, especially low-income consumers. “Pick what’s best for you and your family,” she says.

Counters toxicologist Dr. Alexis Temkin of the Environmental Working Group: “All the residues found were within legal limits set by the Environmental Protection Agency. She adds that “although the levels are legal, that doesn’t necessarily mean they are safe.

On the other hand, the report provides information to help consumers make informed decisions about the produce they choose to purchase.

Before you turn away from buying that produce, remember that both organic and conventionally grown fruits and vegetables have pesticides of different sorts. There is a Pesticide Residue Calculator from toxicologists at the University of California, Riverside, that provides some comfort.

You can use the calculator to see that trace amounts of chemicals in conventionally grown produce don’t appear to be hazardous. One may consume 850 apples per day without suffering harm from pesticides. I am a bit sceptical about such claims, but the calculator provides another perspective.

I am a work in progress, trying to have about half of my plate filled with fruits and vegetables. That is the best move I’ve made in my diet in a long time. You too should think about getting those fruits and vegetables!

What is your approach?

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• Sleep Apnea: This is a common condition in the United States. It can occur when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. This is known as obstructive sleep apnea. If the brain does not send the signals needed to breathe, the condition may be called central sleep apnea
• Type 2 Diabetes: This is the most common type of diabetes, a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes mainly from the food you eat. Insulin, a hormone made by the pancreas, helps glucose get into your cells to be used for energy. In type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well. Too much glucose then stays in your blood, and not enough reaches your cells.
• Fasting Blood Glucose Levels: A test to determine how much glucose (sugar) is in a blood sample after an overnight fast. The fasting blood glucose test is commonly used to detect diabetes mellitus. A blood sample is taken in a lab, physician’s office, or hospital. The test is done in the morning, before the person has eaten. The normal range for blood glucose is 70 to 100 mg/dl. Levels between 100 and 126 mg/dl are referred to as impaired fasting glucose or pre-diabetes. Diabetes is typically diagnosed when fasting blood glucose levels are 126 mg/dl or higher.

African Americans with severe sleep apnea and other adverse sleep patterns are much more likely to have high blood glucose levels —a risk factor for diabetes—than those without these patterns, according to a new study funded in part by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

The findings suggest that better sleep habits may lead to better blood glucose control and prove beneficial for type 2 diabetes prevention and diabetes management in African Americans, who are at higher risk for type 2 diabetes than other groups. They also point to the importance of screening for sleep apnea to help fight the potential for uncontrolled blood sugar in this high-risk group, the researchers said.

Previous studies have linked disturbed sleep patterns, including sleep apnea, to increased blood glucose levels in white and Asian populations. But this new study is one of the few to use objective measurements to link these disturbed sleep patterns to increased blood glucose levels in black men and women, the researchers said.  Their findings appear online on April 28 in the Journal of the American Heart Association.

“The study underscores the importance of developing interventions to promote regular sleep schedules, particularly in those with diabetes,” said Yuichiro Yano, M.D., Ph.D., the lead study author and a researcher in the Department of Family Medicine and Community Health at Duke University.  “It also reaffirms the need to improve the screening and diagnosis of sleep apnea, both in African Americans and other groups.”
 

Michael Twery, Ph.D., director of the NHLBI’s National Center on Sleep Disorders Research, added that the study highlights important associations between untreated sleep apnea and poorly-regulated blood sugar. “It also adds to growing evidence that protecting our sleep, like diet and exercise, may help reduce the risk of diabetes and the related risk of cardiovascular disease.”

For the study, the researchers evaluated sleep patterns while concurrently measuring blood glucose markers among 789 black men and women who were enrolled in the Jackson Heart Study, the largest study of cardiovascular disease in African-Americans.  Most of the participants—74%—were women, 25% had type 2 diabetes, 20% were taking diabetes medication, and about 57% had a diagnosis of obstructive sleep apnea but were not receiving treatment for their condition, Yano said. Their mean age was 63 years.
 
Participants completed at-home sleep apnea tests, and each used a wrist actigraph watch, a tool that measures wakefulness and sleep, for seven days.  The test calculated sleep duration (short vs long), sleep efficiency, night-to-night variability in sleep duration, and sleep fragmentation (multiple disruptions during sleep). The researchers obtained several measures of glucose metabolism, including fasting blood glucose concentration, HbA1c levels, and insulin resistance.

The researchers focused on four main groups: regular sleepers (no sleep apnea), those with mild sleep apnea, moderate sleep apnea, and severe sleep apnea. During the course of the study, they found that those with the severe sleep apnea had 14% higher fasting blood glucose levelsexternal link compared to those without sleep apnea. Severe sleep apnea was also associated with higher HbA1c levels, Yano said.

In addition to studying sleep apnea, the researchers found that participants who experienced other types of disturbed sleep—including sleep fragmentation and sleep duration variability—were also more likely to have increased measures of blood glucose.  The associations between disturbed sleep and high blood glucose levels were stronger in participants with diabetes compared to those without diabetes, the researchers said. In those without diabetes, disturbed sleep was also associated with increased insulin resistance.

Yano and his team also found that associations of sleep apnea and high blood glucose levels were stronger among black men than black women.  Black men with severe sleep apnea had 10% higher fasting blood glucose levels than black women with severe sleep apnea in the study.

The researchers noted interventions that treat sleep apnea might help improve blood glucose management, including the use of continuous positive air pressure (CPAP) machines—devices that deliver air through a mask to keep the airway open when worn during sleep—and the encouragement of better sleep patterns in blacks, particularly in those with diabetes. But further studies will be needed to determine if such interventions will be effective, Yano said.  

Reference

Sleep Characteristics and Measures of Glucose Metabolism in Blacks: The Jackson Heart Study DOI: 10.1161/JAHA.119.013209

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