How to Balance Blood Sugar, According to a Dietitian
Steady blood sugar levels are a hallmark of optimal metabolic health. The greater the variability in our blood sugar (aka blood glucose) levels, the more prone we are to adverse health outcomes, including insulin resistance and type 2 diabetes, weight gain, and heart disease.
Newer research also suggests that blood sugar abnormalities and metabolic dysfunction may contribute to our risk of other conditions like dementia (referred to by some as ‘type 3 diabetes’), fatty liver disease, cancer, and infertility.
Significant elevations in blood sugar may require medical intervention, but there are also many lifestyle choices that can help us maintain healthy blood sugar balance.
In this blog post, registered dietitian Anthea Levi of ALIVE+WELL Nutrition (that’s me!) will walk you through the basics of how to balance blood sugar. I recommend nailing these behaviors before experimenting with tools like continuous glucose monitors (or CGMs).
First things first
Before we dive into key recommendations for blood sugar balance, let’s quickly review what’s actually happening in the body when our blood sugar levels rise.
When we consume carbohydrate-containing foods, the body breaks them down into single units of sugar, called glucose. Glucose is our body’s preferred source of fuel; it provides our cells with the energy they need to function optimally.
Following carbohydrate digestion, glucose gets absorbed from our small intestine and enters the bloodstream. The presence of glucose in the circulation triggers the pancreas to produce and secrete the hormone insulin. Insulin helps shuttle glucose from the blood into our cells, where the sugar can then serve as energy.
Over-consuming carbs can cause the pancreas to continuously pump out more and more insulin. Over time, this not only takes a toll on the pancreas but also causes our cells to become resistant to insulin, hence the term ‘insulin resistance.’ When our cells are less responsive to insulin, glucose hangs out in the bloodstream for longer. Higher levels of glucose in the blood can contribute to a whole host of outcomes, from the serious (like type 2 diabetes) to the superficial (like wrinkles).
Here’s the thing, though: Fluctuations in blood sugar levels are completely normal and to be expected! That is, the amount of glucose in our blood is bound to drop when we haven’t eaten for a few hours and is bound to rise after we eat a meal. What matters for our health is how extreme those dips and spikes are, as more severe fluctuations can lead to unwanted outcomes down the line.
COMMON SIGNS + SYMPTOMS OF LOW / HIGH BLOOD SUGAR LEVELS
What does low blood sugar feel like?
Fatigue
Weakness
Anxiety, shakiness, dizziness
Elevated heart rate
Hunger
Sugar cravings
Headaches
Irritability
What does a blood sugar spike feel like?
In the short term, a blood sugar spike can feel like an energy high followed by an energy crash.
Chronically elevated blood sugar can lead to weight gain and fatigue. More severe signs and symptoms of high blood sugar include increased thirst, an increased need to urinate, and compromised vision.
10 tips for BALANCED blood sugar levels
01: Focus on quality, consistency + quantity
Contrary to popular belief, carbohydrates (which include classic starches like bread and pasta as well as foods like fruits, vegetables, and legumes) are not the enemy.
As mentioned, carbs provide essential energy to the brain and body. The key is to focus on the quality, consistency, and quantity of the carbohydrates we consume.
QUALITY > Choose whole grains over refined grains as often as possible. Whereas refined grains like white bread, pasta and rice have been stripped of their fiber, whole grains have their fiber component intact. Fiber is critical for balancing blood sugar levels because it slows down the rate at which glucose is absorbed into the bloodstream. High-fiber carbs cause smaller increases in blood sugar levels, whereas low-fiber, refined carbs are more likely to result in sharp spikes.
CONSISTENCY > Have you ever avoided carbs all day long, then gone overboard on cookies or chips come the evening? This approach is counterproductive for blood sugar balance. That is, it's better to include moderate portions of carbohydrates throughout the day than to consume a large quantity in one sitting (not to mention, a massive carb load before bed can mess with sleep quality). Eating patterns like intensive intermittent fasting regimens or any fad diet that allows for ‘cheat days’ can also contribute to blood sugar abnormalities. Glucose levels tend to be quite low following a fasting period and thus spike once we finally eat a meal (or, in the case of a cheat day, when we suddenly eat all the carbs we’ve been restricting all week).
QUANTITY > Just because carbs aren’t the enemy doesn’t mean we should eat 3 bowls of pasta in one sitting (sorry). Exactly how many servings of carbs each of us needs per day depends on one's body size, physical activity levels, medical conditions, and health goals. I recommend working with a registered dietitian to learn about the exact quantity of carbs that’s ideal for your body.
02: Be a Label Detective
Over-consumption of added sugars is one of the primary culprits for elevated blood glucose levels, so it's helpful to be aware of daily limits for added sugars.
Friendly reminder: Natural sugars are those that are naturally occurring in foods, such as fructose in fruit or lactose in dairy. Added sugars are just what they sound like - sugars that are added to products to increase their level of sweetness. Examples include high fructose corn syrup, honey, brown rice syrup, and sucrose (aka table sugar).
Familiarize yourself with the recommended max for daily added sugars, then use that knowledge to assess nutrition facts panels on packaged foods.
Men: Less than 36 grams of added sugars/day
Women: Less than 25 grams of added sugars/day
03: Avoid 'Naked' Carbs
Eating naked carbs (aka carbohydrates on their own) raises our blood sugar levels quicker than eating carbs along with a source of lean protein and/or healthy fat. Here are some examples:
Instead of a plain white bagel, go for a whole wheat everything bagel and add 2-3 eggs (protein) + 1/2 avocado (healthy fat) to it
Instead of plain dark chocolate, have some almonds (healthy fat) along with it
Instead of white pasta with tomato sauce, try chickpea pasta such as Banza (which is higher in plant-based protein and fiber) + add sautéed spinach and chicken sausage or salmon (protein) to the bowl as well
Instead of noshing on just pretzels or crackers, dip them into hummus (protein/healthy fat) + add a couple of olives on the side (healthy fat)
04: MOVE + MOVE OFTEN
Moving our bodies helps to improve insulin sensitivity and support healthy blood sugar levels. Here are some movement-related goals to keep in mind:
Aim for a minimum of 150 minutes of moderate to vigorous physical activity weekly
Try to incorporate some form of strength work (resistance training or bodyweight-bearing exercise) 2-3 times weekly
Eat, move, repeat. Even just 5 minutes of movement after eating can help lower post-prandial (aka after-eating) blood sugar levels and improve health outcomes over time. Go for a walk around the block after breakfast, lunch and/or dinner to get blood glucose levels trending down
And finally, make a point to move throughout the day. Some studies suggest that moving our bodies often may be even more beneficial for blood sugar regulation than crushing one high intensity workout — and then sitting at our desk for the next 12 hours
05: Eat Regularly, But Not Too Regularly
Grazing all day long can contribute to elevated insulin, as eating 24/7 doesn’t allow our blood glucose levels to trend down between meals. Instead of snacking throughout the day, try to eat at consistent but separate intervals throughout the day.
I recommend eating within about 1 hour of waking up and then every 3 - 4 hours thereafter. Aim to cut off food at least 2 hours before hitting the hay for optimal digestion. Front-loading calories — i.e. eating your bigger meals earlier in the day instead of the inverse — can also be helpful for blood sugar balance. This is in part because have more time to move our bodies after breakfast and lunch, which we now know can help to lower our blood sugar levels after meals. Enjoying a massive dinner and then immediately lying on the couch or getting into bed is less optimal for lowering blood glucose levels.
Here is a sample eating schedule for healthy blood sugar balance:
Breakfast 8:30am
Lunch: 12:30pm
Snack: 3:30pm
Dinner: 7pm
06: Try This Pro Trick
Adding 1 tablespoon of apple cider vinegar (ACV) to water and drinking it either in the morning or right before a meal may help reduce blood glucose levels. Try adding ACV to a large water bottle, large glass or even a pitcher of water and sipping it daily.
Just beware: Do not drink ACV straight! You must dilute it. And if you suffer from acid reflux, discuss this trick with your healthcare provider before trying it. Also, if the taste isn't working for you, know that starting a meal with greens topped with a homemade dressing that contains ACV is a perfect alternative (not to mention, this option serves up fiber as well).
07: up your fiber intake
Speaking of fiber…Fiber is a critical component of a blood sugar-friendly diet. As mentioned above, fiber acts like a mesh in our intestine, helping to slow down how quickly glucose leaves the GI tract and enters the bloodstream. I recommend everyone aims to eat at least 30 grams of dietary fiber from whole foods every day. (FYI: If you aren’t accustomed to eating much fiber, you’ll want to increase your consumption slowly and make sure to drink enough water while doing so to prevent constipation.)
As a friendly reminder, fiber is naturally found only in plant foods, so the best way to up our fiber intake is to increase the amount of plants on our plates. While all plants contain fiber, I like to say that some are ‘supercharged’ with fiber, meaning they deliver a significant amount of fiber in a fairly small volume.
Here are some of my favorite, ~ supercharged ~ high-fiber foods:
Avocado - 1 whole = 9 grams of fiber
Raspberries - 1 cup = 8 grams of fiber
Chia seeds - 2 tbsp = 8 grams of fiber
Blackberries - 1 cup = 7.5 grams of fiber
Legumes - 1/2 cup (cooked) = about 5 - 8 grams of fiber
Blackberries - 1 cup = 7.5 grams of fiber
Ground flaxseeds - 2 tbsp = 4 grams of fiber
Rolled oats - 1/2 cup = 4 grams of fiber
Shelled edamame - 1/2 cup = 4 grams of fiber
08: Beware of Sneaky Sources of Added Sugars
Beware of sneaky sources of added sugars, including condiments like bottled salad dressings and ketchups, coffee drinks (some Starbucks specialty drinks serve 60+ grams of added sugar, more than 2-3 days' worth!), breakfast cereals, flavored yogurts, store-bought juices and smoothies, energy drinks, dairy-free milks, coffee creamers, tomato sauces, and cocktails.
Check out this helpful resource that lists all 61 (!) different names for sugar on food labels.
09: Supplement Smart
Work with a healthcare provider on an individualized supplement regimen that can help support healthy blood sugar balance (if needed). A couple of options I often use with clients include psyllium husk and inositol, depending on their lab values and medical conditions.
10: BLISS OUT
Our stress levels and blood glucose levels are closely linked. High levels of the stress hormone cortisol can cause blood glucose levels to rise. Why? Way back when, high stress levels usually meant we were in danger, so the body pumped out extra glucose in order to provide us with the fuel we needed to, quite literally, fight or flee.
When chronically elevated, cortisol also tells the body to store energy (aka calories), often around our mid-section. This, again, is a protective, evolutionary mechanism. Back in the day, a stressed-out body would quite literally save up calories in case it needed to fend off famine. Nowadays, that stored energy is less necessary. Instead of protecting us, excess visceral adipose tissue (aka ‘belly fat’) can contribute to blood sugar abnormalities thanks to its ability to fuel insulin resistance.
Stressing less can help improve blood sugar levels, so I recommend finding enjoyable ways to unwind (that don’t include things like alcohol). Intentional breathing exercises like box breathing or the 4-4-8 breathing technique, guided meditations via YouTube or apps like Calm or even Peloton, gratitude journaling, and restorative stretching are all great options.
So…
Balancing blood sugar is not a synonym for eating ultra low-carb. The key is to focus instead on the tips above and to choose high-quality carbs most of the time. Here are the nourishing carbohydrates I encourage emphasizing:
Fruits of all kinds
Vegetables of all kinds
Legumes (beans, peas, lentils, chickpeas)
Whole grains like wild or brown rice, quinoa, oats, farro, barley
100% whole wheat breads, pitas, tortillas, wraps
Potatoes of any kind
Parsnips
Starchy squashes like butternut, acorn, and delicata squashes
Plantains
Whole wheat pasta or legume-based pastas such as Banza chickpea pasta or Explore Cuisine edamame noodles
Popcorn (homemade or Trader Joe's olive oil popcorn)
Whole grain, low-sugar breakfast cereals such as Grape Nuts, Post 100% whole grain plain shredded wheat, or Nature’s Path Heritage Flakes
Want to learn more? Here are a some easily digestible resources I recommend checking out:
This podcast episode with Liz Moody and Dr. Casey Means explains why blood sugar matters for more than just weight or diabetes risk.
If you’re a visual person, this Instagram account from Jessie Inchauspé does a nice job of showing average glycemic responses to various foods. Her book Glucose Revolution is also an easy-to-read guide to all things blood sugar balance.
If you’re interested in learning more about the glycemic index (and why it’s not always the most accurate tool), check out this article I wrote about the topic.