Just the Blood Glucose Levels and Beyond.
I would place it with the Prerequisites of CGM Backing it with Data: Pre-Diabetes and Comprehensive Metabolic Panel screening- 14 – are vital before applying a CGM, which would give deep insights into Metabolic Health. The human body is complex, and we need to do Finger-Print Analysis to recommend Finger-Print Recommendations.
We talk about Metabolic Pathways! Pretty simple and looks like
Hell No! The Metabolic Pathway
Monitoring GUT Microbiome Nutrigenomics and Glucose Monitoring is the ultimate bio-hacking Tool. I intend to discuss the Epigenetic- Mitochondrial and DNA Telomere linking to Longevity which could be the Future with monitoring glucose parameters.
Benefits of Monitoring Blood Glucose Levels
Backing my thoughts with data from the 2018 Stanford Study Diabetic-level glucose spikes seen in healthy population. Why CGM for Non-Diabetics? Because CGM suggests even healthy individuals need to mind their carbs. 85% of all chronic diseases in the world are metabolic disorders like diabetes, hypertension, PCOS and Obesity. Also, ICMR in its new briefing states that blood glucose monitoring is a significant factor. It predicts glycemic control in Pre-Diabetics.
I resonate with Glucose Variability as it correlates strongly with Metabolic Health and a tendency of High insulin levels with Obesity. Also, knowing the glucose trends to treat the cloud of Highs and Lows with lifestyle interventions make it an ultimate tool.
Insulin does have a more profound impact on weight loss with Lipolysis.
How Glucose Tracking Can Inform Our Weight Loss Efforts
It all starts with glucose levels- when glucose levels rise, insulin is generally released. Increased insulin levels lead to fat storage and weight gain. Over time, if glucose levels remain high due to diet and insulin production is constantly active, our cells can become “numb” to insulin, which is called insulin resistance. The phenomenon means the body needs more and more circulating insulin to get glucose into cells, leading to higher baseline insulin levels. This process directly counters weight loss efforts.
In obese individuals, high insulin levels also lead to impaired leptin signaling and “leptin resistance,” making it harder for us to feel full, making us more likely to continue consuming calories rather than burn stored fat for energy. On the other hand, decreased glucose levels lead to lower insulin levels, leading to weight loss and decreased fat mass.
Real-time glucose measurements give us the power to understand how the foods we eat impact glucose levels in our blood with rough proxy, our insulin levels. Unlike traditional dietary strategies like calorie counting — which have consistently proved ineffective for sustained weight loss — glucose monitoring provides insight into the underlying physiological processes that lead to fat storage.
The term “glycemic index” — a ranking of foods based on how they affect blood glucose — is a standardized tool to help understand this process, but it can also be a blunt instrument. A few problems have become increasingly clear regarding standardized glycemic indices:
- Interpersonal variability: Individuals who eat the same meal might have highly variable glucose responses due to their unique and complex biological environments.
- Intrapersonal variability: Different meals with the same amount of carbohydrates can generate highly variable glucose levels in a single person. Carbohydrate content alone is often a poor predictor of personal glycemic response.
- Lifestyle: Glucose levels might change based on various factors, such as stress and sleep quantity. For example, restricting sleep to 4 hours per night for 6 – days has led to higher glucose response to specific foods and a 40% lower rate of glucose clearance from the blood.
- Timing variability: The time of day during which we eat can significantly affect glucose levels in the blood, with a high-glycemic and high-calorie meal eaten in the evening causing signiﬁcantly greater glucose and insulin response compared to the same meal consumed in the morning.
- Food combinations: The composition of a meal and the order of foods consumed can cause glucose to change differently than if consumed in isolation
A paper published in an AMA discusses how higher glucose variability and higher (and more) peak glucose levels are each independently associated with accelerated onset of disease and death, even in nondiabetics.
Prospective studies show that higher glucose variability in nondiabetics is associated with an increased risk of cardiovascular disease, Alzheimer’s disease, frailty, cardiovascular death, cancer death, and death from any cause compared to lower glucose variability. Other prospective studies show similar trends for higher levels than lower peak glucose levels, and several human experiments demonstrate that high glucose peaks induce endothelial dysfunction in healthy nondiabetic individuals.
Additionally, higher postprandial glucose levels are associated with higher carotid intima-media thickness, suggesting higher glucose peaks may accelerate the development of atherosclerosis, even in those with adequate glucose tolerance.
Using continuous glucose monitoring (CGM) to guide fueling for peak athletic performance
Fuel during exercise comes from predominantly three sources:
Fat already in your body (stored fat)
Glycogen (a stored form of glucose) resides in muscle cells and the liver, while carbohydrates consumed before and during exercise become fat. In addition, it works for a low-intensity workout, which means you need to work out under approximately 60% VO2 max (e.g., walking or a long easy bike ride).
Minimal to no glycogen occurs during low-intensity exercise (less than 20% VO2 max). As you increase in intensity, the proportion of glycogen used for fuel gradually increases, but fat is still the predominant fuel source for exercise under about 60% VO2 max. Your stored fat gives you the most bang for your buck in terms of energy.
You can exercise for hours at this pace since your body has a substantial store of calories stored as fat, making fat an ideal fuel source for long-sustained efforts. The caveat is that fat is primarily usable under about 60% VO2 max. Thus, while you may be able to travel a long distance, you won’t be able to accomplish it at max speed.
Think of fuel source number 2, stored glycogen, as your reserve tank. Your muscles store glycogen, which can be broken down and used to contract skeletal muscle when needed.
Your liver’s glycogen “reserve tank” of stored glucose can help regulate the level of glucose in the blood. While glycogen is an excellent source of quick fuel for sprints or a few short, high-intensity efforts, these reserve tanks can only hold a certain amount of energy.
The average male (154 lbs) can store between 1600 and 2400 kcals of glycogen-based energy in the muscle and liver combined. That translates to about 10-15 kcals per pound of body weight. This quantity of fuel will deplete significantly after only about 90 min of high-intensity exercise.
What happens if your high-intensity exercise or competition exceeds 90 minutes or if you start your athletic event with depleted glycogen stores?
In that scenario, you have two main options:
- If you continue to exercise, you deplete your muscle and liver reserves, and muscle cells won’t be able to produce energy (ATP) rapidly enough to maintain exercise intensity, and you “bonk.” This option is neither pleasant nor conducive to a strong performance.
- Avoid the unpleasantries, increase your performance capabilities, and either ingest carbohydrates or try a carbohydrate mouth rinse.
- Carbohydrates are the primary energy source facilitating muscle contractions during exercise. Therefore, if you are an athlete who performs repeated sprints, interval efforts, or sustained high-intensity workouts for more than 45 minutes, ingesting carbohydrates during exercise will help preserve liver glycogen and delay fatigue. The duration and intensity of the physical activity largely dictate the number of carbohydrates needed.
Duration Less Than 45 Min, Power Sports
E.g., weightlifting, powerlifting, and field events.
While many sports can fall into “high” or “low” intensity, power sports are in a league of their own. Maximal muscle contractions are required to succeed, and when competing, these maximal contractions will need to occur repeatedly to advance through the rounds and compete for the win.
For muscles to produce a maximal contraction, sufficient glucose is needed, and the muscles get this glucose from stored glycogen in the liver and the muscle cells themselves. Often, people may see a rise in glucose during power sports as liver glycogen is released into the bloodstream as glucose to supply the muscles.
- Fueling insights: Stored liver and muscle glycogen will get you through the early parts of a power sports event. Later in the event, eating a moderate amount of healthy glucose sources can help fuel maximal muscle contractions when glycogen may be running low. Avoid glucose spikes, as they cause insulin spikes that impair fat oxidation and glycogen synthesis ( the production of glucose from other building blocks like lactate, glycerol, certain amino acids, and possibly ketone bodies in times of low glucose availability).
Duration 75-180 Min, High Intensity (More Than 80% VO2max)
E.g., triathlon, open water swimming, marathon.
What do you want to see from your CGM to optimize performance during competition? It’s shorter than 45 minutes as High Intensity (more than 80% VO tax maximize, suppose you want to optimize performance during extended-duration exercises and avoid bonking, an athlete’s term for running out of energy and hitting the wall. In that case, you will need to consume fuel before or during the event.
Remember, the average person who has neither fasted nor followed a low carbohydrate diet has about 90 minutes of high-intensity exercise fuel stored as glycogen. At this intensity, you are going to be relying primarily on glycogen stores, which will get depleted with a longer high-intensity workout. As these become low, glucose values on a CGM may start to dip, indicating that you want to fuel during your physical activity.
When fueling before a workout to ensure optimal glycogen stores for a long-lasting high-intensity exercise, it seems that a good option is to ingest carbohydrates 2-3 hours before the physical activity rather than immediately before the workout (meaning any time within 60 minutes of the exercise). It is because the carbohydrates will likely generate a glucose and insulin surge, and that insulin can impair fat oxidation and gluconeogenesis.
Suppose this happens 2-3 hours before the workout. In that case, the glucose gets stored as glycogen, and the insulin is recovered to an average amount by the time of initiation of the exercise. In other words, it means that you have successfully filled the glycogen tank and have hormones at an excellent level to tap into fat oxidation during the event, which is a good scenario. On your CGM, this would look like a slight glucose rise 2-3 hours before the workout that returns to baseline by the time of the athletic event.
When fueling during the workout, we also don’t want to generate an excessive spike, which can cause a significant release of insulin and impair fat oxidation and gluconeogenesis during the event. Getting some carbs in, but not in extreme excess, will likely support the optimal hormonal balance.
- Fueling insights: Aim for 30-60 grams of carbohydrates per hour (predominantly in the form of glucose and low in fiber). Liquid carbohydrates should be consumed at 15-20 min intervals throughout exercise, while gels get optimally consumed every 20-40 min. We need more research assessing the use of mouth rinsing for practice lasting longer than 70 minutes, but it will likely be as effective as consuming carbohydrates, as in this case, we need the fuel. Thus, your best bet is to finish your fuel rather than rinse and spit.
Let me give you an anecdote, among several, to demonstrate why I find CGM useful in nondiabetics. A patient came to me with normal glucose tolerance by standard metrics. He began CGM, and after about two weeks, it revealed an average glucose of 104 mg/dL. The standard deviation in his glucose readings, a metric of glucose variability, was 17 mg/dL. He averaged more than five weekly events in which his glucose levels exceeded 140 mg/dL.
All three of these metrics are considered normal by conventional standards, but does that mean there’s no room for improvement? I like to see my patients with a mean glucose below 100 mg/dL, a glucose variability below 15 mg/dL, and, as noted above, no excursions of glucose above 140 mg/dL. After about a four-week intervention that included exercise changes and nutritional modifications, his average glucose fell to 84 mg/dL, his glucose variability to 13 mg/dL, and he had zero events exceeding 140 mg/dL. If he can maintain this way of living in the long run, it’s likely to improve his health span and reduce his risk of glucose impairment.
For many people (certainly for most of our patients and me), when you start wearing CGM, it’s 90% “insight” and 10% behavioral. After a few months, the situation flips. You now have a good idea of what triggers the spikes (i.e., less insight), but it becomes remarkable—in fact, it’s hands-down the best I’ve seen yet—accountability tool (i.e., more behavioral). It’s simultaneously a behavioral and analytical tool that can track and uncover strategies and tactics, saving time and money by preventing bad outcomes in the future. Instead of (or in addition to) questioning groundbreaking technology like CGM, we should do more questioning of ourselves and how we use it.
At the time, the medical authorities considered it crazy that you would measure your body using Biomarkers. That’s something that you do every year with your doctor. Now we know that’s a very medieval way of thinking, and things change month to month, if not day to day, and you cannot optimize what you don’t measure. Continuous is how it has to go because measuring yourself three or four times a year is okay, but it’s not allowing you to change your lifestyle and see what happens with immediate feedback. Of course, I’ve got my levels monitored, and I do that daily. The future has to be like that. The idea that you go to your doctor once entirely is scary and certainly seems medieval.
The framework applied to CGM in non-diabetics.
As you look at something like CGM in the case of non-diabetic, we don’t have significant RCTs to point to that, say, in people who are not yet diabetic, and there is a benefit to using CGM. When we talk about CGM specifically, the risk of harm is shallow (but now zero)
For example, anxiety is the most obvious thing that comes to mind, and it can create obsession in someone instances, and we have some patients with a history of eating disorders. These are patients I would not in any way, shape, or form advocate the use of CGM.
The first potential benefit could be insight-based good, which teaches you about carbohydrate tolerance. The second possible benefit is behavior modification, which is effectively a strapped version of the Hawthorne effect. When you’re wearing a CGM, you’re utilizing a monitoring tool. There is no shortage of data to support the idea that when people get asked to monitor food intake, they change in the right direction. How do you create accountability for patients? You say, “Look, we’re going to check in once a day, and I just want you to tell me what you ate” even if you provide no other instruction, I just need you to tell me what you ate,” that level of accountability immediately changes a person’s behavior.
DATA GIVES SHIT TO OUR FEELINGS SCIENCE-BACKED REVIEW: Blood Sugar Control Strategy
#1: Strength Train
Before diving into strength training, it’s essential to understand the “glucose threshold.” The glucose threshold is the point at which sugar output into the bloodstream (e.g., from sugars in your diet, sugars that get broken down and released by your liver, etc.) and uptake (e.g., sugar getting driven into the muscle) are in balance: if you are above the threshold, then glucose levels rise, and you have high blood sugar, and if you are below the threshold, your blood sugar levels fall or stay the same. You can read more about glucose thresholds and blood sugar levels in this study.
Research has found that when you strength train, your ability to drive glucose into muscle tissue from strength training occurs, and thus your ability to cause a decrease in your glucose threshold can happen when you lift weights that are at least 30% of your single repetition maximum weight (1RM). This is (surprisingly) not that heavy or difficult and means you can control blood sugar and upregulate sugar transporters with even relatively light bodyweight exercise.
Let’s take a closer look at this study. Test subjects (diabetic and non-diabetic overweight middle-aged men with previous resistance exercise experience) were assigned to either a low or moderate-intensity protocol. Both protocols consisted of a weight training circuit of 3 sets of 30 repetitions of six basic weight training exercises that you’re probably familiar with or can easily find at a gym: leg extension, bench press, leg press, lat pulldown, leg curl, and seated row. Subjects recovered for 15-20 seconds between exercises and then for a full two minutes between circuits. Weights were set at 23% of one repetition maximum (1RM) for the low-intensity group and 43% of 1 RM for the moderate-intensity group. Blood sugar and rating of perceived exertion (RPE) were measured both between sets and at 15-minute intervals during a two-hour post-exercise resting period. Subjects also ate a 285-calorie breakfast two hours before the test.
Blood sugar levels in the non-diabetic subjects fell initially during exercise, then rose after it as the body released some sugar into the bloodstream to support the practice (a process known as glycogenolysis), then leveled off again.
No surprises there.
In subjects with type 2 diabetes, both the low and moderate-intensity circuits lowered blood glucose. Surprisingly, the low-intensity course produced lower glucose levels and a lower rating of perceived exertion accompanied by less metabolic stress. This finding should be particularly relevant to overweight or untrained individuals who are just beginning a blood sugar management program or for people who just feel too “tired” to exercise before or after a meal because it means that even a single session of low-intensity resistance exercise at a relatively easy weight can offer significant benefits for blood sugar control.
Now, before leaving the topic of strength training for blood sugar control, it is essential to understand that if you’re already a relatively fit person, the heavier and more intense your strength training, the more rapidly you will deplete muscle and liver glycogen levels, the higher your post-exercise metabolic rate will be, and the greater your amount of blood sugar control will be, so you eventually should progress to workouts such as a heavy 5×5 protocol or any of the other strength training strategies I describe here. But it’s also important to realize that even lightweight training will suffice for primary blood sugar control.
Blood Sugar Control Strategy
#2: Pre-Breakfast Fasted Cardio
A study published in The Journal of Physiology suggests a second, potent strategy for controlling blood sugar, especially in response to a meal: exercise before breakfast, particularly in a fasted state.
In this study, researchers in Belgium recruited 28 healthy, active young men. They began stuffing them with what would be considered a pretty poor diet – a diet comprised of 50 percent processed, unhealthy fat (we’re not talking extra virgin olive oil and avocados, but more like soy and lard and the other nasties fed to subjects in laboratory studies) and 30 percent more calories than the men had been consuming before the survey. A portion of the men (the control group) did not exercise during the experiment, and the rest of the subjects were assigned to one of two exercise groups, working out four times a week in the mornings by running and cycling at a strenuous intensity for 60-90 minutes.
Here’s the kicker: two groups – the control group and just one of the exercising groups – were fed a vast, carbohydrate-rich breakfast. In the case of the fed exercising group, this meal occurred before exercising, and then they continued to ingest carbohydrates (in the form of a sports drink) during their workouts. But the second group exercised without eating and drank only water during the training. The researchers did, however, make up for the abstinence of calories in this second group by matching the energy intake of the first group with a big breakfast later that morning after training, a meal is precisely comparable in calories to the fed group’s big pre-exercise and during-exercise portions.
The experiment lasted for a total of six weeks. In the end, the nonexercising group had, not surprisingly, packed an average of more than six pounds of fat. Furthermore, they also developed insulin resistance, meaning their muscles were no longer responding to insulin and weren’t pulling sugar out of the bloodstream efficiently, resulting in the storage of extra fat in both adipose tissue and within intramuscular fat stores.
And the men who ate breakfast before exercising gained weight, too, although only about half as much as the control group. But somewhat surprisingly, just like the sedentary eating group, they also became more insulin-resistant and stored away a tremendous amount of fat.
You’re anticipating what comes next. Only the group that exercised before breakfast gained no weight and showed zs of insulin resistance. Their metabolic rate changed, so they burned the fat more efficiently. The study’s authors concluded that exercise training in the fasted state is more effective form exercise in the carbohydrate-fed state in stimulating glucose tolerance.
And what was one significant characteristic of that pre-breakfast exercise group? You guessed it: increased levels of the muscle protein GLUT-4, which, as you may recall, is responsible for insulin-stimulated glucose transport in muscle and plays a pivotal role in the regulation of insulin sensitivity.
So, exercise before breakfast? Yep. Here’s my morning routine and how I do it.
High-intensity exercise and more prolonged bouts of walking (e.g., two hours versus one hour) reduce blood glucose levels and insulin secretion, suggesting that the effect of exercise is related more to total energy expenditure rather than to peak exercise intensity, leading the researchers to conclude that it is possible that the short duration of the exercise bout in this study (20 minutes) could have had a more significant impact blood sugar if either the intensity or its time had been increased. This is backed up by the study entitled “Effect of Postprandial Exercise Duration on Glucose and Insulin Responses to Feeding,” which found that more prolonged bouts of exercise after a meal produce a greater significant decrease in glucose and insulin.
Once again, sugar transporters play a significant role here. Researchers reported that “insulin binding to its cellular receptors in muscle and fatty tissues recruits GLUT4 transport proteins to the cell surface that facilitates glucose transport. Muscular contractions stimulate glucose transport into muscle cells without the need for insulin through an independent mechanism, but in an additive manner, thereby potentiating the effects of post-meal exercise.”
So let’s stop for a moment.
What do we know so far from all these studies? We know that one excellent strategy to control blood sugar would be to set a habit of exercising before breakfast in a fasted state, preferably using either more extended aerobic exercise, brief high-intensity exercise, or (if you’re like me) even just a bit of yoga or a simple walk, and then, if time permits, to go on an easy 20-60 minute walk after dinner.
OK, there’s one more strategy; we don’t give that mere importance.
Blood Sugar Control Strategy
Using a standing desk can lower blood sugar levels; there’s research to back it up!
In one study, office workers standing for 180 minutes after lunch reduced the post-lunch blood sugar spike by 43% compared to sitting for the same amount of time. Interestingly, researchers noted that both groups took the same steps after lunch, indicating that the smaller spike in blood sugar was due to standing rather than other physical movements around the office.
Another office worker study discovered that alternating between standing and sitting every 30 minutes throughout the workday reduced blood sugar spikes by 11.1% on average. And yet another study showed that the harmful effects of sitting after meals, with excessive sedentary time post-meal at the office, are linked to a whopping 112% greater risk of type 2 diabetes.
And that is why I recommend standing or walking workstations and incorporating a concept called “greasing the groove.” This is a concept I originally discovered in a book called The Naked Warrior. The idea is this: Instead of (or in addition to) doing a long or hard workout at the gym, and you simply spread your exercises throughout the day.
This not only allows you to become proficient at specific movements such as pull-ups or squats but also elevates your metabolism throughout the day and gets you fit or maintains fitness without always needing to set aside time for structured workouts. For example, I have a pull-up bar installed above my office door, and every time I walk under that bar, I have the rule to do five pull-ups.
Other examples of “Greasing the Groove” that I include in my own life to become fit and control blood sugar even when I’m not exercising are:
- I began daily with a few minutes of yoga, calisthenics, and deep nasal breathing.
- I do 25 body-weight squats.
- Thirty burpees at least once per day.
- I do 100 jumping jacks for every hour that I sit.
- And take a cold shower 2-3 times each day.
You get the idea. Even during a day at the office, you don’t have to “work out” to be working out or to be controlling blood sugar.
Whew! This has been quite a post thus far. You’ve learned why you need to control blood sugar, how sugar can wind up in either fat or muscle, why you should strength train (even at low intensities), the benefits of pre-breakfast fasted cardio, the benefits of post-evening meal walking, and the concept of staying active at the office with activities like standing and greasing the groove.
But I’m still going. At the risk of getting vilified in the comments section of this post, sugar in your food isn’t always bad and doesn’t always mean bad-news-bears for your blood sugar levels.
News Flash: Sugar In Your Food Isn’t Always Bad! Stop Demonizing Insulin
Prepare to be shocked. Ready? Okay, here we go. Sugar is not as bad as you can believe. Yes, you heard me right.
These days, sugar is one of the most demonized substances on the planet. I have been astonished at the number of people who will look at the label of, say, an extremely healthy protein powder or adaptogenic herb complex or kombucha bottle and completely flip out over the 5 to 10 g of sugar or fructose or dextrose or maltodextrin that they see on the label of the package. This practice becomes even more shocking when you look at the level of physical activity in these folks: Ironman triathletes, Spartan athletes, CrossFitters, and people for whom this amount of sugar is genuinely a speed bump when it comes to any amount of metabolic damage.
This would fall into the category of what I have, on a previous podcast, deemed as “orthorexia, “an unhealthy obsession with analyzing every tiny ingredient on a food label and flipping out if there’s even a semblance of something that might make you fat or bump up your blood sugar or be a “toxin.”
And yet you hear the same things over and over again, often from highly active, insulin-sensitive people:
“Sugar is toxic!”
“Any sugar gets turned into fat in the liver!”
“Sugar oxidizes cholesterol, no matter what!”
“It causes massive insulin spikes that make you fat!”
“Sugar rips you out of ketosis and fat-burning mode!”
Whenever I hear such extreme statements about sugar, I get slightly annoyed, and you’re about to discover why.
When Sugar Is Bad?
So, when is the intake of sugar a problem? Let’s turn to this whole “sugar is toxic” argument to answer that question.
In a 2010 review of the science of sugar, entitled “Misconceptions about fructose-containing sugars and their role in the obesity epidemic,” Luc Tappy, a researcher at the University of Lausanne in Switzerland who is considered by biochemists who study fructose to be the world’s foremost authority on the subject, said there is “not the single hint” that HFCS was more harmful than other sources of sugar. Here’s what Tappy has to say:
“A causal role of fructose intake in the etiology of the global obesity epidemic has been proposed in recent years. This proposition, however, rests on controversial interpretations of two distinct lines of research. On the one hand, in mechanistic intervention studies, detrimental metabolic effects have been observed after excessively isolated fructose intakes in animals and human subjects. On the other hand, food disappearance data indicate that fructose consumption from added sugars has increased over the past decades and paralleled the increase in obesity. However, both lines of research are presently insufficient to demonstrate a causal role of fructose in metabolic diseases. Most mechanistic intervention studies were performed on subjects fed large amounts of pure fructose, while fructose is ordinarily ingested together with glucose.
The use of food disappearance data does not accurately reflect food consumption and hence cannot be used as evidence of a causal link between fructose intake and obesity. Based on a thorough review of the literature, we demonstrate that fructose, as commonly consumed in mixed carbohydrate sources, does not exert specific metabolic effects that can account for an increase in body weight. Consequently, public health recommendations and policies aiming at reducing fructose consumption only, without additional diet and lifestyle targets, would be disputable and impractical. Although the available evidence indicates that the consumption of sugar-sweetened beverages is associated with body-weight gain, and it may be that fructose is among the main constituents of these beverages, energy overconsumption is much more important to consider in terms of the obesity epidemic.”
In a nutshell, research shows that sugar-sweetened compounds are harmful to us, not because there’s anything particularly toxic about the sugar they contain but because people consume too much sugar.
The list of research backing up this idea that sugar is not the issue but that overeating sugar is the issue goes on and on.
Your neural nerd will love this! 🧠
Dr. Ateeb Shaikh