How Continuous Glucose Monitors (CGMs) Improve Metabolic and Mental Health

Summary

Dr. Bret Scher from Metabolic Mind discusses the benefits and nuances of continuous glucose monitors (CGMs) for metabolic and mental health. While CGMs offer real-time blood sugar data, aiding those with diabetes and metabolic dysfunction, they're not without limitations. The video emphasizes the importance of understanding CGM data within the context of individual lifestyle and dietary choices, suggesting that CGMs can serve as an educational and accountability tool, potentially improving both metabolic and mental health.

Takeaways

• 📈 CGMs are valuable tools for monitoring and improving metabolic health, which can potentially enhance mental health.
• ⚠️ CGMs measure glucose levels in the interstitial space, not directly in the blood, and readings may have a slight delay.
• 👨‍⚕️ CGMs were initially designed for people with type one diabetes but have expanded their utility to those with type two diabetes and metabolic dysfunction.
• 🧠 The connection between metabolic health and mental disorders like depression and anxiety suggests CGMs could indirectly benefit mental health.
• 🚫 Traditional blood sugar measurements like fasting blood sugar and hemoglobin A1C have limitations in assessing metabolic health.
• 🍽 CGMs provide detailed insights into how specific meals, exercise, sleep, and stress affect blood sugar levels.
• 🔍 CGMs allow for personalized dietary experiments to understand individual responses to different foods and lifestyle factors.
• 📉 CGMs can show that certain foods, like red meat, might not negatively impact blood sugar levels as believed by some.
• 🏃‍♂️ Physical activity such as walking after meals can help reduce postprandial blood sugar spikes.
• 🤔 There is no consensus on the 'ideal' glucose response, but postprandial levels under 140 mg/dL and returning to baseline within an hour are suggested as optimal.
• 🌅 CGMs can help differentiate between normal physiological responses like the dawn phenomenon and signs of insulin resistance in those practicing intermittent fasting or a low-carb diet.

Q & A

What is a Continuous Glucose Monitor (CGM) and how does it work?

A Continuous Glucose Monitor (CGM) is a small device that attaches to the abdomen or upper tricep area. It uses a micro filament that pierces the skin and sits in the interstitial space to provide near real-time measurements of blood sugar levels.

How accurate are CGMs in measuring blood glucose levels?

CGMs are generally very close to actual blood glucose levels and provide near real-time data. However, they are not perfect as they measure glucose in the interstitial space, not directly in the blood, and there can be a few-minute delay in the readings.

Who were the initial users of CGMs and how has their use expanded?

CGMs were initially used by people with type one diabetes to adjust their insulin pumps quickly. Their utility was soon recognized for helping people with type two diabetes, metabolic dysfunction, and even those without medical conditions looking to improve their metabolic health.

What is the potential link between metabolic health and mental health as discussed in the script?

The script suggests that poor metabolic health is strongly associated with an increased risk for mental disorders such as depression, anxiety, bipolar disorder, and schizophrenia. Therefore, improving metabolic health through tools like CGMs could potentially help improve mental health.

Why might fasting blood sugar measurements be considered 'worthless' in the context of the script?

Fasting blood sugar is criticized as it only provides a one-time check and does not reflect the blood sugar levels throughout the day, which is a more comprehensive view of metabolic health.

How does a CGM differ from traditional methods like fasting blood sugar and hemoglobin A1C?

A CGM provides continuous, near real-time data on blood sugar levels, showing how they respond to meals, exercise, sleep, and stress. In contrast, fasting blood sugar and hemoglobin A1C offer only a snapshot or an average over a three-month period, without daily fluctuations.

What experiments can one conduct with a CGM to understand the impact of different foods on blood sugar?

With a CGM, one can experiment with how specific foods like oatmeal or red meat affect blood sugar, or how the order of macronutrient intake (fat and protein before carbs) influences glucose response.

What is the 'dawn phenomenon' mentioned in the script and how does it relate to CGM readings?

The 'dawn phenomenon' refers to an early morning rise in blood sugar levels, which can be seen in CGM readings of those practicing intermittent fasting or following a low-carb diet. This rise is not necessarily a sign of insulin resistance but could be a normal physiological response.

How does the script suggest interpreting CGM data for individuals practicing intermittent fasting or on a low-carb diet?

The script suggests that for those practicing intermittent fasting or on a low-carb diet, CGM data should be interpreted within the context of their lifestyle, considering that a morning rise in blood sugar might be due to the dawn phenomenon rather than insulin resistance.

What is the role of a healthcare practitioner in the context of using CGMs, as per the script?

The script recommends working with a healthcare practitioner experienced with ketogenic therapy to evaluate standard tests and CGM data within the right context, especially for those in ketosis, ensuring proper interpretation and guidance.

How can CGMs serve as an 'accountability partner' in managing one's health?

CGMs can act as an accountability partner by providing real-time feedback on how dietary choices affect blood sugar levels, which can motivate individuals to adhere to their health goals more strictly.

Outlines

00:00

📊 Understanding CGMs for Metabolic and Mental Health

The video script discusses the impact of Continuous Glucose Monitors (CGMs) on metabolic health and its potential influence on mental health. CGMs, initially designed for type one diabetics, are now recognized as valuable tools for improving lifestyle and metabolic health, which could indirectly benefit mental health. The script emphasizes the importance of understanding how CGMs work, their limitations, and how they can provide detailed insights into blood sugar levels throughout the day, unlike traditional methods like fasting blood sugar and hemoglobin A1C tests. It also cautions viewers to consult healthcare providers before making lifestyle changes and acknowledges the lack of consensus on ideal glucose levels for non-diabetic individuals.

05:02

🔍 Exploring CGMs' Role in Intermittent Fasting and Low Carb Diets

The second paragraph delves into the use of CGMs for individuals practicing intermittent fasting and following low carb diets. It addresses the common misconception that early morning blood sugar rises indicate insulin resistance, suggesting instead that this could be a normal response in the context of a low carb lifestyle. The script advocates for a reevaluation of standard medical tests for those in ketosis and emphasizes the importance of working with healthcare practitioners experienced in ketogenic therapy. Additionally, it highlights CGMs as accountability tools, helping individuals maintain their dietary and lifestyle choices by providing real-time feedback on blood sugar levels. The video concludes by encouraging viewers to engage with the content, seek further information, and consider how CGMs might assist in improving both metabolic and mental health.

Keywords

💡Continuous Glucose Monitors (CGMs)

Continuous Glucose Monitors, or CGMs, are wearable devices that track blood sugar levels in real time. They are typically worn on the abdomen or upper arm and use a small filament to measure glucose levels in the interstitial fluid. In the video, CGMs are discussed as a tool for improving metabolic health, which can have a positive impact on mental health. The script highlights how CGMs provide more detailed information than traditional blood sugar tests, allowing users to see how different factors like diet, exercise, and stress affect their glucose levels.

💡Metabolic Health

Metabolic health refers to the body's ability to properly process and utilize nutrients, particularly glucose. It is a critical aspect of overall health, as poor metabolic health can lead to conditions like diabetes and is also linked to mental health disorders. The video emphasizes the role of CGMs in managing and improving metabolic health, which can, in turn, support mental well-being.

💡Mental Disorders

Mental disorders encompass a wide range of conditions that affect a person's mood, thinking, and behavior. The video script suggests a correlation between metabolic health and the risk of developing mental disorders such as depression, anxiety, bipolar disorder, and schizophrenia. The discussion implies that by improving metabolic health through the use of CGMs, one might also mitigate the risk or manage these mental health conditions.

💡Interventional Studies

Interventional studies are a type of clinical research where an intervention, such as a new treatment or lifestyle change, is deliberately introduced to a group of participants to observe its effects. The video mentions that there are no outcome studies on healthy individuals using CGMs, but data from studies involving individuals with type one diabetes can be extrapolated to understand potential benefits for a broader population.

💡Fasting Blood Sugar

Fasting blood sugar is a measure of blood glucose levels after an overnight fast, typically taken in the morning before breakfast. The video script criticizes fasting blood sugar as a 'worthless test' because it only provides a snapshot and does not reflect blood sugar levels throughout the day, which is where CGMs offer a more comprehensive view.

💡Hemoglobin A1C

Hemoglobin A1C, or A1C, is a blood test that provides an average blood sugar level over the past two to three months. It is used to diagnose and monitor diabetes. The video script contrasts A1C with CGMs, noting that while A1C gives a broader picture, CGMs offer real-time, day-to-day data that can be more actionable for individuals looking to manage their metabolic health.

💡Postprandial Blood Sugar

Postprandial blood sugar refers to blood glucose levels after a meal. The video discusses the importance of monitoring postprandial blood sugar increases, suggesting that levels should ideally be under 140 milligrams per deciliter and return to baseline within an hour after eating. CGMs allow individuals to track these levels and make dietary and lifestyle adjustments accordingly.

💡Dawn Phenomenon

The dawn phenomenon is a natural rise in blood sugar levels in the early morning hours, even in individuals without diabetes. The video script mentions that low-carb dieters or those in ketosis might experience an early morning rise in blood sugar, which could be misinterpreted as a sign of insulin resistance. However, with a CGM, they can monitor that this rise is part of a normal physiological response and not indicative of metabolic dysfunction.

💡Ketogenic Therapy

Ketogenic therapy, or keto therapy, is a treatment approach that involves a very low-carbohydrate, high-fat diet to induce ketosis, a metabolic state where the body burns fat for energy. The video suggests that individuals on a ketogenic diet may benefit from CGMs to monitor their blood sugar levels and ensure they are within a healthy range, especially since standard metabolic health markers might not apply in the same way to those in ketosis.

💡Accountability Partner

An accountability partner is someone who helps you stay committed to your goals, often by monitoring your progress and providing encouragement or feedback. In the context of the video, CGMs are described as an 'accountability partner' because they provide real-time feedback on blood sugar levels, which can motivate individuals to stay on track with their dietary and lifestyle goals.

Highlights

Continuous glucose monitors (CGMs) are a valuable tool for improving metabolic health and potentially mental health.

CGMs provide near real-time measurements of blood sugar levels, offering detailed insights into metabolic health.

CGMs were initially designed for people with type one diabetes but have broader applications.

The strong link between poor metabolic health and mental disorders suggests CGMs could aid in mental health improvement.

Fasting blood sugar and hemoglobin A1C tests have limitations in assessing metabolic health.

CGMs offer a more comprehensive view of blood sugar responses to meals, exercise, sleep, and stress.

CGMs can help individuals understand how specific foods affect their blood sugar levels.

There is no universal response to ketosis, and individual reactions to CGMs may vary.

CGMs can be controversial due to differing opinions on what constitutes a healthy glucose response.

The goal of CGM use is not necessarily a flat glucose line but understanding glucose fluctuations.

Interpreting CGM data requires consideration of individual metabolic contexts, such as low-carb diets.

CGMs can serve as an accountability tool, helping individuals adhere to dietary and lifestyle changes.

For those practicing intermittent fasting or on a low-carb diet, CGMs can provide insights into morning glucose rises.

CGMs can help differentiate between normal physiological responses and signs of insulin resistance.

Working with a healthcare practitioner experienced in ketogenic therapy is recommended when using CGMs.

CGMs are not only educational but can also serve as powerful tools for improving both metabolic and mental health.

Transcripts

Continuous glucose monitors, or CGMs

have taken the metabolic health world by storm,

but not without some controversy.

Now I believe that as a whole, CGMs are an incredible tool

for helping people improve their lifestyle

and metabolic health.

And by improving metabolic health

they have the potential to help improve mental health.

However, there are some caveats

and important details to understand

to get the most benefits from CGMs.

So let's dig into the details

so you can better understand if CGMs could help you

achieve your health goals.

Welcome to Metabolic Mind, a nonprofit initiative

of Baszucki Group, transforming the study

and treatment of mental disorders

by exploring the connection

between metabolism and brain health.

Thank you for joining us on this journey.

Before we get into the details of CGMs,

please remember our channel is

for informational purposes only.

We're not providing individual or group medical

or healthcare advice or establishing a

provider patient relationship.

Many of the interventions we discussed can have potentially

dangerous effects if done without proper supervision.

Consult your healthcare provider

before changing your lifestyle or medications.

In addition, please recognize

that people may respond differently to ketosis

and there isn't one recognized universal response.

Now, as many may know,

A CGM, continuous glucose monitor, is a small device

that goes on your abdomen

or upper tricep area that has a micro filament

that pierces your skin

and sits in what's called the interstitial space

and it provides near realtime measurement

of your blood sugar.

So the first caveat is it isn't perfect,

it isn't actually in your blood,

so it's not directly reading it.

And there is a few minute delay in its readings

between what's in the blood and what it picks up on.

But all in all, they tend to be very close

to your blood glucose level and very close to real time.

Now, they were first using people with type one diabetes

who needed to adjust their insulin pumps quickly according

to their momentary glucose readings.

But others quickly saw the utility for helping people

with type two diabetes, metabolic dysfunction,

even people without any medical conditions who want

to improve their metabolic health.

And since there's such a strong association

between poor metabolic health

and the risk for mental disorders like depression, anxiety,

bipolar disorder, schizophrenia, among others

it makes sense that by associations CGMs can help improve

mental health as well.

But here's the problem with what we're doing now.

So the blood sugar measurements we usually use in medical

practice have some gaping holes in

what they tell us about our metabolic health.

Fasting blood sugar is the most commonly used

and in my opinion, most worthless test, that we have.

It's a one-time check and tells us nothing about

what our blood sugar is doing 99.9% of the time.

So a hemoglobin A1C is much better

as it provides an estimated average blood sugar over a three

month period, but that requires waiting three months

to evaluate the effect of a lifestyle

or medication change or other intervention.

And it doesn't tell you specifics about what you did

that may have helped or hurt your blood sugar.

But a CGM tells you so much more.

You can see your fasting blood sugar

how your blood sugar responds to specific meals

to exercise, poor sleep, stress, and more.

And it can give you a daily average of your blood sugar.

It's kind of like a running hemoglobin A1C

on a day-to-day basis.

So are you curious about maybe

how the heart healthy oatmeal affects your blood sugar

or the Honey Nut Cheerios

with a heart-healthy seal on the box,

many people find they aren't so healthy after all

once you're wearing a CGM.

Or since many in the medical and dietary world

believe red meat causes diabetes,

maybe you want to see how red meat affects your blood sugar.

Chances are you'll see red meat within the context

of a low carb diet treats, rather than causes

type two diabetes for most people.

And there are other cool experiments you can do

like what happens when you eat fat and protein first

and carbs last or vice versa,

you'll likely see a difference in your blood sugar response

with the glucose peak lower

and slower when carbs are eaten last after fat and protein.

Or how does going on a walk

after your meal affect blood sugar?

It likely helps blunt the post meal or postprandial rise.

And there are endless experiments with food

and other lifestyle activities that you won't be able

to learn with just a fasting blood sugar

or even a hemoglobin A1C,

but there tends to be disagreement about how

to interpret a CGM.

My disclaimer is that there haven't been outcome studies on

healthy individuals using CGMs.

Most of the data come from people with type one

or some with type two diabetes,

but we can use that data as well

as data from observational studies in healthy populations

to reach some general conclusions.

But here's a key point.

The goal isn't necessarily a completely flat glucose line.

And here's where CGMs can be controversial.

It's normal to have variations during the day.

The key is how high they go and how long they stay up

before returning to baseline.

I'll say that again, it's normal for glucose to go up

and down during the day.

But how much up and down is okay or healthy?

Now we have to admit right

there isn't clear consensus on this question

for people without type two diabetes.

But I can say it should be better than the

general population.

As some studies suggest over 90%

of the American population have some degree

of metabolic dysfunction.

So in this setting, we don't want

to be normal or average, right?

So my opinion is that postprandial blood sugar increases

should be under 140 milligrams per deciliter at a maximum,

and 120 is likely even more ideal

and they should return

to baseline within an hour after eating.

But being even tighter than that is unlikely

to provide significant further benefits, I think.

Again, there's no data on this,

but to me it just makes sense from the data that exists.

And there are other situations to consider with CGMs.

For instance, those who practice intermittent fasting

and eat low carb may find their early morning

blood sugar rises.

Maybe they go from mid 90s to now 105 or 110.

According to medical guidelines

that come from a high carb society

this is a sign of pre-diabetes and insulin resistance.

But many who are eating low carb

or in ketosis may find this finding is consistent

with what's called the dawn phenomenon.

And the CGM may show

that their average daily glucose is improved from before

and solidly in the normal range.

Thus suggesting the morning glucose rise is a normal

physiologic response to low-carb and intermittent fasting

and not a marker of insulin resistance.

But you likely need a CGM to investigate with

that granularity if it's indeed the case.

So situations like this highlight the need

to evaluate standard tests within a different lens

for those are in ketosis.

And that's one of the many reasons why we recommend working

with a healthcare practitioner experienced

with ketogenic therapy.

There are a number of sites where someone can search

for these practitioners and we will link

to them in the description below.

And one more thing to mention is

that CGMs can be a great accountability partner.

Well, what do I mean by that?

Well, let's say you want to stray

from your low carb way of eating

and add in high carb or high sugar foods.

If you don't feel any different right away

there may not be a deterrent to continuing along this path.

But if you see your blood sugar shooting up in real time,

all of a sudden you may be more likely to get back on track,

and that's a powerful accountability partner.

So the bottom line is that a CGM can be a powerful

educational and accountability tool

to help someone improve their metabolic health.

And given the connection between metabolic and mental health

they can likely be powerful tools

for helping with mental health as well.

And I hope you found this helpful.

If you did, please like and subscribe

and please leave us a comment as I'd love

to hear your experience with CGMs.

Also, you may want to watch our prior video outlining the

important connection between metabolic

and mental health to better understand

how improving one can help improve the other.

All right, thank you for watching.

I'm Dr. Bret Scher, and we'll see you here next time

at Metabolic Mind.

A non-profit initiative of Baszucki Group.