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Are Continuous Glucose Monitors (CGMs) Making You Healthier? · Doctor Turned Health Coach

• 0:22
  All right, today I want to talk a little bit about CGMs, continuous glucose
• 0:26
  monitors. They're very popular.
• 0:28
  You've probably heard of them, and you've definitely seen people around where
• 0:32
  they have a little patch the size of a quarter on the back of their arm.
• 0:37
  And it's this little thing that sits there. It's a little sensor that sits there
• 0:41
  with tape over it, and it sits there for about two weeks.
• 0:45
  And you have a device that connects to it and can collect the data.
• 0:49
  It can tell what your approximate blood sugar is.
• 0:53
  So what's the advantage of these things and what's the downside?
• 0:56
  That's really what I want to talk about today.
• 0:58
  And I wanted to make this podcast episode a little bit less scientific and,
• 1:03
  you know, structured and really just to give you an idea of what some issues
• 1:08
  are with a device like this and what are some advantages.
• 1:12
  So imagine you want to make a decision.
• 1:15
  You want to decide what should I do about the way I eat, exercise, my stress levels.
• 1:21
  Those are the common decisions for which we might turn to a continuous glucose
• 1:26
  monitor because we are accustomed to having our blood sugar checked first thing
• 1:30
  in the morning, fasting, right? That's kind of the blood test that we traditionally get done.
• 1:35
  But the downside to that is it only tells you what happened that particular
• 1:40
  day. That Tuesday, September 8th, when you did that test, it only tells you
• 1:44
  how you slept that night, maybe what you ate the past few days.
• 1:47
  It doesn't give you a whole lot of other information.
• 1:49
  The times that fasting blood sugar is really valuable is when it's incredibly low or incredibly high.
• 1:56
  If your test came out at 70, I would say, all right, you know,
• 1:59
  there's probably something going on that's bigger that we can identify.
• 2:02
  If it came out at 130, I'd say, okay, there's definitely some problem with your
• 2:07
  body metabolizing sugar, maybe your hormones or insulin, something is off and
• 2:12
  we can do something about that.
• 2:14
  However, when you're in the middle, not so useful. So you might say,
• 2:18
  okay, well, I'm going to wear this patch and then I'm going to eat whatever I eat.
• 2:21
  And based on that, I'm going to make a decision as to what I should avoid, what is okay for me to do.
• 2:28
  And maybe you even assume that it's going to help you lose weight,
• 2:30
  become healthier, fitter.
• 2:32
  There's a few problems with that. The first one is some people will have ice
• 2:36
  cream and their continuous glucose monitor is not going to spike because their
• 2:40
  body just doesn't tend to spike a lot from ice cream.
• 2:44
  But they might have a banana and it's going to spike. So they assume,
• 2:48
  I should stop having bananas.
• 2:50
  What they don't realize is that it's actually not that ice cream is okay and
• 2:54
  bananas are bad, or bagels are okay and bananas are bad.
• 2:58
  The problem is your body is in a current metabolic position where it's doing
• 3:03
  whatever it wants to. Maybe it's not very predictable.
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  And just because it doesn't respond to, let's say, the ice cream,
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  but it responds really bad to a banana, it doesn't mean that over a long term,
• 3:16
  if you continue having ice cream as your snack and avoid bananas,
• 3:19
  that your overall health will be better.
• 3:21
  And we could maybe say that, in general, most of you, I think, will agree that, look.
• 3:27
  Ice cream probably has a lot of sugar, has a lot of fats, has a lot of additives,
• 3:31
  and it's probably not going to be as good for your body.
• 3:34
  And it's much easier to overeat ice cream. But bananas or any other kind of
• 3:38
  fruit, even though they might spike your sugar, in the long run,
• 3:42
  they actually might be better for you.
• 3:44
  This idea, this concept that anything that spikes your sugar is bad and a spike
• 3:49
  of sugar must be a bad thing is false.
• 3:53
  And I'm not trying to say that CGMs are bad or that the data interpretation.
• 3:58
  Is done improperly. We'll get to that in a minute.
• 4:01
  What I'm trying to say is that it's a much bigger picture.
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  The way you slept the night before, your stress levels, how much you exercise,
• 4:09
  all of those things also affect your blood sugar.
• 4:13
  And well, your plasma, it's not your plasma, it's your, I forgot what the actual
• 4:18
  thing is that it measures when it sits in your arm.
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  What really matters when you
• 4:23
  want to make a decision based for with any kind of data is to understand,
• 4:28
  what are all the things that affect that data and if you make that decision
• 4:32
  what are all the potential downstream effects of that decision i could have
• 4:36
  somebody who says i'm just going to eat meat because i've noticed that with meat,
• 4:42
  i will never have any problems with my blood sugar. It's steady as steady can be.
• 4:47
  The downside, of course, as if you listen to my content, is generally a very
• 4:52
  restrictive diet of only meat.
• 4:53
  Number one is not sustainable. Number two might give you some problems,
• 4:57
  maybe with your cholesterol, maybe with your fiber, maybe with your digestion,
• 5:02
  maybe with acne, maybe with a whole lot of other stuff. Or it actually might be incredible for you.
• 5:07
  You might switch to a carnivore diet and feel amazing and fix a lot of things.
• 5:12
  But we just can't use a CGM for that information.
• 5:16
  A classic example I always like to give, if you have a bagel,
• 5:21
  right, maybe your CGM will go from 100 to 120 or 110 and then it'll kind of
• 5:28
  come down over the next six hours.
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  When you have a banana, your sugar might spike to 160, but it might come down
• 5:37
  to back to 90 or 100 very quickly, within an hour, within two hours. So what happened there?
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  The amount of time, the duration of time that your blood sugar was over 100
• 5:49
  was much longer, much larger with the bagel.
• 5:53
  And we call that the area under the curve. It doesn't matter.
• 5:55
  A lot of CGMs and apps and devices can actually measure that for you, but they simply are not,
• 6:00
  sophisticated enough to factor other things in, like, okay, well,
• 6:04
  maybe you were stressed, maybe you didn't sleep enough, maybe you also did hard exercise.
• 6:09
  And exercise is a classic example for somebody who wants to make a decision
• 6:14
  based on their blood sugars alone, or I should say the CGM data alone.
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  Because if you do hard exercise, especially if you do kind of that higher intensity,
• 6:25
  70 80 90 percent of your max heart rate exercise your blood sugar is going to
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  go up does that mean you should avoid that exercise
• 6:33
  hopefully you don't believe that right because that's really how we get our
• 6:37
  vo2 max to go up that's how we really improve our cardiorespiratory fitness
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  so should you use a cgm should you not use a cgm
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  the first question i ask myself is do i have enough data to tell me already
• 6:49
  what i should be changing what i shouldn't be changing have i tried enough things.
• 6:54
  If you haven't figured this part out yet, it's probably not a good idea to jump
• 6:57
  to a CGM because it's a lot of data points that if you don't have really good
• 7:02
  help with, you might make wrong decisions for your long-term health.
• 7:06
  Because yes, maybe you'll improve your body composition, your weight might come
• 7:10
  down, your muscle mass might go up.
• 7:12
  But did you actually decrease your risk of autoimmune disease?
• 7:15
  Did you decrease your risk of dementia? Did you decrease your risk of joint
• 7:19
  damage, of diabetes? because it's not that simple, right?
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  These are complicated phenomenon that have many different factors that play into them.
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  Now, who is a CGM good for? If you really have no idea where your blood sugar
• 7:35
  is, what's driving it, and you just want to get a sense of how different things
• 7:39
  affect it, and you are really motivated to take strong action, a CGM can be really nice.
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  But if you need a CGM data to keep you motivated and take action,
• 7:50
  I can generally tell you from the experience of thousands of patients that I've
• 7:54
  had who've worn CGMs, it's one of those devices that you simply can't wear for a very long time.
• 8:00
  You just burn out from it. So it's a lot of data. It's a lot of things to keep track of.
• 8:05
  So maybe a better option is to just get a handheld glucose device.
• 8:12
  And that one is just $30, right? And it doesn't, it doesn't attach to you all the time.
• 8:16
  And you could just measure your blood sugar from time to time.
• 8:18
  If you really are like, hey, you know, I was really stressed during this meeting.
• 8:22
  I want to know what my blood sugar is. Or I woke up in the morning and I got
• 8:26
  super, super hungry. Is my blood sugar really, really low?
• 8:29
  Like if your blood sugar is in the 60s and 70s when you wake up in the morning,
• 8:32
  that's an indication that, whoa, you better eat something. But not only that,
• 8:36
  you better figure out what is crashing your blood sugar so low overnight.
• 8:40
  So that can be kind of helpful.
• 8:42
  Another problem, kind of the last problem actually that I'll mention,
• 8:45
  is for some people, a blood sugar of 100 may be okay. For another person,
• 8:50
  100 is a big problem. They really need to be at 80.
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  For another person, they get super hungry at 70.
• 8:57
  And for another person, they don't get hungry even at 65, 60.
• 9:03
  So there is a lot of individuality that we just haven't teased out,
• 9:07
  haven't figured out. And if we figured them out, they haven't been incorporated
• 9:12
  into these devices. They haven't been incorporated into the technology.
• 9:15
  And so you're not really getting good data from that.
• 9:18
  So all of this to say that CGM is...
• 9:22
  A boatload of data coming at you all at once. And yes, you might make a decision
• 9:27
  that lowers that number.
• 9:29
  What we don't know is if that number is actually lower, are you healthier?
• 9:35
  Because again, there are so many different factors that play into it.
• 9:39
  Now, I know this is a bit of a controversial topic because every,
• 9:44
  fancy concierge doctor, every high-end bespoke physician these days,
• 9:49
  they slap a cgm on you as soon as you walk in the door
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  and they might be able to do that it might actually be good for them because
• 9:56
  they have the technology they have the manpower to sit there and interpret that
• 10:01
  data but the question is is it right for you.