We are big fans of using data to better understand your body and your health. In that context, we think continuous glucose monitoring (CGM) might be the single most important hack you can do for longevity.
If you are new to the idea of using a CGM device, thispodcast episode of “Data-driven Health Radio” will get you fully up to speed and will get you excited to try it for yourself.
The podcast is an interview ofDr. Casey Means the Co-Founder and Chief Medical Officer ofLevels Health. This is one of a few companies pioneering the use of CGM as a direct-to-consumer service (use of CGM devices has been traditionally limited to people with diabetes).
The interview is really worth listening to in its entirety. Here are our highlights:
Dr. Mean’s Journey: The Promise of Personalized Medicine
The story of how Casey Means ultimately decided to start Levels Health follows a familiar pattern among people focused on longevity. She studied human biology at Stanford University at a time when data-driven consumer testing companies such as 23andMe were starting to gain momentum.
It was a time of great promise about the future of personalized medicine and she came to see health as defined by how our unique biochemical genetic blueprint (i.e., our genome) is affected primarily by our food and lifestyle choices (i.e., epigenetics, or how our genes are expressed in practice).
When she attended Stanford Medical School, however, she quickly realized that the mentality in the medical community was very different. She learned that the focus of conventional medicine was all about pattern recognition.
The cornerstone of medical practice is to analyze a patient’s signs and symptoms in order to arrive at a diagnosis that would in turn trigger prescribed courses of action. An approach focused on understanding the biochemical individuality of each person, and using dietary and lifestyle tools based on this information were not a priority in med school.
After getting her degree, Dr. Means became a Neck and Head surgeon. In her practice focused on eyes, ears and throat medicine, she started noticing two things:
(1) most of the conditions she was treating were inflammatory in nature (e.g., sinusitis); and
(2) treating these conditions with surgery was ineffective as it did not address the root causes. So she saw lots of patients coming back with recurring symptoms.
Taking a step back trying to understand why, she quickly realized that many of the conditions she was treating seemed to share similar root causes: poor diet, sedentarism, stress, poor sleep practices, and disrupted microbiomes.
She concluded that if she was going to make a difference in helping her patients reclaim their health, she needed a different approach.
A New Approach
She decided to shift her focus from surgery to functional medicine. She completely reframed her practice around longevity and metabolic optimization.Functional medicine is very different from conventional practice because it is based on a systems approach to illness. It cuts through all the specialization silos that define current medicine today and focuses on the connections.
This approach led her to conclude that most of the chronic diseases she was seeing shared metabolic dysfunction as a root cause. And she knew that this could be effectively addressed through diet and lifestyle changes.
Dr Means started seeing great results with her patients. By getting them to focus on the four levers that determine blood sugar (food, movement, stress, and sleep) their health started to improve quickly.
But treating one patient at a time put a firm ceiling on the difference she could make. She concluded that if she was really going to maximize her impact, she needed to do something different. Something that could really scale.
Her search for a new approach zeroed in on models of behavior. She wanted to find a way by which people could change their habits to achieve better health outcomes.
That’s when she saw a glaring gap: nutrition is a notoriously open loop system. It provides no immediate feedback and its effects are only seen over time.
Dr. Means realized that if she could close the loop between what you eat and what it does to your metabolism, people would have clear reasons and motivation to adjust their behavior.he knew from experience that the way to do this was through constant monitoring of your blood sugar.
That’s what led her to start Level Health.
The Profound Benefits of Continuous Glucose Monitoring
A continuous glucose monitor consists of a sensor the size of a quarter that you wear in the back of your arm. It has a very thin filament that easily and painlessly goes under your skin. Each sensor can be worn for 14 days.
Through this sensor, the CGM takes a blood glucose measurement every 15 minutes and sends that information to an app on your phone. Until companies like Levels Health came along, CGMs were available only to people with diabetes. Now anyone can access this technology.
The huge benefit from using a CGM is learning how your day to day activities influence your glucose levels. Your morning (fasted) glucose and, more importantly, the up and down swings in glucose levels (glucose variability) you experience during the day (due to food, stress, exercise, etc.), are highly reliable independent predictors of metabolic health.
Every time you experience a spike in blood sugar, your body needs to react by creating insulin to process it. Over time, your cells become less sensitive to the insulin and get less efficient at clearing blood sugar. This is the path that eventually leads to metabolic dysfunction and chronic diseases like Type-2 Diabetes.
A CGM makes it very easy to see these glucose spikes and gain clarity as to what triggers them. That insight closes the loop between behavior and effect, which then makes it much easier to adjust your habits and to learn how to modulate your glucose spikes.
Information = Actionability for Health
With a CGM, you can experiment with sequencing your food in different ways to minimize glucose variability. For example, It has been observed that if you precede carbs with protein, fat, or fiber, you can minimize the impact on glucose levels.
You can also modulate glucose levels after a meal simply by taking a short walk or practicing deep breathing techniques. Other glucose modulating tools include intermittent fasting, exercise, and adjusting portion sizes.
Dr. Means points out that staying healthy does not necessarily require you to give up carbs. She herself is vegan and consumes large amounts of carbs. But through trial and error, combined with the visibility afforded by a CGM, she learned how to keep her glucose levels flat throughout the day.
In her view, staying healthy is about having the information you need to better understand your metabolism so that you can self-regulate and lower your exposure.
And this information is highly dependent on each individual. Two people can have the exact same meal at the exact same time and have diametrically opposed glucose responses.
Metabolic Intuition and long-term health
Understanding what is going on inside your body (somatic awareness) has been shown to be correlated with better health outcomes. That’s essentially because when you are more in tune with your body you are better able to listen to what it is trying to tell you. You can then more easily self-regulate and promote positive behaviors.
With a CGM, your body gives you that feedback very easily. You can start linking your post-meal slumps or your late afternoon anxiety to these glucose spikes, and you can pair that with how you are subjectively feeling to derive deep insights on how your body functions. This is what Dr. Means calls metabolic “intuition.” She has used CGM for long enough that now she can be very accurate in predicting her glucose levels by how she feels at any given moment.
Ultimately, what Dr. Means aspires to do is provide a tech-enabled solution that can help people reconnect with their body and understand the cues that it gives so we can take more control over our health.
What you can do
Experiment with a continuous glucose monitor (CGM) yourself to gain a thorough understanding of your body and which factors affect it positively and negatively. You can sign up for the Levels Health programhere.
Another alternative offering a similar solution is Nutrisense. You can learn more about their offeringhere.