When you had “spikes”, how high was that? (ideally in mmol/l, but I can divide by 18)
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My brief experience using a CGM was very educational. It’s one thing to hear that I should take a walk after eating or avoid highly processed grains, etc. I hear all kinds of things that are supposed to be good for me, and how do I know if those rules of thumb apply to me?
Well, now I know the rules apply to me as well. If a CGM cost $20/month or less, I’d wear one all the time.
After the CGM, diet changed as follows:
- movement after eating carbs (I only eat an apple immediately before a workout for example)
- higher glycemic foods in morning (steelcut oatmeal, berries)
- no bread, pasta, rice on a regular basis
- no eating lunch; breakfast and dinner only
- eat protein / fat first (I eat an egg (or 3) before my oats and berries, for example)
- no sports or protein bars (amazingly bad for me)
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This is how the LEVELS app defines sugar spikes. What is a blood sugar spike, and why does it matter? - Levels
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The operating worse is “supposed”. Be careful with this hearsay wisdom. I can tell you numerous times in medicine, where doctors recommended a treatment because it was supposed to be good for the patient when in actual studies it turned out not be the case. For example doctors pushing Vitamin E or fen-phen in the 90’s and other non-sense.
My take on CGM data based behavior modification is that at best it’s a costly nuisance and at worst it can be harmful if it leads to unhealthy dietary changes like for example - not eating fruit or skipping meals. This is coming from a guy that did years of KETO and IF while competing in mountain bike racing… and getting podiums until I wrecked my body with unsound dietary experiments.
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I agree with much of what you say but cling to the idea that I’d rather have more data about how my body works than less data.
It’s up to me to make good decisions with the data. But without data I have to rely on “rule of thumb”. If I make mistakes, hopefully I’ll see indicators in my blood work and physical / mental performance. I’ve made a lot of mistakes to be honest but I’m learning as fast as I can.
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AIUI there is a good argument to keep peaks below 8mmol/L 140/144 mg/dL. That is because it keeps out of the inositol metabolism.
As far as I can tell Levels think this figure should be lower. I don’t know their arguments for this and I am completely relaxed at hitting say 140mg/dL post prandial after 90mg/dL preprandial as long as it comes back down.
That, however, is an argument about Levels and their analysis rather than the principle of a CGM. I am pleased to have worn a CGM whilst taking Rapamycin and then going on a pub crawl. It was quite informative.
The thread is here:
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The sole reason this forum exists is the fact that rapamycin showed clear life extension in every animal study to date and some clinical benefit in at least one trial human trial. Do you really think any of the forum members would otherwise self experiment with taking an immunosuppressant ? Personally, I am still waiting for more data on rapamycin before trying the regimen myself. Brad Stanfield will begin his human trials soon and Matt Kaeberlein dog studies will finish in several years.
Exactly the point I was trying to make, though I may have been unclear. You are on the fence about rapamycin (and other interventions/tools) precisely because the data don’t yet support it for you and your particular risk/benefit threshold or profile. I’m not suggesting that anyone here is blindly trying things with NO data. However, a lot of people are comfortable enough with the risk/benefit profile of certain interventions based not on large or long-term human clinical trials. I agree it would be wonderful to have plenty of long-term human data, but a lot of people aren’t waiting because the data suggest to them that the benefits outweigh the risks.
This is, I think, the crux of the difference in mindset between clinicians like you and Dr. Stanfield, and those people labeled “biohackers” who are willing to try interventions that haven’t been through the same clinical testing process that most treatments in medicine have. And although rapamycin has more data behind it than using CGM for longevity purposes, this is largely still from animal data. And, no one is going to try to validate whether CGM works in animals the way many people are using it, because it just doesn’t apply; further, no one is likely to fund a human study to determine whether CGM is useful for longevity either. Thus, like with a lot of interventions discussed on this forum, many people don’t see the lack of a clear demonstrable benefit from clinical trials as a roadblock to using it and testing whether it provides a benefit to them. Like with any intervention, we could be wrong and doing more harm, but at this point a lot of what is discussed here is experimentation based on educated speculation anyhow.
The reason I am pushing back hard on the CGM is the cost of $3000 or so per year. That is a lot of money for “experimentation”. IMO, for an average individual this is an awful misallocation of resources. For example, for $3000 you can build a small home gym with weights, treadmill, etc. Exercise is hands down the ultimate way to extend your lifespan proven by very clear results of hundreds of human studies.
I don’t disagree with you on this point, if every CGM cost this much. I currently pay nothing for my CGM and have a prescription for a year’s worth of sensors, even though I am not diabetic. And, as you’ve said before, many people need to use it only a few times to see the trends and relationships they need to make necessary adjustments. So, if an average person could afford say $500 a year, that could still buy them a couple of months of testing and potentially provide some insights, especially if they work with a doctor that is as well-versed as you are. It still doesn’t mean there is NO potential benefit. We just don’t know if there is or isn’t to the degree that you and a lot of others would like (me included).
My guess is we could argue about the details of CGM for each individual for a long time. I suspect, however, that if used with the right mindset, the appropriate expectations, and guidance from a doctor, there are legitimate use cases for CGM in non-diabetics, even though their use in this population has not been clinically validated. If we were ONLY using CGM in isolation, I can imagine that adjustments we make based on it may be potentially harmful, as you suggest. However, a lot of people here, as well as many doctors I’m assuming, rely on data from an assortment of markers and blood tests. If, for example, using a CGM somehow increased my ApoB, I would know about it because I am getting regular blood tests. Yes, certainly there can be unintended consequences to making any dietary, lifestyle, and medication changes, but that is precisely why measurement over time and across multiple biomarkers is important.
Anecdotally, my Dexcom G6 has worked pretty well, with the average blood glucose readings within an acceptable level of variation from my A1c measurement, which has been consistent for close to two years now at 4.9-5.0. I agree that there is the potential for variance and spurious signals (e.g. compression lows), but as with any measuring device one must know its limitations and set expectations accordingly.
Lastly, doctors use medicines off label all the time, despite the lack of clinical trials for efficacy for those off-label conditions. Aside perhaps from more safety data with certain medications, that sort of use doesn’t strike me as much different from what we are doing here when repurposing drugs and tools. Likewise, just because there are clinical trials doesn’t guarantee that there is no long-term harm from a medication. I’ve been taking an SSRI for over twenty years. As far as I’m aware there are no studies of people who have been taking these medications for that long. But, I keep taking it because I see a benefit in my particular case, despite the lack of long-term data. In fact, it is even worse for some medications like SSRIs in that we don’t know the reason that these medications actually work. So, not only have I and a lot of other people been taking medications given by doctors for decades without long-term clinical data, the doctors giving them to us don’t even know what they are doing to our brains!
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You’re spending over £500K a year on testing??? How?
I introduced my friend to CGM about two years ago. He has a history of diabetes in his family. Members of his family have lost limbs. He’s a smart guy and although fit was prediabetic. He convinced his physician to prescribe it and off he went. I hadn’t seen him for a while because he’d moved states but we talked about him using it he was seeing positive results.
I saw him a few months back and he was physically transformed. He looked great and his Hb1ac and glucose were now in the perfect range. He’s undoubtably much much healthier now. He told me that he’d basically gamified it. I know that this is just anecdotal but as he explained to me. Seeing the data was transformative for him. Whereas before it was all vague and didn’t feel as if the general medical advice he was given was concrete. I think, at least for some people the data makes it ‘real’ and actionable. Personally, I think everyone should try them- I haven’t BTW, even though genetically I apparently am highly predisposed to diabetes. It might not help everyone and that’s fine. But, I would much rather have more data so I can make educated decisions about my diet - most of us have no idea what effects diet has on our physiology. Maybe my friend and I have similar personalities and we respond to data. For me it’s seems like a useful tool that could potentially prevent diabetes.
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As physician for the past 25 years I have disagree with that statement. Most patients make emotional decisions and are horrible in properly evaluating risk vs benefit. They rarely see the big picture. They tend to exaggerate the risk through possibility of rare side effects and completely miss the benefit. Yet they have no problems taking medication like ibuprofen that causes 16,000 deaths and 100,000 hospitalizations each year. Little knowledge is indeed a dangerous thing.
The crux of the difference in mindset between clinicians people labeled “biohackers” is that clinicians see when many cases when biohacking fails, whereas biohackers only see when they fail. The worst example is the dumb six glass a day recommendation, definitely a bottom of barrel type of biohacking but one of those “seems like a good idea” that gets repeated enough. While it’s true that some people could use a bit more water, we have seen many cases of presyncope due to water overload induced hyponatremia.
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10k pa = per annum, yearly. Gets weekly tests that add up to this over a year I’d imagine.
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I’m very envious of your budget for blood tests 
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This makes much more sense, LOL 
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Glucose spikes doesn’t cause type 2 diabetes I think, only when the pancreas or something gets too fatty, meaning from too much fat mass on the body than what’s good for that person.
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Its a rough approximation. Labs such as Randox charge £255 for two tests which averages the figures down, but some charge over £200 for one test. I also do specific tests for things like lithium, selenium, copper and manganese from time to time.
Mainly, however, it is tracking things to make sure I am doing no harm with the unusual things that I do.
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This is the question as to what is the value of good health. I do spend a lot on things to eat such as supplements. I bought 100kg of various types of citrate for about £1,500.
However, I take the view that if I can substantially avoid the main diseases of aging even if my life is no longer that is a very valuable thing to have.
What I do, however, is to tell people my results in terms of what vitamin D I take and how it affects my vitamin D levels, or what lithium I take to maintain a serum level just under 50 microMolar.
This sort of information sadly is hard to get. To be honest it would be nice if some other people could track these things so we could develop a database that understands the variety of response to dosing.
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Dosing is very individual. For instance, I took 5000 IU of D3 daily and my level was only 30 (29 is deficient). I am now taking 10,000 IU daily and am looking forward to getting my new D3 levels this summer because the test is unreasonably expensive here in Hong Kong.
I think you will be right that there will be individual variation. It would, however, be IMO quite useful if some other people could do some weekly D3 tests whilst tracking what vitamin D is actually taken. It would give some idea as to the ranges of responses.
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Also, with vitamin D3, I think you need to track magnesium dosing as well since many people have a magnesium deficiency which then prevents the absorption of D3.
I take 5000 iu of D3 daily and my level is 51. I take it with magnesium threonate. My magnesium levels are always within range.
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