What can CGMs teach us about metabolic health?- Diet Doctor Podcast

Nick Norwitz, PhD, and his fellow medical students decided to create their own study to help learn about metabolic health. They wore continuous glucose monitors (CGMs) and held discussions about the larger topic of metabolic health.
According to the students, it was a great success. But some online commenters raise serious concerns about using CGMs in this way.
In this episode, we explore the upside (and potential downside) to using CGMs to assess metabolic health, and discuss the broader topic of nutrition education.
Find the link to the research article at: www.dietdoctor.com/video/podc...
Table of content:
0:00 Introduction
1:24 Nick Norwitz, PhD
2:30 Motivations behind the study
5:20 Curriculum updates in the nutrition training
9:03 Blood sugar doesn’t equal metabolic health
15:06 A potential pushback of the study
20:37 Response from the attendings about the study
27:43 The impact and the future of the study
33:10 Mark Czeisler, PhD
36:00 The change towards metabolic health
41:20 The concern with blood sugar in the study
49:18 Mealnie Hoenig, MD
50:02 Overall impression of the study
55:51 The state of nutrition training in medical school
1:00:43 Conclusion
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[@robstriathlontipsforbeginners]

I used a CGM in January this year because I felt more and more short-tempered eating foods and my blood pressure was high. And I'm very active training for triathlons, don't smoke, and barely drink alcohol. My doctor was writing me off as just being genetically inclined to have high blood pressure. She prescribe me a medication. The CGM showed that me that when I would eat a lot of carbs my blood sugar would go up to 140 and stay high for 3-4 hours and then drop suddenly in a slightly hypo range. Since switching to a low carb diet my blood pressure has dropped over 20 points (both numbers) and adding fasting into my routine seems to be helping even more over time. Doctors desperately need to be taught more about nutrition. Going low carb helped me easily kick caffeine as well. The best video I've seen on KZbin recently is Dr Pradip Jamnadas "The Bittersweet Truth". It's on the Galen Foundation's page.

[@RebeccaRaven]

I have a Freestyle Libre. I pay for it out of pocket, because I don't have a diabetes diagnosis. Forget I'm trying to NOT be diabetic. T2D runs in my family and the side effects can be devastating. I love mine and it's amazing how many "healthy" food send my blood sugar soaring...and it's clear from my graphs that my insulin kicks in late and goes on too long. If I don't challenge my blood sugar, it works just fine.

[@puetzranch]

Did you have to get a prescription even though you are paying?

[@normanrotwell1760]

Rebecca, do mind sharing the recurring cost?

[@paulmacfarlane3027]

As mentioned by another commenter, the low reading during night can be from position and/or simple error. I have found that some sensors can be off by 20 to 25 points, so every time I replace one, I have to calibrate against one or two different blood stick meters which themselves can have +/- 10% to 15% standard error. The main benefit of a CGM is for the alarms and for seeing trends. I got my A1c down to 5.6% last check which is pretty rare for T1D. Others have gotten below 5, but it takes a lot of vigilance.

[@carolmoening9891]

I have a Libre 2 CGM. My last A1C was 5.8 and my CGM alarm goes off every night about 3 am as my numbers go below 55 routinely. By using CGM overtime, eating low carb. I have reversed my diabetes. Too bad insurance won’t pay. I pay out of pocket. Still cheaper than insulin out of pocket.

[@szghasem]

Thanks Diet Doctor! This is a great addition to your work of spreading the word. Encouraging to see what started at grass roots level is now spreading to places like Harvard. Keep up the good work!

[@aharonavramovich7240]

It is possible that low glucose measurement on the CGM during the night, might be an artifact from position and direct pressure on the CGM or the arm during the sleep.

[@paulpladin9590]

It happens often in the type 1 community. We call them compression lows. CGMs measure interstitial fluid, not blood. This fluid is easily displaced as anyone who has ever slept on a wadded up sheet knows.

[@shinjokagama7521]

Hats off to Dr. Nick.

[@michaeldillon3113]

This may not be a helpful question but how the heck did the importance of nutrition and disease get so sidelined in medical education and treatment . I recall a doctor (Dr Jan de Winter ) who I came across 40 years ago who said ' if doctors don't become nutritionists then nutritionists will become the doctors .

[@dmackle3849]

Except the pharma kickbacks will prevent that happening. The problem with inspirational phrases is that they don’t take in to account the invisible hand of corruption that allows the supposed paradox to exist.

[@edpomi]

The whole pharma kickback meme is not aomething that I have experienced in 20 years of being a doc.... There is pharma financed "continuing education" which is obvuously skewed towards medications. The question regarding why we don't learn about nutrition ..... Look into The Flexner Report.

[@k9rescuer934]

The system operates on sick care and profitability……no money in keeping people healthy!

[@theresehazen528]

Excellent quote

[@dmackle3849]

@@edpomi I should have been less sloppy in my comment. Your “continuing education” point is much closer to the invisible hand influence that I’d intended to convey. We live in a world where monetising everything is someone’s idea of opportunity. While it brings amazing development it unfortunately leads to highly inefficient systems because no governing body dare suggest a “reduction” in “care”. Sell less food, healthier food, less healthcare, less medication, less insurance, and then all of the redundant effort can just go holiday on a beach somewhere.. just ain’t gonna fly. Parodied extremely well in the B-Ark chapters of Hitchhikers Guide to the Galaxy. FWIW 😀

[@bradje12]

Simply inspiring!

[@darrylthornton5377]

Excellent podcast

[@markiangooley]

The Dexcom alarm is a pain in the tuchus. I’ve used a Dexcom for only ten days - got a sample one, but my insurance refuses to let me get anything but a Freestyle Libre - and that was what I hated about it.

[@jacqui4green]

During sleep the CGM reading may be vastly and erroneously low due to positional compression.

[@missdaisydoodle]

Have always loved Dr Nick but his reference to star-bellied sneetches put me over the top! Love his work and style. Thanks for all you do, Nick!!

[@felis1224]

I have the Dexcom, my insurance paid for most of it. The hoops I had to jump though to get it were unreal! In the end it cost me about 150, it would have been over a 1000 if my insurance didn’t cover it, I would not been able to afford it . I’m glad to have it. Very helpful!

[@Julie1988HI]

My doctor put in an order for me in October 2022. Whoever placed the order put in a sensor and receiver; with no mention of the transmitter. Insurance rejected the receiver (which was fine because I have a Smartphone and downloaded the app). But it was HELL finding someone who would acknowledge I was not ordered a critical component. And even worse that they kept making my doctor's office provide 3 pre-authorizations. A box of 3 Dexcom sensors arrived in late November, but were useless without the transmitter. In late December another box of 3 sensors arrived. STILL no transmitter. February 13th, someone from the insurance mail pharmacy called to say the transmitter does not need any pre-authorization! I am paying for all of this out of pocket because I am a believer in having as many 'single' indicators as possible to learn what works for me. I think Dexcom could sell a starter kit that has the sensors and one transmitter included to avoid the confusion. This is been made too hard! I look forward to the day CGM technology is a function of the smartwatch!

[@lilytea3]

0:06: 🎧 This podcast episode discusses an experiment conducted by medical students at Harvard Medical School, where they wore CGMs to monitor their blood sugar and explored the other aspects of metabolic health. 4:50: 😕 Nutrition training at Harvard Medical School is still poor in terms of time and quality. 9:20: 📚 The educational part of the study included CGM data and interpretation of screening labs to help students understand metabolic health. 14:26: 📝 Students report feeling better athletically, mentally, and self-reflecting when their blood sugar is stable between 70 and 90. 19:27: 📊 Wearing a continuous glucose monitor (CGM) can make people more aware of their food choices and help them make healthier decisions. 24:02: 📚 The speaker discusses the use of CGMs for medical education and patient advocacy. 28:41: 👏 The speaker is commended for integrating continuous glucose monitoring (CGM) into a discussion on metabolic health. 33:11: 🎙 Dr. Mark Seisler discusses his experience as a participant in a study on metabolic health and CGM wearables. 37:56: 👥 The speaker found it exciting to learn from real-time biofeedback and be more conscious of their actions, including dietary choices, as well as considering the social aspects of wearing a monitoring device. 43:12: 🍽 Monitoring the impact of various elements of life on one's own body, such as food and activities, is valuable for personalized health. 47:48: 📊 The speaker discusses the importance of biometric feedback and the potential for expanded access to monitors for improved metabolic health. 53:25: 📚 Starting with a small lesson on glucose, first-year medical students are encouraged to build their knowledge on metabolism and energy handling. 58:06: 📚 The study has sparked curiosity and motivation among the participants to learn more and conduct further experiments in nutrition. Recap by Tammy AI

[@jdillon3035]

Perfect timing...I'm having my check-up soon and I'm planning on asking the doctor for a CGM. My opinion is that there is a lot of benefits for using a CGM but one big big concern is one of privacy. Eventually as more wearable medical devices come out and wireless connectivity is becoming the norm, who will have access to all my current medical data and how will they use it?

[@michaeldillon3113]

Hi fellow Dillon 🙂. Look at comment above yours .

[@theresehazen528]

Inspiration!

[@johnphelps9900]

Is there a link to the study report?

[@hortensemason4073]

Love the term "metabolic health".

[@patriciahoke4722]

I listened to this podcast on my morning walk today. I am trying to get my doctor to cover a CGM currently - this effort will be in vain, I anticipate, and I will end up having to buy one myself at a very high cost (currently on hold with the insurance company). The pod was somewhat interesting, but I was hoping for more. For instance, it may be somewhat understandable that HCPs push back against the idea of covering CGM for pre-diabetes and non-diabetics because they (docs) themselves would be the ones having to take the time to review this information. (Is this true? This possibility just occurred to me.) Wouldn't it be good if insurers would cover CGM to go directly to the patient with the availability of physician opt-in. This doesn't reflect well on me, but I found myself getting disgusted at all the privileges at Harvard.

[@johnhoran8692]

I have found when sleeping depends on cgm location and pressure gives lower readings. Example cgm on my arm and I sleep on that side lowers my numbers more then what it should be.

[@kathya1956]

So that’s what that is

[@tammyb8742]

Inspiring to see the up and comers getting 'woke' about the nutritional deficiencies the health industry is built on. Can't wait to see the future changes 👏 🙌 It is my understanding (according to Dr Fung) that some people can go into ketosis at night I'm assuming that would account for the low dips in blood sugar. As he says we don't die every night because our body goes into ketosis...

[@Snuffkin]

Nice to see the young medical kids are catching up! As a non diabetic, metabolically flexible person it will be nice to see the info on blood sugar in that group of people. My CGM shows my blood glucose staying at 5/6 without change for 10/20/24 or how many hours I don’t eat. Never going low. Hopefully the years of taking snapshot info and basing some “universal truth” that every man, woman, pre menaupausal , post menopausal, vegan, carnivore, vegan , omnivore, ancestral group, should adhere to will die.

[@tjh4619]

what is the difference when your monitor reads low (60 and below) and a blood droplet test at the same time shows 30 to 40 points higher?

[@yjsungmstw2]

Is there a link of the article or pre-print of this study?

[@dietdoctor]

Here you go! journals.sagepub.com/doi/full/10.1177/15598276221119989?journalCode=ajla

[@bobbernie1597]

FYI my non diabetic wife is a cold water open water swimmer and her CGM reads mid 40’s when she swims in the SF bay

[@DarthNoshitam]

Let's be real, doctors would riot if the pastries were removed from their lounges

[@sharkair2839]

i would love to see the diet doctors results with the cgm.

[@grantw7946]

I like how my CGM tracks my A1C so closely.

[@johnthesecure]

Add 32:30, Bret says/agrees/admits that not everyone should be using a CGM. I'd like to understand this position in more detail. It might be best use of scarce resources if government or other insurers only provide or subsidise these monitors for people with diabetes. But I can't see why Joe Public should be discouraged from using one. What are the risks? What is the "inappropriate use" that he mentions around 32:50? Do we discourage people from measuring their weight or girth? Maybe Bret is just trying to clarify that he wouldn't *recommend* a CGM for everyone.

[@jeffreypua1981]

I can help answer. The cgm data of glucose is a biofeedback tool. I have a patient who is a doctor and wore one. He complains at night for no reason he gets a 55 when sleeping. As a result he gets up to eat something like jam or juice. Because that is what he thinks is healthy. So the information is data and needs the proper education and context. Another example is I was wearing one when I had a cold and my glucose went up to 120s when fasting. So I know when sick the number can be higher. Everyone can benefit but not everyone has the understanding on what the number means.

[@johnthesecure]

Thanks @@jeffreypua1981 Doesn't sound any worse than weighing oneself or looking at urine color. Or even reading one's horoscope or tea leaves! You can easily over-interpret any piece of data.

[@FSSpag]

What’s cgm?

[@williammorgan7769]

Continuous Glucose Monitoring www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring

[@timfarness9949]

Continuous glucose monitoring

[@karena2970]

Continuing glucose monitoring. I pulled of the description box. I was thinking same thing!!

[@sagi2tarius-722]

are continuous insulin monitors on the horizon?

[@angelgirldebbiejo]

Yes they already have them

[@frederikmohlmann4818]

How about continuous cortisol monitors?

[@teknerd]

It would be amazing if the CGM manufacturers combine CGM and CIM in one sensor. I hope Abbott and Dexcom make it happen.

[@puetzranch]

@@frederikmohlmann4818 this would be great!

[@1timbarrett]

Sorry to be a stickler for spelling, but is Dr Hoenig’s first name ‘Melanie’ or ‘MEALnie’?

[@williamthurman9082]

Continuous glucose monitor

[@Julie1988HI]

His point of hospitals not understanding blood sugar.... I am T2D since 2017. October 2022 I went in for surgery (to have a plate removed) with a BS of 111. I was working hard to lower it and keep it in control. The next day (in recovery) they took my BS and it was 160 because they added glucose IN my IV? Why??????????

[@sammyehelton670]

Guessing maybe your blood sugar dropped during surgery

[@belwynne1386]

I believe glucose can go up during wound healing.

[@kathya1956]

@@belwynne1386or even stress like surgery

[@nataliajimenez1870]

Dr Bernstein often talks about having to call hospitals to make sure that his diabetic patients are not given glucose in their IVs. He has had patients hospitalized with diabetic ketoacidosis (blood sugar levels above 400) and still having doctors that give them sugar in their IVs. He even includes a form in his book to be used for patients that have to go to hospitals stating that the patient should not get glucose/dextrose in their IVs

[@jessicajohnson4087]

So.... what is a CGM??

[@jessicajohnson4087]

Nevermind. Continuous glucose monitor. Got it 👍. ☺️

[@frederikmohlmann4818]

Star Trek Medical Tricorder.

[@shinjokagama7521]

The idea that it is OK to eat foods that spike sugar level as long as the sugar level comes back to normal level after 45 minutes is wrong. If you eat foods that spike sugar level frequently, it will affect your insulin sentivity in the long run.

[@louisag5410]

Lying on your CGM at night will give very low and erroneous readings…

[@karenbole7130]

Too bad that a cgm cost too much and of course insurance wont pay for one, even when youre a diabetic

[@frederikmohlmann4818]

Covered for diagnosed diabetics in most (if not all) parts of Canada by provincial and/or private insurers. Just saying.

[@pattyorourke8068]

In Washington state they are covered by insurance only if the patient is on insulin and testing more than 3 times a day. I hope that someday CGMs will be inexpensive, and readily available over the counter, as fingerstick glucometers are now.

[@karenbole7130]

@@frederikmohlmann4818 not here in us. Capitalism at its finest. Owned by the corporations, and elites. Mighty dollar worth more than human life. Sorry Rant over

[@karenbole7130]

@@pattyorourke8068 maybe i should move

[@marccarrier]

@@frederikmohlmann4818: Covered in Canada if diabetics AND on insulin or incidents of hypoglycemia. Not covered for Type 2 not on insuline.

[@worldnomad2301]

20min in. Nick is very hesitant to say going to a 140 blood sugar, but coming down quickly as being normal. This is what is concerning about his whole ideology. He really thinks people should be under 100 all the time. Yet, he’s the “coach” training people in this study? Scary 😬

[@sharkair2839]

a normal healthy person will stay below 100. that's is an optimal range. an a1c of 4.0 to 5.0 also is optimal. i try to keep my glucose from 80 to 120. it's up to the individual to decide how tightly they want to control their blood sugar. my glucose right now is 107. a little high so i will wait for it to dropp below 100 before i'll eat anything.

[@worldnomad2301]

@@sharkair2839 They will stay below 100 on a fasting test, but they could easily rise to 140 spike with even natural carbs. This isn’t a big deal, but Nick acts like it is.

[@sharkair2839]

@@worldnomad2301 not everyone spikes. some people can eat anything and keep the glucose under 100. we are all different. i watched someone here on you tube. he ate a bowl of grapes. his glucose actually went lower than he started. if i ate a bowl of grapes my numbers would be off the charts. we all just need to do the best we can do. anyone just checking their glucose is way ahead of the game. so many refuse to check, preferring to stick their head in the sand. hope is not a good strategy.

[@worldnomad2301]

@@sharkair2839 I still disagree that a 140 spike is a big deal. Even the diet doctor doesn’t think it is a big deal. It’s really just Nick thinking this.

[@sharkair2839]

@@worldnomad2301 maybe if we are eating one meal a day or perhaps twice a day it should have minimal impact. however, i subscribe to bernstein method. to have a average glucose of 83. it is challenging to say the least. but to avoid complications of high blood sugar it's best to avoid spikes. a spike is considered 30 points or more.

[@stevenhejkal8470]

Nurses? Dieticians? Not even mentioned? C'mon.

[@punkin60]

Totally irrelevant to topic… Nick is so dang cute!

[@davidwinebrennerjr4196]

This is silly as hell for non diabetics or T2 folks who simply need to lose fat in a caloric deficit under personal fat threshold. This isn't an issue of eating too many fibrous carbs or lean protein or health fats. This Doc to be is a keto nut. You reduce your credibility by keeping nuts on.

[@pursuehealth940]

You definitely took a wrong turn on your way to your favorite KZbin channel. The calorie deficit channel is not here!

[@davidwinebrennerjr4196]

@@pursuehealth940 it’s just science not voodoo. This is the voodoo channel?

[@nataliajimenez1870]

T2 diabetics need to know what foods consistently increase their blood sugar sharply and for prolonged periods of time. They have used this monitoring to reverse their diabetes and fatty liver disease. Also controlled research has shown that has compared diabetics using low fat vs low carb diets show that low carb diets have been more efficient in reversing the disease for a long period of time