{"id":1020,"date":"2020-08-31T17:41:16","date_gmt":"2020-08-31T17:41:16","guid":{"rendered":"http:\/\/joshmitteldorf.peachpuff-wolverine-566518.hostingersite.com\/?p=1020"},"modified":"2020-09-01T02:24:36","modified_gmt":"2020-09-01T02:24:36","slug":"what-i-learned-from-the-glucose-monitor","status":"publish","type":"post","link":"https:\/\/scienceblog.com\/joshmitteldorf\/2020\/08\/31\/what-i-learned-from-the-glucose-monitor\/","title":{"rendered":"What I Learned from the Glucose Monitor"},"content":{"rendered":"<p><span style=\"font-style: italic\">My fasting blood glucose has been creeping up over several years. (My fasting blood sugar is around 110, and HbA1c=5.7; fasting insulin=3.1, triglycerides=91.) Recently, I tried a continuous glucose monitor for the first time, to see what I could learn about eating and exercise habits that affect my blood glucose. The experiment led me to some reading and thinking that was worthwhile, but the results themselves were disappointing, limited (first) by flaws in the technology and (second) by wide variability that I could not trace to any of the usual behavioral correlates.<\/span><\/p>\n<hr \/>\n<p><span style=\"font-weight: bold\">Why concern ourselves with blood sugar?<\/span><\/p>\n<p>Insulin is generated in the pancreas after we eat, with a cascade of effects on the body. The primary short-term effect is to prevent glucose levels in the blood from getting too high, by notifying the liver of the need to pull glucose out of the blood and store energy as fat.<\/p>\n<p>Loss of insulin sensitivity is a primary hallmark of human aging. Most of the known life extension strategies in lab animals have to do with insulin in one way or another. For example, the worm gene\u00a0<span style=\"font-style: italic\">daf-2<\/span>\u00a0is the worm\u2019s only insulin receptor, and mutating (weakening) the\u00a0<span style=\"font-style: italic\">daf-2<\/span> gene doubles the worm\u2019s lifespan. Life extension benefits of exercise and caloric restriction are thought to work, at least in part, through the insulin metabolism.<\/p>\n<p>But glucose is also dangerous, and as we get older we are poisoned by excess sugar in the blood. High blood sugar leads to [list from\u00a0<a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/hyperglycemia\/symptoms-causes\/syc-20373631\" target=\"_blank\" rel=\"noopener noreferrer\">Mayo Clinic<\/a><span style=\"color: #111111\">]<\/span><\/p>\n<ul>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Cardiovascular disease<\/span><\/li>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Nerve damage (neuropathy)<\/span><\/li>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Kidney damage (diabetic nephropathy) or kidney failure<\/span><\/li>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Damage to the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness<\/span><\/li>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Clouding of the lens of your eye (cataract)<\/span><\/li>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Feet problems caused by damaged nerves or poor blood flow that can lead to serious skin infections, ulcerations, and in some severe cases, amputation<\/span><\/li>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Bone and joint problems<\/span><\/li>\n<li style=\"color: #111111\"><span style=\"color: #111111\">Teeth and gum infections<\/span><\/li>\n<\/ul>\n<p>So for long-term health, the name of the game is to keep blood sugar down with as little insulin as possible, hence preservation of insulin sensitivity is the target. Metformin is a well-studied drug for keeping blood sugar down without insulin. I have been taking it (irregularly) for the last several years, intermixed with berberine and <em>Gynostemma\u00a0<\/em>(Chinese name: jiaogulan =\u00a0<a href=\"https:\/\/en.wiktionary.org\/wiki\/%E7%BB%9E\" target=\"_blank\" rel=\"noopener noreferrer\">\u7ede\u80a1\u84dd<\/a>).<\/p>\n<p>This reasoning plus direct evidence for life extension in rodents and indirect evidence of life extension in humans has led me to take metformin, though it is not without side-effects.<\/p>\n<p><span style=\"font-weight: bold\">Long-term effects of metformin\u00a0<\/span><\/p>\n<p>Metformin is a credible longevity drug, statistically associated with lower risk of cancer, heart disease and especially dementia in humans. Six years ago,\u00a0<a href=\"https:\/\/dom-pubs.onlinelibrary.wiley.com\/doi\/full\/10.1111\/dom.12354\" target=\"_blank\" rel=\"noopener noreferrer\">this study<\/a>\u00a0laid the foundation for metformin as a longevity drug with the claim that people taking metformin had lower all-cause mortality, despite the fact that a population of type-2 diabetics was being compared to a healthier population. This finding inspired Nir Barzilai to raise support for the\u00a0<a href=\"https:\/\/www.afar.org\/tame-trial\" target=\"_blank\" rel=\"noopener noreferrer\">TAME study<\/a>.<\/p>\n<p>But metformin has its risks. A long-time contributor to this site, Dr Paul Rivas pointed me to evidence that\u00a0<a href=\"https:\/\/blog.humanos.me\/metformin-block-health-benefits-exercise-podcast-ben-miller\/\" target=\"_blank\" rel=\"noopener noreferrer\">metformin can interfere with exercise metabolism<\/a>. Paul notes his personal experience with loss of peak performance while taking metformin. My own experience is consistent with this, though I have never done a rigorous A\/B comparison.\u00a0<a href=\"https:\/\/www.nrcresearchpress.com\/doi\/full\/10.1139\/H07-144#.XzgnIehKiwV\" target=\"_blank\" rel=\"noopener noreferrer\">This study<\/a>, demonstrating a small but consistent decrease in peak performance, appears to me to be well-designed and analyzed. A plausible mechanism is the interference of metformin with mitochondrial function [<a href=\"https:\/\/cancerandmetabolism.biomedcentral.com\/articles\/10.1186\/2049-3002-2-12\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>,\u00a0<a href=\"https:\/\/portlandpress.com\/biochemj\/article-abstract\/348\/3\/607\/38313\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>].\u00a0\u00a0<a href=\"https:\/\/portlandpress.com\/biochemj\/article\/462\/3\/475\/47770\/Effects-of-metformin-and-other-biguanides-on\" target=\"_blank\" rel=\"noopener noreferrer\">This article<\/a> claims that metformin suppresses synthesis of ATP, which is the reservoir of energy for immediate use in all cell types. Ben Miller has done the most direct and most recently relevant human <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/acel.12880\">experiments<\/a> in this area and his findings suggest the intriguing possibility that metformin blocks exercise adaptations almost completely in about half of individuals, but not at all in the other half. (If you want to know which half you\u2019re in, you\u2019ll have to wait for next year\u2019s study.)<\/p>\n<p>For the majority of Westerners who exercise little or not at all, metformin may show reduction in long-term risk of age-related disease; but there is no data I know of on the subset of people who do vigorous exercise, comparing metformin to no metformin. <a href=\"https:\/\/blog.humanos.me\/metformin-block-health-benefits-exercise-podcast-ben-miller\/\" target=\"_blank\" rel=\"noopener noreferrer\">Does metformin block the health effects of exercise?<\/a>\u00a0Rhonda Patrick cites\u00a0<a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/acel.12880\" target=\"_blank\" rel=\"noopener noreferrer\">credible references<\/a>\u00a0on this subject\u00a0<a href=\"https:\/\/www.youtube.com\/watch?v=2Bsk7qZ8888\" target=\"_blank\" rel=\"noopener noreferrer\">as fast as she can get the words out<\/a>, and her conclusion is that exercise is a better anti-aging program than metformin, and you really can\u2019t have both.<\/p>\n<p><span style=\"font-weight: bold\">Do glucose-control herbs also blunt the benefits of exercise?<\/span><\/p>\n<p>I wrote a few years ago listing\u00a0<a href=\"https:\/\/scienceblog.com\/joshmitteldorf\/2015\/10\/13\/can-botanicals-replace-metformin\/\" target=\"_blank\" rel=\"noopener noreferrer\">botanical alternatives to metformin<\/a>. Much less research has gone into these herbs, so we must think theoretically about interference with benefits of exercise.<img decoding=\"async\" src=\"https:\/\/selfhacked.com\/app\/uploads\/2016\/03\/AdobeStock_176731322.jpeg\" alt=\"Branch of ripe red barberry after a rain with drops of water\" \/><\/p>\n<p>Berberine works by a mechanism of action that overlaps metformin. Both metformin and berberine promote AMPK (which in turn promotes sugar burning). Both metformin and berberine inhibit mitochondrial Complex I (slowing the conversion of sugar to usable energy). There is tentative experimental evidence that (unlike metformin) berberine does not inhibit adaptations to exercise [<a href=\"https:\/\/europepmc.org\/article\/med\/31434437\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>,\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1567576920300370\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>,\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0300908411001325\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>].<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-1024\" src=\"https:\/\/scienceblog.com\/wp-content\/uploads\/sites\/2\/2020\/08\/Gynostemma-leaves-1024x686.png\" alt=\"\" width=\"584\" height=\"391\" srcset=\"https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Gynostemma-leaves-1024x686.png 1024w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Gynostemma-leaves-300x201.png 300w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Gynostemma-leaves-768x515.png 768w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Gynostemma-leaves-447x300.png 447w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Gynostemma-leaves.png 1250w\" sizes=\"auto, (max-width: 584px) 100vw, 584px\" \/><\/p>\n<p><span style=\"font-style: italic\">Gynostemma<\/span>\u00a0is a Chinese herb popularized by Life Extension Foundation in their proprietary compound called\u00a0<a href=\"https:\/\/www.lifeextension.com\/vitamins-supplements\/item02207\/ampk-metabolic-activator\" target=\"_blank\" rel=\"noopener noreferrer\">AMPK Activator<\/a>. In\u00a0<a href=\"https:\/\/www.researchgate.net\/profile\/Neal_Davies\/publication\/6594599_Anti-hyperlipidemic_and_hypoglycemic_effects_of_Gynostemma_pentaphyllum_in_the_Zucker_fatty_rat\/links\/0deec534687621baad000000\/Anti-hyperlipidemic-and-hypoglycemic-effects-of-Gynostemma-pentaphyllum-in-the-Zucker-fatty-rat.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">animal models<\/a>\u00a0and in humans,\u00a0<span style=\"font-style: italic\">Gynostemma\u00a0<\/span>suppresses blood sugar and blood cholesterol. Like metformin and berberine, it works through AMPK,\u00a0<a href=\"https:\/\/www.sciencedaily.com\/releases\/2019\/01\/190115111944.htm\" target=\"_blank\" rel=\"noopener noreferrer\">which appears to be a good thing<\/a>.\u00a0 It is\u00a0<a href=\"https:\/\/pubs.acs.org\/doi\/abs\/10.1021\/jf404726z\" target=\"_blank\" rel=\"noopener noreferrer\">anti-inflammatory<\/a>, and has a history in China as cancer therapy, supported by\u00a0<a href=\"https:\/\/link.springer.com\/article\/10.1186\/s13020-016-0114-9\" target=\"_blank\" rel=\"noopener noreferrer\">mouse and\u00a0<span style=\"font-style: italic\">in vitro<\/span>\u00a0studies<\/a>. In rodent studies,\u00a0<span style=\"font-style: italic\">Gynostemma<\/span>\u00a0has a beneficial effect on strength and endurance [<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S014486170800249X\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>,\u00a0<a href=\"https:\/\/academicjournals.org\/journal\/AJAR\/article-abstract\/A90D90A38317\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>,\u00a0<a href=\"https:\/\/www.cabdirect.org\/cabdirect\/abstract\/20123234921\" target=\"_blank\" rel=\"noopener noreferrer\">ref<\/a>]. The\u00a0<a href=\"https:\/\/www.thieme-connect.com\/products\/ejournals\/abstract\/10.1055\/s-0030-1248298\" target=\"_blank\" rel=\"noopener noreferrer\">one study<\/a>\u00a0I\u2019ve found on human diabetes shows modest benefits after 12 weeks. The only counter-indication that I have seen is that it\u00a0<a href=\"https:\/\/www.jbc.org\/content\/279\/40\/41361.short\" target=\"_blank\" rel=\"noopener noreferrer\">increases insulin release (<span style=\"font-style: italic\">in vitro<\/span>)<\/a>, which I believe to be pro-aging.<\/p>\n<p><span style=\"font-weight: bold\">Is it more important to suppress postprandial spikes or to depress fasting glucose levels?\u00a0<\/span><\/p>\n<p>HbA1c is a standard blood test for diabetes. It is\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0168822707000599?casa_token=GhqpXske4v8AAAAA:buDEfYlDOcRS1al3mTt2HhtcstMOs5-IjpSq2vJV8yfOjfow5hjfSiVKhDRASLYKq_PJpSM2\" target=\"_blank\" rel=\"noopener noreferrer\">related to average blood glucose<\/a>\u00a0levels over the previous 90 days (= the half-life of hemoglobin in the blood). But the glycation of hemoglobin (as measured by A1c) happens<a href=\"https:\/\/tcoyd.org\/2019\/10\/strike-the-spike-controlling-blood-sugars-after-eating\/\" target=\"_blank\" rel=\"noopener noreferrer\">\u00a0predominantly during the brief glucose spikes<\/a>, rather than the much longer periods of average glucose levels. So it might be fairer to say that A1c summarizes peak glucose events over a 90-day period. And we might guess that the long-term health risks of high blood sugar are similarly more sensitive to the peaks than to the average.<\/p>\n<p>I believe that apoptosis is on a hair trigger as we age, and part of the reason for this is too much p53.\u00a0<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00125-011-2049-0\" target=\"_blank\" rel=\"noopener noreferrer\">This study<\/a>\u00a0links P53 activation to postprandial glucose spikes, rather than to high average glucose levels.\u00a0\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S016882270800332X\" target=\"_blank\" rel=\"noopener noreferrer\">This study<\/a>\u00a0links deterioration in endothelial function (related to arterial disease) with glucose spikes. The same paper lists ROS and oxidative stress as additional risks.<\/p>\n<p>For a long while, it has been established that high fasting blood sugar is associated with\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0002870312003134\" target=\"_blank\" rel=\"noopener noreferrer\">cardiovascular risk<\/a>. Of course, there is also association with\u00a0<a href=\"https:\/\/diabetes.diabetesjournals.org\/content\/48\/11\/2197.short\" target=\"_blank\" rel=\"noopener noreferrer\">obesity and T2 diabetes<\/a>, but for these, it is natural to think of fasting blood sugar as the result, rather than the cause.<\/p>\n<p><a href=\"https:\/\/kresserinstitute.com\/normal-blood-sugar-isnt-normal-part-2\/\" target=\"_blank\" rel=\"noopener noreferrer\">Chris Kresser<\/a>\u00a0says the best indicator of metabolic health is blood glucose levels 2 hours after a meal. If you can bring your blood glucose down to normal within 2 hours after eating your insulin sensitivity is good. For me, unmedicated, it was 3 hours after dinner, but less than 2 hours after breakfast. Either berberine or metformin tamed the after dinner spikes within 2 hours.<\/p>\n<div>\n<table>\n<tbody>\n<tr>\n<td><span style=\"color: #231b0a;font-weight: bold\">Marker<\/span><\/td>\n<td><span style=\"color: #231b0a;font-weight: bold\">Normal<\/span><\/td>\n<td><span style=\"color: #231b0a;font-weight: bold\">Pre-diabetes<\/span><\/td>\n<td><span style=\"color: #231b0a;font-weight: bold\">Diabetes<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"color: #231b0a\">Fasting blood glucose (mg\/dL)<\/span><\/td>\n<td><span style=\"color: #231b0a\">&lt;99<\/span><\/td>\n<td><span style=\"color: #231b0a\">100-125<\/span><\/td>\n<td><span style=\"color: #231b0a\">&gt;126<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"color: #231b0a\">OGGT \/ post-meal (mg\/dL after 2 hours)<\/span><\/td>\n<td><span style=\"color: #231b0a\">&lt;140<\/span><\/td>\n<td><span style=\"color: #231b0a\">140-199<\/span><\/td>\n<td><span style=\"color: #231b0a\">&gt;200<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"color: #231b0a\">Hemoglobin A1c (%)<\/span><\/td>\n<td><span style=\"color: #231b0a\">&lt;6<\/span><\/td>\n<td><span style=\"color: #231b0a\">6-6.4<\/span><\/td>\n<td><span style=\"color: #231b0a\">&gt;6.4<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p>Kresser claims that these guidelines from the American Diabetes Association are not strict enough, and that statistics show increased future risk of diabetes even for people in the ADA \u201cnormal\u201d range. But he cites\u00a0<a href=\"https:\/\/high-fat-nutrition.blogspot.com\/2007\/10\/physiological-insulin-resistance.html\" target=\"_blank\" rel=\"noopener noreferrer\">Petro Dobromylskyj<\/a>, who makes an exception for anyone on a low-carb diet (how low isn\u2019t specified). Paradoxically, low-carb diets are claimed to be healthy, even though they decrease insulin sensitivity. I have been unable to make sense of this.<\/p>\n<p>Kresser emphasizes that all numbers should be interpreted in the context of a person\u2019s other lifestyle and health indicators. In people who are active and not overweight, he is not inclined to worry about statistics in the \u201cprediabetic\u201d range. (I take comfort in this personally, and who can say if I\u2019m fooling myself?) But I can learn something from the way my glucose stats respond to medications, eating and exercising, whether or not I believe the absolute levels are concerning.<\/p>\n<p>Writing in\u00a0<a href=\"https:\/\/www.sciencemag.org\/news\/2019\/03\/war-prediabetes-could-be-boon-pharma-it-good-medicine\" target=\"_blank\" rel=\"noopener noreferrer\">Science Magazine<\/a>\u00a0last year, Charles Piller reviewed the ADA guidelines and found a consensus in the opposite direction \u2014 that they were probably too strict, and unnecessarily worrisome to a great many people. By ADA\u2019s definition, 80 million Americans are \u201cpre-diabetic\u201d, which is 40% of the adult population. The conflict really is not over the statistics but the interpretation. You can say either \u201cPeople with A1c levels above 6 are at increased risk of progressing to diabetes\u201d or equally well, \u201cMost people with A1c levels less than 6.4 will never develop diabetes.\u201d Both statements are true.<\/p>\n<p><span style=\"font-weight: bold\">As promised: my experience<\/span><\/p>\n<p>The Freestyle Libre was very easy to use and set up. I followed the instructions and used a spring-loaded device to insert the monitor behind my biceps. It was painless. There\u2019s a tiny wire that goes a few millimeters into the skin and an adhesive covering with a button containing the electronics.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-1021\" src=\"https:\/\/scienceblog.com\/wp-content\/uploads\/sites\/2\/2020\/08\/libre.jpg\" alt=\"\" width=\"992\" height=\"760\" srcset=\"https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/libre.jpg 992w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/libre-300x230.jpg 300w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/libre-768x588.jpg 768w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/libre-392x300.jpg 392w\" sizes=\"auto, (max-width: 992px) 100vw, 992px\" \/><\/p>\n<p>The wearable button stores data for up to 8 hours. The other part of the kit is a reader that downloads data every time you bring the reader within an inch or two of the button. As long as you take a reading every 8 hours or less, you won\u2019t lose any data. And you can do it as often as you like, to get real time feedback on your glucose state.<\/p>\n<p>The wearable button ($45) is meant to last two weeks, and then it must be discarded. My insurance (Blue Cross Medicare Advantage) wouldn\u2019t pay for it because I didn\u2019t have a diagnosis of diabetes. I found this out only after several trips to the drug store, interspersed with phone calls to Blue Cross, where I got repeated assurances that it would be covered. The reader ($85) can be reused. Apparently, it doesn\u2019t do anything that a cell phone app couldn\u2019t do, but Abbott (parent company of Freestyle) has arranged it so that you can only use the cell phone app if you purchase the reader.<\/p>\n<p>To analyze historic data, you can use capabilities built into the phone app, or plug the reader or cell phone into a computer, using a USB cable. The data is uploaded to a\u00a0<a href=\"http:\/\/libreview.com\" target=\"_blank\" rel=\"noopener noreferrer\">web site<\/a>\u00a0containing analysis tools and an option for creating a CSV file for more detailed manipulation in a spreadsheet. (The download button is not so easy to find, but I called Abbott\u2019s tech support number, and connected without excessive wait time to a friendly and knowledgeable technician.)<\/p>\n<p>My intention was to vary the glycemic content of my meals, my exercise schedule, eating and fasting schedule, and the medications I was taking (metformin and berberine) to learn what I could about glucose management. The first day I fasted, and I was concerned to see that all day my fasting glucose ranged between 110 and 120. (For reference: the standard healthy range for fasting glucose is 70-100. Below 70 is \u201chypoglycemia\u201d. Above 100 is \u201cpre-diabetes\u201d and above 125 is \u201ctype 2 diabetes\u201d.)<\/p>\n<p>I ate a meal, and glucose shot up to 179 before bedtime, only gradually coming back down during the night. As it turned out, 179 was my high for the week.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-large wp-image-1022\" src=\"https:\/\/scienceblog.com\/wp-content\/uploads\/sites\/2\/2020\/08\/Glucose-jjm-1024x352.png\" alt=\"\" width=\"584\" height=\"201\" srcset=\"https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Glucose-jjm-1024x352.png 1024w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Glucose-jjm-300x103.png 300w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Glucose-jjm-768x264.png 768w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Glucose-jjm-500x172.png 500w, https:\/\/scienceblog.com\/joshmitteldorf\/wp-content\/uploads\/sites\/2\/2020\/08\/Glucose-jjm.png 1318w\" sizes=\"auto, (max-width: 584px) 100vw, 584px\" \/><\/p>\n<p>The data is cut off after 10 days, though the monitor is supposed to have a lifetime of 14, because it fell off my arm. I looked for patterns in my data, and was able to learn only four things:<\/p>\n<ul>\n<li>Glucose rose after a meal. (I didn\u2019t get as far as being able to distinguish a meal with more carbs from a meal with more fiber or protein.)<\/li>\n<li>Glucose also rose, to a lesser extent, when I exercised.<\/li>\n<li>Taking metformin with a meal substantially reduced the glucose spike after the meal, and raising the glucose trough a few hours later. The range (stdev) but not the average glucose was affected.<\/li>\n<li>Taking berberine did not have this immediate effect.<\/li>\n<li>There was a strong downward trend over the 10 days. I interpreted this to mean that the monitor was gradually loosening in my skin, probably because I am a long-distance swimmer.<\/li>\n<\/ul>\n<p>(In a long phone support session with an Abbott representative, they acknowledged the reality of my experience: that the monitor can loosen over time, resulting in readings that are anomalously low. They were happy to replace the monitor, and advised me against long periods of swimming. )<\/p>\n<p><span style=\"font-weight: bold\">Unresolved<\/span><\/p>\n<p>I was left wondering all the things I wanted to discover at the beginning of my experiment.<\/p>\n<ul>\n<li>What kinds of meals minimize the glucose spike? High fat? High fiber? High protein?<\/li>\n<li>Could exercise before or after the meal help tame the spike?<\/li>\n<li>Could I detect short- and long-term effects of metformin, berberine, and jiaogulan?<\/li>\n<\/ul>\n<p>The thing that impressed me most was the natural variability of blood sugar, changing from hour to hour, uncorrelated with either food or exercise. I trust the body knows what it\u2019s doing. \u201c<span style=\"font-style: italic\">Le corps a ses raisons que la raison ne connait pas.<\/span>\u201d*<\/p>\n<p>I hope to try the monitor for 2 weeks again when swimming season is over.<\/p>\n<p>In the meantime, I am taking a modest, common-sense approach. I am going to leave out metformin but continue daily exercise and low doses of berberine and\u00a0<span style=\"font-style: italic\">Gynostemma<\/span>, lightening my evening meal and ending the day\u2019s food 3 hours before bedtime.<\/p>\n<p>Walking burns calories (pulls sugar from the blood) 3 to 5 times as fast as sitting, and walking after a meal feels like a natural and pleasant thing to do. My doctor recommends it. I\u2019m going to try walking half an hour after breakfast and dinner, pending my next experiment with the CGM.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>My fasting blood glucose has been creeping up over several years. (My fasting blood sugar is around 110, and HbA1c=5.7; fasting insulin=3.1, triglycerides=91.) Recently, I tried a continuous glucose monitor for the first time, to see what I could learn about eating and exercise habits that affect my blood glucose. The experiment led me to &#8230; <a title=\"What I Learned from the Glucose Monitor\" class=\"read-more\" href=\"https:\/\/scienceblog.com\/joshmitteldorf\/2020\/08\/31\/what-i-learned-from-the-glucose-monitor\/\" aria-label=\"Read more about What I Learned from the Glucose Monitor\">Read more<\/a><\/p>\n","protected":false},"author":65,"featured_media":1022,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1020","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What I Learned from the Glucose Monitor - Josh Mitteldorf<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/scienceblog.com\/joshmitteldorf\/2020\/08\/31\/what-i-learned-from-the-glucose-monitor\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What I Learned from the Glucose Monitor\" \/>\n<meta property=\"og:description\" content=\"My fasting blood glucose has been creeping up over several years. 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The surprising fact that our bodies are genetically programmed to age and to die offers an enormous opportunity for medical intervention. It may be that therapies to slow the progress of aging need not repair or regenerate anything, but only need to interfere with an existing program of self-destruction. Mitteldorf has taught a weekly yoga class for thirty years. He is an advocate for vigorous self care, including exercise, meditation and caloric restriction. After earning a PhD in astrophysicist, Mitteldorf moved to evolutionary biology as a primary field in 1996. He has taught at Harvard, Berkeley, Bryn Mawr, LaSalle and Temple University. He is presently affiliated with MIT as a visiting scholar. In private life, Mitteldorf is an advocate for election integrity as well as public health. He is an avid amateur musician, playing piano in chamber groups, French horn in community orchestras. His two daughters are among the first children adopted from China in the mid-1980s. Much to the surprise of evolutionary biologists, genetic experiments indicate that aging has been selected as an adaptation for its own sake. This poses a conundrum: the impact of aging on individual fitness is wholly negative, so aging must be regarded as a kind of evolutionary altruism. Unlike other forms of evolutionary altruism, aging offers benefits to the community that are weak, and not well focussed on near kin of the altruist. 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Much to the surprise of evolutionary biologists, genetic experiments indicate that aging has been selected as an adaptation for its own sake. This poses a conundrum: the impact of aging on individual fitness is wholly negative, so aging must be regarded as a kind of evolutionary altruism. Unlike other forms of evolutionary altruism, aging offers benefits to the community that are weak, and not well focussed on near kin of the altruist. 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