Measuring Metabolic Health Changed My Life

I have recently been paying special attention to my overall metabolic health and you should too. This was an aspect of my health that I was less in tune with as it was not visible in my daily life and unmeasured. I recently decided to change this and wanted to share my findings, why this matters, and how you can learn about your own metabolic health

Table of Contents:
Intro
Blood Glucose Measurement Methods
Why I did not use a CGM
What I learned Measuring my Glucose

What is Metabolic Health & Why it Matters

Before we dive into my learnings I wanted to quickly define metabolic health and discuss why it is important. Metabolic health at its root is how well your body converts nutrients into energy yet we will mostly focus on glucose metabolism/ Insulin sensitivity for this conversation. 

Metabolic health is a crucial part of your health as Insulin sensitivity plays a major part in diseases like: heart disease, cancer, neurodegenerative disease and diabetes. Poor metabolic health increases your risk for all these diseases in massive ways.  The cumulative risk from having metabolic dysfunction costs years of life and health quality.  As one example, metabolic syndrome is the second leading risk factor for developing cancer behind smoking [3]. Getting your metabolic health in order is one of the biggest levers we have for improving our life expectancy and quality of life as we age. 

Metabolic health is clinically looked at through the lens of what is called metabolic syndrome which is defined as having 3 or more of the following [1]. 

1. Abdominal obesity. This means having a waist circumference of more than 35 inches for women and more than 40 inches for men. 
2. High blood pressure of 130/80 mm Hg or higher
3. Impaired fasting blood glucose. This means a level equal to or greater than 100 mg/dL
4. High triglyceride levels of more than 150 mg/dL.
5. Low HDL (good) cholesterol. Less than 40 mg/dL for men and less than 50 mg/dL for women is considered low.

Over 35% of Americans have metabolic syndrome and this is nearly 50% by age 60 [2]. I also want to note metabolic syndrome requires having at least three of these but having less than three or zero is better and you should know where you stand on all these factors  

For today let’s focus on the insulin side of things which we will use blood glucose as a proxy for. This was my blind spot in tracking my metabolic health for many years. The other factors that make up metabolic syndrome were more on my radar and things I was already paying attention to. 

Blood Glucose Measurement Methods

To get started at looking at our bodies glucose response and this aspect of Metabolic health we have the following options.  

Blood tests like HbA1c and fasting glucose/insulin 

HbA1c is a way to look at your average blood glucose levels over the past 3 months. I have added this to all my blood work to keep tabs on my average glucose and aim to have it below 5.1% which should roughly equate to an average blood glucose <100mg/dL. The  issue with HbA1c is that it is a very blunt test that looks at average glucose levels and lacks information on the magnitude of glucose spikes, which can be more critical for health outcomes. I aim for this <100mg/dl average glucose levels but also would like to keep my change from baseline glucose level or standard deviation less than 15mg/dL. 

Another blood test to consider is the standard fasting glucose test or fasting insulin test. These accurately measure the glucose or insulin in a fasted state to ensure this is in healthy lower ranges. A less blunt test would require monitoring your glucose levels at different times to see how your body responds to meals and life factors. As an example the Kraft patterns shown below are ways a person may react to ingesting glucose and better show your Metabolic health in terms of glucose response curve. In order to get this data you need to monitor your glucose at different times and this brings us to the next options we have for measuring our insulin resistance. 

Continuous glucose monitor 

These are devices that implant into your arm that consist of a sensor and transmitter (that connects to your phone).  This enables you to have a continuous graph of your glucose and understand how you react to different foods and environmental factors. This is probably the best method for getting the full picture of your glucose regulation system, however, I chose not to go this route at this time. 

Why I Chose to Not Use A CGM

1. Cost / Difficulty to get 
   CGM’s are $80 to $200+ a month depending on the device. If you have some form of diabetes much of this is covered by insurance but without diabetics the costs add up and most devices require a prescription. There are companies that simplify the process and deal with the prescription but these have high costs and monthly subscription plans.  The main CGM manufacturers are Libre, Dexcon, and Medtronic if you are interested in learning more.
2.  Accuracy
   The accuracy of CGMs is less than normal blood glucose monitors. They require being calibrated with a typical blood glucose reader and even then have accuracy in the ~10% range. This is not a deal breaker for me who is most interested in changes in glucose vs. super accurate values but is a limitation of these devices.
3. Not needing majority of data 
   At this time I am just wanting to dip my toes and start to understand my blood glucose levels and how I reacted to foods and meal timing. For my current goals I did not need the 24/7 monitoring. I also know if I ever want to try a CGM I would need a standard glucose blood tester to calibrate it so figured I would start there.
4. I don’t want another metric to obsess over 
   Data is awesome but I know if I had a CGM I would have another metric to be looking at and just didn’t want the overhead of something else to obsess over. 

Blood Glucose Tester

This brings us to the option for monitoring your glucose that I chose to start with (besides blood work) , The standard blood glucose tester. I bought the Contour Next One for ~$40 on Amazon which had great reviews, is very accurate, and comes with a free app that tracks all my data. I chose this option as it seemed the simplest path to start understanding my body's insulin sensitivity. 

What I learned measuring my blood glucose 

1. My fasting blood glucose is often higher than I would like
   1. My first learning was that my fasting glucose in the morning was higher than I would like and close to the 100mg/dL level that would indicate prediabetes. I found that I had a glucose spike in the morning that is called “the dawn phenomenon”.  Based on my research this is largely caused by increases in cortisol to help the body wake up. Since my fasting glucose falls back to healthy ranges by mid morning I am not super concerned by this but found this interesting and something I am still working to fully understand. Having a CGM to determine how my glucose looks at night would be helpful here.
2. White rice doesn’t spike my blood glucose crazy high  
   1. I love white rice and have heard that for many people this causes massive glucose spikes so as soon as I got my reader wanted to check if one of my favorite foods is killing me. Luckily, my body seems to handle white rice without a big glucose spike and I did not find white rice causing a glucose spike particularly higher than other meals. I still am trying to understand my body's responses to different foods but for now have focused on meals I have regularly. So far I have not found any particular food that spikes my glucose much more than any other but have seen how meals high in simple carbs cause bigger spikes than my more normal meals. 
3. Eating meals with fiber helps reduce my glucose spike by a large amount
   1. I noticed my glucose spike is much lower in magnitude when I eat a meal with fiber. This tracks with my expectations but cool to see the data for myself. 
4. Walking or moving after eating reduces my blood glucose spike by 10-20%
   1. Similarly to the fiber point above, taking a walk or being active post meal reduces my glucose level 1 hour after eating a meal. This is again in line with expectations. 
5. Periods of stress or poor sleep raise my fasting blood glucose levels .
   1. I have noticed that both periods of lower than normal sleep and high stress cause my fasting glucose to be higher and my glucose spikes post meal to subsequently also be higher. This directly shows one way how sleep and proper stress management improve health and in a way that is less intuitive. 
      
6. OGTT test results. The OGTT or oral glucose tolerance test is the golden standard test for diagnosis of diabetes. Like the graph of the Kraft patterns it allows you to see how your body responds to a given amount of glucose. To perform this test make sure you are fasted for at least 8 hours and take 75g of glucose/ dextrose and measure your glucose at ~20-30 min increments to get a glucose response curve. 

Below are my results from this test. They show a normal glucose response curve with my 2 hour glucose level below 140 which is considered normal [4]. This is good news! ! The biggest learning was how high my glucose got with so much sugar in the absence of other macronutrients and the cognitive impacts of this big glucose spike. I felt awful doing this test and found it super hard to concentrate and think clearly during these two hours. I always hear about the effect of glucose on mental function but have never experienced it quite like 75 grams of pure glucose first thing in the morning.  The normal response curve is nice to see but this appreciation for cognitive effects of glucose spike was a learning experience for me. 

Summary 

You could say these learnings are unnecessary for a healthy and very active 30 something year old but I love experimentation. I find that the process of data collection and diving into something like measuring my metabolic health helped me retain all the information I have read on the subject. This also gives me some data on my glucose levels I can compare myself to in the future. I am sitting at 0/5 of the factors for metabolic dysfunction and intend to keep things that way. This experiment cost me very little and helped me understand my body on a deeper level.

 I hope you have learned something about the importance of Metabolic Health and are thinking about where you stand in this critical aspect of health. Thank you for reading and if you enjoyed this post please sign up with your email to not miss the next post or even better share with a friend who might find this interesting. I’m super busy so any signal people are enjoying these motivates me to keep writing. 

Also for those of you who prefer visual content I have launched a brand new YouTube channel that follows this blog’s content!
https://www.youtube.com/channel/UCv9aVmB57LVQa9rPLmCVifg  

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Sources:

[1] https://www.hopkinsmedicine.org/health/conditions-and-diseases/metabolic-syndrome
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312413/ 
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191378/ 
[4]https://www.ncbi.nlm.nih.gov/books/NBK532915/#:~:text=The%20results%20of%20the%20OGTT,200%20mg%2FdL%20indicates%20diabetes
[5] https://denversdietdoctor.com/diabetes-vascular-disease-joseph-r-kraft-md/