Thanks for the insightful post once again! Here are a few comments and counter points to start the discussion.
1. First, I fully agree that fasting glucose and A1c don't give you the full picture. Worse, they might even give you the wrong picture regarding your metabolic health. But, unfortunately, that's where we are in the health care system. My argument against A1c is that it is a lagging indicator of your glucose metabolism. You are always in reactive mode if you rely on A1c, rather than proactive.
2. I am a big proponent of proactive management of your health, so I don't think CGMs are helpful for those who are proactive. They are likely to throw you into a cycle of fear and food analysis-paralysis that is not very helpful or even healthy, IMO. That can cause more stress than it is worth.
3. Proactive health management requires eating healthy foods (which means whole foods), and that in itself is both necessary and sufficient as a guide. No further complications are necessary (based on my own experience and the advice of whole foods practitioners that I follow). For example, starchy vegetables are just fine (I eat a lot of sweet potatoes) as long as they are whole.
4. Regarding glucose peaks and CVD risk: If the primary goal is to regain insulin sensitivity in its true sense (i.e. not by controlling postprandial glucose levels for the same level of insulin production by the pancreas, but by reduced level of insulin production), then there is no reason to fear postprandial glucose spikes. The question is what is the definition of "frequent" in "frequent spikes"? Humans have eaten starchy vegetables for millennia (and still do in the blue zones and other native regions) without CVD. One big reason could be that they didn't eat all day. By spacing your meals (and not snacking in between), we can mimic the same. Your body is given a chance to lower glucose and insulin levels sufficiently before the next meal. I think this is where the case for fasting combined with whole foods becomes very strong.
5. Now, once you are diabetic, I fully agree that you need all the tools, including CGM, to take back control.
All good points, however, I think CGM for non-diabetics can help get some real time data to complement (not substitute) other healthy habits including consuming appropriate diet, exercise, sleep etc. Having said that, yes, this is more useful to calibrate one's response to various meals and other lifestyle changes to "learn" first and then "confirm" later if a particular diet or lifestyle change leads to a different outcome. While it is not clear if "glucotypes" as suggested by some researchers is a real world phenomenon, there is evidence to suggest non-diabetics have GV as well.
In other words, if a non-diabetic person is willing, able and can afford a CGM, then an intermittent or periodic test-change-test protocol could be useful by way of "personalized medicine" and yes, not as a long term tool - don't see a strong rationale for chronic use.
Also, non-diabetics who travel frequently or have other work or family related disruptions to normal routine may benefit from test-change-test approach to gauge how their work or personal circumstances may affect their profiles; and of course, potentially act on it as appropriate.
Exactly, Surendran. My objective to use a CGM temporarily is to establish a baseline for my glucose variability based on diet, exercise, sleep, and other factors. Interested in finding out which foods, fruits etc. cause GV so that I can tailor my diet to better control glycemic variability. I completely agree with Vivek that eating "good" food is the only way to control GV long-term but I would like to explore if CGM can be used as a tool towards that goal.
Thanks for the insightful post once again! Here are a few comments and counter points to start the discussion.
1. First, I fully agree that fasting glucose and A1c don't give you the full picture. Worse, they might even give you the wrong picture regarding your metabolic health. But, unfortunately, that's where we are in the health care system. My argument against A1c is that it is a lagging indicator of your glucose metabolism. You are always in reactive mode if you rely on A1c, rather than proactive.
2. I am a big proponent of proactive management of your health, so I don't think CGMs are helpful for those who are proactive. They are likely to throw you into a cycle of fear and food analysis-paralysis that is not very helpful or even healthy, IMO. That can cause more stress than it is worth.
3. Proactive health management requires eating healthy foods (which means whole foods), and that in itself is both necessary and sufficient as a guide. No further complications are necessary (based on my own experience and the advice of whole foods practitioners that I follow). For example, starchy vegetables are just fine (I eat a lot of sweet potatoes) as long as they are whole.
4. Regarding glucose peaks and CVD risk: If the primary goal is to regain insulin sensitivity in its true sense (i.e. not by controlling postprandial glucose levels for the same level of insulin production by the pancreas, but by reduced level of insulin production), then there is no reason to fear postprandial glucose spikes. The question is what is the definition of "frequent" in "frequent spikes"? Humans have eaten starchy vegetables for millennia (and still do in the blue zones and other native regions) without CVD. One big reason could be that they didn't eat all day. By spacing your meals (and not snacking in between), we can mimic the same. Your body is given a chance to lower glucose and insulin levels sufficiently before the next meal. I think this is where the case for fasting combined with whole foods becomes very strong.
5. Now, once you are diabetic, I fully agree that you need all the tools, including CGM, to take back control.
All good points, however, I think CGM for non-diabetics can help get some real time data to complement (not substitute) other healthy habits including consuming appropriate diet, exercise, sleep etc. Having said that, yes, this is more useful to calibrate one's response to various meals and other lifestyle changes to "learn" first and then "confirm" later if a particular diet or lifestyle change leads to a different outcome. While it is not clear if "glucotypes" as suggested by some researchers is a real world phenomenon, there is evidence to suggest non-diabetics have GV as well.
https://www.metabolismjournal.com/article/S0026-0495(23)00244-5/fulltext
In other words, if a non-diabetic person is willing, able and can afford a CGM, then an intermittent or periodic test-change-test protocol could be useful by way of "personalized medicine" and yes, not as a long term tool - don't see a strong rationale for chronic use.
Also, non-diabetics who travel frequently or have other work or family related disruptions to normal routine may benefit from test-change-test approach to gauge how their work or personal circumstances may affect their profiles; and of course, potentially act on it as appropriate.
Exactly, Surendran. My objective to use a CGM temporarily is to establish a baseline for my glucose variability based on diet, exercise, sleep, and other factors. Interested in finding out which foods, fruits etc. cause GV so that I can tailor my diet to better control glycemic variability. I completely agree with Vivek that eating "good" food is the only way to control GV long-term but I would like to explore if CGM can be used as a tool towards that goal.