Beyond the "Shoulds": CGMs and Metabolic Health

The Bottom Line

• There are far too many "shoulds" when it comes to personal nutrition
• This strategy of telling people what to eat isn't working to make us healthier or happier
• Continuous glucose monitors (CGMs) offer a different approach.  They are a tool we can use to gain insight into two critical areas:
1. The state of our metabolic health
2. Personal, metabolic responses to specific foods (our unique bioindividuality)
• Primarily due to their ability to cultivate awareness that leads to personalized, actionable insight, CGMs receive an Inherent Health Score of an A-

The Problem with Nutrition "Shoulds"

I recently asked ChatGPT to estimate how many headlines have appeared in the past decade across America's ten most circulated newspapers telling us to "eat" or "avoid" certain foods for cancer prevention, metabolic health, or inflammation reduction. The answer? Between 3,000-15,000 headlines framing nutrition information this way.

For those of us programmed to be "good kids" or "healthy people" who genuinely care about eating foods that keep us running well, this creates an overwhelming barrage of conflicting "shoulds." If these headlines were creating a healthy, happy country, I'd stay quiet. But the approach simply isn't working.

The stark reality: Only 12% of adults in the US are truly metabolically healthy according to modern criteria. Even more concerning, approximately one in three US adults now meet the formal criteria for metabolic syndrome—having at least three major risk factors like high blood pressure, impaired glucose regulation, abnormal cholesterol, or excess waist circumference.

A Different Approach to Food and Health

Yes, it's important to understand food basics. But there's a crucial difference between being told what we should and shouldn't eat versus learning how what we put in our bodies supports (or doesn't support) our function. It's like the difference between having your child memorize arbitrary math problems versus helping them develop analytical and quantitative skills for true mathematical literacy.

If I had to distill fundamental nutrition advice for kids, I'd quote Michael Pollan: "Eat real food, mostly plants, not too much." But this post is for those of us who never heard these wise words as children—for us 88-percenters who don't have pristine metabolic health and have let culture and our ‘survival code’(which I’ll address in future posts) drive eating behaviors we aren't always proud of.

Two Essential Questions

To move in the right direction with metabolic health and our relationship with food, we need to ask:

1. How can I build greater awareness of my own metabolic health?
2. How can I understand my unique bioindividuality—the way I metabolize and respond to different foods within my life context?

Enter Continuous Glucose Monitors

CGMs provide real-time data about glucose dynamics for individuals. When used correctly, they're powerful tools for answering both questions above. While CGMs have been prescription tools for diabetics for over 20 years, non-diabetics can now access them without a prescription through devices like the Dexcom Stelo and Abbott Lingo, or through subscription wellness services like Levels, Nutrisense, and Veri.

My Month-Long CGM Experiment

To gain insight into my metabolic health and individual food responses, I ran a month-long experiment with the Dexcom Stelo device. Despite some sensor malfunctions (which Dexcom kindly resolved with replacement sensors), I learned valuable lessons:

Surprising Discovery #1: Intense mental stimulation caused my highest blood glucose peaks. I'd never considered the start of my workday—juggling four operating rooms simultaneously with impatient surgeons—as "stress." The CGM revealed that my body, particularly my adrenal glands producing cortisol, definitely interpreted these situations as stressful.

Discovery #2: Being on call significantly impacted next-day glucose regulation. After nights with no sleep or just a couple hours, my average glucose level was 5-10 points higher the following day.

Positive Discovery #3: The meal prep my wife and I had worked on over the past couple years was actually working. Our home eating patterns kept my blood sugar in good ranges most of the time—validation that our efforts had a positive impact.

I learned much more than this, but these insights highlight how different we all are regarding baseline health status and responses to life's demands—our food environment, work stresses, and everything else. This is bioindividuality. There's no need for direct comparison with others. Instead, have self-compassion, but let that compassion give you courage to meet yourself where you are, as you are. Lasting personal change only begins when you embrace your reality.

Building Metabolic Health Awareness

Keep it simple: Studies show blood glucose should peak about an hour after eating, reaching maximum levels around 140 mg/dL. If you only focus on how often you exceed 140 mg/dL and your 24-hour average blood glucose, you're doing fantastic.

For deeper insight, you can monitor additional parameters like standard deviation and timed responses to specific foods or meals (detailed values in the Resources section below).

Try an At-Home Oral Glucose Tolerance Test (OGTT)

Here's an interesting experiment: Create your own OGTT by consuming 75g of fairly pure carbohydrates. Options include:

• 1.5 bagels
• 20oz of Gatorade
• Two 12oz cans of regular Coca-Cola (78g)
• Five slices of white bread

Record glucose values before eating and at 30, 60, 90, and 120 minutes after. Optimal responses (following Dr. Peter Attia's strict standards):

• 30 minutes: <140 mg/dL
• 60 minutes: <120 mg/dL
• 90 minutes: <100 mg/dL
• 120 minutes: Return to baseline (without significant dip below)

The OGTT provides dynamic insight into blood sugar regulation after a controlled glucose load. Unlike fasting glucose's static snapshot, the OGTT challenges your system in real-time, potentially uncovering early insulin resistance and glucose intolerance before diabetes develops. It's considered the gold standard for assessing integrated function of pancreatic beta cells, insulin sensitivity, and systemic glucose disposal.

Understanding Your Bioindividuality

Keep a food log! Open a Google doc or grab a notebook and jot down:

Minimum: What you eat and when For deeper insight: Add movement/exercise times, stressful periods, sleep quality, and other notable daily events

Review your CGM data alongside your food log daily. Write down one or two lessons learned each day. By month's end, you'll have a significantly better understanding of your metabolic bioindividuality.

Conclusion

This post covers substantial ground, but I hope it serves as a guide if you choose to "look under the hood" of your body's sugar regulation and utilization abilities. At Inherent Health, we currently grade CGMs for non-diabetics as A- for their ability to foster unique, actionable insight.

CGMs earn this high grade because they:

• Build awareness effectively
• Aren't overly expensive
• Provide windows into complex, dynamic bodily processes that primary care physicians often don't help us understand
• Require minimal time and energy for month-long experiments
• Deliver much clearer understanding of baseline metabolic health and bioindividuality appreciation

I’ll explain the Inherent grading systems for tools and tactics more in a future post!

My parting advice: Ensure you're in the right mindset before you decide to experiment with a CGM. If your ego will be extremely critical when numbers don't match what you think they "should" be, wait. Only run the CGM experiment when you're ready to approach it playfully, where the goal is learning, not passing a test.

Resources

CGM Guidelines for Optimal Health

Additional Information

Metabolic Syndrome Definition: A cluster of conditions occurring together that increase risk of heart disease, stroke, and type 2 diabetes. Diagnosis requires at least three of these risk factors:

• High blood pressure (≥130/85 mmHg)
• High fasting glucose (≥100 mg/dL)
• High triglycerides (≥150 mg/dL)
• Low HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women)
• Excess waist circumference (≥40 inches in men, ≥35 inches in women)

References

• University of North Carolina Study: Only 12% of American Adults Are Metabolically Healthy
• Peter Attia MD: CGM in Non-Diabetics