Continuous Glucose Monitor

So for me working too much and spending too much time with kids does not allow ample training. At 55-years old with reduced exercise (I am always doing something, like digging a pump track for example) gaining weight has become much easier and it’s unhealthly side effects.

So it has become the hot topic of science for the last years that insulin is the primary cause of inflamation based diseases, and excessive glucose causes too much insulin.

Athletes are starting to wear CGM devices to test how glucose affects performance but I would say the evidence is mostly inclonculsive a this point. Here is an expensive product that might be interesting.

Many of use are more fugal here and you can do this yourself buying a 50$ Freestyle Libre (the same device different software). Either direct or from Ebay in some countires.

I also wrote a blog post on this. For me this has been incredible and change my life in the last 2-months.

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It’s great you’ve found a routine that works for you both in terms of weight loss and adherence. Finding a sustainable long term solution is what really matters.

I might be starting a flame war, however I am respectfully skeptical of the conjecture that insulin is the primary driver of obesity. Short of diabetes/insulin resistance, humans are highly adaptable and we can gain/lose weight on an all carb or an all fat diet.

Layne Norton has written several articles and videos criticizing what he considers Jason Fung and Gary Taubes’ oversimplifications. Of course, I’m no expert so maybe I’m off base.

Your attitude is perfect. I am actually not advocating low carb and I also read Fung and Tubes work and believe their is some good science there but I agree it could be overly simplified. We can see fairly easily we have increased processed carbs, sugars and HFCS and reduced fat and the world has gotten much fatter. The trend seems clear. We also increased from 3 solid meals a day to 6-10 times a day of getting calories. So more frequent calories means more time with raised insulin levels. So my suggestion is to kind of forget about carbs and focus on insulin (via glucose)

I agree short term people can loose weight doing anything. Any calorie reduction will stimulate weight loss temporarily. Calorie reductions usually come with insulin reductions even if eating 100% carbs.

But when you start most “diets” it seem hard. If that is the case then it is not likely sustainable. Also if you or I started getting insulin injections regularly now you and I would start gaining weight and eventually get fat.

I do like appreciate the discussion and it seems clear that with only changing the amount of insulin and not the number of calories you eat you will start losing weight and be able to maintain that new weight. Now will you stop losing, in many cases yes. FYI I am not doing low carb :slight_smile: I am doing intermittent fasting to reduce glucose levels and a few of those hacks to reduce the spikes. The other day I did one meal, broccoli followed by a whole pizza (smallish) with some added Olive Oil :slight_smile: my daily average glucose level was still low even though it was spiked for a long time…

Here is what Layne says. This is actually my point exactly

Focusing on Insulin you have huge flexibility in how and what you eat. Your plan can continually change and you can make systematic changes in real time as your food choices change.

More and more people are getting on OMAD (one meal a day), and staying there with perfect success for years. Including Hershel Walker that was an professional MMA figter at the age of 50 and at OMAD for 20-years.

Jack Dorsey from Twitter has been doing OMAD from years. So rarely do you see people sticking with diets for years but there are many examples of people doing that with OMAD. OMAD is just one of the methods of reducing insulin, and will likely not resonate with most people although once you kill the insulin spikes shifting to 2 or 1 meal a day becomes very easy.

I don’t agree with his reduced calorie mindset though :slight_smile: meaning for short term loss it is fine but with an abundance of insulin you still have a problem. When you are very healthy you may not have an abundance of insulin so that shifts the story a little. I do agree calories are involved I just think focusing on them causes more harm than good. And if you have a little weight to loose focusing on insulin can be a game changer because it gives you so much flexibility and is so simple especially with a CGM.

I feel like we’re talking about two things:

  • psychological adherence which is the most important human factors, because what people actually do is ultimately what matters
  • weight gain/loss/energy balance

On what eating style ‘works’ for every individual, there is no doubt everyone is different. Eating is so deeply tied with emotions and cultural practice that it’s important to find the habits that aid in building a virtuous cycle. A lot of people find success in OMAD, keto, carnivorve, etc. I think it’s great that people find styles that work for them.

What I do think is incorrect is the ‘it’s all hormones’ message and Carb-Insulin Model (CIM) pushed by Jason Fung and Gary Taubes. Their explanations seem to lack much scientific backing and mechanistic power. I believe the main body of scientific evidence still supports that it is calorie deficiency that is responsible for weight loss. Scientific studies where calories are equated, see the same weight loss from low carb or high carb diets.

I say this as someone who switched to eating only chicken breast and vegetables and couldn’t figure out why my body wasn’t changing. It finally clicked when I read the Renaissance Diet book and figured out I was just eating too much chicken breast hence my calories were too high.

Sadly I have to completely agree with you :slight_smile: I have always avoided talking about diets because it is so individual and confusing. I felt I could open up a conversation here and even though Taubes, Fong and others (me) have pushed this simplistic hormone model forward and it is gotten popular, I feel that changing the focus from carbs to insulin will be a game changer for many individuals because it allows so much flexibility especially when using a CGM. I guess it is obvious, but in my clarification here I am fully agreeing with you. It’s individual.

So let’s take the non-simple approach and say that long term sustainable loss is about appetite control. Without appetite control it is not likely sustainable. Eat too much and you gain, as you pointed out. So ultimately this moves back towards calorie in/out although I would argue in many people insulin may the source of the problem or at least the solution for resetting appetite control (your appestat).

You would have to check with a CGM for yourself, but even in some individuals chicken and veggies could cause a big enough insulin spike that can lead to a glucose drop leading to excess hunger. I know this is pushing towrds the fringes of reality but it is possible due to this individualization of the effects of food on specific individuals.

I love this conversation. I really appreciate your feedback. Because of my recent success and the realization that everyone trying to lose weight could try a CGM to see how their insulin levels work, I wanted to say something a little controversial with a blanket claim which is not always the best approach.

My fasting glucose levels were too high (the top of normal, touching on pre-diabetic some days) and changed everything focusing on insulin so I am biased.
Although I have been intermittentent fasting 16/8 for the last 2-years. Recently going to OMAD (23/1) was a game changer. There are studies showing that fasting can produce more HGH as well as the cleansing process related to fasting (Autophagy).

I realize fasting is a different subject but focusing on insulin, fasting might be the best solution for many people.

I also updated the title and clarified very slightly.

Thanks again.

This is a biased article but I still believe that Peter believes in what he is suggesting and it holds a lot of merit although much less so in the very healthy young crowd. I think a previous junk food period could contain remaining effects for a while and still worth checking.

Funnily enough I came upon Peter Attia’s article when I was talking to a diabetic friend about their FreeStyle Libre CGM. I was also just listening to Peter Attia’s recent 3 hour (!) podcast with Layne Norton.

CGMs are obviously a god send for diabetics and pre-diabetics. And again, if it’s a tool that helps people setup good behavioural practices then it’s obviously a good thing. Without long term behavioural changes, all the obsessing and measuring is useless and we can argue models and accounting until we’re blue in the face.

For me, the main obstacle was educating myself on the basics of proper diet/nutrition models. I didn’t understand anything about energy balance or macro/micro nutrients. I was eating entire chicken breasts at multiple meals to get ‘enough protein’. But once I grasped calories in/calories out it started to make sense for me. Generally I don’t suffer from binge eating so my own experience is perhaps atypical. I know that for a lot of people eating is very emotional and hence difficult to control. I think that’s why there appears to be a gulf between the CICO model and the actual implementation of eating habits.

Nonetheless I think It’s incredibly hard to navigate the nutrition information landscape we have today. I get youtube recommendations for Jason Fung and Eric Berg all the time and I consider them to be mediocre sources of information. We don’t even need to mention the clickbait sound-bite voices trying to reach viral fame. I think the CICO model is sound but whatever path humans need to try and implement an effective behaviour change is valid.

On a technical side note, don’t CGMs and lab blood glucose markers (fasting glucose, HbA1c) only measure glucose? I would think we need to concurrently measure insulin to have a complete picture of insulin sensitivity/resistance. I could have in range blood glucose but have a high continuous level of insulin in my system which would still be bad.

Luckily, I think the recommended interventions are ‘simple’ and inexpensive: lose weight, cardio, and weight training. But I just spent $500 on bike maintenance so maybe it’s not so cheap after all :joy:

I am really happy to continue this converstation. I have a feeling we are more in agreement then disagreement. But I think it would help to add some clarification. I would semi-arbotrairily break this into 3 likely overlapping classifications.

  1. Insulin Managment
  2. CICO
  3. Appetite Control

I think in order to really call a system CICO and that CICO is working you need to count calories. Otherwise you could possibly be at a calorie deficite and gaining weight or the opposite but you have no idea unless you are going strongly one way or the other and then it is not likely a sustainable plan.

You can believe you have a basic idea of how many calories you are consuming and a basic amount of how much energy you are expending but that could easily be off very significantly. Even with counting it’s likely pretty far off but still likely closer.

So appetite control just means you have gotten to a place that your body manages itself correctly and maintains a reasonable weight or loses weight until you are at a reasonable healthy weight and it is sustainable without significant math or effort. Most often you have to be at a healthy weight for this to occur. You could call it or say “your body is automatically doing CICO” for you but for many individuals you could equally say they have gotten to a reasonable level of insulin control. As I am sure we both have seen frequently people that train a fair number of hours per week can get to “appetite control” with most reasonable diets. Different people can handle different levels of reasonable. For sure most healthy 20 years old have more flexibility than most 50 year olds.

Based on my definitions here it would seem you are more in the appetite control category then CICO. Correct me if I am wrong. You have a eating system that works for you and it might have started based on CICO principals now it does not require calorie management. I am currently in both CICO and insulin managment state. If OMAD proves to be sustainable then we could call it a form of appetite control. I can say I am not hungry, takes no great effort and I am losing weight to it seems to fit into that category at this point.

Does this make sense to you? I think if we agree (even if it is not what I stated exactly) it can help lead us both to a better understanding (or at least for me and or my ability to provide more useful advice).

I agree insulin measuring would be very helpful and without it you have no idea of your insulin resistance level but I am not convinced at this point it’s necessary. Meaning if you get to a healthly weight and don’t have excessive fructose (regular HFCS more specially - Colas being the worse) then you will likely have a “skinny liver and pancrease” so your insulin sensitivity should be at a reasonable level. Secondly if your glucose levels operate normally this is a secondary confirmation. Most people with insulin resistance also have raised fasting glucose levels. I was unknowingly in that category a month ago, but after learning I could have determined with a fairly high degree of confidence that mine was raised without measuring my glucose levels. So I would say I definitly had insulin resistance and still likely have a little but it is dissappearing quickly on OMAD.

In my case I had what I consider a high amount of inflamation but never knew why. It should have been obvious but self-evaluation is frequently not peoples strong point :slight_smile: I figured weight had something to do with it but it was not so black and white as it is now.

I think your separation is quite appropriate. At the bottom, the CICO model explains the mechanics of weight gain/loss while at the human behavioural level, insulin/appetite heavily affects behaviour which will drive the inputs.

At this point, I’m in a maintenance phase. I’m just using the moving average of the daily morning scale measurement to inform if I need to adjust my calories up or down. I don’t meticulously track calories but mostly because I can guess and understand I only need to be in the ballpark. I can eat a lot but I wouldn’t say I have satiety issues, I’ll control the portion and stick with it. (Unless we’re talking about potato chips which are definitely a trigger food :joy:)

But there are certainly tricks out there if you want to keep yourself full but calories low. Thibaudeau recommends a protein shake before a meal to reach the ‘full’ feeling faster. Greg Doucette has a lot of recipes of high volume, low calorie foods, often using protein powder or sugar substitutes (stevia, sucralose) to make almost-as-good versions of ice cream, cake etc. I think there’s a lot of good options for people these days.

As your example shows, if nothing else a CGM is a good tool for early warning/diagnosis of pre-diabetes. There’s nothing like a warning signal to motivate behavioural change and to stick with it. After all we are on a forum for a bike training tool that designs your workouts to the watt :joy:

I forgot to say, congrads on the $500 bike maintainence :slight_smile: that must feel nice. My friend and a tester on this project did a big one for me last year and switched my bike to the Shimano GRX shifters/brake levers and oval chain ring and a bunch of super nice changes, felt like a new bike. Not cheap at all. But luckily he is a great bike mechnanic and did it for free. I am ok mechanic but he is at a whole other level then I am :slight_smile: Will respond later on the rest.

The problem I have with CICO is that calorie counting is so grossly innacurate. Yes if you do a large defficite overt time it’s going to cause weight loss in most people but trying to hit a specific target you are always going to be under or over. If you are 20 calories over everyday you will end up gaining 1kg of weight each year, 10 years 10kg. Obviouisly you can’t be accurate within 20 calories each day which would require 99% accuracy. You would be lucky to be within 10% by counting.

If you have proper appetite control as many people in the world do (less and less all the time), then maintaining a consistent weight and hitting “100% accuracy” is a reality. Now, do we really think peoples bodies are 99.9% accurate on CICO? Not likely, but there is a control mechnism in place to not add excess fat to their bodies. I am not disputing that calories matter, it’s just CICO is a very flawed mathematical system due to the precision required for long term consistent weight and you can’t keep counting and starving forever via will power.

If you are always eating the same foods and quantities with small deviations and BMR and burn are consistent then sure you could skip the counting and just make small adjustments.

I just watched this 6-minute discussion :slight_smile:

And I fully agree with everything Lane says, and he agrees all these diets can and do work and finding the one that works for you. So my suggesting that CICO for everyone was/is wrong, but my main suggestion is that thinking about CICO is wrong for most people and I still believe is correct. I know we are talking about performance cyclists here and CICO can be significantly more valuable to that group then the general population. So my message to this audience is likely flawed :slight_smile:

When talking about the general population, remember CICO is what everyone has been trying to follow for the last 50 years, and the world is getting fatter and fatter. So it’s not that it is wrong, it’s that it drives the wrong behavior and generally does not work for most people.

So Lanes only flaw in my opinion is he ties it all back to calorie defficite which is not helpful for most people. While their is some truth in this, the core idea is disruptive for the average joe.

So ultimely finding what leads you to appetite control is what I believe the solution is, and it it sounds like you found that through CICO. For most of the alalytical western world I believe a CGM has the possibility to have a much more possitive affect on the general population because it can help find a long term way of eating that works for the individual. It gives a tremendous amount of flexibility. Controlling insulin has incredible unrealized potential in the general population at this point. The problem I see for most people trying to control insulin is these inflexible diets like low carb and especially keto.

With 50-70% of the US population having a problem with excess insulin and 80% of those people not realizing it, then glucose/fructose control is the #1 thing they can do to have a hope of achieving appetite control (well this is heavily my opinion). Now if CICO worked for them and got them to their target weight and then they had a system to sustain that weight it can also work but this transitionairy period from CICO to a new life is not simple for most.

Sorry if this keeps going on. I know you are very smart on this stuff and know as much or more than I do from a research perspective. I have over 200 books in my kindle library on health, fitness and diet and talked to a lot of people and done a lot of experimentation. I have tried CICO so many times and it only works short term so in that regard I am biased. Let’s see where we are both at in 2-years as well as where the world is at regarding CGM. With the tremendous amount of investment going into it I think we will have a much better perspective. Even in your case, if you are bored some time, I really can say very healthy people might find some very interesting learning from 50$ and 14 days of experiments.

First I’d like to say I’ve really enjoyed this discussion, especially your personal experiences.

Detailed calorie tracking is definitely a massive pain in the ass. Weighing the portion, cataloguing and classifying everything is tedious work. Even if we drop the requirement to weigh the portion it’s still a lot of extra guess work with no immediate benefit. It’s accounting work that nobody wants to do and doesn’t really ‘help’. It’s no mystery why most people can’t adhere to it long term.

But I think the analogy with spending/budgeting is illustrative here. Savings are clearly income minus spending. Everyone ‘knows’ you should save but a lot of people have shopping and debt problems. There’s often an emotional fulfillment with buying and it’s easy to craft a story to justify the spending. Easy access to credit and predatory lending practices only help to increase the problem. I had a financial advisor friend who gave a seminar on the importance of budgeting and how everyone should have a budget. After the seminar I asked them if they had a budget. Obviously, no :joy:

We all ‘know’ the right thing to do but we muddle and fail through it in our own ways. For some people, they need to resort to the extreme of cutting up their credit cards and having automated forced savings that they can’t access.

When I talk about CICO I’m only referring to the underlying model that weight will change with calorie surpluses/deficits (saving = income - spending). I think when you talk about CICO perhaps you’re describing the entire process of measuring/estimating and tracking calories. If so, then obviously the CICO process doesn’t work for the majority of people. Creating a calorie ‘budget’ and then having them continually jump through emotional and tracking hoops to keep to it is clearly too much.

That’s why I think whatever process or ‘hack’ to keep people on track, whether it’s OMAD, IF, keto, is a good thing. We need emotional and cognitive shortcuts that actually work long term. We ‘know’ we should eat less, but how do we actually implement it.

What is interesting to me is that the CGM is an immediate actionable measurement as opposed to say scale weight that needs to be smoothed over a couple days. Having that instant feedback really allows for attention to be paid to your food choices. To make a bike analogy here, a CGM is like having a power meter.

Almost half of the $500 was labour :joy: All I got were new tires and a cassette :rofl:

Love it. We are on the same page. I am not sure that CICO is as accurate as spendings, meaning you might spend a little more then you make (or at least appear to) and still end up positive :slight_smile: especially if it was more broccoli, nuts and olive oil :slight_smile: but I would agree there is a fairly linear relationship between ± calories and gains / loss.

As you mentioned my point was only about finding a long term “final” solution that works for a wider audience then CICO. And with such a large percentage of the world having excess insulin it’s very likely we could change the world with the instant feedback of a CGM. It’s a game changer for me and I believe I am generally on the healthy end of the spectrum. Regular exercise, mostly high quality foods…. But just too many calories (to make you happy) or too much glucose…

If not the CGM then taking steps to reduce excess glucose and fructose are likely more palatable then CICO for most and in the long term should improve their fat building and flattening the curve seems to suppress hunger as well. For me it works better then protein shakes which I currently have a few kilograms of in the kitchen :slight_smile:

Oh yeah that labor element sucks up those funds. I live in Poland so goods are 30% more then the US but labor is about 1/3.

Again beautiful discussion. I thought we were likely aligned :slight_smile:

You can see the glucosegoddess on Instagram has 500k followers and these 10 hacks I suggested. She is a CGM junkie and her book is good. I know you have a working system and don’t need it :slight_smile: but if things ever change…

Going off topic, but my Polish friend bought a beautiful gravel Rondo bike recently, which is a Polish bike maker. Definitely recommend taking a look if you don’t know about them.

I don’t speak Polish so researching anything in Poland is not so easy for me, but I really don’t pay that much attention to bikes until I am ready to buy one :slight_smile: I don’t even have a road bike. Only a CX, MTB and BMX. I prefer dirt to roads (especially because of Polish roads and drivers) and have about 150km of trails next to my summer house and 90% of my outdoor riding is with my kids :slight_smile:

As a Type 1 diabetic, these conversations worry me, like how we get the post “my HR is 180, am i about to die” from people who get a HR monitor for the first time, monitoring blood glucose is a complex thing, it is not just affected by the food you intake, this morning my blood sugar was lower than yesterday, because I didn’t wake up during the night and have a PEE

I have already seen in people wearing the device concerned that they are diabetic because their blood sugar was higher than expected, after eating a meal, because the web site says BS should be between 4.0 - 7.0 mmol, so people who see 7.1 think there is something wrong, when 11 can be a acceptable value (for a none diabetic), here is a short list of things that can affect blood sugar, and to have a accurtate idea of how anything affected your blood sugar, you have to consider all the things that could affect it

Not saying the CGM for none diabetics is a none starter, just it’s more complex that most people think (not just sugar in, blood sugar up), and if you go looking for dragons, you are sure to find them

You make very good points. I was watching the Cleveland Clinic seminar on CGMs and they point out that there are subtleties to ranges and more importantly, target times/percentage in range.

More data is certainly not always a good thing, especially without the experience and interpretation of professionals.

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I have two friends that are T1 also. I can say you are obviously an expert on your body and insulin, food and other factors. But let’s look at the non-T1s.

Most people that are overweight (let’s use the broad figure of BMI=25+) have raised glucose / insulin levels. If they have raised fasting levels it’s very hard for them to burn fat. Getting those levels down can be night and day for loosing weight. There is essentially 0 risk by lowering their fasting or average daily glucose levels. So a CGM just shows you patterns that makes that easy and real time feedback. I am not suggesting this is better than a doctor at evaluating your risk factors or where you are at. It is not. As you may know a CGM is accurate but more relative accuracy, not true blood glucose accuracy. So I don’t see any risk factor here. It’s no different then blindly following keto. Your glucose levels are going to drop all you are doing is monitoring that and getting a real-time kick in the pants when you don’t follow the rules. Or in my case if you have very loose rules, you learn as you go as to what works and what doesn’t.

So again even mayo clinc says normal people have very low risk in hypoglycemia conditions in some large study of 41% of normal people go hypoglycemia on a regular basis. So I see no risk in recommending a CGM to ispire you to lower you glucose levels for people that are over weght, and that mostly means loosing weight with a glucose focus. Glucose focus is significantly more flexible than Keto and with the right choices likely healthier.