Using CGMs In A Functional Medicine Approach To Improve Metabolic Health

The use of continuous glucose monitors (CGMs) is on the rise, and for good reason. Just 1 in 8 adults in the USA have optimal metabolic health, bringing to light the importance of focusing public health efforts on supporting healthy blood glucose regulation, decreasing inflammation, and considering other factors that contribute to metabolic health.  

Poor metabolic health can lead to a higher risk of chronic diseases like type II diabetes and cardiovascular disease and can also impact sleep quality, energy levels, and cognitive function. CGMs can help guide personalized dietary and lifestyle interventions to help keep glucose levels in range and help individuals work towards better metabolic health. 

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What is Metabolic Health?

A recent study defined metabolic health as having optimal levels of blood sugar (fasting glucose <100mg/dL), HDL cholesterol (>40/50 for men/women respectively), triglycerides (<150 mg/dL), blood pressure (120/80 mm/Hg or under), and a waist circumference of <40 inches in men and <35 inches in women, without the use of medications. 

With 1 in 3 Americans experiencing metabolic syndrome, working towards unified guidelines to define optimal metabolic health is important, and there is not yet a standardized definition of metabolic health across all health organizations.  

Good metabolic health can translate to more energy, lower risk of developing chronic disease, and improved healthspan - meaning you feel better and can live a healthier life for longer.

Factors Influencing Metabolic Health

There are several factors that may influence metabolic health, including:

• Age
• Gender
• Muscle mass/body composition
• Physical activity level
• Smoking status
• Education level
• Dietary patterns

One recent study found that better metabolic health was associated with female gender, younger age, higher education level, being a non-smoker, low body mass index, and including vigorous exercise in their lifestyle. When looking at dietary patterns, another study found that including higher amounts of refined, processed foods was associated with poorer metabolic health, while a diet similar to the Mediterranean diet was associated with a higher rate of metabolic health.  

Importance Of Maintaining Stable Blood Glucose Levels

Keeping your blood sugar levels stable and in a healthy range helps maintain good energy levels, alertness, and mood. A recent study found that a fasting level of 80-94 mg/dL, regardless of age or sex, was associated with the lowest mortality risk. Blood glucose levels that rise above a normal range are associated with a higher mortality risk, and higher sugar may lead to inflammation and a higher risk of chronic diseases, including type 2 diabetes, obesity, cardiovascular disease, and metabolic syndrome. 

Symptoms of Poor Metabolic Health

Symptoms of poor metabolic health may include:

• High blood pressure
• High cholesterol
• High triglycerides
• High fasting blood glucose
• High waist circumference

Sometimes, symptoms like fatigue, low energy, poor sleep, and poor recovery may be present, though individuals may not experience physical symptoms. Body weight does not always translate to metabolic health status either, as normal-weight individuals may also experience poor metabolic health.  

Continuous Glucose Monitors: An Overview

A CGM is a piece of wearable technology that allows the user to track glucose levels continuously. The monitor is placed on the back of the arm or lower belly, using an applicator so that the sensor lands just under the skin. The sensor then measures interstitial glucose levels in the fluid under the skin every five minutes, day and night. Most devices last for 7 to 14 days before they need to be replaced, and the monitors transmit the wearer's glucose data to an app associated with the device. Both the user and any healthcare provider they share the data with can see glucose levels, trends, and history.  

The most common traditional method of monitoring glucose is a fingerstick blood sample; however, these samples measure blood glucose in one moment in time. It can require the user to do multiple fingersticks throughout the day to get meaningful data, whereas the use of a CGM just requires the initial application stick. It should be noted that there is a slight lag time when comparing fingerstick glucose measurements to CGM data, however. Since CGMs measure glucose in the interstitial fluid as opposed to blood glucose, there's typically a 5-30 minute period of time until the CGM "catches up" to fingerstick results. For that reason, it may be more helpful to pay attention to the "time in range" data from a CGM instead of a "moment in time" reading from a CGM.  

Incorporating CGMs Data Into Personalized Treatment Plans To Help Improve Metabolic Health

A functional medicine approach to improving metabolic health is centered around highly personalized strategies and support that include nutrition, lifestyle, exercise, and mindset recommendations. Incorporating CGMs into personalized treatment plans can provide valuable data to not only uncover underlying dysfunction of blood sugar regulation but also to monitor how recommendations are impacting blood sugar in real time. These data points can help your provider - and you - tweak your care plan to get the best results.

Tracking Real-Time Blood Glucose Levels

The ability to monitor real-time data on blood glucose can be an invaluable tool to better understand metabolic health for those with metabolic dysfunction and for healthy individuals alike. The real-time data feedback can serve as an effective tool to inspire adjustments in lifestyle habits and nutritional intake, providing the user and their healthcare provider immediate feedback on dietary interventions and physical activity choices. Having that immediate feedback is linked to better behavioral modification in studies using CGMs in prediabetic and diabetic populations to improve metabolic health.   

CGMs provide continuous monitoring and data collection through the sensor that is placed just under the skin. Once applied, the sensor then measures interstitial glucose levels in the fluid under the skin every five minutes, day and night. Most devices last for 7 to 14 days before they need to be replaced, and the monitors transmit the wearer's glucose data to an app associated with the device, allowing the user and the provider to monitor the data continuously.  

Identifying Glucose Variability Patterns

Glucose variability, or how much glucose levels change over the course of time, is associated with a higher risk of hypoglycemia, vascular complications, and overall mortality in those with metabolic dysfunction. Frequent blood glucose spikes and subsequent crashes can also lead to a higher risk of developing diabetes over time, in addition to more immediate symptoms like fatigue, low energy, depression, or anxiety.

Because the sensor is continually providing feedback on glucose levels day and night, CGMs can help identify trends in glucose variability and allow the user and their healthcare practitioner to examine any patterns related to diet, sleep, time of day, or other lifestyle factors. One study using CGMs found that in people without diagnosed metabolic dysfunction, the average glucose peak after eating was 99 mg/dL plus or minus 7 mg/dL, though other studies in the healthy general population suggest a range of 70-140 mg/dL as a "normal” range of glucose variability throughout the day.    

Personalized Dietary And Lifestyle Interventions

Studies examining the validity of CGMs for personalizing dietary recommendations demonstrate that the monitors can be beneficial for monitoring diet changes as part of a therapeutic plan. CGM data gives the user and the healthcare provider insight into the user's behaviors and glycemic patterns and can bring to light changes in glucose variability that may be due to certain foods, stress, or other lifestyle factors.   

Reviewing said CGM data could help in creating the appropriate nutritional recommendations to optimize time spent in a healthy glucose range and decrease the risk of chronic inflammatory conditions associated with higher glucose values. The visual display allows the user to easily monitor how different meals, meal timing, exercise type, intensity, stress, and illness all impact their blood glucose, bringing more body awareness into the picture of a healthy lifestyle.    

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Summary

Improving metabolic health is a growing focus in healthcare to help improve the ever-increasing rates of chronic diseases that are often associated with poor metabolic health. The rise of wearable technology, such as continuous glucose monitors, can be helpful tools as part of a personalized functional medicine strategy to improve metabolic health. Real-time feedback on how nutrition, stress, and lifestyle habits impact blood glucose can help drive behavior modification and improve a user's understanding of how their daily habits are affecting their metabolism.