**The Dumbest Health Trend Of 2024: CGM | Dr Karan — Transcript & Summary | SozAI** Source: https://sozai.app/transcript/dumbest-health-trend-2024-cgm-dr-karan/ Dr Karan critiques the 2024 health trend of continuous glucose monitors (CGMs), highlighting their inaccuracies and potential negative impacts on health and behavior. ## Key Takeaways - CGMs provide incomplete and sometimes misleading data about blood glucose levels. - Blood glucose is influenced by many factors beyond diet, making single-metric focus problematic. - Obsessing over CGM data can promote unhealthy eating habits and stress. - CGMs measure interstitial fluid glucose, which lags behind blood glucose, reducing accuracy. - Health is multifactorial and cannot be reduced to glucose spikes alone. ## What the video covers - Continuous glucose monitors (CGMs) are popular among health influencers for tracking blood sugar spikes. - Dr Karan tests CGM readings comparing glucose responses to an apple and fried chicken, finding unexpected results. - CGMs only measure glucose spikes, which are normal and influenced by many factors beyond diet, such as sleep, stress, and illness. - Blood glucose is affected by numerous uncontrollable factors, making CGM data difficult to interpret accurately. - Obsessing over CGM readings can lead to unhealthy behaviors, including restrictive diets and potential disordered eating. - CGMs measure glucose in interstitial fluid, not blood, causing a lag and inaccuracies in glucose readings. - Studies show CGMs are less accurate than finger-stick tests or laboratory tests, often underestimating blood glucose after meals. - Focusing solely on blood glucose oversimplifies health, ignoring other critical biomarkers and factors. - Goodhart's law warns against overvaluing a single health metric, as it can lead to harmful consequences. - Dr Karan advises caution about CGM use in healthy individuals due to potential psychological and physiological risks. Answers ## Questions about this video Are continuous glucose monitors (CGMs) accurate for healthy individuals? CGMs measure glucose in interstitial fluid, which lags behind blood glucose, leading to inaccuracies. Studies show they are less accurate than finger-stick or lab tests, especially after meals. Can factors other than food affect blood glucose readings on CGMs? Yes, factors like sleep, exercise, stress, illness, and menstruation can all impact blood glucose levels, making it difficult to isolate the effect of diet alone. What are the potential risks of using CGMs for healthy people? Using CGMs obsessively can cause stress, promote unbalanced diets like high-fat, low-carb eating, and may contribute to disordered eating behaviors due to fixation on glucose numbers. ## Full Transcript — Download SRT & Markdown 00:00 Speaker A Health influencers have found a brand new wellness trend: continuous glucose monitoring. Continuous glucose monitoring, continuous glucose monitor. Are these glucose monitoring gizmos really all they're cracked up to be, or could those blood sugar spikes you've heard so much about not quite be the biological boogeyman you've been led to believe? And it completely changed my life. Well, he said that he had been tracking his blood sugar for weeks and that he was learning how the foods that he was eating, they were high in sugar. Well, to answer that question, I'm going to run a simple experiment on myself. I'm going to wear this continuous glucose monitor, CGM, and use it to compare my glucose response to two different foods: one undeniably healthy, a luscious red apple, and the other, well, you know. And we'll see which one is the best for me based on the glucose spike it provokes. Now, let's take a look at those readings. I ate an apple and this fried chicken hot wing. And which one would you assume gave me the biggest spike? That's right, it's the apple. To just look at these readings, you'd have to conclude that this piece of fruit, with its fiber, water, and vitamins, was worse for me than this ultra-processed fried chicken with its salt and fat. They say doctors don't get much nutrition training, but the answers don't quite add up here. And this is the problem with CGMs: they only tell you about one thing, glucose spikes, which, by the way, are a perfectly normal response to eating just about anything. Like most things in life, our health depends on much more than one factor. But even if glucose spikes were as important as influencers and celebrity doctors tell us, do you even have any control over them in the first place? You might, you might be surprised to find out. Let's play a quick game. Which of these do you think can impact your blood glucose: the amount of sleep you've had, how much exercise you're doing, your levels of stress, periods of illness, or whether you're menstruating or not? The answer is all of them. And if there's one thing you should take away from this video, it's that blood glucose is like a moody teenager, affected by everything and impossible to understand what's really making it act up. Imagine being a new mother. You've been up all night feeding your tiny human, and you're shattered. Your partner's gone to work and now left alone with a screaming gremlin who even Super Nanny would probably hand an iPad to. You're exhausted and stressed, and in a fit of madness, you decide to throw a CGM into the mix because some influencer on TikTok is doing the same. And what a surprise, you've registered a massive glucose spike straight after breakfast. How can you possibly know which of the factors I just mentioned, including the guilt you feel for pacifying your infant with a screen, are causing the spike? It's impossible to say. There's absolutely nothing you can do to prevent your blood sugar spiking in response to the events I just mentioned, so there's absolutely no point worrying about them. Yet wearing a CGM will be nothing but a constant reminder of just how spiky your glucose is. And this really gets to the heart of the problem with healthy people wearing CGMs. Physical health is the result of a complex array of interacting factors, some of which, like our genes, are not even under our control. It's impossible to measure all of these factors. Instead, we prefer to collapse all that nuance into a single number: our blood glucose, because it's easy to measure. And we end up giving that number way more significance than it really deserves. Yes, it's true that what gets measured gets managed, and blood pressure is a perfect example of that. But at the other end of that spectrum, we have Goodhart's law, which tells us when a measure becomes a target, it ceases to be a good measure. Imagine a hospital was given a target so all of its patients who walked in through its doors were seen by a doctor within 10 minutes. Sounds good, right? That's really putting the patient first. Well, it might seem like that on the surface, but what about when the hospital's understaffed? When an emergency is happening? What if the number of patients attending the hospital goes up by a quarter? Then the only way the staff can meet the target is by rushing through consultations or procedures and compromising patient care. Focusing solely on a single measure in isolation can lead to all sorts of perverse outcomes, and that sums up blood glucose measurements in healthy people to a tee. We've all encountered obsessive calorie counters or step counters who become so fixated on reaching their arbitrary goal, they lose sight of the forest for the trees. If you can't eat anything without first worrying about your glucose response to it, are you denying yourself your favorite food even occasionally? And what impact is that device really having on your life? Remember too that one guaranteed way of flattening a glucose curve is to eat high-fat foods or drastically reduce your consumption of carbohydrates. Despite what you may hear on TikTok, carbs are not your enemy. It's easy to see how obsessing over CGM readings could lead to people eating all sorts of unbalanced diets just so their blood glucose levels stay low. I can see two potential negative outcomes from this. One, I can imagine seeing individuals with deranged blood lipid profiles from eating high-fat diets, which exposes them to all sorts of negative cardiovascular health outcomes. Second, I worry that obsessive use of CGMs and a fixation on an arbitrary number and the demonization of carbohydrates in particular could lead to disordered eating behaviors, which frankly I wouldn't wish on anyone. If all of that isn't enough to convince you to think twice about wearing one of these stress patches, just wait till you find out how inaccurate they are in the first place. Let me tell you about that. Now, CGMs don't actually measure the glucose in your blood. Rather, they measure glucose in the interstitial fluid, the ISF, and that's the fluid between cells. The problem with this is that glucose levels in the interstitial fluid tend to change slower than a tortoise getting out of bed, much more slowly than glucose levels change in blood vessels. And this causes a lag between the two. In other words, what you see on a CGM may not be the real amount of glucose in your capillaries. To see how big that difference can be, let's take a look at this graph. The continuous black line shows the interstitial fluid readings taken by CGM, while the dots are the actual blood glucose levels. You can see how big the difference between the two is. Sometimes, quite frankly, the CGM readings here are misleading. Now, it's true the person in question here was exercising so intensively they needed to consume carbs while exercising, and this is what probably caused the large variation in glucose levels. Perhaps you're thinking, well, I don't do anything like that kind of exercise, so if I use a CGM, it should be more accurate. Well, you'll be pleased to hear that you have more in common with elite athletes than you think. When a group of participants aged between 60 and 85, so hardly professional sportspeople, have their blood glucose tested with either a CGM, a finger stick instrument, or the gold standard laboratory test, not only was the CGM the least accurate of the three, but it underestimated the increase in blood glucose for eight hours after finishing a meal. So, as both of these studies show, you cannot assume that what CGMs show you really is an accurate reading of your blood glucose. But even if they did, would that be enough to tell us everything we wanted to know about our overall health? As I'm going to explain, blood glucose is simply the tip of the iceberg when it comes to overall health. And like the Titanic steaming into an ice field, we ignore other biomarker icebergs at our peril. To listen to some CGM zealots talk, you'd think that monitoring your blood glucose was the be-all and end-all of human health, when nothing could be further from the truth. If your doctor susp... 00:13 Speaker A about not quite be the biological Boogeyman you've been led to believe and it completely changed my life well he said that he had been tracking his blood sugar for weeks and that he was learning how the foods that he was eating they 00:25 Speaker A were high in sugar well to answer that question I'm going to run a simple experiment on myself I'm going to wear this continuous glucose monitor CGM and use it to compare my glucose response to two different foods one undeniably 00:38 Speaker A healthy a luscious Red Apple and the other well you know and we'll see which one is the best for me based on the glucose spike it provokes now let's take a look at those readings I ate an apple 00:49 Speaker A and this Fried Chicken hot wing and which one would you assume gave me the biggest Spike that's right it's the Apple to just look at these readings you'd have to conclude that this piece of fruit with its fiber water and 01:00 Speaker A vitamins was worse for me than this ultr processed fried chicken with its salt and fat they say doctors don't get much nutrition training but the answers don't quite add up here and this is the problem with cgms they only tell you 01:12 Speaker A about one thing glucose spikes which by the way are a perfectly normal response to eating just about anything like most things in life our health depends on much more than one factor but even if glucose spikes were as important as 01:25 Speaker A influencers and celebrity doctors tell us do you even have any control over them in the first place you might you might be surprised to find out let's play a quick game which of these do you think can impact your blood glucose the 01:35 Speaker A amount of sleep you've had how much exercise you're doing your levels of stress periods of illness or whether you're menstruating or not the answer is all of them and if there's one thing you should take away from this video it's 01:47 Speaker A that blood glucose is like a moody teenager affected by everything and impossible to understand what's really making it act up imagine being a new mother you've been up all night feeding your tiny human and you're shattered your partner's gone to work and now left 02:00 Speaker A alone with a screaming Gremlin who even Super Nanny would probably hand an iPad to you're exhausted and stressed and in a fit of Madness you decide to throw a CGM into the mix because some influencer on Tik Tok is doing the same and what a 02:13 Speaker A surprise you've registered a massive glucose Spike straight after breakfast how can you possibly know which of the factors I just mentioned including the guilt you feel for pacifying your infant with a screen are causing the spike it's impossible to say there's absolutely 02:28 Speaker A nothing you can do to prevent your blood sugar spiking in response to the events I just mentioned so there's absolutely no point worrying about them yet wearing a CGM will be nothing but a constant reminder of just how spiky your glucose 02:39 Speaker A is and this really gets to the heart of the problem with healthy people wearing cgms physical health is the result of a complex array of interacting factors some of which like our genes are not even under our control it's impossible 02:52 Speaker A to measure all of these factors instead we prefer to collapse all that Nuance into a single number our blood glucose because it's easy to measure measure and we end up giving that number way more significance than it really deserves yes 03:05 Speaker A it's true that what gets measured gets managed and blood pressure is a perfect example of that but at the other end of that Spectrum we have good heart's law which tells us when a measure becomes a Target it ceases to be a good measure 03:18 Speaker A imagine a hospital was given a Target so all of its patients who walked in through its doors were seen by a doctor within 10 minutes sounds good right that's really putting the patient first well it might seem like that on the 03:29 Speaker A surface but but what about when the hospital's understaffed when an emergency is happening what if the number of patients attending the hospital goes up by a quarter then the only way the staff can meet the target is by rushing through consultations or 03:41 Speaker A procedures and compromising patient care focusing solely on a single measure in isolation can lead to all sorts of perverse outcomes and that sums up blood glucose measurements in healthy people to a tea we've all encountered obsessive calorie counters or step counters who 03:55 Speaker A become so fixated on reaching their arbitrary goal they lose sight of the forest for the trees if you can't eat anything without first worrying about your glucose response to it are you denying yourself your favorite food even occasionally and what impact is that 04:09 Speaker A device really happing on your life remember too that one guaranteed way of flattening a glucose curve is to eat high fat foods or drastically reduce your consumption of carbohydrates despite what you may hear on Tik Tok carbs are not your enemy it's easy to 04:24 Speaker A see how obsessing over CGM readings could lead to people eating all sorts of unbalanced diets just so their blood glucose levels stay low I can see two potential negative outcomes from this one I can imagine seeing individuals with deranged blood lipid profiles from 04:39 Speaker A eating high fat diets which exposes them to all sorts of negative cardiovascular health outcomes second I worry that obsessive use of cgms and a fixation on an arbitrary number and the demonization of carbohydrates in particular could lead to disordered eating behaviors 04:55 Speaker A which frankly I wouldn't wish on anyone if all of that isn't enough to convince you to think twice about wearing one of these stress patches just wait till you find out how inaccurate they are in the first place let me tell you about that 05:06 Speaker A now cgms don't actually measure the glucose in your blood rather they measure glucose in the interstitial fluid the ISF and that's the fluid between cells the problem with this is that glucose levels in the interstitial fluid tend to change slower than a 05:21 Speaker A tortois getting out of bed much more slowly than glucose levels change in blood vessels and this causes a lag between the two in other words what you see on a CGM may not be the real amount of glucose in your capillaries to see 05:33 Speaker A how big that difference can be let's take a look at this graph the continuous black line shows the interstitial fluid readings taken by CGM while the dots are the actual blood glucose levels you can see how big the difference between the 05:45 Speaker A two is sometimes quite frankly the CGM readings here are misleading now it's true the person in question here was exercising so intensively they needed to consume carbs while exercising and this is what probably caused the large variation in glucose levels perhaps 05:59 Speaker A you're thinking well I don't do anything like that kind of exercise so if I use a CGM it should be more accurate well you'll be pleased to hear that you have more in common with Elite athletes than you think when a group of participants 06:10 Speaker A aged between 60 and 85 so hardly professional sports people have their blood glucose tested with either a CGM a finger snc instrument or the gold standard Laboratory test Not only was the CGM the least accurate of the three 06:24 Speaker A but it underestimated the increase in blood glucose for 8 hours after finishing a meal so as both of these studies show you cannot assume that what CGM show you really is an accurate reading of your blood glucose but even 06:37 Speaker A if they did would that be enough to tell us everything we wanted to know about our overall health as I'm going to explain blood glucose is simply the tip of the iceberg when it comes to overall health and like the Titanic steaming 06:48 Speaker A into an ice field we ignore other biomarker icebergs at our Peril to listen to some CGM zealots talk you'd think that monitoring your blood glucose was the Beall and end all of human health when nothing could be further 07:01 Speaker A from the truth if your doctor suspects you may be at risk of any kind of underlying metabolic disorder they may well measure your blood glucose however they'll also be interested in your blood pressure your weight your family history 07:13 Speaker A of diabetes and many other lifestyle factors such as whether you smoke or drink or how much exercise you do it's the combination of these risk factors that increases someone's probability of developing type 2 diabetes but be honest how many Fitness influences out there 07:27 Speaker A encourage you to check your blood pressure or waste measurement as often as they check their blood glucose about as many of them that post content of themselves without filters don't forget so-called glucose spikes are part of our body's natural response to certain foods 07:40 Speaker A in fact Dr pet tier one of the most prominent proponents of cgms himself acknowledges there is no scientific data showing the use of CGM leads to long-term health benefits in people who don't have type 2 diabetes okay is there 07:54 Speaker A a randomized control trial demonstrating the efficacy of CGM in anything outside of patients with diabetes there is not more than this one of the major CGM providers acknowledging on its own website that brief infrequent glucose spikes may actually be beneficial for 08:08 Speaker A our bodies than a consistently flat glucose curve as is so often the case it's the dose that makes the poison although don't rely on this as a defense in court and this really can't be said loudly enough there is nothing in the 08:20 Speaker A medical literature to suggest that glucose spikes in healthy individuals are anything to worry about the whole idea that we should be worried about glucose spikes and cgms are the answer is a house built on quicksand and as I'm 08:32 Speaker A about to explain it's not just that it's a faulty idea I think cgms are even worse than that an entire industry has grown up around CGM these last few years as part of the personalized diet Trend we're seeing and it's virtually 08:44 Speaker A impossible to go online on social media and not see someone singing their praises or some company offering expensive programs to help with this it's got to the point now that you can even buy anti-g glucose Spike pills incredibly some CGM fanatics who proudly 09:00 Speaker A masquerade their concerns about your glucose spikes are actually encouraging you to eat junk food on the basis that all will be well as long as you take their magic pill only £40 a month well as long as you sun up to their monthly 09:13 Speaker A subscription I mean why not just save your money and eat less junk food this is a really strange situation to be in it's hard to imagine any other health marker becoming so popular to measure in healthy individuals as this has I doubt 09:26 Speaker A I'd even be making this videos if it weren't for the influencers and Market experts out there who are responsible for convincing so many people to spend money on cgms and don't forget they aren't cheap CGM cost can easily run 09:38 Speaker A into the hundreds or even thousands of pounds per year I mean I had to spend £80 on this thing just for the sake of this video and it's only for a 2E trial as well as the monitor itself you need 09:49 Speaker A the breathable sensor tape and the waterproof sensor covers as well well why bother with financial stability when you could have a cupboard full of miracle cures and snake oil accessories let's be on one thing there are people out there making a lot of money from 10:03 Speaker A selling products and supplements to healthy people in order to control a natural physiological reaction on the basis of fear on the basis that you should be afraid of the way your body naturally Works to me this is nothing 10:14 Speaker A more than a marketing scam maybe the problem begins with companies and certain well-known individuals but it quickly gets blown out of proportion by ill-informed influencers who either haven't done their research or are simply out to make a quick Buck or both 10:28 Speaker A but does that mean there's no one out out there apart from diabetes sufferers who might benefit from using a CGM well possibly not but here's one example athletes undergoing prolonged moderate or high-intensity exercise need to consume carbs while they're exercising 10:42 Speaker A to fuel their activity to be clear we're talking here about people who can do endurance exercises like cycling for hours at a time the length of exercise they engage in the intensity at which they're doing it and where they are all 10:54 Speaker A play a role in determining how much glucose these individuals need selective use of a CGM could play a role in managing these calculations but by the time an elite level athlete arrives at the point at which they need to monitor 11:06 Speaker A their carb intake they're already highly trained in their sport they've optimized their nutrition and probably many other aspects of their life and when they reach for a CGM it will be in full knowledge of its limitations and as 11:18 Speaker A always it's what you do with the information you get from any test that really matters not the data itself with that in mind what easy actions can you take to manage your blood glucose without shelling £100 a month plus for 11:31 Speaker A this device let's play another quick game which of the following would you guess can lower blood glucose in a diabetic individual eating more fiber going for a walk after eating a meal getting enough sleep or eating fats and 11:44 Speaker A proteins before you eat carbs as you probably already realize the answer is all of them if you're suffering from diabetes all of these options are valuable tools to help you manage your condition and you certainly don't need to wear a CGM to tell you that in fact 11:58 Speaker A eating more fiber going for more walks and getting more sleep is good advice for pretty much all of us so is not giving babies tablets to keep them quiet and while we're debunking semi- miraculous Health Scan products wouldn't 12:11 Speaker A it be great if you could simply pop a pill to regulate your appetite or knock back a drink in a cute little bottle to boost your microbiome yes these products actually exist and are vying with cgms and unicorn tear for the number one spot 12:24 Speaker A in the health fad Hall of Fame as we speak to find out more about the truth of probiotic drinks or the zic weight loss injection click on these videos to watch those next Topics: continuous glucose monitor CGM blood glucose health trends 2024 nutrition glucose spikes health influencers disordered eating Goodhart's law health measurement --- This 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