Inflammation is usually divided into two types: acute and chronic. Acute is the type that most people think of when they hear inflammation. This is what happens right after you cut yourself, brush up against poison ivy, or get an infection like the “common cold” or the flu. Your body sends out white blood cells that assess the situation and signal for reinforcements to attack the problem via chemical mediators, such as histamine, that can trigger specific cellular changes. As a result of this assault, you may experience one or more of the five most common symptoms of acute inflammation: redness, pain, swelling, warmth, and loss of function (e.g., difficulty bending an inflamed joint).

Inflammation is also responsible for most of the symptoms you have when you “feel sick,” like fever, chills and fatigue. While these can be annoying or uncomfortable, they are an indication that the body is doing its job protecting you. Without inflammation, even simple infections could become deadly. In most cases, once the harm is dealt with, the body can heal and return to normal—this usually takes somewhere between hours and days.

However, sometimes the inflammation never gets better and instead turns into a process that lasts for months or years—this is chronic inflammation. It may occur in response to an abnormality in the body, like cholesterol plaques in your arteries (atherosclerosis) or toxins from smoking. In many cases, chronic inflammation does not have a definitive cause. Sometimes the body attacks itself even though there is no injury or harmful agent floating around; this leads to auto-immune diseases, like rheumatoid arthritis and inflammatory bowel disease. Symptoms can range from very mild to severe, and even people with the same condition can have varying degrees of symptoms. Over time, chronic inflammation can cause permanent damage to cells and tissues.

How Do We Measure Inflammation? 

Sometimes blood tests can help confirm the presence of chronic inflammation by measuring for particular markers. Erythrocyte sedimentation rate (ESR) is a common test. It looks at how fast red blood cells settle to the bottom of a tube of blood. Normally, the cells settle slowly, but if you have inflammation they sink faster. This is a non-specific test, meaning that it only tells you if you have inflammation, not the cause. Another blood test measures your C-reactive protein (CRP) levels. During an inflammatory response, the liver makes CRP and releases it into the bloodstream. In general, higher levels of CRP indicate the presence of inflammation, but this test also does not identify the root cause.

Another potential marker of inflammation is uric acid (UA). Uric acid is usually a byproduct of DNA/RNA breakdown or the metabolism of ATP, the energy currency of your cells. High levels of uric acid may be present in and contribute to proinflammatory medical conditions like heart disease and diabetes. Research is still needed in this area, but some studies suggest that not only do uric acid levels potentially correlate with inflammation, but they may also precede insulin resistance, which can then lead to diabetes. 

Inflammation is important regardless of whether you feel it happening. Chronic inflammation has been linked to cardiovascular disease, diabetes, dementia and depression, among other conditions. Knowing you have inflammation can encourage you to identify risk factors that you can control and change, like sugar intake, that could lower chronic inflammation.

How does excess sugar affect inflammatory markers?

It is important to make a distinction between the different types of sugars in our food. One way that food sugars can be categorized is based on how they affect your blood glucose levels—this is called the glycemic index. Foods that cause a spike in blood glucose levels after a meal are said to have a high glycemic index. These include the refined carbohydrates that you have probably been told to avoid. Refined carbohydrates have had their fiber removed (along with other nutrients) and are found in bread, white sugar, cakes, cookies, crackers, tortillas, white rice, and many cereals. Foods that raise your blood glucose levels quickly have been associated with elevated levels of inflammatory markers, like CRP.

You may have heard that different types of sugar like fructose, high-fructose corn syrup, and sucrose (table sugar) can cause more or less inflammation, but so far studies have not shown a difference in the levels of inflammatory markers among kinds of sugars. That is not to say that they don’t affect your body in different ways, as we’ll address next, but there does not seem to be a difference in how they affect blood tests like CRP. 

What does high blood sugar do to your body?

Eating too much of any type of sugar can lead to spikes in your blood glucose levels, also called hyperglycemia. In most healthy people, the body responds to these spikes by releasing insulin, a hormone that works to bring glucose levels back down to normal. If, however, you repeatedly have too much glucose in your body, over time the cells become “numb” to insulin, causing blood sugar to rise. This state is known as insulin resistance and it is proinflammatory, potentially causing damage throughout your body. 

One target of these harmful effects is your endothelial cells, the cells that line your blood vessels. Repeated levels of high blood sugar can cause your blood vessels to produce damaging reactive molecules called free radicals, via compounds called advanced glycation end products (AGEs). Too much free radical activity generates oxidative stress, damage to endothelial cell function, and inflammation in the blood vessels. Hyperglycemia can also cause oxidation of free fatty acids stored in your fat cells, which contributes to inflammation.

In addition, glucose causes the oxidation of low-density lipoprotein (LDL), increasing your risk of plaque build-up in your blood vessels. Another negative effect is that high blood sugar levels promote blood vessel constriction and platelet clumping, which can promote blood clots.

Lastly, we all know that excess sugar leads to weight gain, which in turn increases your risk of other medical problems like obesity, high blood pressure, and many more. What’s more, excess fat tissue—particularly around the waist—promotes immune cell activation and secretes large quantities of proinflammatory chemicals. Diabetes, which is fundamentally a disease of glucose dysregulation, is itself a severe proinflammatory state. 

What long-term health problems can inflammation cause?

In light of the detrimental effects that high blood glucose levels can have on the body, it should not come as a surprise that many health problems are related to hyperglycemia and inflammation. Long-term inflammatory diseases are the most significant cause of death worldwide. While chronic inflammation may be present without symptoms or only mild findings initially, it contributes to many long-term health problems, including:

• Cardiovascular diseases, including heart attacks and strokes: There is a relationship between inflammatory markers, like high-sensitivity CRP (hsCRP), and risk of cardiovascular disease. Also, atherosclerosis (plaque buildup in your blood vessels) involves chronic low-grade inflammation and is the main culprit in heart attacks and strokes.
• Obesity: Fat tissues secrete inflammatory chemicals; the higher your body mass index (BMI) the more pro-inflammatory compounds you have circulating in your body. This may partially explain why obesity increases your risk of heart diseases, diabetes, and cancers.
• Cancers: Inflammation seems to play a role in cancers, including kidney, prostate, ovarian, hepatocellular, pancreatic, and colorectal.
• Diabetes: Immune cells affect your pancreas, which produces insulin, and the presence of inflammatory markers further highlight diabetes’ relationship with chronic inflammation. This inflammation also leads to many of the complications associated with diabetes, like diabetic retinopathy, neuropathy, and nephropathy, as well as the increased risk of heart attacks and strokes.
• Rheumatoid arthritis: Chronic inflammation in your joints that can lead to permanent damage and loss of function.
• Lung diseases like asthma and chronic obstructive pulmonary disease: Inflammation from irritants lead to lung problems.
• Alzheimer’s disease: Chronic inflammation is linked to cognitive decline and dementia.

What can you do to limit inflammation?

While it may seem like inflammation is everywhere, there are steps that you can take to limit it.

Changes in your diet are among the easiest ways to decrease inflammation. Avoid refined carbohydrates, sugary beverages, and other foods that cause spikes in your blood glucose levels. Instead, increase your consumption of fiber, fruits, vegetables, nuts, seeds, and other low-glycemic-index foods, all of which may help lower your risks of cardiovascular disease and diabetes. The plant chemicals called polyphenols in green and black teas have been shown to lower levels of inflammatory markers, like CRP. Curcumin, present in turmeric, has been shown to help with inflammation in animal studies.

You already know that exercise, especially moderate intensity exercise, can help with weight loss—but it may also decrease the levels of proinflammatory chemicals in your body, regardless of how much weight you lose. And exercise decreases your risk of heart disease, diabetes, obesity and other medical problems, so it’s an all-around winner when it comes to improving your health.

Smoking and stress are two other factors that can increase inflammation. Similarly, people with sleep disorders, or who simply don’t get enough sleep on a regular basis, are at higher risk of having chronic inflammation.

Inflammation is an important part of your body’s defense systems, especially when it comes to fighting infections. However, it can also wreak havoc in your body if left unchecked, especially over the long run. Positive lifestyle choices that limit inflammation can go a long way toward keeping your body healthy.

The post Inflammation and glucose levels: How high blood sugar can turn a good system bad appeared first on Levels.

The heat we produce in our bodies is the result of countless chemical reactions occurring in every cell. This heat production is generally matched with an equal heat dissipation, ensuring body temperature stays in a narrow range. Human bodies have a unique advantage over other terrestrial mammals—our naked skin is a superior thermoregulator, allowing us greater heat dissipation than other animals. Interestingly, glucose, a seemingly innocent nutrient, gets in the way.

Of course, the most obvious instance is elevated glucose is diabetes, where we see this phenomenon quite readily. Whether it’s type 1 or type 2, people with diabetes have a harder time keeping body temperature in control [2]. This phenomenon is particularly evident with exercise in diabetes. During exercise, the increased physical exertion results in greater heat production, which is generally accounted for by a comparable increase in heat loss. However, the “heat loss” side of the equation is compromised with diabetes—indeed, during a bout of exercise, someone with diabetes will keep up to 54% more heat than a comparably sized person without diabetes [2, 3]!

Importantly, the problem of glucose-induced changes in body temperature isn’t simply a consequence of chronically elevated glucose levels. Even in healthy people without diabetes, acute spikes in glucose, either by glucose infusion or excessive carbohydrate consumption, body temperature climbs [4, 5].

The blood vessel is at the core of the problem with poor body temperature control and high glucose levels. To effectively remove heat from the body, we need a hemodynamic shift that arises from coordinated changes in the size of blood vessels throughout the body—blood vessels in the core of the body constrict and those at the periphery (i.e., skin) dilate. These changes allow the body to transfer the heat being generated from deep within the body to the skin and eventually to the air around the body.

Beyond the discomfort of being hot and sweaty, having a high body temperature can compromise optimal function, including one of the most important things we do for our health: sleep. Increased body temperature, especially through reduced heat dissipation, is one of the most common causes of “frequent waking” insomnia [6]. Thus, it’s little surprise that consuming a high-carbohydrate load before bed, and the commensurate blood glucose and body temperature spike, results in more frequent waking and worse sleep [7].

So, if you’re “feeling the heat”, it might be time to check your glucose levels.

References

1. Ahmed, A.; Sadaniantz, A., Metabolic and electrolyte abnormalities during heat exhaustion. Postgrad Med J 1996, 72, (850), 505-6.
2. Kenny, G. P.; Sigal, R. J.; McGinn, R., Body temperature regulation in diabetes. Temperature (Austin) 2016, 3, (1), 119-45.
3. Kenny, G. P.; Stapleton, J. M.; Yardley, J. E.; Boulay, P.; Sigal, R. J., Older adults with type 2 diabetes store more heat during exercise. Med Sci Sports Exerc 2013, 45, (10), 1906-14.
4. Green, J. H.; Macdonald, I. A., The influence of intravenous glucose on body temperature. Q J Exp Physiol 1981, 66, (4), 465-73.
5. Welle, S.; Campbell, R. G., Stimulation of thermogenesis by carbohydrate overfeeding. Evidence against sympathetic nervous system mediation. The Journal of clinical investigation 1983, 71, (4), 916-25.
6. Lack, L. C.; Gradisar, M.; Van Someren, E. J.; Wright, H. R.; Lushington, K., The relationship between insomnia and body temperatures. Sleep Med Rev 2008, 12, (4), 307-17.
7. Jalilolghadr, S.; Afaghi, A.; O’Connor, H.; Chow, C. M., Effect of low and high glycaemic index drink on sleep pattern in children. J Pak Med Assoc 2011, 61, (6), 533-6.

The post How do blood sugar levels affect body temperature? appeared first on Levels.

In the summer of 2018, Aynul left his full-time job to start ZenQualify. As the increased stress of running a startup added on, so did the weight. 

“I got up to about 25% body fat, and I wasn’t doing any tracking like resting heart rate or anything,” comments Aynul. “The only way my startup could be successful in the long-term is if I’m healthy, alive, and focused on running it– I became very focused on a fitness routine, started measuring my calories, nutrients, and glucose levels.”

Aynul set out on a mission to learn and gamify his metabolic health.

“I wanted to change the script from simply just buying groceries and eating into finding out what food was actually the best for me, and what gave me the most significant increase in life quality,” says Aynul. “My idea in my early twenties has been like, after I hit it big, I’m going to hire a team of nutritionists and figure it out. In reality, you can do this by yourself without spending a lot of money; all you need is the visibility of your data.” 

The Lean Startup Meal

Aynul’s approach to his perfect nutritional strategy started with a search to blueprint the perfect meal. 

“I like food, but food variety probably isn’t going to 100x or 10x my life if I’m already eating healthy,” says Aynul. “I was looking for a tremendous upside; if I optimize one meal, I can put more time and focus into my startup or other things that may provide that asymmetrical upside.”

Aynul’s one-meal approach was primarily aimed at easing the cognitive load of deciding what to eat on a daily basis. 

“The psychology of sticking to one meal at a time is that it frees up much more time for me to focus on my startup,” explains Aynul. “It’s one less thing to think about.” 

Aynul began using Levels halfway through a two-month health and wellness sprint, in which he lost 20 pounds. Developing metabolic awareness, Aynul believes, helped lock him into his future maneuvers of replacing foods and iterating recipes with confidence. 

First, Aynul used BiteSnaps to measure out and maximize his micronutrients in his daily meal, followed by an amplification of his macronutrients.

“I started eating the same meal once or twice a day, every day, to learn how my body interacted with a single recipe over a long period, and then I would work on iterating it for added benefits,” says Aynul. 

One meal at a time isn’t uncharacteristic of Aynul, someone who describes his intense discipline as a common element in his personal and professional approaches throughout the years. 

“My first meal probably wasn’t even that healthy,” admits Aynul. “It was pretty basic– just white rice, chili beans, broccoli, and chicken. It eventually evolved into sunflower seeds, chickpeas, salmon, and green beans. I basically reverse-engineered the Mediterranean diet, which was kind of cool because I discovered the benefits of the diet along the way rather than just reading an article on the Internet.”

If one doesn’t have visibility into how things are actually impacting them, Aynul emphasizes, you’re basically shooting in the dark.

“A big part of America’s health problem is that we’ve normalized making important health decisions based on Googling articles, the production of which is easily incentivized by the food industry,” challenges Aynul. “The reason why so much nutritional information online is successful in promoting fads and inefficient, or even dangerous health practices, is because people can’t really tell if they work or not. So many people are basically just winging it– if they had the data, they’d actually see what works best for them rather than making sweeping assumptions about their health.” 

Aynul soon learned that potatoes, regardless of their form, spike his glucose levels. 

“I learned that potatoes, regardless of their form, can impact my blood sugar the same way as a can of soda,” states Aynul. “I had a baked potato that spiked me significantly. I assumed that the preparation of the potato was what made it unhealthy, like fries are bad but baked potatoes are good, but they spiked me just the same. That was probably my strongest moment of loving Levels. I also learned that most processed carbs and white carbs mess with me, but surprisingly eating white rice and beans was less of a spike than a healthy potato meal, so I stick to what’s good for me.”

“Wearing a CGM and having your metabolic data so accessible is so much easier than checking a glycemic index at every meal,” says Aynul.  “I don’t use calorie-tracking apps anymore, so I feel like I’ve self-actualized at that front.” 

Fasting: From Zero to One

Aynul became interested in food minimalism, citing two important motivations: how many renowned entrepreneurs utilize fasting in one form or another, and how fasting may impact chronic neurological conditions. 

“My family was not strict about fasting during Ramadan, so I didn’t do it until Levels made it obvious glucose spikes were bad, scaring me into it,” says Aynul. “Now, fasting is no big deal to me. I’ve been doing 36-hour fasts regularly and basically do a 24-hour fast with my one meal a day.”

By visualizing the data behind the impact of fasting, Aynul was able to draw correlations to his overall feeling, corresponding to his overall feeling and focus throughout the day. 

“My short-term goal was extreme mental clarity,” explains Aynul. “I felt I had maybe four hours of it, but now I feel like I’m up to eight hours, and I think a significant reason is because I’m not on three rollercoaster meals per day. Not having to worry about what I’m going to eat helps a ton.” 

Fasting is fairly popular in the startup community, whether done on accident or with intention. Vinod Khosla, venture capitalist and co-founder of Sun Microsystems, and Jack Dorsey, Founder & CEO of Twitter and Founder & Square CEO, regularly fast until dinner. Phil Libin, Founder of Evernote, does prolonged periods of fasting and dropped 85 pounds. 

“Another pleasant side-effect of maximizing my lifestyle by minimizing food is my food costs have dropped significantly,” says Aynul. “I’m like a startup– minimizing my burn rate takes away a lot of financial strain that may come with putting everything into a startup. I’m not even sacrificing anything, I’m eating nicer, better, tastier, and healthier food for less money, and in effect, extending my odds of survival over the long-term. I’m very symbiotic with my company right now, and I feel like I’m just extending every number that matters to me.” 

Aynul was motivated to close his nutritional feedback loop and close any gaps in knowledge. 

“I’m the type of guy who reads NIH articles for fun,” laughs Aynul. “I’m fascinated by how fasting can impact neurological disorders. My dad had Parkinson’s growing up, and it was hard for me to watch my dad’s mental health deteriorate over three decades because he is the smartest person I know. I’ve always been paranoid about what goes on in my body– ironically, Andy Grove, the CEO of Intel, once said that ‘only the paranoid survive’ and was later diagnosed with Parkinson’s.” 

“You can pretend that chronic diseases just happen, but I have a hunch most diseases are connected to our lifestyles and preventative care goes a long way. It just so happens that people start considering the impact their lifestyle has on their health until it’s too late. I noticed music and fasting were used as treatment so I thought it might be possible to minimize my risk, preventatively. I’m confident we’ll find out more of our lives are in our control and that we can do things about it earlier, but only if we have courage.”

Solving Small Problems by Solving a Big Problem

By narrowing his sights on finding his one perfect healthy meal, Aynul has been able to weed out other negative eating habits, such as eating too much sodium or sugar, and receive a wide variety of benefits such as better sleep and skin quality. 

“I genuinely believe Levels has put several years on my life,” says Aynul. “It reinforced what I was doing right, and helped me eliminate what I was doing wrong.” 

It’s estimated the human body needs just 500 milligrams per day of sodium to perform its vital functions, whereas the average American consumes 3,400 milligrams per day. 

“By fasting and eating just one meal a day, I went from about 3k milligrams of sodium to under 1500,” notes Aynul. “It didn’t really require a concerted effort, it basically happened on autopilot. Someone might phrase quitting sugar or quitting salt like a habit, but in reality, that’s just a side effect of doing all of this other stuff like eating one healthy meal a day. Focusing on your metabolic health is like a health hack that takes care of all these other mini-hacks.” 

Aynul has also reduced the conflict between slumping energy levels after heavy meals and quick caffeine pick-ups. 

“In the first year of working on my startup, I was probably drinking three or four cups of like black tea every day,” says Aynul. “I realized I was basically fighting the grogginess that comes from eating food that was otherwise impacting me poorly. Instead of fighting the food with caffeine, I just needed to eat better and less.” 

Through a combination of reduced caffeine intake and an overall more metabolically healthy approach to food, Aynul has also improved his sleep quality. 

“Mornings used to suck, I used to wake up not wanting to get out of bed,” says Aynul. Now, I wake up, and I’m pretty Zen’d out. A good morning just  changes the fabric of your whole day.” 

Further, Aynul claims his skin has cleared up significantly. 

I used to have minor acne my entire life, and I feel like it was a function of food,” says Aynul. My skin just looks healthier and tighter. Recently someone was shocked to learn I was 31 because they thought I was 22, and that’s just pretty awesome.” 

Final Thoughts

Aynul was motivated to re-think his nutrition from scratch, and began methodically challenging his intuition by experimenting with a variety of foods and lifestyle changes. 

“I wanted to get far away from bro-science and Reddit science and test things on my own,” says Aynul. “There is a lot of snake oil out there, and many people just buy into the idea of something and start to perpetuate biased word-of-mouth recommendations, and it’s tough to make an informed decision just by reading stuff online.”

Aynul views metabolic health as a stepping stone in an overall goal to live a longer and healthier life– and that all starts with one perfect meal. 

“Levels is helping me close the loop and actually eat the right food,” concludes Aynul. If I only eat one meal a day, which I do, it needs to be powerful. I genuinely believe that we can live to 150 and 200 years old one day with radical technology advances, but to get there, you need to have your wellness momentum already in your favor.” 

Today, Aynul is focused on his entrepreneurial ventures while making minor tweaks on the quest to uncover a deeper understanding of his metabolic health.

The post Choosing the right diet shouldn’t be Russian roulette: an interview with Aynul Habib appeared first on Levels.

There are a lot of reasons why it is so hard to choose healthy behaviors, many of which are entrenched into our society. These range from cultural norms regarding nutrition and “comfort food,” relentless food marketing and advertising, the addictive nature of ultra-processed food, culturally-reinforced taste preferences, complex psychological and social dynamics around food, limited access to healthy foods for many individuals, public policy that financially bolsters production and purchasing of disease-promoting foods, and a culture that promotes sedentary behavior. What’s more, we have a healthcare and medical education system that still largely emphasizes reactionary sick-care over prevention and disease reversal.

Currently, the leading causes of illness and death in the United States are chronic diseases like heart disease, cerebrovascular disease, Alzheimer’s disease, diabetes, and infections.

The commonality between all of these diseases is that you are significantly more likely to get these diseases and die from them if you have a poor diet and lifestyle. Even something like getting extremely sick from the flu is directly related to how we eat and live, as evidenced by individuals with diabetes being six times more likely to need hospitalization for influenza than non-diabetic individuals. Meaningful behavior change in how we eat and live is at the center of reversing our chronic disease epidemic, and without effective tools to achieve these aims, we will never dig ourselves out of our current chronic disease epidemic hole.

Fighting chronic illnesses primarily with drugs and surgery is the wrong approach. If the goal of the battle is to improve poor diet and lifestyle at scale, the weapon needs to be tools to improve diet and lifestyle, and drugs and surgery do not do that.

The vast majority of chronic diseases are strongly linked to insulin resistance, a condition of poor metabolism where cells become less responsive to the hormone insulin, which helps cells take up glucose for energy. Spiking blood sugar over and over throughout your life will cause insulin resistance, and minimizing blood sugar spikes throughout life will greatly decrease the possibility of it ever developing, and can help reverse it.

It seems simple enough.  But if it were that simple, then how have we ended up with half the adult US population (and likely many more) having overt insulin resistance?

Epidemic levels of insulin resistance is a result of our changing diets, lifestyles, and toxic exposures over the past century. This condition of insulin resistance feeds into almost every symptom and condition you could imagine, and contributes to:

• Obesity
• Alzheimer’s dementia
• Cardiovascular disease
• High blood pressure
• Cancer
• Chronic kidney disease
• Nonalcoholic fatty liver disease
• Depression
• Anxiety
• Stroke
• Peripheral vascular disease (and resultant amputations)
• Preventable blindness
• Dry eyes
• Infertility (PCOS)
• Erectile dysfunction
• Impaired immunity
• Gout
• Arthritis
• Chronic fatigue
• Chronic pain/fibromyalgia
• Gastric reflux
• Acne
• Skin tags
• Hidradenitis suppurativa
• Psoriasis
• Increased flu severity
• COVID-19 mortality

There is virtually no symptom or disease that is not touched by insulin resistance. Improving insulin sensitivity and metabolic fitness is an unequivocal and high value way to reduce risk of chronic disease and improve daily life.

Unfortunately, the American healthcare system has not yet figured out how to inspire people at large to adopt a diet and lifestyle that prevents and reverses metabolic dysfunction and insulin resistance.

This is because the healthcare system has not developed tools that tap into key features of sustainable behavior change, and has not had economic incentives to do so. A doctor or coach telling a patient general recommendations about what to eat or how to exercise is not a behavior change tool, it’s a conversation. And these conversations do not tend to have their desired effect, as evidence by research that shows that up to 40% of patients do not adhere adequately to physician instructions for lifestyle changes, with the prevalence rate rising to 70% or more when significant lifestyle modification or complex behavior changes are required. Even with something as simple as taking a medication, 50% of patients do not take their medications as prescribed by their doctor. Top-down advice given in a typical healthcare visit does not work at scale to fundamentally improve the health of individuals.

What’s worse, many doctors aren’t even discussing lifestyle and diet with patients, despite unequivocal evidence that it improves chronic disease outcomes. Why might this occur? Many physicians get less than 10 hours of nutrition training in medical school, and insurance tends to reimburse poorly for extended counseling. The result is a medical culture where patients with clinical obesity receive dietary and lifestyle counseling only about 30% of the time by their primary care physician.

Simply put, our medical culture does not currently incentivize or achieve healthy behavior change at scale, and this is costing lives.

Levels solves this type of behavior change. We believe that effective behavior change stems from 4 factors:

1. Closed loop systems
2. Body-awareness and interoception
3. Accountability
4. Personal control

These features are built into the Levels product. By tracking glucose in real time, having personal access to biometric data, and having granular visibility into how choices are affecting health in real time, transformation occurs, is motivated from within, and is decoupled from emotion or deprivation. This is a patient-driven approach that leverages behavior change research and insights to meaningfully inspire behaviors that have a direct relationship to the physiology that underlies a majority of the diseases and symptoms faced by our population.

1. Closed Loop Systems

The thesis of Levels is that behavior change comes from closed loop systems. The concept of “closed loop” and “open loop” systems comes from control theory:

In open loop control, the control action from the controller is independent of the “process output”.

In closed loop control, the control action from the controller is dependent on feedback from the process in the form of the value of the process variable.

Diet and nutrition is a notorious open loop system, in which people have never had a direct feedback mechanism for how their diet is affecting their health and lifestyle. Many of our customers describe diet as a “black box”, where they make choices based on what they’ve read, but they really have no idea if it’s working.

The current feedback mechanisms for diet are all open loop, and include things like:

1. DNA tests, in which you get a result along the lines of, “bananas are bad for you”, but it’s hard to connect that result to real outcomes after eating a banana.
2. Food journaling, in which you write down what you eat and how you feel, and you can sometimes make tenuous connections between cause and effect.
3. Blood tests, in which your results are a multi-month (or multi-year) trailing indicator of your health, and if your numbers are out of range, a doctor will frequently say something along the lines of, “You should make better choices”, which lacks the specificity necessary to lead to behavior change. Getting a yearly result of a fasting glucose of 101 mg/dL (early prediabetic range) does nothing to specify what behavior changes need to happen to reverse this.
4. Monitoring weight, which can be hard to interpret due to dynamic influence of weight by hormonal fluctuations, water, and inflammation.

It’s worth further clarifying how a closed loop system differs from an open loop system. In a closed loop system, it’s possible to directly attribute action with consequence. This is not to say that other behavioral mechanisms that give real-time feedback (like gamification, streaks, or community support) are not useful, but they are not closed loop systems, as they don’t engender solid attribution.

Continuous Glucose Monitoring (CGM) is the first tool that we can use to measure real time biomarkers and close the loop on diet and nutrition—a notoriously opaque and misleading market that leaves most people feeling helpless and confused.

Glucose is not a panacea for metabolic health, but it’s the single most important thing to track for the 80%+ percent of the population who exhibit signs of metabolic dysfunction, and more than 50% with overt insulin resistance. It is also the only blood based biomarker that is able to be monitored at home continuously, in the “background,” without being initiated by the user/patient. This is what makes it a great place to start.

When we consider next steps for what we should focus on, we need to keep our thesis in mind. There’s no limit to the functionality we can add to a software product that leverages a glucose data stream, and many of these will be distractions from our thesis. For example, we could easily add genetic data into Levels, which would add value but would not close a loop and would likely not lead to behavior change.

Fitness, sleep, heart rate, and activity data, on the other hand, is real time data and can have an immediate and measurable impact on how somebody responds to a given choice, helping us move towards a more intelligent technology that is able to determine the “weight” of the impact of various choices (sleep, exercise, stress) on overall glycemic control.  This makes it a great candidate for a data stream we should consider adding in the near-term.

Similarly, automated event detection allows us to prompt our customers with quick feedback during (or immediately after) an event that can close the loop on a given behavior, which makes it a good candidate as well.

2. Interoception

One of the reasons closed loop systems are particularly powerful in this context is because they improve interoception (also known as “somatic awareness”), which is a person’s sense of the internal state of their body at a given moment in time.

Having awareness of signals originating within the body (ie, a physical awareness of one’s heartbeat or respiratory patterns) has been associated with better physical and mental health outcomes, and increased motivation. Conditioning to improve interoception capabilities has been hypothesized to be important in chronic pain, high blood pressure, gastrointestinal disorders, mood and anxiety disorders, addiction, and asthma.

Interestingly, training to improve interoception capabilities — such as structured heartbeat biofeedback that improves heartbeat discrimination capabilities — has been shown to significantly improve health outcomes. In short, it appears that becoming more sensitive to bodily workings through biofeedback — which can “close the loop” between internal processes and psychological state —  is important for wellbeing.

It’s common for people to feel tired, energized, angry, unmotivated, depressed, distracted, and a host of other states without understanding the reasons why they feel that way. When it comes to subjective mood states, it’s easy to misattribute causality because there are so many variables that can affect how one feels—sleep, hydration, caffeine, exercise, stress, food intake, food timing… the list goes on.

In fact, it was exactly this type of misattribution error that led to the first lightbulb moment that Sam, Levels Co-founder, had while using Levels. On his second day using a continuous glucose monitor, after his normal healthy breakfast of steel cut oats, he started to notice that his hands were shaky, and he felt tired and hungry.

In his head he was thinking, “Oy… Well I did have 3 cups of coffee this morning, and I didn’t really sleep that well… This caffeine crash is getting out of control. I’m switching to tea starting tomorrow.” Then he checked his levels and saw that his glucose levels had spiked to 215 mg/dL and he was crashing down to 50 mg/dL (for reference, individuals without diabetes rarely exceed a glucose level of 140 mg/dL; for additional context on what’s normal, check out our blog post). He was experiencing severe hyperglycemia followed by reactive hypoglycemia and the symptoms that come with it, and he misattributed it to coffee or sleep.

In fact, this is something he’d been doing for his entire life, and this is the first time he had data to guide his decisions. He switched to eggs for breakfast and no longer experienced these symptoms. It was eye opening for Sam, who has read dozens of books on diet and nutrition and was actively trying to make healthy choices, was still doing things that made him feel bad throughout the day—not to mention that they were negatively affecting his long-term health.

In the context of glucose and metabolism, we call this “metabolic awareness.” It’s a newly discovered intuition for most people in which you can start to associate subjective feelings with specific choices, confirmed by data. When your heart is racing and you feel warm, you might start to recognize that as a symptom of hyperglycemia after eating something with a lot of sugar. Likewise, you can start to connect your crashing energy levels and lack of focus with the carb-heavy lunch you had earlier and the subsequent hypoglycemic crash.

If you can close the loop by allowing people to specifically attribute how they feel with a decision they’ve made, you not only allow them to consciously improve their decision making, but you also change their subconscious decision making processes.

What we’ve found amongst our team and many of the individuals who have gone through the Levels program is that glucose biofeedback removes much of the emotional or conscious elements of behavior change. With a closed loop between glucose and a negative sensation like fatigue or anxiety, and the attribution of the negative sensation linked to a specific choice (food, lack of sleep, etc), people have found diminished enjoyment and reward in the trigger, making it inherently less desirable and easy to eliminate.

It’s hard to explain unless you’ve experienced it yourself, but when the loop is closed after making a particular dietary choice—especially if it’s associated with a negative lifestyle event like feeling tired—you don’t need to make a conscious decision to change your behavior because the decision is made by your body. It’s more akin to getting food poisoning, where you don’t consciously decide, “I’m not eating clams ever again,” because the decision is “made” for you by your body; after food poisoning, the idea of clams is inherently no longer associated with pleasure or reward.

Glucose biofeedback has a similar impact, subtly nudging us towards more metabolically-friendly food choices by conditioning us with feedback that changes the reward equation. It also helps us understand with granularity how choices relate to subjective experience, thereby potentially strengthening a novel form of interoception. It’s these improvements to interoception that we expect will make for incredibly powerful and lasting behavior changes.

3. Accountability

One commonly understood mechanism of behavior change is adding an obligation that brings with it social pressure to stay adherent. Many organizations have used this tactic successfully, including Alcoholics Anonymous (where you’re accountable to your peers in the group), Omada, and simple arrangements like hiring a personal trainer to force you to work out at a regular time.

When we started Levels, accountability was not a value proposition we considered, but the more feedback we gather the more we realize that for certain markets, adding an accountability layer is extremely powerful.

Accountability also covers much of what is commonly referred to as “gamification”. In our case, that would include features like “streaks” and other mechanisms that show longitudinal progress.

Another aspect of accountability might be better defined as competition. One of Fitbit’s breakout moments was when they introduced the ability to compete with your friends and family members to see who hit their goals and took the most steps. This not only encouraged adherence to your goals through social pressure, but it also built in a viral sales loop, where people would encourage their friends to purchase the product so they could compete with each other. The nature of accountability within a competitive framework falls into the “autonomous accountability” category of the Self-Determination Theory, whereby individuals pursue accountability from a foundation of internal motivation to execute a desired behavior.

4. Control

Finally, an additional feature of behavior change captured by the Levels product is increased control.  Recent research shows that in 2018, 80% of consumers found conflicting information about food and nutrition, and 59% say that the conflicting information makes them doubt their choices. Individuals are currently faced with seemingly endless food marketing claims, competing popular nutritional ideologies, and nutritional recommendations from different medical governing bodies, and this can create a counterproductive environment rooted in the “paradox” or “tyranny” of choice. In this model, individuals with too many choices have decreased motivation, less satisfaction with choices, and creates decision-related anxiety and regret.

We believe that the objective datastream generated by glucose monitoring makes the myriad daily choices drastically simpler and allows individuals to execute on better choices with increased control. For example, knowing that oatmeal spikes glucose to 180 mg/dL effectively eliminates this as a positive nutritional option. This is now no longer a food choice. Knowing that taking a 20 minute walk before eating a banana reduces a subsequent glucose spike makes walking a clear positive choice.  Objective data that CGM provides can engender a unique and renewed sense of objective control, which has an impact on behavior change motivation; research suggests that “perceived control is associated with emotional well-being, reduced physiological impact of stressors, enhanced ability to cope with stress, improved performance, and a greater likelihood of making difficult behavior changes.”

What’s more, this process is extremely efficient. Using Levels for just a month can clarify eating and lifestyle decisions that an individual may have been waffling about for decades.

Conclusion

Successful behavior change at scale is required to solve the metabolic health crisis. If hundreds of millions of Americans do not make the consistent daily choices to eat and live in a way that minimizes glucose variability, we will continue to see epidemic rates of insulin resistance and related chronic disease. Drugs and surgery cannot be the lifeline thrown to everyone; they are more often a band-aid that does not actually reverse the dysfunctional physiology that causes disease.

Drugs and surgery are what we refer to in medicine as “tertiary prevention,” meaning prevention of complications if someone has already developed a disease.  If there is anything we have learned about chronic lifestyle related diseases, it is that we need better solutions than waiting till someone is in florid diabetic ketoacidosis (a severe manifestation of uncontrolled diabetes) to begin proper treatment. At Levels, our long-term goal is to enable primary prevention, meaning prevention before someone has overt disease. If people are to avoid diabetes, they have to be equipped with tools that help them monitor the drivers of these diseases, well before they manifest in full blown pathology.

The conventional top-down approach to healthcare advice, coupled with a bias towards drug and surgical interventions, will not work to meaningfully improve human health, resilience, longevity, or happiness. Advice does not inspire sustained behavior changes at scale, and drugs and surgery manage downstream symptoms and manifestations of disease, but do not typically reverse or prevent disease.  What’s more, a physician or coach cannot be with a patient 24 hours a day intelligently inspiring and informing choices, and yet this is fundamentally what is needed, because disease is a result of the hundreds of choices we make daily.

Digital health technology is poised to take on the chronic disease epidemic in a radically different way, and we are fortunate that glucose monitoring tools exist to make this sustainable positive behavior change a reality for anyone who wants to optimize their health and prevent future disease. By focusing on aspects of behavior change and human nature that are robust and leverageable, digital health technology can catalyze progress in ways that the traditional practice of medicine cannot.

The post The Levels Theory of Behavior Change appeared first on Levels.

The mission of Levels is to reverse the trend of metabolic dysfunction. We’re in the Tesla Roadster phase of the business right now, building the high unit cost model that we can learn from and optimize to get the cost down over time—which is in part why we’re shamelessly copying Tesla in writing this post. The people that are most at risk of metabolic dysfunction cannot afford a $399 program, so we need to get the price down as quickly as possible.

Within the next 5 years we’re going to be talking about the metabolic health crisis in the same way that we currently talk about the opioid epidemic and cancer. This is the single biggest health crisis in the world and has yet to penetrate the zeitgeist.

Most people don’t yet realize the magnitude of the problem that metabolic dysfunction poses for society. If you want to dig deeper into this, you should check out our blog post Ultimate Guide to Metabolic Fitness, but the highlights are:

• More than 10% of the US is currently diabetic, and the rate is accelerating.
• There are almost 90 million prediabetic Americans, 70% of those people will be diabetic within 10 years, and 84% of people with prediabetes do not know they have it.
• Fewer than 25% of candidates of eligible age qualify for the military and this is largely due to the majority of the population being metabolically unfit – it’s a national security problem
• Metabolic dysfunction might be the single largest (preventable) force pushing up the cost of healthcare. Individuals meeting at least 3 criteria for metabolic syndrome have 60% higher annual costs; diabetes alone contributes to $327 billion in medical costs and lost productivity, expected to exceed $600 billion by 2030.

And that just covers the United States. In Mexico, diabetes is the #1 cause of death (followed closely by heart disease and stroke, both metabolic-associated vascular diseases) and only 5% of patients with diabetes are estimated to have the disease under adequate control. India is estimated to have over 77 million people living with diabetes.

One reason we’ve been so in the dark about metabolic health is because there are no good tools to measure how your diet affects you in a quantifiable way. The biggest levers for metabolic health are, in no particular order:

• Sleep
• Diet
• Exercise

There’s no way to say which is the most important because they’re so interdependent. If you sleep poorly, your body releases stress hormones, generates inflammation, triggers hormones that lead to sugar cravings, and develops acute insulin resistance. Together, this may result in erratic mood and energy throughout the day, making it harder to exercise and prepare healthy meals, and generates a negatively reinforcing cycle of poor metabolic health.

We currently have good tools for measuring and quantifying sleep (Eight Sleep, Oura) and exercise (Apple Watch, Fitbit, Whoop), which has allowed people to discover how their choices are affecting those aspects of their life, but there hasn’t been a way to quantify how your diet affects you. This has forced people into the position of making guesses as to what is working and what’s not, leaving 59% of people saying conflicting food and nutrition information makes them doubt their choices.

In the same way that everyone knows to get 8 hours of sleep, and how Fitbit convinced people that walking 10,000 steps is a good target for exercise, we will show people that maintaining a flat glucose curve is optimal for lifestyle and long-term metabolic health.

Empowering people to see for themselves how their choices affect their health gives them agency. We all know that eating a bag of potato chips is bad for us in a general, ill-defined sense, but without an immediate consequence like pain or death it’s hard to feel compelled to overcome the powerful rewards of smell, texture, and taste.

By quantifying the consequence of a choice in real-time, we can effectively close the loop on diet, connecting a specific action to the nature and degree of the reaction and allowing us to continuously improve our choices. The first time you see the data that closes the loop on how your choice of breakfast directly caused your mid-day energy crash: that’s when you make a change.

Behavior change doesn’t come from lecturing people or telling them to “make better choices”. We know this from research examining whether patients implement their doctors’ recommendations: the vast majority do not. The solution to this problem is bottom up — most people will voluntarily make better choices if they have evidence that those choices are making a direct, immediate, and positive impact on their lives.

The “calories in, calories out” model of nutrition is simplistic to the point of being wrong. We owe a debt of gratitude to the people who have blazed the trail in our modern understanding of metabolic health, including Drs. Jason Fung, Rhonda Patrick, Peter Attia, Dom D’Agostino, Molly Maloof, Ben Bikman, Louise Burke, David Perlmutter, Mark Hyman, Eric Topol, David Sinclair, Sara Gottfried, David Jenkins, and many others.

We are defining the category of metabolic health, using real-time tracking with biowearables. The center of gravity of healthcare is shifting towards greater democratization of data, which is increasingly putting more power in the hands of the individual. Enable a person to make informed choices based on their own data to improve their own health, repeat many times across many people, and it adds up to a global-scale result. In short, the master plan is:

1. Build premium software to quantify the effect of diet on metabolic health.
2. Use that money to expand awareness and scientific understanding of metabolic health; build a more affordable product.
3. Use that money to build an even more affordable product.

Don’t tell anyone.

The post The Secret Levels Master Plan (just between you and me) appeared first on Levels.

David Lee studied biology in college and wrote a paper about how a ketogenic diet can affect epilepsy and seizures. If keeping insulin sensitivity high and blood glucose levels low could potentially prevent these processes from happening in the brain, David wondered what other longevity benefits one could receive. He tried a strict keto diet, but as a collegiate soccer athlete always chasing better performance, he realized his athletic output requirements needed more juice. 

David learned that a typical keto blueprint didn’t work with his sprint-heavy workout routines. He soon embarked on a mission to find a way to leverage the potential long-term benefits of keto while also getting explosive sprint energy.  He started following people like Tim Ferris, Peter Attia, Dom D’Agostino, and others who were experimenting with CGMs. 

“In January 2020, I did a DEXA scan that put me at 18.5% body fat,” notes David. “I was spending a lot of time at work and eating liberally, and decided to make a big health push. I started using Levels around June 2020 to refine my understanding of nutrition. I dropped about 13 pounds in about two months, and being able to visualize the metabolic journey with Levels was insightful.” 

David credits the new perspective of his metabolic health as an impetus for envisioning a stronger connection between food and energy. 

“I am big on using data to make informed decisions about my general wellbeing,” remarks David. “I want to have a lot of metrics to develop feedback loops that lead to actionable improvements. Levels helped me summarize a very important component of my biochemical profile. The objective data is great to connect perspective and personal performance to drive actionable insights.

Metabolic Health as a Keystone Habit

For David, the best metabolic health approach is to build a flexible set of habits built on short feedback loops based on data, rather than a rigid pass-or-fail goal tracking system. 

“As a data scientist, I try to view all data as being part of a system. I think a lot about systems and habits,” says David. “If you have good habits and a finely-tuned autopilot system, you’ll directionally be pretty good. Levels helped me get that instant feedback loop and hone in on my habits and make sure I was going in the right direction.”

Being directionally correct has allowed David to eliminate the extra worry that may come with optimizing his personal nutrition so he can focus on stringing together positive days. 

“James Clear’s book Atomic Habits helped me bring a lot more awareness to the actions I was taking on a daily basis, particularly how I could rewire my days around a certain keystone habit,” believes David. “If you set metabolic health as your keystone habit, you’ll end up driving much more awareness and accountability to every other aspect of your life: sleep, exercise, nutrition, stress, and so on. Before you know it, you’re stacking other healthy and beneficial activities together while attempting to optimize your metabolic health score in the app.” 

However, building habits can be difficult if they come with the responsibilities of tedious rote work such as manually logging food and exercise, and then trying to correlate it with an additional response data set, such as blood glucose. 

“What I liked the most about Levels is that it helped make eating healthy and making good choices less neurotic,” comments David. “Snapping a picture of your meal is so easy– otherwise I would hate logging anything because it’s just tedious. Even logging workouts is tedious. I set up templates for these things because individual logging is so annoying.” 

The nuances of nutrition can be tricky to nail down without a real-time cause and effect. David had a functional understanding of how what types of foods were good for him in theory, and seeing his metabolic data helped him develop a more granular understanding. 

“Prior to tracking my metabolic health, I basically just relied on intuition,” says David. “One of the most significant eye-openers was the impact white rice and white flour could have on me. Whether it was enchiladas or sushi, or anything that was white rice based, I would spike up. So now, I plan to have that at the end of the week or before or after a really hard workout.” 

As long as he was eating directionally good, David found a delayed gratification piggy-bank effect on his metabolic health. 

“I could have a cheat meal with minimal metabolic impact because I had basically built some sort of credit with my body, explains David. “Recently, I had a Blizzard from DQ and it didn’t do much, whereas maybe if I had like two bad days in a row, my glucose levels would have probably exploded.”

Optimizing Workout Strategy

David is very principled and strategic about his workout routines and nutrition. He found that by reducing the cognitive load of deciding his workouts and nutrition, he was able to focus more on how he can better optimize his athletic endeavors by prioritizing his metabolic health.

“I liked seeing which things are working well, which ones aren’t,” says David. “With Levels, right away, I was able to see validation that I ate well. Seeing those green metabolic health scores drove my other behavior. It became easier to connect data sets. I noticed that if I had a great workout one day, I also tended to have a green metabolic score– I also felt overall better and more accomplished on that front. I focused on making life decisions that gave me better metabolic health scores because they were linked to overall positive results in many other aspects of my life.”

Being able to see a single objective data makes it easier to quantify subjectivity. If we can ascertain a positive impact from our actions on our overall well being, we’re able to focus on the things that give us more long-term enjoyment in life. 

“I found that having accessible metabolic data just makes you a more conscious and thoughtful eater,” concludes David. “It also gives you a ton of flexibility. For example, if I’m about to eat something I’d consider bad for me, I better enjoy it because it’s going to bomb the score. Better yet, I can plan to take actions after something that spikes me to minimize the negative impact while also getting a stronger burst of energy.”  

Planning his daily workouts in one sitting a month in advance, David found that he was able to reduce the daily requirements of deciding what to eat and how to work out. 

“The first thing I did when I woke up was check my workout and be locked into it,” comments David, “That would roll into the rest of my day’s nutrition. I would pair my meal types with my workouts. I found this reduces the necessity to think of it on a daily basis, and I think it created a really good synergy of accountability to yourself.”

In action, David found that he could coordinate his meals with his type of workout to maximize his athletic output and set reasonable expectations.

“I tried to monitor how HIIT versus low-intensity longer duration exercise impacted my glucose levels,” explains David. “If I was doing HIIT exercises like sprints, I wanted to see that big spike. If I was doing long runs, I’d look for my levels to be fairly flat. If I saw myself crashing, I would eat foods to replenish my glycogen. This all connects to my daily nutrition and planned workout as well.”

“The objective data makes it easier to make directionally good nutritional decisions, and that makes it so much easier to be consistent without the added mental stress of calculating calories and living a rigid lifestyle because of your diet.”

By using the Zone Comparison feature in Levels, he could see how his HIIT versus longer-duration impacted his energy levels, and that information influenced how he would eat before, during, and after a meal.

“If I didn’t see a big spike in my HIIT exercises, I felt that I probably could have ran a little bit harder, or that I should have done the exercise with more effort or giving myself a shorter break. I wanted to see that large spike, I wanted to be huffing and puffing. I wanted to visualize the glucose being broken down. If it was a longer-duration exercise, like a 90-minute run, I expected to see a long and slow breakdown.” 

Final Thoughts: Directionally Good Metabolic Health 

David Lee is on a mission to feel better and live longer, and he’s found that by focusing on his metabolic health and setting the goal of being directionally good, achieving his other goals becomes much easier. 

“My nutrition plan is simple now and picking food is so much easier now: these are the foods that make me feel good, hopefully I can cook them well so they taste good too, and these are the meals that make me feel bad,” laughs David. “Instead of having to do a lot of the manual labor these insights would usually require, I can build a real-time awareness of where my metabolic health is at any given moment.” 

Without the immediate response, David posits, he would end up trying to retroactively piece together meaning over weeks and months. The shorter the feedback loop, the easier it is to focus on making improvements rather than just monitoring and logging.

“Metabolic health and overall wellness go hand in hand,” comments David. “At the end of the day, it becomes much easier to stack good days together in a row versus trying to set a vague long-term goal over a period of weeks or months. Having that feedback loop makes it so much to stack good habits together, which leads to more good days.”

The post David Lee: Using CGM to build keystone habits for athletic performance and metabolic health appeared first on Levels.

Most people, due to chronically elevated insulin from eating processed carbohydrates and sugars frequently, are “stuck” in “glucose burning”—this is the most common state of metabolic inflexibility. Essentially, the person is still burning glucose as the primary fuel even during a fasting period (i.e., hours after eating). This is a disease state associated with numerous health problems, such as insulin resistance, type 2 diabetes, Alzheimer’s disease, infertility, and more.

Interestingly, long-term adherence to a low-carbohydrate, ketogenic diet (KD) can cause a sort of “reverse metabolic inflexibility”. In this state, rather than being stuck in “glucose burning”, the body shifts to be almost exclusively in “fat burning mode” as a result of low insulin levels. This is a healthy state—the body is operating perfectly fine with prolonged reliance on fat as the primary metabolic fuel. However, this does mean that a load of glucose takes longer to clear. In other words, if you’ve been adhering to a KD and you suddenly consume a substantial load of carbohydrate, you can expect to see a higher-than-normal rise in glucose. This is expected—after all, you’ve shifted your metabolic function to rely on fat for fuel!

There is no need to fear this “reverse metabolic inflexibility”, but it is important to be aware of the phenomenon. For example, if you’re about to take an oral glucose tolerance test with you doctor, you may want to shift back to true metabolic flexibility by increasing your carbohydrate consumption in the three or so days leading up to the test. By doing this, you’ll likely have no problems on the glucose tolerance test. For some people, maintaining true metabolic flexibility may be sufficient reason to “carb cycle”, though there is no evidence that such a strategy carries long-term benefits vs. a traditional ketogenic diet.

The post What should I expect to see on my continuous glucose monitor if I’m on a keto diet or in ketogenesis? appeared first on Levels.

Hormonal fluctuations during the menstrual cycle. Red line = estrogen; Dashed lined = progesterone.

During the menstrual cycle, the body is engaging in energetically intense processes like ovulation and building up the uterine lining to receive a fertilized egg. Sex hormones like estrogen and progesterone appear to play a role in energy metabolism, insulin sensitivity, and how glucose is processed in the body. In general, estrogens seem to promote insulin sensitivity, and progesterone promotes insulin resistance.

Research has shown that glucose concentrations in the luteal phase (post-ovulation) are significantly higher than in the follicular phase. Concordantly, in some studies, there has been found to be an increase in insulin resistance in healthy women during the luteal phase of the menstrual cycle (when progesterone-to-estrogen ratio is high) in comparison to the follicular (pre-ovulation) phase (when estrogen-to-progesterone ratio is high). This suggests that the reduction in insulin sensitivity during the luteal phase depends on the increased level of progesterone.

Estradiol (estrogen) improves the expression of insulin signaling molecules in skeletal muscle.  Estrogens exert beneficial metabolic effects by lowering body-fat and improving insulin sensitivity in females. Insulin sensitivity is higher in the follicular phase and decreased in the luteal phase.

In some studies, fasting insulin rises before ovulation and reaches a maximum during the luteal phase, indicating relative insulin resistance during the luteal phase of the cycle in agreement with studies showing lower insulin sensitivity in the luteal phase using glucose tolerance tests.

Based on this literature, given relative insulin resistance during the luteal phase (post-ovulation), it seems reasonable to focus on minimizing glucose (and insulin) stimulating foods during this time to minimize the glycemic impact of this phase.

The post How does the menstrual cycle affect glucose levels? appeared first on Levels.

How do oral steroids affect my glucose levels?

Individuals who find themselves taking oral steroids like predisone for a medical condition are likely to see their blood sugar go haywire while on the medication. There are many different ways of getting steroids in the body, like oral (pills), inhaled, liquid drops (eyedrops), topical (creams and lotions), and intravenous. Depending on the condition, a particular route may be favored over another. For a poison ivy rash, a cream might be ideal. For severe asthma, inhaled or intravenous might. For chronic sinusitis, oral pills may be prescribed. For styes, a eyedropper liquid form might be used. Oral and intravenous are the mostly likely to have a significant effect on glucose levels and metabolism.

Steroids are generally prescribed for their anti-inflammatory and immune suppressing properties, but have several side effects, of which one of the most severe is hyperglycemia (high blood glucose).

One of our founders who normally has extremely stable glucose levels had to take a week of prednisone for a respiratory illness. His normal flat line glucose went from this:

Stable, low glucose levels in the 60-70 mg/dL range

…to this:

Highly erratic glucose with large swings up to 150 mg/dL

Exaggerated elevation of glucose with slow return to normal

Oral steroids affect glucose regulation through a number of different mechanisms, all of which can lead to increased glucose levels in the blood. Here are some of the main causes:

1. Steroids induce insulin resistance by directly interfering how the cells absorb glucose. Specifically, steroids inhibit signaling of the  GLUT4 glucose transporter channel within muscle cells, resulting in 30%-50% reduction in insulin-stimulated glucose uptake in the cells, and a 70% reduction in insulin-stimulated glycogen synthesis (glucose storage). Both of these lead to more glucose floating around in the blood stream, and less ability of the cells to take up glucose after eating.
2. Steroids are responsible for the breakdown of proteins in the body, with the resulting increase in serum amino acids (amino acids are the building blocks of proteins). High levels of serum amino acids also interfere with insulin signaling in the muscle cell, leading to less glucose uptake, and more floating in the blood.
3. Finally, steroids increase fat breakdown (lipolysis), resulting in an increase in blood levels of free fatty acids and triglycerides. The elevation of free fatty acids and triglycerides promote the accumulation of fats inside the cells (specifically in the form of acetyl coenzyme A, diacylglycerol and ceramide), which causes reduction of the ability of the cell to take up and store glucose.
4. Steroids reduce insulin synthesis in the pancreatic beta-cells and it is thought that they reduce pancreatic cell size through the induction of beta cell death.
5. Additional mechanisms, detailed in this paper.

With all of these impairments in normal glucose uptake and management, the result can be very erratic readings on continuous glucose monitors. While steroids can be lifesaving, it is important to be on minimal effective dose for as few days as possible to minimize these side effects.

Check out the following video that one of our early customers Ali Spagnola made about her experience taking oral steroids for a rash while wearing Levels:

The post Taking steroids? Expect glucose turbulence appeared first on Levels.

The reason your glucose level is dropping while sleeping could be due to a wide variety of issues, described below.

The Impact of REM Sleep on Glucose Levels

Research also shows that glucose levels decrease by an average of 5% during REM sleep, as compared to non-REM sleep stages, which may contribute to periodic dips seen at night in nondiabetic people. In fact, healthy people who have glucose dips below 70 mg/dl have twice as many dips as night as compared to during the day.

Meal and Alcohol Timing and Glucose Levels

When you wake up after a long night’s sleep, your body has been in a fasting state for quite a few hours. During this fasting period, your body expends circulating and stored glucose to perform all the usual physiologic processes. If you tend to stop eating earlier in the evening, and do not snack at night, this fasting window will be greater and it may lead to lower glucose levels during that night.

Additionally, drinking alcohol in the evening could lead to low glucose values overnight. It’s thought that drinking alcohol decreases the ability of the liver to make new glucose via gluconeogenesis, which can lead to lower circulating glucose levels. To counter this decrease, alcohol stimulates the breakdown and release of stored glucose (glycogen). This balance between impaired gluconeogenesis (new glucose product) and increased glycogenolysis (stored glucose release) means that alcohol shouldn’t significantly affect glucose levels for normal, healthy individuals eating a standard diet.

The situation is different though for those who’ve been fasting or are in a ketogenic state, because these individuals already have much less glucose stored as glycogen in the liver and muscles. Normally this state prompts the liver to produce new glucose via gluconeogenesis, but, as noted above, alcohol inhibits this process. The result is that glucose levels can fall to dangerously low levels and in extreme cases, this hypoglycemic state can lead to seizures, coma, or death.

Pressure Induced Sensor Error

Your glucose levels might not actually be dropping at night, it could just be your sleeping position causing a Continuous Glucose Monitor (CMG) sensor error.

One study found that individual sensors intermittently exhibited unusual glucose readings greater than 25 mg/dl away from the subject’s median of 70-110 mg/dl during sleep, and these odd dips were strongly correlated to subjects lying on the sensors.

The analysis also stipulates that the cause of the dip could be due to local blood-flow decreases caused by the compression of tissue in the sleeping position.

Another study confirmed the claims that some dips in glucose could just be the effect of motion and pressure on glucose sensors. If you lay on the sensor, you could see a dip in the readings that isn’t actually expressive of your real blood glucose content.

To get more accurate readings at night, you can try to adjust your sleeping position in a way that doesn’t put a lot of pressure on the sensor.

Nocturnal Hypoglycemia

In the modern digital world of DIY medicine, a quick Google search may convince you that your glucose dropping at night is a condition called nocturnal hypoglycemia. This is a condition that affects individuals with type 1 or type 2 diabetes, is often associated with insulin use, and refers to blood glucose levels drop below 60-70 mg/dl while sleeping at night.

Nocturnal hypoglycemia most commonly affects diabetic individuals who:

• Skip meals, specifically dinner
• Exercise before going to bed
• Drink alcohol before going to bed
• Have some type of infection

Some symptoms of nocturnal hypoglycemia include:

• Sweaty, hot, or clammy skin
• Shaking or trembling
• Changes in normal breathing patterns, such as sudden fast or slow breathing
• Higher heartbeat
• Nightmares that wake the person up

If you have a diagnosis of diabetes and have noticed these sudden drops in glucose and experience any of the above symptoms, follow up with a doctor to get a professional opinion.

The post Why do my glucose levels go low during sleep? appeared first on Levels.