I’ve always loved to experiment on myself particularly in the area of health and human performance.
Over a decade ago I found myself wearing several gadgets at the same time that each tracked various aspects of my life such as the number of steps I’d taken, my pulse, heart rate and how I slept. These gadgets, known as wearables, are all too common nowadays, but at the time I was comparing them as health solutions for our clients’ employees. You can read more about that little experiment in my book as the unintended consequences led me to investigate the damage electro-magnetic frequencies (wifi and Bluetooth technologies) do to the body.
My latest experiment was less painful and far more insightful. Plus I was able to coerce my husband into the fun. We tested out the latest leap-forward in addressing metabolic health – the Signos App paired with a Continuous Glucose Monitor (CGM). Before getting into our experience and how Artificial Intelligence (AI) comes into the picture, it’s important to address just how critical your metabolic health is to your overall health.
The Wonders of Your Metabolism
We often compare our metabolism to the engine of a car. But such an analogy obscures the intricate complexity of the processes going on inside our body giving us energy, clear thought and optimal health.
At its simplest level our metabolism is the process of converting food into energy that then powers every individual cell in our body. Looking a little closer we see that it is the mitochondria inside our cells that carry out the conversion of digested fatty acids and glucose, ultimately synthesizing ATP (adenosine triphosphate), the unit of energy in the human body. ATP powers every one of our over thirty trillion cells to carry out the many trillions of chemical processes in our body every second.
Another critical part of the process involves the hormone insulin which binds to insulin receptors on cells signaling for them to let the glucose flow inside. But if there is mitochondrial dysfunction (usually caused by environmental factors like nutrient deficiencies, toxins, poor sleep, impaired microbiome, sedentary lifestyle and stress) the flow may be blocked causing blood glucose levels to remain high. In turn this causes more insulin to be released by the pancreas to attempt to force glucose into the cells. This is known as insulin resistance.
Over time, the cells of the pancreas get exhausted churning out all that insulin and they can’t keep up with demand, leading to chronically elevated blood sugar levels resulting in a diagnosis of diabetes. High blood sugar creates all sorts of problems in the body such as damage to blood vessels leading to neuropathies, kidney and eye disease as well as cardiovascular disease. Plus the impaired production of ATP affects every single cell in the body and consequently impacts processes as varied as immunity, neurological health, detoxification, and cellular repair (a dysfunction of which leads to cancer). Inflammation runs rampant as the body tries to compensate and get back into balance.
These wide-ranging implications are why signs of a struggling metabolism show up years before a diabetes diagnosis. A recent study found that conditions such as eye, nose and throat infections, asthma, high blood pressure and heart irregularities are much more common in those who go on to develop diabetes years later.
Even if you don’t have a formal diagnosis there are many potential signs of poor blood sugar management and metabolic dysfunction such as:
Weight gain. Excess glucose gets stored as fat. This is probably the most obvious sign but is by no means a requirement. You do not have to be overweight to have metabolic dysfunction.
Dips in energy levels. If you are getting a good night’s sleep but often feel exhausted or in need of a nap mid-afternoon it’s a sign of poor glucose management.
Gastrointestinal issues. Due to an impaired gut lining and lack of energy flowing to the enteric nervous system in the gut walls.
Acne or other skin issues. High insulin levels lead to hormone disruptions, and skin inflammation is triggered by mitochondrial damage and oxidative stress.
Brain fog or lack of focus. Mitochondrial dysfunction can lead to a decrease in energy available to the brain, and triggers inflammation.
Depression, anxiety or other mental health concerns. High blood sugar can affect the production of neurotransmitters. Mitochondria function impacts your response to stress.
Migraines or chronic pain. Neurotransmitters are involved in regulating pain perception.
Infertility. Polycystic Ovary Syndrome (PCOS) is basically insulin resistance where the excess insulin over-stimulates the ovaries to make testosterone unbalancing the required hormones for ovulation, forming cysts instead.
Excess wrinkles. Through a process of glycation where excess glucose in our blood sticks to the most common protein in our skin, collagen, and compromises its structural integrity.
Behavior Change Through Gentle Daily Nudges
Understanding a bit more about our metabolism and its effect on these seemingly unconnected symptoms can highlight the problem with addressing a single symptom with a pill. It’s not getting at the root cause of the problem and that’s before you start listing out the often nasty side-effects of pharmaceuticals.
The best marker we currently have available on our metabolic health is the level of glucose in our blood and its stability or variability throughout the day.
A Continuous Glucose Monitor (CGM) is a small device that sticks to our skin and provides real-time measurement of our current blood glucose level. CGMs were originally developed to help diabetics manage their need for insulin with the data transmitted wirelessly to an insulin pump typically every five minutes. They are now available to anyone as part of the growing wearables or precision health market.
One study reported that 90 percent of CGM users felt it contributed to a healthier lifestyle, 87 percent felt they modified their food choices based on their CGM data, and 47 percent reported being more likely to go for a walk after seeing their blood glucose level spike after eating.
While there are various ways to try out a CGM I elected to test the Signos program which is aimed at employers who want to drive healthy behavior change in their employees. The idea being for the employer to subsidize a 6-12 month program with the aim of reducing future healthcare costs through medication elimination and healthier employees. Eligible employees fall into three categories with slightly different programs for each:
Type 2 diabetics who are not insulin-dependent. They may be on other drugs such as Metformin or GLP1’s.
Those who have been told they are pre-diabetic or verging on a diagnosis.
As a preventive measure or health/lifestyle modification program for anyone else.
I fall into the third category with no diagnosed health conditions and not considered overweight. My husband could lose a few pounds.
After completing a friendly online questionnaire, one of the Signos-network doctors signed off on our program. Currently a CGM is considered a medical device requiring a doctor’s prescription.
A few days later a box of CGMs arrived (they should be switched out every 10 days) with clear instructions on downloading the app and getting started. We don’t use smart watches so paired our mobile phones with the device and immediately saw our glucose level in real-time. The key difference with the Signos program and a basic CGM from your doctor is the comprehensive monitoring of multiple aspects of your lifestyle which impact your metabolic health.
While I gave up wearables 10 years ago after my original experiment, I found this latest iteration surprisingly unintrusive. Perhaps it was the knowledge that it was a temporary program aiming to highlight the areas I needed to improve and “train” me on what works best for my body rather than an ongoing requirement.
The food tracking system took a bit of getting used to but after the first day or two seamlessly blended into my routine. Let’s face it, most of us eat many of the same items day to day or at least week to week. Once you’ve input a meal it remembers it to quickly log another time. Sleep and exercise are also logged with a time stamp and you can watch the progression of your glucose level across the hours. (If you’ve paired the app with an Apple or Google health device, sleep and exercise data are passively incorporated).
The glucose time graph indicates your optimum glucose range and tags events such as a meal or workout so you can see immediately how it influenced your glucose level. The dashboard tracks the percentage of the day you are within range.
To ensure you are not overwhelmed, the program starts with getting you used to the logging and the app itself before slowly adding activities each day that educate and inform. During this first week or two the app is getting to know you as an individual, building its data, and understanding what aspects of your food intake and lifestyle are most affecting your glucose variability.
Activity suggestions that might pop up include going for a walk right after eating, identifying added sugars and making different choices for certain food items, noting if your glucose variability is worse after going to bed late or having to get up early, logging your water intake and noting its effect on your levels, trying different kinds of exercises (weight-bearing for example), testing out food order (such as saving simple carbs for the end of the meal), delaying eating when the urge first arises, guessing your glucose level without looking at the app (learning to read body signals) and much more. You can go at your own pace and spend more days focused on a single aspect if you prefer, but the objective is to gently guide you into behavior change using the real-time data to give you instant feedback and solidify new habits.
AI Makes it Personal
The biggest advantage of a program like Signos is the personalization generated with the use of AI.
There is plenty of generic advice available on how to better manage your insulin resistance or full-blown diabetes without medication. Following a ketogenic diet and intermittent fasting are two of the most popular. The idea behind keto is broadly to minimize your carbohydrate intake so there is less glucose broken down in the first place. With limited glucose available your body switches over to burn fat as ketones. This can be a helpful short-term strategy to improve your metabolic flexibility and allow your pancreas a bit of a break so it can heal.
The problem is your body needs glucose to function properly and if deprived of carbohydrates will synthesize glucose from cortisol which can compromise your cardiovascular health and has also been shown to deplete your muscle mass. Intermittent fasting can achieve the benefits of keto without these downsides. 1
However, generic advice to follow a particular diet or exercise program can only take you so far and many people cannot find the motivation to start or continue such a program especially if results are less than optimal.
You are an individual with a unique genetic makeup, microbiome, lifestyle, and current state of health. Adding a CGM to the mix, together with the power of AI, leads to a substantial jump in both engagement and long-term results.
I’m not a fan of AI it has to be said. I don’t use Siri. I’ve never used ChatGPT. I particularly worry about AI in healthcare as together with education these are the two areas of life that most benefit from human interaction and we need more of it, not less. However, I am a data junkie and realize the human brain cannot find patterns in the oodles of data-points that impact a single biomarker like blood glucose levels. So I have to admit the benefits in this case of embracing AI to revolutionize treatment of this most critical aspect of health.
The personalization generated by the Signos program together with the ability to tweak so many different aspects that impact metabolic health can truly drive long-term behavior change. AI is able to analyze the vast amount of data and simplify it into a presentable format that provides immediate feedback. The personal precision results in the right behavior changes for optimal health for that individual. And the whole approach is incredibly cost effective as there is no need for a human coach unless some help is required on meal planning for example.
Outcomes
The main takeaways from the experiment for me was a change in how I used to graze all day and the timing of my exercise routines. I already had extremely healthy food choices and practiced intermittent fasting most days where I keep to a 10am to 6pm window of eating but in between these hours I would keep snacking. My glucose was relatively stable (compared to my husband who saw large spikes after a bowl of cereal in the mornings or the one day he decided to test a fast-food burger and fries!) but the program made me more conscious that the constant snacking was causing me gastrointestinal discomfort.
The food tracking also highlighted that I probably wasn’t eating enough calories on a daily basis and was especially low in protein so I have remedied that situation. It’s been a couple of months since we ended the program and the behavior changes are still in place. I have adjusted my routine that I do some sort of exercise or movement after each meal, drink more water, and try and leave any simple carbs to the end of the meal.
It’s our daily habits that build health. Focusing on the ones that directly affect our metabolism have the greatest influence on our vitality and longevity. AI and a program like Signos can help you identify where to start, and the habits that will impact you as an individual the most.
About the author: Emma Tekstra is a Fellow of the Institute of Actuaries, an independent health researcher, and author of “How to Be a Healthy Human; What Your Doctor Doesn’t Know About Health and Longevity.” With a 30-year background in employee benefits and corporate health and wellbeing, she consults with employers looking for real solutions to runaway health care costs, and to startup companies bringing health solutions to market. Read more at About page.
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Super interesting article. Thank you! Can you say more about what kind of snacking/grazing you used to do before you tracked your glucose and how you stopped yourself from doing it after? Also when you said you weren’t getting enough protein, what specific protein did you add into your diet and why? Finally, most people feel they eat TOO many calories. How did you decide you needed to eat more? (One add-on question: Does your husband eat cereal often? Is there such a thing as “healthy” cereal?). Thanks Emma!
Thanks - very interesting. I excerpted this: "The problem is your body needs glucose to function properly and if deprived of carbohydrates will synthesize glucose from cortisol which can compromise your cardiovascular health and has also been shown to deplete your muscle mass. Intermittent fasting can achieve the benefits of keto without these downsides. *
I couldn't find what the asterisk (*) referred to.