Nutrition Made Simple Podcast Episode 15: Continuous Glucose Monitoring & Fighting Chronic Disease With Levels Health

Today, we are talking about CGM (Continuous Glucose Monitoring) with one of the founders of Levels Health, Josh Clemente.
Most people have no idea how their body is responding to the food that you eat. In fact, the data isn’t widely available until it’s too late and you are diagnosed with diabetes. 34.5% of all US adults had pre-diabetes, based on their fasting glucose or A1C level (Table 3). 13.0% of all US adults had diabetes (Table 1a; Table 1b). (https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf)
Continuous glucose monitoring allows you to see how your body responds to the food and make adjustments to prevent and treat chronic disease.
 
In this podcast, Josh Clemente and Nicole Aucoin talk about:
  • How continuous glucose monitoring has evolved
  • What we have learned from our continuous glucose monitoring experiments
  • How sleep, stress, and what you eat all factor into blood glucose control
 
At the end of this podcast episode, I will share the top 3 lessons I learned from my continuous glucose monitoring experiment. For more information about Levels Health, click the link below!

Are you interested in doing your own glucose monitoring experiment?
Click the link below and get access to Levels.

Topics Discussed In This Episode

How continuous glucose monitoring has evolved

Continuous glucose monitors were developed to measure glucose levels in the blood in real time for people who have blood sugar dysregulation.
How continuous glucose monitory has evolved:
  • Availability has increased
  • The cost has decreased
  • Small improvements in microelectronics and our cell phones have contributed to the medical device technology we can use
  • Bluetooth allows continuous streaming to the phone without scanning or without finger pricks
  • Real time results to monitor your body all day long

What we have learned from our continuous glucose monitoring experiments

Josh found that his blood sugar elevated and basically went into a diabetic blood sugar range from a fasted CrossFit workout. The stress of the workout is introducing cortisol and adrenaline, which are telling your body you’re in a fight or flight mode.
Nicole found the same result that her blood sugar elevated during CrossFit workouts. Her blood sugar went up the highest when she was exercising. This is a natural physiological response.
So you can indulge a little bit more right after those hard workouts with some carbs and not experience a big blood sugar spike.
Nicole now thinks twice about some things that she’s eating and how she pairs food together, based on the things that she has learned from monitoring her glucose for over six weeks.

How sleep, stress, and what you eat all factor into blood glucose control

What you eat correspondingly affects how you sleep.
Eating sugar or lots of carbohydrates at night spikes your blood sugar throughout the night and leads to a restless night of sleep. You will then wake up with an elevated blood sugar.
The quality of your sleep and the consistency of your sleep affects how your metabolic system functions. 
There have been some studies to show that just a single night of short sleep can cause a 40% reduced glucose clearance from the blood after an oral glucose tolerance test. 

You can do your own glucose monitoring experiment through Levels Health too! 

ADDITIONAL PODCAST EPISODES TO LISTEN TO

  • 5 Habits Of Highly Successful Nutrition Clients >>HERE
  • Nutrition Made Simple >>HERE
  • 3 Reasons Your Diet Failed You >>HERE

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Episode Transcript:

Nicole Aucoin (00:04):
Welcome back to the Nutrition Made Simple podcast. At Healthy Steps Nutrition, we believe something as fundamental as nutrition shouldn’t be complicated, which is why we focus on a simple habit-based approach when working with clients. I’m your host, Nicole Aucoin, registered dietitian and founder of Healthy Steps Nutrition, CrossFit HSN, and HSN Mentoring. I’m also the author of the Healthy Kids Cookbook: 100% Kid-Approved Recipes for the Whole Family. You can find it on Amazon.

Nicole Aucoin (00:36):
In this podcast, we will be teaching you how to take one step at a time to becoming the healthiest version of yourself. Today, we are talking all about continuous glucose monitoring with one of the founders of Levels Health. Before we dive into continuous glucose monitoring, it’s important to understand why you should care about this. Most people have no idea how their body is responding to the food they eat. In fact, the data isn’t widely available, until it’s too late and you’re most of the time diagnosed with diabetes.

Nicole Aucoin (01:11):
Here are the stats. 34.5% of U.S. adults have pre-diabetes, based on their fasting A1C, a three month average of your blood sugar. 13% of U.S. adults have diabetes. Diabetes is a condition where your pancreas can’t keep up with the work that it needs to do based on the food that you’re eating. Your pancreas secretes something called insulin, which is a hormone that helps you break down glucose. If you’re constantly eating sugar and carbohydrates and your pancreas isn’t able to keep up, you’re going to have high blood sugar.

Nicole Aucoin (01:50):
Imagine your pancreas is a car and you don’t take care of that car. You don’t change the oil. Eventually you are going to have problems and something is going to break. That is diabetes. The truth is, your car didn’t break overnight. It happened from years of wear and tear, sometimes faster than others. Yes, there is Type I diabetes where some people are born with the inability for their pancreas to work. You’re not going to get around not taking insulin. But Type II diabetes, what most people have, all comes from lifestyle choices and the food that we eat.

Nicole Aucoin (02:25):
Continuous glucose monitoring allows you to see how your body responds to the foods and make adjustments to treat chronic disease. Super interesting. Today’s podcast, I talk to Josh Clemente. He’s one of the founders of Levels Health. We talk about how continuous glucose monitoring has evolved over the years, what we both have learned from our continuous glucose monitoring experiments, and how sleep, stress and other factors all go into your blood sugar and how it is controlled.

Nicole Aucoin (02:59):
At the end of this episode, I will share the top three lessons I learned from my personal glucose monitoring experiment. We will get to this episode right after this message. Do you know someone that’s looking to get healthy this year? We would love for you to share this podcast with them. You never know who could use some words of encouragement. Take a screenshot, post it on social media, and please don’t forget to tag @healthystepsnutrition, so your friends can find some more awesome free help.

Nicole Aucoin (03:30):
Don’t forget to subscribe to this episode either. All right. Enjoy this podcast on continuous glucose monitoring with Josh Clemente from Levels Health. Josh Clemente, welcome to the Nutrition Made Simple podcast. I’m so excited to have you here.

Josh Clemente (03:46):
Thanks, Nicole. I’m so excited to be here.

Nicole Aucoin (03:48):
We are talking all about chronic disease today and something that is really cool, continuous glucose monitoring.

Josh Clemente (03:57):
Yes. Continuous glucose monitoring is near and dear to me. It’s been transformative in my own life. I call myself patient zero for the Levels products because I historically have been very interested in physical fitness. I’ve played sports my whole life. I’ve been a CrossFit trainer for nine years now, although I don’t train that often anymore. It’s just more so I take physical fitness and performance very seriously.

Josh Clemente (04:23):
But I’ve only recently, through continuous glucose monitoring, understood the other sides of what it means to be healthy, and specifically the paradigms of nutrition, sleep and stress management. I’m just excited and privileged to be able to work on this project of bringing this crazy tech that was developed for the management of diabetes, to, I think the whole new world of wellness and nutrition management.

Nicole Aucoin (04:47):
It is so fascinating to me because most people have no idea what’s going on, on the inside of their body. They eat something and maybe they might realize that they have low energy, like the afternoon crash, but they probably don’t even correlate it to what they eat. Let alone what is actually going on, on the inside of your body. What’s happening to your blood sugar? How is your body responding to food? Essentially, that’s what continuous glucose monitoring does.

Nicole Aucoin (05:13):
It helps you understand how food that you eat is processed and how your body responds to it. The cool thing is, every person’s a little bit different.

Josh Clemente (05:21):
Absolutely. The fascinating thing is just that we have data that we’re using in so many different ways in society, and exactly to your point, the one big gaping hole is our health. Most people get one dataset maybe like when they get blood work done at the doctor’s office per year. They’re using that. Not only is the doctor using it this way, but the individual is using this way to project their health, to extrapolate one data point and say, “This is how healthy I am.” There’s no other similar situation in society.

Josh Clemente (05:52):
We have massive datasets on everything from real estate to finance, to … I mean, name it. We have more data about our social trends and social transactions and how many likes we have from who, than we do about whether or not our daily lunch is causing us to be sick. I think it’s fundamentally imperative that we change that. We put people into an empowered position where every day you’re making objective data-driven decisions that are tailored to you.

Josh Clemente (06:23):
The singular benefit is that we will be able to, I think, give the individual control. The secondary benefit is that it will be tailored and unique. Like you just mentioned, there’s so much individuality that we’ve only discovered with this technology. Continuous glucose monitors were developed to do exactly what they sound like. They measure glucose levels in the blood in real time for people who have blood sugar dysregulation. Typically, for people with diabetes.

Josh Clemente (06:54):
Recent studies in the non-diabetic population have shown that … And the most interesting one, which I’ll just jump right to the chase on, was done in 2015, which showed that two people could eat the same two foods, which were in this case, a banana and a cookie made with wheat flour and they can have equal and opposite blood sugar responses. To say that that flips the table over on an ideal diet is to understate it.

Josh Clemente (07:17):
It’s truly the case that we really need tailored information about the individual, both in terms of, I think probably genetics and body composition, but also context. The reason that people have such wildly different responses to the same food is not just genetics, which was actually shown in the study. It’s also something like, how stressed are you? How much body fat do you have on your body? How much muscle mass, lean muscle mass to metabolize the food you’re eating?

Josh Clemente (07:46):
All of that combines into a context and we can now use that real-time data to solve that problem. It doesn’t have to be something big and scary.

Nicole Aucoin (07:54):
So much information that you just said. All of it is super interesting, but the truth is, 60% of our U.S. population has one chronic disease. 40% has two or more, and it didn’t happen overnight. It’s daily actions, elevated blood sugars consistently, and a ton of other factors that play into, are you getting sicker or better every single day? Right? I remember talking to Julie Foucher a couple of weeks ago on a podcast. We were talking about when you’re diagnosed with something is not when it happened. It’s years of decisions.

Nicole Aucoin (08:27):
If you can proactively understand how your body is handling certain foods, stress, and sleep, how they all impact your overall wellness, you’re going to make informed decisions. I worked in the hospital as a dietician for a long time. Continuous glucose monitors were new when I was working there and not widely available. Now they are more widely available to the general public. You can actually educate yourself. You don’t have be diabetic.

Nicole Aucoin (08:56):
I’m sure you can answer this question. I can answer from experience, but people think, “Nicole, you have a needle in your arm. Does it hurt?” Right? That’s the first question people ask.

Josh Clemente (09:05):
What’s interesting is I just love what you touched on there just briefly, the compounding effects of our decisions. It’s like every day, we’re sitting down and we’re saying, “I’m going to eat lunch. What am I going to eat and why?” The answer is overwhelmingly based on emotion or based on an internet search or based on something that someone told you at some point that worked for them. That’s a major problem because as you just said, these decisions, we make hundreds of them every day.

Josh Clemente (09:31):
These are our lifestyle choices and they compound together into an outcome. It’s not overnight. It is truly that we are on a spectrum of health and we’re constantly making trades. We’re balancing our health in one direction or another. Without feedback, it’s very easy to over time, make very small, poor decisions that ultimately lead to a very large health consequence. Really being able to just course correct or see trajectory in real time is just a massive improvement. It’s literally shining a light where we previously had none.

Josh Clemente (10:03):
We were flying blind. The history of continuous glucose monitors is really interesting. I mean, it was developed in the lab initially and done in like end of one experiments to just see if this could work. Then eventually was moved into the very expensive, very advanced therapeutic space where someone was paying thousands of dollars a month to be able to, in most cases, manage Type I diabetes where you have to very accurately meter insulin and based on glucose levels.

Josh Clemente (10:35):
Because it’s been a very tightly controlled development process in a specific population, that has led to a very long development process. It’s been decades really that this tech has been in some various stage of development. We’ve seen an explosion in innovation in CGM over the past like five years, where the costs have come down by almost two orders of magnitude. Well, in 10 years have come down by two orders of magnitude. In just five years, it’s been an order of magnitude.

Josh Clemente (11:04):
The availability has gone through the roof. Small improvements in like the microelectronics and our cell phones have contributed to the medical device technology we can use. Bluetooth, for example, making its way into the continuous glucose monitor and allowing continuous streaming to the phone without scanning or without finger pricks, all of this has been amazing. I think not the least of which is just the patch that you wear has become so small and slim and convenient that you can … I was training for a triathlon with one of these early in 2020, pre-COVID.

Josh Clemente (11:36):
Swimming every single day, long exercises, long workouts, lots of sweat, and the device is just like, it’s there, but I don’t know it’s there. The reason is that that needle that you were touching on is actually a very flexible filament. It’s almost like a hair-like implement. That flexibility makes it such that it can move with the fascia and the tissue and it doesn’t feel rigid. You can’t feel that as a sensation in your arm.

Josh Clemente (12:03):
It’s really, for that reason, giving you extremely high-quality data, because it is actually interacting with molecules in your interstitial fluid without, I think, sacrificing comfort. It’s those advances that have all happened fairly recently that I think are making this really plausible to move from the medical therapeutic use case over to general wellness in the general population.

Nicole Aucoin (12:29):
You literally cannot feel it. What hurt me is taking off the Band-Aid because it was pulling out the hair on my arm. The actual needle did not hurt at all. You literally cannot feel it. The coolest thing is you can see basically every minute what your body is doing. Like right before you eat something, right after, one hour after, two hours after. When you eat something, your blood sugar should go back to normal, but a lot of times it doesn’t.

Nicole Aucoin (12:56):
Depending on what you eat, it could take much longer. What you guys have done is put a number system next to how your blood sugar responds. The first thing I did when I got the level system, because I used it for six weeks and my husband did, and I have an interesting story about him. I was like, “I’m going to have an acai bowl.” Because everyone thinks acai bowls are the best thing since sliced bread. Right? Everyone’s like, “This is healthy.”

Nicole Aucoin (13:21):
It got a one. My acai bowl got a one out of 10. I don’t know if there’s a zero in the score, but I’m guessing one is really low and-

Josh Clemente (13:30):
There is a zero, but it’s hard to get.

Nicole Aucoin (13:34):
The reason was because my blood sugar skyrocket and it took so long for it to go down. Acai itself is actually really good for you, but when go buy an acai bowl in a store, it’s loaded with sugar and then they add honey, and then they add more sugar with fruit and all this stuff in there. It’s just a lot of carbohydrates that you’re eating and you don’t even realize.

Nicole Aucoin (13:58):
When you look at the core problem of why we have chronic disease issues in the U.S. and why we have such big obesity issues in the U.S., it’s coming down to we’re not educated on what we eat and we’re tricked every single day by food marketing companies.

Josh Clemente (14:12):
A hundred percent. Yeah. I like to think of it as we have developed too much power in terms of the amount of energy that we can get into a single meal and we are powerless. We don’t have a feedback mechanism built into our bodies to know that. Historically, it’s easy to just look at what’s available in the store or look what’s available for food takeout options, and assume that that was designed by some smart regulating body to be best for us.

Josh Clemente (14:48):
It’s like, “This is the food that’s available in the store, so that must be what’s good for us.” It’s very easy for people to just go on autopilot and assume that, but it’s exactly the opposite. The path that the food supply has taken is the path of least resistance, which is whatever humans are predisposed to crave, we will provide that. Humans historically have been in conditions of famine. Food has been scarce. For the vast majority of evolution, we did not have any agriculture.

Josh Clemente (15:15):
It was like we had to hunt and gather and eat whatever was available. We were fasting for long durations of time and calories were scarce, and so we have always craved calories. Anything we can get, and the higher the calorie density, the better. That’s typically sugar and sources of really rich fats. Those are the things that we love. They taste great. They’re rewarding to eat. Now we’re in a situation where we can produce as much of that as we want for every person on the planet.

Josh Clemente (15:42):
That is exactly what we’re doing. Unfortunately, we’ve now exceeded the ability of the human physiology to metabolize that. We can literally train wreck ourselves in a single meal and eat more fast-acting carbohydrates than a prehistoric person would come across in literally years, if ever. What’s really interesting is like I said, it’s because of that scarcity situation where we evolved without surplus being available. We don’t have a sensory feedback mechanism.

Josh Clemente (16:09):
It doesn’t hurt to eat sugar. In fact, it’s extremely desirable and enjoyable. It’s like a positive reinforcement mechanism, which is really bad when you have so much of it available. All that to say, I think that when you can replace that sensory feedback, that pain that you have when you touch a hot stove with data, if you can just see feedback from your body that says, “Look, you’re not feeling pain right now, but what’s happening is not good. This is a disaster for you.”

Josh Clemente (16:39):
It can supplement that. You can recognize, “Oh, wow, that acai bowl, despite the fact that it says healthy and fruits and vegetables or what have you, or all-natural sugars, it’s still overloading my system in a significant way. Maybe I should just eat some acai straight and try that instead.” Then when you see how much better that is for you, you might … And using the Levels features, we’ve developed metrics to help score those things as you touched on.

Josh Clemente (17:03):
You can see the acai bowl may be a one, maybe a handful or a bowl of fresh acai may be a seven or an eight or a nine even. You’re getting all those antioxidants and nutrition benefits without detonating your glucose insulin pathways.

Nicole Aucoin (17:21):
It’s so interesting. I think you’re right, when you can see what’s happening on the inside of your body, you’re so much more prone to make positive choices. My husband was, I would say … He really loved his sugar at night. He liked his brownies. He liked his cookies and it literally took him wearing the monitor, seeing that his blood sugar was elevated all night from the brownies that he was eating. Then he started correlating that with the quality of sleep that he was having and he hasn’t done it since. It’s been like a couple months now.

Josh Clemente (17:56):
Wow.

Nicole Aucoin (17:57):
It’s super interesting to see. We’re not perfect. We all have our cravings and you’re right, our brains literally light up when we have sugar and fat together. It’s not our fault that we crave more and more because psychologically we do crave more. Our brains like that. It is really interesting when people are educated and understand what’s going on in the inside of their body, how their decision-making changes.

Josh Clemente (18:25):
Absolutely. The theory of the Levels organization is that fundamentally our thesis is that people don’t want to be unhealthy. Actually that’s not a very popular position. It’s very common in industry circles to think that, “No. People don’t want to change. They’re not going to change. It’s an uphill battle. Everyone wants to be unhealthy.” I just certainly disagree at a personal level. The organization is built on the idea that with better information, people will act.

Josh Clemente (18:53):
It is certainly not the case. We’ve seen this with smoking. As better information has come around with respect to how smoking can lead directly to lung cancer, we’ve seen precipitous drop-off in voluntary cigarette smoking. I think the same thing will happen with nutrition where your husband, for example, sees, “Oh, this is destroying not only my blood sugar control, which has inflammatory effects, but also my sleep, which if I’m not recovering that puts us into an elevated state of stress.

Josh Clemente (19:21):
We feel terrible the next day. We’re more likely to indulge and repeat the vicious process.” He sees that and takes action and decides like, “Actually, the reward is not worth the penalty.” Again, I’ll point to my own experience. Growing up, like I said, I played a bunch of sports. I was always active, never had a problem with weight gain and so I really believed for the longest time that a calorie was a calorie.

Josh Clemente (19:48):
Whether it came from broccoli or from pure cane sugar, as long as it’s energy and I can use it and burn it on the playing field or in the gym, it doesn’t matter. I can eat anything. We now know what the hormonal implications of certainly sugars, but other foods, that that’s not true. Also, to go back to my example, I was living that as a total candy addict. I would eat candy for dinner in college, and I carried this through into my professional life where I was always a dessert guy.

Josh Clemente (20:18):
Just really loved to reward myself with whatever dessert was available every night. Since using the continuous glucose monitor and connecting what ultimately was some significant physical, mental, and mood burnout that I was experiencing when I first started experimenting with CGM, with those decisions, and seeing how closely my mood tracked with my blood sugar control, or lack thereof, I haven’t touched candy since. I mean, I’ve had dark chocolate, but it’s been about three years since I’ve had a piece of candy.

Josh Clemente (20:49):
It wasn’t a discipline-based decision. It wasn’t something like I’d suddenly developed massive motivation to just take on this huge challenge and quit cold turkey. It was like, no, I was actively arming myself and I didn’t know it until I saw the data. Now I’m just unwilling to do that to myself. It is pretty amazing.

Nicole Aucoin (21:07):
I think everyone wants to feel well, right? You don’t want to be in a bad mood. You don’t want to have these energy ups and downs. You want to sleep well, and so many times we don’t connect the dots to go back to what we ate. If we started thinking, “Okay. I’m having a large sub and chips for lunch. Then I feel like crap in the afternoon. Why is that? Oh, I just need a coffee in the afternoon and that’s the reason.” Well, what if we changed and had a little bit more balanced meals for lunch and just watched, how do we feel in the afternoon?

Nicole Aucoin (21:40):
Are you starting to feel better? I think when you’re starting to get in tune with how you feel and connecting it to what you eat, you’re much more likely to stick with something because you’re like, “Oh, I actually feel better. I want to feel well.” Going back to what you were saying, I truly believe the same thing. People want to feel the best that they possibly can, right?

Josh Clemente (22:01):
I totally agree. Yeah. Right now, it’s a very trial and error process, but we’re going from a situation where we were flying blind completely and it was really a matter of doing exactly what you’re saying, where let’s say you feel bad at 2:00 PM. You’re just like, “Ah, man, I just want to lay down and go to sleep.” Then you start thinking like, “Well, did I sleep poorly last night? Maybe I did. I stayed up late. I ate that popcorn. Huh, I wonder … Well, maybe it’s just bad sleep.”

Josh Clemente (22:29):
Then you completely ignore the fact that you went for a sushi lunch and you had a bunch of sushi rolls with white rice. That doesn’t even cross most people’s minds, that it could be two hours later you’re experiencing a reactive hypoglycemic event where your body had a huge blood sugar spike from the white rice, had to flood your system with insulin to get that out, over compensated.

Josh Clemente (22:49):
Your blood sugar is crashing, and now you’re feeling lethargic and low energy, and your mood has dropped out. To make matters worse, you’re hungry and you want to go get some snacks. That is the vicious cycle that many people live. Because they were previously trying to navigate that based on emotion or on just blind guesses, it didn’t work super well or it doesn’t work super well for most people.

Josh Clemente (23:11):
That’s why I’m super optimistic about real-time biometrics being able to just in a very lightweight way, not in a disciplinarian sense, but just surfacing that insight and saying, “Yeah. That was actually lunch. You’re experiencing the fallout from lunch, as surprising as that may be.” Then you can just test something different and watch and notice the qualitative experience change.

Josh Clemente (23:34):
For me, when I took those massive spikes and crashes out of my diet, I started to feel so much more consistent. It wasn’t that I had superhuman energy, but I didn’t have those lows, which were what I was trying solve for.

Nicole Aucoin (23:46):
You sleep better. I noticed tracking my blood sugar for those six weeks, that when I ate a little bit more carbohydrates at night, I did not sleep well. I woke up with elevated blood sugar. I would have never connected those dots as quick as I did when you have those metrics, those biometrics to look at the data.

Josh Clemente (24:05):
Yeah. The sleep connection is I think bidirectional. Meaning, I think that the quality of your sleep and the consistency of your sleep affects how your metabolic system functions. There have been some studies to show just a single night of short sleep can cause a 40% reduced glucose clearance from the blood after an oral glucose tolerance test. Then also, like you said, that what you eat correspondingly affects how you sleep.

Josh Clemente (24:35):
So there’s this crazy feedback loop you can get into where, whether it starts with bad food or bad sleep, it doesn’t really matter because ultimately they lead to worse and worse outcomes for both. I’m really, really looking forward to the combination. We’re bringing sleep data into the Levels app right now for the first time and starting to make that actionable. I just cannot wait to be able to connect those dots for people in a way and show them the causal factors that are affecting their sleep.

Josh Clemente (25:04):
Because I mean, it really sucks to be trying to chase down bad sleep. It’s one of the worst. I can’t think of a worse thing than just constantly [inaudible 00:25:11], “Oh wow. That could have been that dessert I ate.” It’s like a breakthrough.

Nicole Aucoin (25:15):
I’m excited about what you guys are doing with Levels because it’s going to give the general population so much more access to understand their bodies in real time. It’s a really cool thing that you guys are doing. I’m excited, and we’re going to be starting to integrate what you guys do with our nutrition coaching, because it provides dieticians a whole nother level of support you can give to clients. Okay. Your body is reacting this way to the food you eat.

Nicole Aucoin (25:41):
Let’s make these specific adjustments and see how you feel and how your blood sugar responds to it.

Josh Clemente (25:46):
Yeah. I can’t wait for that to kick off. I think right now the Levels program we’re building is certainly tailored towards metabolic awareness. It’s just connecting, with a very short feedback loop, the actions we’re taking and the reactions our bodies experience. We have a lot of ground to cover there, but the future is where experts like yourself can bring this data in, import it into the conversation with the client and have the conversation begin from a position of objective personalized data.

Josh Clemente (26:19):
I can only imagine … Not being a dietician myself, but I can only imagine that that would be significantly beneficial to start off with months of both lifestyle information about how this person’s sleeping, how this person’s eating. Then correspondingly how their bodies are responding to it, and be able to begin there rather than from scratch.

Nicole Aucoin (26:38):
Absolutely. It’s not saying you have to do it forever, but I do think you should do it for a season to see how your body’s responding to food, get into a good routine and then maybe you go back to it or not. I think it’s really, really cool. Anything that you’re really surprised about wearing the continuous glucose monitoring system yourself for a while? What were you most surprised about in regards to … We have a lot of CrossFit athletes that listen to this podcast, in regards to exercise and blood sugar?

Josh Clemente (27:08):
I had read about the physiologic effects of intense exercise and knew about what I should have expected to see. But when I first did, I think it was a CrossFit Open Workout, shortly after I got … I was just doing it on my own obviously. I wasn’t in The Open. I was doing this workout with my CGM on for the first time. My blood sugar went … So average, the Levels goal is to stay below 110 milligrams per deciliter, including meals.

Josh Clemente (27:38):
My blood sugar went to over 210, which would be a diabetic blood sugar range from a fasted CrossFit workout. It was hyperintense. I was pushing super hard. What’s happening there is something that I think is profoundly interesting. It was totally fascinating to me to see what was going on. Basically, the stress of the workout is introducing cortisol and adrenaline, which are telling my body we’re in a fight or flight mode here. We need fuel available for the muscles.

Josh Clemente (28:06):
The liver just starts cranking out sugar and releasing it into the bloodstream. Your liver can produce new glucose from protein and fat on your body. That’s one of the fascinating mechanisms that you see in real time in a hard workout, where you actually don’t need necessarily to carb load before a hard workout. Your body is going to do everything it needs to not only produce the glucose you’re going to use, but a significant overload.

Josh Clemente (28:34):
It’s pretty wild to see that happen in real time, and then to understand the mechanisms and carry that out. I think it touches on a lot of the different stress pieces that we come across in life. Just comparing that super intense, 110% output where you see a massive glucose elevation with say two hours of low intensity zone two training on a bike, where for me, my blood sugar just monotonically decreases. It just continuously drops and then it will flatten out where basically at the point where my liver is producing enough to keep me level.

Josh Clemente (29:09):
Those two different regimes of exercise, I think being able to see the data has completely changed how I fuel for exercise. I now know that for a hyperintense workout, when first of all, I don’t want a lot of food in my stomach anyway, because I just generally would feel nauseous trying to keep food down when I’m pushing that hard, but I also don’t need it. Unless I’m going to be going that intense for 90 minutes or two hours, I’m not going to deplete my glycogen and there’s no need for me to carve up.

Josh Clemente (29:39):
For the longer duration rides, I will potentially need to time some fueling in order to keep myself from bonking, because I’ve also seen that happen where my glucose will just crater and I’ll hit like 50 or 55 or something mid-ride and completely lose energy. We’re in the very early stages of using this for performance, but those lessons learned of just seeing how your body responds is pretty brilliant to me.

Nicole Aucoin (30:02):
I can tell you this, I’m going to say the same exact thing that you said. I saw the same thing with my CrossFit workouts. My blood sugar would go up in the 200, low 200 range, consistently doing CrossFit workouts. It wasn’t because I had a bunch of food before. I usually just have an applesauce on my way in the morning before I go to the gym. That’s usually all I have. It’s not like a 15 gram applesauce is bringing your blood sugar up to 200. It is from the exercise. It was super interesting.

Nicole Aucoin (30:31):
What was even more interesting after your blood sugar goes down, but then you eat something and it doesn’t go as high as you think it would after, which is also super interesting.

Josh Clemente (30:41):
Exactly. Yeah. I want to clarify, it may sound bad that your blood sugar goes that high during a workout, because we’re talking about how glucose spikes are bad and all that stuff, but it’s entirely different physiologically from eating a sugary meal that would do that to you.

Nicole Aucoin (30:54):
Yes.

Josh Clemente (30:55):
This is your body taking stores of fat and protein available and breaking them down, recombining into glucose and releasing for your muscles to use. So many studies have been done to show that high intensity interval training in particular is directly related to better insulin sensitivity. Meaning the body improves its ability to clear glucose from the bloodstream. That mechanism, although it’s interesting to watch and counter-intuitive, is definitely connected with better outcomes long-term.

Josh Clemente (31:26):
Like you said, when you’re in that glycogen-depleted phase, you finish that hardcore workout, all of that glycogen has been used. Your body has been producing new glucose, you’re now in a mode where your muscles are primed to suck in glucose to replenish that glycogen. So you can indulge a little bit more right after those hard workouts with some carbs and not experience a big blood sugar spike, which really goes to the concepts that we’ve all heard about, but helps to reinforce them.

Josh Clemente (31:54):
On days when I put in a really hard workout and deplete those glycogen reserves, I’m not going to feel super bad about replenishing knowing that I’ve … And I’m not going to overdo it. I used to really overdo it, eating Pop-Tarts and stuff. I’ve seen I can definitely overdo it after a hard workout, but now it’s more tailored to what I know I can tolerate.

Nicole Aucoin (32:14):
It goes back to what we’ve been talking about this whole time. When you have the data, you can make more educated decisions on how to properly fuel your body for overall wellness and health and also performance, which is really neat that you guys are going to be helping more pro athletes understand how their bodies are responding too. Any final thoughts with continuous glucose monitoring before we jump off.

Josh Clemente (32:38):
Well, I mean, I think that we’re just scratching the surface. Just to paint the picture of the future, we’ve demonstrated the potential for … Well, we’re just starting to demonstrate the potential really for this metric, glucose. I’m really looking forward to, with wider adoption, seeing all the innovation that comes. Right now Levels is focused on the data science and the software.

Josh Clemente (33:01):
But the potential for the hardware is that with sufficient adoption, we could have the innovation drive us towards multiple analytes that are glucose, free fatty acids in the blood, insulin, cortisol, all these hormones that are driving our experience, the sensations we feel. Not to mention the molecules associated with fuel and metabolic health status. I think we’re really at the beginning. It feels like an evolutionary step to start using this tech in real time.

Josh Clemente (33:31):
I mean, five years from now, I think it’s going to be effortlessly integrated in a number of ways and to both the decisions we make every day and also our understanding of where we’re heading. It’s very, very much, I think, going to be similar to financial data where we are using it in real time to plan ahead and similar to retirement, we want to make sure we’re financially secure for retirement.

Josh Clemente (33:55):
We’ll be able to ensure that we’re going to be healthy enough to enjoy retirement, I think, using this data. Just looking forward to it.

Nicole Aucoin (34:02):
Thank you so much for all that you guys are doing, because I truly think we’re in a really cool place where people can have access so soon to information that is going to shape their future and set them up for success long-term. Hopefully, get these numbers down so we don’t have 60% of the population with chronic disease and so many people not even knowing that they have blood sugar issues or they’re putting themselves at risk every single day because of the decisions that they’re making.

Nicole Aucoin (34:31):
Thank you for all that you guys are doing. You can find Josh at levelshealth.com, but where else can people find you?

Josh Clemente (34:40):
You can find me on Twitter @joshuasforrest, with two Rs. Then on Instagram @josh.f.clemente. Then I even more so recommend following along on the Levels accounts @levels on Twitter and Instagram. We like to boost our members, how they’re using the product and what they’re learning. Also, we post articles to the blog and help surface information about metabolism, metabolic fitness and continuous glucose monitoring.

Nicole Aucoin (35:06):
You guys do such a good job on your blog, posting educational information for anyone to learn more about continuous glucose monitoring and how to positively impact their health and wellness. Thank you for all that you guys do. Thanks again for coming on the podcast. If this all sounded super interesting to you, and you’re like, “Hey, I want to get Levels. I want to test and go through a continuous glucose monitoring experiment myself.” We will put the link in the show notes to get set up with Levels Health.

Josh Clemente (35:38):
Thank you very much, Nicole. For those who do want to participate, we are currently still in development so we have an invitation-only beta, but Nicole has the link to have everyone jump ahead of the waiting list and participate early if you’d like to. Thank you in advance to anyone who does and looking forward to your feedback.

Nicole Aucoin (35:55):
Awesome. You just told me before we started recording, there’s 85,000 people, and it’s the beginning of February, that are on that wait list. You guys have quite a bit of people that want access to this, which is really, really cool.

Josh Clemente (36:10):
Yeah. That’s right. It’s very vindicating because I think it just shows that there is … As we touched on in this show, people don’t want to be unhealthy. They want better information. They want to make educated decisions for themselves and then feel confident. I think that number helps to demonstrate how true that is.

Nicole Aucoin (36:29):
I hope you enjoyed that episode on continuous glucose monitoring. It really is an interesting thing that you can do to empower yourself, to make educated decisions. I can tell you from personal experience, I think twice about some things that I’m eating and how I pair foods together, based on the things that I’ve learned from monitoring my glucose for over six weeks. As promised, here are my three biggest lessons that I learned.

Nicole Aucoin (36:53):
Number one, pairing protein, carbs and fats together really does help stabilize your blood sugar and prevent those quick spikes and quick crashes. It helps you normalize your energy levels. Number two, you mentioned this during the podcast, but eating carbs and sugar at night really affected my blood sugar overnight. It caused a second spike and my blood sugar was higher fasting in the morning when I had sugar and carbohydrates at night.

Nicole Aucoin (37:26):
Some people can break down carbohydrates better than others. I learned that I do not process carbohydrates the best, probably because I don’t eat a ton of carbohydrates at one time. All right. The third thing has to do with alcohol. A glass of wine did not spike up my blood sugar. In fact, Jason and I went out to dinner a few times and I had a glass of wine, mashed cauliflower, broccoli, and some salmon and my blood sugar didn’t go up at all.

Nicole Aucoin (37:53):
It was rated a nine out of 10, that meal, based on how my blood sugar responded. Contrary, a Mojito on the other hand, spiked it up drastically. How much sugar are you drinking? Do you have sugar-sweetened beverages? Or if you’re drinking alcohol, are you having sugar in the alcohol? I would be mindful of that because it definitely will affect your blood sugar. We talked a little bit about exercise and how it spiked up your blood sugar, but I was fascinated by this.

Nicole Aucoin (38:26):
My blood sugar went up the highest when I was exercising. It was all a natural physiological response, not because of food that I ate. If you are interested in jumping the 85,000 people wait list of Levels Health, you can click the link in the show notes and you can skip the line and start your own continuous glucose monitoring experiment with our link in partnership with Levels Health. One last thing, if you are thinking, “Now is the time. I need someone to help me with my nutrition.”

Nicole Aucoin (38:59):
We would love to help you. You can work with a dietician at our Healthy Steps Nutrition HQ location, or find a nutrition coach near you. Click the link in the show notes, or go to hireanutritioncoach.com and find a Healthy Steps Nutrition coach near you. I hope you enjoyed this episode. Please, don’t forget to subscribe so that you don’t miss another episode. We’ll see you back next week.

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About the author

Nicole Aucoin, MS, RD, LD/N

Founder, Healthy Steps Nutrition
Home of CrossFit HSN & HSN Mentoring

Author of Nourish & Healthy Kids Cookbook

Author of The Basics of Nutrition Coaching Course, CrossFit Preferred Nutrition Course

CrossFit Level 2 Trainer