Repeatedly, that is why individuals ought to truly learn the references and never get caught up in “drugs 3.0” hype over listening to “sciency” blogs. I’ll decide it aside this time, however the broader theme right here is it’s simple to carry illusory confidence for anybody (together with physicians btw) that they “know one thing” and makes them really feel they’re particular as a result of they know one thing past what the scientific/medical neighborhood is aware of.
CGMs aren’t confirmed to be helpful in nondiabetics – there’s negligible proof. I’m fairly aware of the literature Attia has cited and have deeply thought-about it. Not one of the cutoffs Attia makes use of is supported by any proof he cited – it seems to be arbitrary.
For those who learn his assertions within the article and decide aside the references – which just about no person does – what he’s claiming is clearly with out proof. The 2018 examine he cites means that glycemic dysregulation isn’t totally captured by conventional metrics – but it surely does NOT recommend that the classification of excursions above 140 mg/dL gives greater than conventional metrics – it’d or it may not. Some individuals have extremely variable particular person glucose ranges.
The examine he cites doesn’t verify any proof of glycemic variability readings with outcomes. Even when it did, there is no such thing as a justification for utilizing CGMs in sufferers broadly for greater than 2 weeks as a brief diagnostic. Glycemic variability could also be solely indicative of poor well being reasonably than causal.
For those who learn his quotation: Postprandial Hyperglycemia and Glycemic Variability | Diabetes Care | American Diabetes Affiliation
“The largest hole nonetheless is the lacking proof as derived from randomized potential intervention research focusing on postprandial hyperglycemia and looking for to cut back onerous CV finish factors. In reality, there was some stark disappointment not too long ago on this context. As this proof by intervention is, nevertheless, key for the final word approval of a therapy idea that it’s obligatory to look after postprandial hyperglycemia and glucose variability past attaining applicable glycemic management as assessed by HbA1c, the present web steadiness of attained proof isn’t favorable that we should always care.”
For those who learn additional in your cited weblog submit:
” Potential research present that greater glucose variability in nondiabetics is related to an elevated threat of heart problems, frailty, cardiovascular loss of life, most cancers loss of life, and loss of life from any trigger in comparison with decrease glucose variability.”
Take a look at the precise quotation for AD and it solely says hyperinsulinemia.
Take a look at the quotation for frality and it solely says HOMA-IR.
And so forth…
Nowhere does it say glucose variability or point out any cutoff of 140 mg/dL. None of them use CGMs. They use both OGTT or HOMA-IR.
There are much more flaws within the article. I’m not going to choose by way of all of them.
That being stated, I do use a CGM for knowledge gathering functions (there is no such thing as a confirmed use for this – the info may find yourself being principally ineffective), however it’s NOT for prevention as a result of it’s NOT an economical method and there’s no actual proof for broad use. I might not advocate one for non-diabetics if they’re looking for preventatives till there’s actual proof.
It’s fairly doable CGMs may present biofeedback that might improve adherence to life-style interventions for nondiabetics, however that isn’t demonstrated in a randomized scientific trial. It’s far simpler to transcend the proof to recruit sufferers to pay 6 figures a yr – CGM is a giant a part of that – particularly in case you perceive his background and monitor file of going far past the proof on NuSI which he quietly withdrew from when it burned into the bottom thus far that he needed to leap ship as quickly as there was smoke.
He has been an enormous proponent of LC diets, regardless of the shortage of proof, and regardless of the NuSI debactacle. So it’s not notably stunning he’s going after glucose variability, however he neglects mentioning widespread confounders – postprandial triglycerides as an impartial threat issue for early atherosclerosis, which additionally impacts downstream dementia dangers. Even when he’s proper about glucose variability – it’s fairly believable buying and selling carbs for fats is simply buying and selling one difficulty for one more. He doesn’t even point out that after. He’s making assertions with out proof, together with fully arbitrary ones.
Let’s illustrate it in a easy hypothetical instance: if one has a twin brother with nearly an identical metrics and life-style – then one trades consuming blueberries for say sausage as a result of sugar ranges go barely over 140 mg/dL – are you certain that glycemic variability issues (assuming it seems to be later supported to some extent)? Consuming extra sausage (or processed meats on the whole) has suggestive proof for early atherosclerosis and dementia, in addition to most cancers. Unprocessed crimson meats can also be the case, maybe past a sure tough threshold of consumption, however we aren’t sure. So would one nonetheless preserve consuming sausages as a substitute of blueberries primarily based on glycemic variability with proof exhibiting (1) the opposite twin isn’t getting diabetes/glucose intolerance with blueberries (2) the primary twin brother is having early atherosclerosis with carotid ultrasound/CAC? In all probability not. There are many different variables not captured.
So once more, I recommend you keep away from “influencer” blogs and social media to sway towards details – it’s simple to get caught up – I initially thought possibly Sinclair’s resveratrol claims may have advantage till I truly learn by way of the citations and different papers very, very fastidiously – then I noticed he’s going method overboard as a enterprise technique with excessive certainty. Traditionally, proposed longevity interventions are fraught with hyperbole for therefore many a long time, so we must be notably cautious of the should be vigilant and meticulous. Attia has a number of friends I love reminiscent of Dr. Matt Ok and Dr. Miller who acknowledge hyperbole is detrimental to their repute of their scientific profession for his or her friends and the “ageing” discipline that’s already fraught with hyperbole on the whole. Once more, Attia isn’t a dependable supply and he has a monitor file of doing that with incentives to take action – leaping past the proof considerably – though I suppose he realized a bit from his first tour with NuSI to mood that to a decrease quantity. Attia’s voice is amplified by different mini “influencers” on social media, regardless of clearly a extreme lack of proof and you find yourself with groupthink. I hope you may see the true points right here and I recommend you truly dive deeper than blogs/podcasts/the like.
