Me and Dr. Peter Attia are having a knock down drag out fight but he doesn’t know it since he is famous and busy and can’t answer my emails. It revolves around the use of continuous glucose monitors (CGM) by people who don’t have diabetes. He thinks this a good idea and he does it himself.
This is part and parcel of the carbohydrate/sugar as overarching evil of Drs. David Ludwig (my other unacknowledged knock down drag out fight) and Dr. Robert Lustig. Their names are confusingly too similar.
I think the best way to think about this issue is to stipulate 5 baseline things:
-All tests and measurements- hemoglobin A1C, blood sugar, continuous glucose monitors, body mass index……. everything – have more or less slop. That is there are inevitable errors in the number result of the test.
-Diseases that have a definition by the results of a test like diabetes, hypertension, obesity, high blood cholesterol, old age etc. etc… have a linear correlation with death rate. That is the lower the better until you reach the lowest possible level where you also die, but the difference is that at the low level limit you die very quickly. For example if your blood glucose or blood pressure or cholesterol? or weight or age is too low.
-There is a continuous correlation between the danger of a disease and it’s determining test level, so there is a continuously diminishing benefit to lowering/improving it.
-Any intervention in medicine has 3 drawbacks, it is dangerous, painful and expensive.
-Every action has a personal value that cannot be judged. There are people who don’t want to quit smoking for example.
Now it is easy to see the problem and the fallacies of dietary and lifestyle recommendations if you agree with the stipulations, which you could also argue with if you want. Since eating low or no carbs is bigly beneficial to diabetics, and since many of us are pre-diabetic or pre-pre-diabetic, if everybody ate low carb diets there would almost certainly be statistical benefits. Likewise a low salt diet or taking statins or multiple cholesterol lowering drugs would help some number of “normal” people.
So this is my email response to Dr Attia’s disagreement with an editorial that argued that continuous glucose monitors were not worthwhile for non diabetics. (3)
Dear Dr. Attia,
I think the fallacy of your argument lies in the anecdotal patient you described who learned from the continuous glucose monitor that his blood glucose was cruising and bouncing too high – “After about a four-week intervention that included exercise changes and nutritional modifications his average glucose fell to 84 mg/dL, his glucose variability to 13 mg/dL, and he had zero events exceeding 140 mg/dL. If he can maintain this way of living in the long-run, it’s likely to translate into an improvement in healthspan and reduce his risk of glucose impairment.”
Would that approach not have improved the prognosis of anyone and wouldn’t not doing the healthy intervention not cause damage to anyone?
So the tool is a motivational agent but an expensive one.
1. https://peterattiamd.com/ama24/ June 14, 2021 NUTRITIONAL BIOCHEMISTRY #165 – AMA #24: Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM “Hyperinsulinemia on an [oral glucose tolerance test], even in the presence of normoglycemia, is the canary in the coal mine.” —Peter Attia
3. Jaklevic MC. Start-ups Tout Continuous Glucose Monitoring for People Without Diabetes. JAMA. 2021;325(21):2140-2142. doi:10.1001/jama.2021.3789
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- firstname.lastname@example.org or phone-354-6605.