When someone is able to lose weight easily or does not gain weight as quickly as other people with similar patterns of food consumption and exercise, etc., we tend to say that they have a ‘better metabolism’. By doing so, we wrongly assume that metabolism only means burning calories fast. In fact, metabolism is our body’s life force, and it is imperative to keep our metabolic health and fitness optimum to ensure longevity and overall well-being. Let’s see what metabolism really means and how to embark on a fulfilling metabolic fitness journey.
Highlights
Metabolism is the chemical processes in our body, including the conversion of food to energy, which is required for running all cellular processes,
Exercise and physical activity are imperative for metabolic fitness, which is directly related to how much we use our muscles. Even low levels of physical activity have a beneficial effect on metabolic fitness and the overall health of an individual,
Keeping your glucose levels in balance also contributes to metabolic fitness.
What is Metabolism?
Metabolism refers to all the chemical processes in our body, including the conversion of food to energy, which is required for running all cellular processes. It involves everything from hormone production and balance to the creation of neurochemicals that function in the brain, digestion, sleep cycles and rhythms, and so much more.
Understanding how metabolic processes work within your body can provide insights into how food and exercise affect your health and longevity. The way energy is used within the body is a complex process. At the outset, this might seem as simple as a calorie-in/calorie-out equation, but there’s much more to it. Energy usage is affected by your hormonal pathways and, more specifically, by insulin. Let’s understand the larger role of this hormone.
Insulin is produced in the pancreas and is an anabolic hormone, which means that it promotes the storage and build-up of fuel within the body. Insulin signals our cells to pick up glucose from the blood to use as fuel. Any excess fuel either gets stored in the liver and muscles as glycogen or is in fat cells as triglycerides.
When cells in your muscles, fat and liver don’t respond well to insulin, you might end up developing insulin resistance. Insulin is unable to take up glucose from your blood easily, causing the pancreas to create more and more of it. This might lead to a build-up of fuel (glucose and triglycerides) in the body and potentially less efficient usage of glucose. Insulin resistance is essentially impaired insulin sensitivity.
It is important to track your insulin levels to ensure that it’s doing its job properly and saving us from imbalanced sugar levels in our bodies. One of the most efficient ways to measure insulin is to measure glucose values. Glucose values are affected by the insulin level in the body, making them an efficient way to monitor insulin values as well.
Glucose levels are affected by a variety of factors. Some of the important ones include the food you eat, your stress levels, when you eat (your metabolism slows down later in the day), your sleep quality, how much you exercise, etc. Being able to understand how your body’s glucose values trend could be a great way to understand what affects your metabolism in a positive way and what needs more optimization.
To put it simply, by getting insight into how your metabolism works, you can figure out when you are likely to have enough fuel in your body for maximal performance and gains as you exercise and work out. This window of performance differs for every individual based on their lifestyle, but you can optimize your lifestyle to align your fueling state and performance windows. This takes us to the concept of metabolic fitness: what it is and how to achieve it.
Metabolic fitness means when all the individual parts of our body—brain, heart, muscles, liver, lungs etc—are all fit and functioning well, and added together to give a complete picture of our total fitness. The idea of breaking fitness down into our individual parts gives us a new perspective on our health and provides us with new ways to improve it. The scope of metabolic fitness is wide and includes larger factors like longevity, strengthened immune system, maintenance of healthy weight and better physical endurance to relatively smaller, specific things like better sleep and smoother skin. Being metabolically unfit can cause a number of health problems, including obesity, diabetes, depression and anxiety, heart disease and chronic inflammation, among others.
Exercise and physical activity are imperative for metabolic fitness, which is directly related to how much we use our muscles. Even low levels of physical activity have a beneficial effect on metabolic fitness and the overall health of an individual. The amount of subcutaneous and visceral fat stored in the body depends on how much fat you use as your source of fuel. By determining the state of your metabolism, you can figure out whether your body is in storage mode or is primed for consuming fat as fuel. Remember, this is not a diet or a new protocol—this is a way for you to measure and understand your own body.
Additionally, keeping your glucose levels in balance also contributes to metabolic fitness. All of these tried and tested methods contribute toward blood sugar management and overall metabolic fitness. They include managing your carb intake and incorporating more fibre into your diet, reducing stress, practising portion control, getting enough sleep, eating more probiotic foods, and more.
Conclusion
Most diets and calorie restriction methods that many people tout do work and show results, but only when you follow them over a long period of time. If you’re not aiming to get fit for just the next three months or a year but want to improve your fitness standards for life and increase your longevity as a result, you have to take a sustainable approach to your fitness. For example, avoiding foods you like might give you the results you want in the shorter run, but the approach isn’t sustainable. Taking a slow, balanced approach to maintaining the health of individual parts of your body contributes to your overall metabolic fitness. Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns before undertaking a new healthcare regimen including making any dietary or lifestyle changes.
When we think of metabolism and metabolic health, our minds immediately rush to the concept of weight. We traditionally look at weight as a marker of metabolism and assume that if we are in the correct body mass index (BMI) range, our health is top-notch. However, metabolism and metabolic health are so much more than that.
Our food choices, genes, microbiome, sleep, exercise, age and sex all shape our metabolism and metabolic health. To understand the depth of metabolic health and the metabolic health crisis, it is first imperative to understand the meaning of and difference between metabolism, metabolic health and metabolic syndrome.
Highlights
Metabolic health is when the body has ideal levels of five parameters—blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure and waist circumference—without the use of medicines,
The decline in metabolic health can be attributed to poor nutrition, stress and anxiety, inactivity, lack of sleep, late-night eating and environmental pollutants,
Metabolic health can be improved by exercising regularly, eating nutritious food, improving sleep, being mindful and practising deep breathing.
What are metabolism and metabolic health?
Metabolism is a series of chemical processes taking place in every cell that help convert the calories we eat into fuel that can be used and stored as energy to keep us alive.
This life-sustaining process helps repair and restore the body, giving it energy when it is required. Metabolic health is when the body, as a result of metabolism, has ideal levels of five parameters—blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure and waist circumference—without the use of medicines. It represents how well the body converts fuel into usable energy.
If the body fails to run this process efficiently, it causes several conditions such as brain fog, Alzheimer’s disease, cardiovascular diseases, cancer, obesity and many more, depending on the region where the cells have been affected.
When two or more of the metabolic health parameters go haywire at the same time, it is called metabolic syndrome, making the person metabolically unhealthy and increasing their chance of developing type 2 diabetes or serious heart conditions if not treated.
What is the metabolic health crisis?
The metabolic health crisis is a chronic problem ravaging the world. With the rates of obesity and diabetes going up in countries around the globe, the problem is becoming more severe than ever before.
A person is considered metabolically unhealthy if they have three or more of the following problems:
A waistline of 35 inches or more for women and 40 inches or more for men
Fasting blood glucose levels above 100 mg/dL
HDL cholesterol levels are less than 40 mg/dL in men and less than 50 mg/dL in women
Triglyceride levels above 150 mg/dL
Blood pressure of 130/85 or higher (this is, however, also dependent on age)
Metabolic dysfunctions, such as a change in the parameters listed above, cause obesity by interfering with the body’s ability to expend energy stored in the form of fat.
Although obesity is an important marker for this metabolic health crisis, other markers, particularly changes in glucose levels, are a serious cause for concern since poor metabolic health usually follows most of these dysfunctions.
Each dysfunction adversely impacts the body and mind, causing potentially life-threatening conditions. Countries are seeing a massive rise in cases of diabetes, obesity, cholesterol, heart diseases and so on.
According to WHO, 422 million people worldwide have diabetes, and 1.5 million deaths are attributed to diabetes each year. In 2016, 1.9 billion people worldwide were overweight, with 650 million being obese.
Most of the world’s population lives in countries where being overweight and obese kills more people than malnourishment. These staggering numbers only prove that this problem is snowballing, and if nothing is done, the repercussions could be catastrophic and far-ranging.
What is causing the decline of metabolic health?
The rapid change in lifestyles caused by increasing work hours, stress and multiple other factors has led to a drastic decline in metabolic health, a trend likely to continue for the foreseeable future. The 7 causes of this sudden metabolic health crisis can be specifically attributed to a few factors:
Poor nutrition: Highly processed and sugary foods are now easily available and are highly addictive. These poor food choices are leading to obesity, along with less-than-ideal HDL cholesterol levels, higher blood glucose levels and higher triglyceride levels. Additionally, those who are eating relatively healthier foods are still not getting the right nutrients. That’s because some cultures, for instance, inherently eat more carbohydrates as part of their diet with very little balance of fibre and proteins.
Stress and anxiety:Stress and anxiety are major causes of the metabolic syndrome. When stress increases, the adrenal gland releases a hormone called cortisol into the bloodstream. Cortisol stimulates the production of glucose in the body to make the body ready to either fight or flee a situation. When cortisol production is in excess, enough insulin needs to be produced to help absorb the extra glucose. Over time, your body’s cells do not absorb glucose efficiently, leading to insulin resistance. As a result, you not only have an excess amount of glucose circulating in the body, but you are also likely to gain weight as a by-product of the imbalance.
Lack of sleep: Research suggests that lack of sleep may increase the risk of developing diabetes and obesity due to dysregulation of glucose, insulin and appetite. When we sleep, the body rests and repairs itself, getting rid of all the toxins in the body. If you are sleep deprived, the production of the hormones in charge of regulating appetite—leptin and ghrelin—gets distorted. This leads to an increase in appetite, causing more weight gain. Additionally, lack of sleep can also trigger the release of cortisol, adding to the problem of obesity. Studies have shown that people who sleep less than 6 hours a day are more likely to develop serious and chronic diseases.
Sedentary lifestyle: With more desk and work-from-home jobs, the number of hours people are sitting has increased. This inactivity has exacerbated obesity and caused a decline in metabolic health because the calories taken in are higher than the overall calorie expenditure. The surplus energy is stored as fat and causes several problems.
Environmental pollutants: Pollution in the environment has caused significant damage to our DNA. It leads to inflammation in our bodies, impairing our metabolic health. Studies have found that exposure to particulate matter triggers pulmonary and systemic inflammation, leading to chronic problems such as cardiovascular diseases and other cardiopulmonary diseases.
Late-night eating:Eating food late at night can increase weight, insulin resistance and cholesterol. Studies have shown both late-night eating and snacking post meals at night were associated with a higher BMI. Both men and women displayed higher abdominal fat and higher chances of metabolic syndrome if they ate late at night. Glucose levels post dinner is higher than glucose levels post lunch or any other meal in the day. If there is little to no gap between bedtime and the last meal and there is no physical activity at night, the circulating glucose in the body is high, leading to greater insulin resistance and a higher propensity for weight gain.
What can we do to understand our current situation and improve our overall metabolic health?
Most metabolic health parameters can be measured through simple blood tests. However, these tests are usually done either after a person reaches a certain age or displays symptoms of a certain health condition. To understand metabolic health conditions that are less visible, it is advisable to get devices that offer real-time insights into your blood glucose levels, such as continuous glucose monitoring devices (CGMs).
These devices give detailed insights into an individual based on their lifestyle. Wearable devices can help you understand your food intake, activity levels and metabolic health and improve it.
Focusing on nutrition: Cutting highly processed and sugary foods is the first step towards improving metabolic health. To take it a step further, focus on eating in a metabolically healthy way. This means preventing glucose spikes and crashes or insulin resistance. Include a variety of fruits, vegetables, whole foods, fibre, fats and protein in your diet to regulate glucose levels and prevent insulin resistance. Foods such as nuts, seeds, fish, legumes and black beans are great for keeping all metabolic health parameters in check. Do keep track of calories for everything you intake.
Getting moving: Movement is one of the best ways to get metabolically healthy. Not only does moving help reduce weight, it also helps improve metabolic rate (amount of energy the body expends over a period of time), prevents cardiovascular disease and regulates insulin and cholesterol. WHO recommends at least 150 minutes of exercise per week. Low-intensity physical activity, such as brisk walking, is the best way to improve metabolic health and reduce stress. High-intensity exercise can also improve metabolic health, but care should be taken to ensure it is not done often to prevent the stress caused to the body by over-exerting the muscles.
Improving sleep: We’ve seen how sleep deprivation can impact the body and mind. A good night’s rest helps the body repair itself and remove toxins. Adults should ideally get at least 7 hours of sleep to help their bodies get rid of all the toxins. Proper sleep will prevent cortisol spikes caused due to sleep deprivation. Building good sleep habits like sleeping in a dark room, making sure not to use electronics before you sleep and ensuring you eat your meals early enough are some of the ways sleep can help keep your metabolism in check.
Practicing mindfulness: Heightened emotions keep the body in an unhealthy level of stress, impairing the body’s cognitive abilities.Mindfulness is a great tool to help reduce stress levels. It brings the mind back to the present moment, allowing the mind to stay focused and less emotional. Since stress is one of the major causes of declining metabolic health, mindfulness is a good way to boost metabolic health. Additionally, mindfulness and meditation help improve mental health problems such as mild depression and anxiety by helping combat their symptoms. These concerns are often linked to changes in metabolic health due to a change in lipid profiles.
Deep breathing: According to Harvard Health, relaxation techniques such as deep breathing quell stress. Breathing properly and deeply stimulates the parasympathetic nervous system responsible for the body’s rest and digesting function. This helps the body improve its metabolic rate while also lowering heart rate and stabilizing blood pressure.
Conclusion
Our metabolic health depends on five optimal markers without medication—blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure and waist circumference. The world is seeing a fast decline in metabolic health and a rapid increase in cases of obesity, diabetes, cardiovascular disease and many more lifestyle-related diseases. This sudden change can be attributed to poor nutrition, stress and anxiety, physical inactivity, lack of sleep and environmental pollutants. A simple blood test or a continuous glucose monitoring device can help you understand and keep track of your metabolic health. Once you’re more aware of the workings of your body, it is easy to improve your metabolic health by exercising regularly, eating the right nutrients, improving sleep, being mindful and practising deep breathing.
Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns and before undertaking a new healthcare regimen including making any dietary or lifestyle changes.
Metabolic flexibility is the body’s ability to process fuel from either source of energy—fat or glucose. When this ability is impaired from poor health or genes, it can cause metabolic inflexibility, a condition typically characterised by the burning of glucose over fats. To measure if fat is being burned, it is prudent to observe glucose and ketone levels. Metabolic flexibility also supports athletic performance, and can be a precondition to diabetes, insulin resistance or obesity. It can also be genetically inherited. Metabolic flexibility can be improved by fasting (which nudges the body to burn fat, consuming more protein and maintaining good health through effective and frequent exercise.
How does metabolic flexibility impact our body?
Simply put, metabolic flexibility is our body’s ability to supply fuel or energy for any activity from either of the forms in which it is stored, primarily glucose or fat. Good metabolic flexibility means the body is able to efficiently use both pools for energy. In optimal metabolic health, the back and forth between the two to supply fuel for activities is frequently possible. When the body seeks energy, it burns through glucose first, then through glycogen (which is glucose stored in the liver instead of the bloodstream), and finally, the fats. In times of restrained carbohydrate consumption or fasting, fat is the body’s preferred source of fuel.
In practice, a metabolically healthy person isn’t dependent or primed to rely on glucose as a primary energy source. In this state, the body can reliably draw energy from fat as well. A side effect of the body’s reliance on glucose is that blood sugar levels may rise from the release of insulin, which also inhibits the burning of fat. It may further cause a variety of adverse health conditions such as insulin resistance, diabetes or even obesity from sustained or underutilised fat deposits. A 2018 review of research on the topic makes it clear that there are certain factors that affect metabolic flexibility. These include:
The components of a diet and the frequency of food consumption. This means the nutrients consumed, as carbohydrates are stored as glucose. A higher frequency of food consumption will spike glucose levels more often, which can lead to the body using it as a source of energy, and may also lead to insulin resistance (IR).
Physical exercise and its impact on the mitochondria and insulin sensitivity. Physical exercise catalyses the mitochondria and its consumption of energy. This makes the body’s cells more receptive to insulin. Since insulin allows energy to be processed by cells, it moderates glucose levels in the bloodstream. Over an extended period of time, this also prevents insulin resistance (IR). IR is a precondition for type 2 diabetes and obesity.
Consumption of certain pharmaceutical drugs mimic the effect calorie restriction or exercise may have on key organs that participate in metabolism, such as mitochondrial function, or how cells produce energy in a regulated way. Broad-stroke benefits from this include enhanced muscular and heart-related functions and a reduced body weight.
A cohesive way to track metabolic flexibility is to monitor glucose and ketones levels.
How to measure ketones?
To track when the body is using fat as a fuel source, one can measure ketones. Their concentration increases as the body releases fat for certain organs to use as energy. Since other organs, like the brain, are not fuelled by fat, ketones are released simultaneously to fulfil such energy needs. Essentially, ketone presence indicates that the body is burning fat to fuel the body. It also indicates metabolic flexibility, since it demonstrates that the body is capable of using fat to meet its energy requirements.
Ketones contain three compounds: acetoacetate (AcAc), beta-hydroxybutyrate (BHB) and acetone. Of these, AcAc is generated at the first stage, from the release of fatty acids from storage. BHB originates from AcAc, while acetone is made as a by-product of this process. AcAc is measured through a urine test. This has limitations, because if ketone levels are raised sustainably, the count in the result of the urine test is a less accurate result. BHB is measured via a blood test, which is considered to be accurate, although expensive. Both methods yield measurements in millimoles per litre (mmol/L). They are scored between 0 and 6, and a reading of 0.5 mmol/L indicates that the body is burning ketones, or is in a state of ‘ketosis’. Acetone, the final ketonic element, is measured through a breath test in parts per million (PPM). A reading of 2 acetone PPM shows that the body is in ketosis.
How monitoring glucose levels can help monitor ketones
Glucose and ketones are complementary units of energy present in the body. Stable glucose levels indicate suitable conditions for fat burning. As a natural next step, ketone monitoring can establish the occurrence of fat burning. When one tracks both measures, it gives us a bird’s-eye view of metabolic health. Continuous glucose monitoring (CGM) measures how consumption of food can alter or elevate blood glucose levels. Ketone monitoring can indicate when the body receives benefits of ketosis, such as depleted glycogen levels, and fat is being burned.
Metabolic flexibility and athletic performance
Metabolic flexibility can impact athletic performance. Depending on the specifics of a sport, there are differing macronutrient needs to optimise physical performance. For example, before beginning a marathon or undertaking similarly strenuous physical activity, glucose levels are recommended to be brought back into normal range rather than be in a depleted state. A generous degree of fat in a diet, combined with moderate carbohydrates, can be a suitable fuel for optimal athletic performance. Such a diet is labelled low-carbohydrate, high-fat (LCHF) and could lead to lower glucose production, and subsequently, utilisation by the body.
What is metabolic inflexibility?
A disruption of the body’s ability to switch between the two sources of energy can cause metabolic inflexibility. Fat is the key source of fuel for a resting body. However, eating a diet rich in carbohydrates can get their body used to getting their energy needs from glucose (or sugar), which is how carbs are stored in the body. People with this condition may also have a higher carb-to-fat burning ratio. Any disruption or alteration in the ability to retain metabolic flexibility could cause insulin resistance, thereby also raising blood sugar levels.
Metabolic flexibility/Metabolic Inflexibility and metabolic health
Metabolism is a series of life-sustaining chemical processes in each cell transforming the calories we eat into fuel to keep us alive. Metabolic health is defined as having ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure and waist circumference without using medications. Metabolic flexibility is the ability and capacity of our body’s organs—cells, tissues, and organisms—to allow for oxidation to make fuel available. Metabolic inflexibility is a lack of this ability to switch between fuel sources, i.e., fat and glucose, to meet energy needs. Metabolic inflexibility can be a result of conditions like insulin resistance, diabetes and obesity. Metabolic flexibility can impact metabolic health in certain ways.
There is evidence to support the hypothesis that children of people with insulin-resistance carry the condition in their skeletal muscle. Further, there can be an association of this impairment in how their metabolism may draw energy from fat. Research also suggests that under diabetic conditions, there is an excess of fat available due to impaired insulin signaling systems. This fat can surround the catabolic machinery, that is, a metabolic process that breaks down digested food into energy-fuelling molecules and prevents it from breaking down glucose for nutrition. Consequently, the accumulated glucose rises and may prevent the mitochondrial function. This can happen by altering the body’s protein pool or causing a rigid gene transcription programme. Mitochondrial malfunctioning, such as its indecision while in the face of nutrient overload or intense substrate competition, is related to obesity-related conditions. Nutrient overload takes place when the body consumes more energy than it requires or burns. It is considered chronic when this becomes a dietary pattern over a sustained period of time. Substrate competition is the circumstance when enzymes, which speed up metabolism, face a shortage of substrates to latch on to so they can execute the metabolism process. This can also create an environment in which the body reduces or does a poor job of switching between fuels (glucose and fat) for energy.
Ways to improve metabolic flexibility
Metabolic flexibility can be improved upon. By definition, it requires the body to use both sources of fuel available with ease and frequency. Glucose is a short-term, immediate source of fuel, while fuel from fat is sustainable and more of a slow-burn resource.
Exercise is a suitable first step to improve or regain metabolic flexibility. In a 2013 study conducted on 24 obese adults who exercised five days a week for up to an hour at a maximum 85% heart rate capacity, the following results were found:
Improved insulin sensitivity, i.e., a reduction in insulin resistance, which is a precondition for diabetes, and obesity.
Impaired fasting glucose (IFG) blunts the impact of impaired glucose tolerance (IGT), i.e., it moderates the effects of a condition that is considered borderline diabetic.
It also suppresses hepatic glucose production (HGP) with less impact on fatty acid suppression. The former prevents an excess of glucose availability, and the latter allows fats to become comparatively available as a fuel source. This can make the energy storage environment conducive to metabolic flexibility.
Eating a diet with emphasis on certain nutrients is another key step for metabolic flexibility. A low magnesium count can hamper the body’s functional or metabolic processes. In particular, it can affect stress response and the body’s systemic inflammatory response. A review consolidates that a diet with polyphenols, omega-3 fatty acids and dietary fibre can positively impact mitochondrial function and dynamics. Polyphenols are organic nutrients present in plants. They are present in berries, herbs and spices, clove, peppermint, cocoa powder, chestnuts, artichokes, red onions and fruits such as black olives.
Conclusion
Metabolic flexibility is the body’s ability to use either fat or glucose for energy. The lack of this ability is called metabolic inflexibility, which can lead to excess glucose in the bloodstream or an over-reliance on carbohydrate consumption. Both can have significant cardiovascular and metabolic side effects such as diabetes, obesity and insulin resistance. Metabolic flexibility can aid in athletic performance. It can be regained or improved by eating certain nutrients—namely polyphenols, omega-3 fatty acids and dietary fibre—and exercising to nudge the body towards burning fat.
Disclaimer:The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns and before undertaking a new health care regimen including making any dietary or lifestyle changes.
Glucose is a major source of energy for the cells and one of the most important molecules in the body. Disruptions in glucose levels or the way in which the body processes glucose can lead to various health problems since it is linked to the most dominant bodily functions. Glucose regulation is tied to metabolic health. Monitoring glucose levels can offer insights into our health as well as have benefits in terms of implementing changes in lifestyle, diet, or exercise.
Highlights
Blood sugar levels fluctuate all day long. Patterns of rises and crashes can offer valuable and actionable insights into your metabolic health,
The burning of fat is closely tied to insulin levels, which in turn depend on, or are closely related to, blood glucose,
A good first step is becoming aware of where your levels stand. Glucose monitoring can provide you with great insights such as glucose variability.
The body produces glucose from protein, fat, and, most frequently, carbohydrates. It is a simple sugar or monosaccharide. Glucose is absorbed directly into the blood from the intestines, which results in a rapid increase in blood glucose or blood sugar. It is then transported through the bloodstream to generate energy for all the cells in the body. Our cells cannot use glucose without the help of insulin, a hormone that allows cells to absorb it. Thus, the body depends on glucose to keep all its mechanisms functioning effectively, giving us the energy to go about our day-to-day activities.
Glucose levels often go unnoticed when they are within the ideal range. However, when these levels in the blood are too high or low, our normal functioning is affected. There is a complex system in place for keeping glucose within a healthy range, metabolizing it into fuel, or storing it for later use. Insulin plays a crucial role in this process.
How to Monitor Blood Glucose Levels?
By tracking the metabolic biomarker of glucose levels, it is possible to understand what kinds of foods or activities are helpful in glycemic control. Blood sugar levels fluctuate all day long.
Patterns of rises and crashes can offer valuable and actionable insights into your metabolic health.
There are a number of tests that can help you understand your blood sugar the A1C test, measures your average blood sugar levels over the past two or three months.
The fasting blood sugar test measures blood sugar after not eating overnight, and the glucose tolerance test, which measures blood sugar levels after ingesting a glucose-containing liquid and also checks the post-meal glucose levels. However, the most accurate measure of glucose over time can be done by continuous glucose monitoring (CGM), which automatically tracks blood glucose levels around the clock.
You can check your glucose level anytime at a glance, and can also observe how it changes over the course of a few hours, days, or weeks to notice patterns. CGM works through a tiny sensor inserted beneath your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between your cells.
The sensor tests glucose at regular intervals, every few minutes. A transmitter wirelessly sends this information to a monitor, which may be part of an insulin pump or a different type of device, where your sugar level is displayed every 1, 5, 10, or 15 minutes. Your monitor will sound an alarm if your sugar drops to a dangerously low level or a high preset level.
Six benefits of monitoring blood glucose levels
You can keep your blood glucose levels at an optimum range in a number of ways. A good first step is becoming aware of your glucose levels and the pattern of dives and rises. By identifying and recording changes in blood glucose levels over time, you can see how different foods, workouts, or other factors can affect them, and this can lead to improvements in metabolic health.
Glucose monitoring can give you great insights into constructs like glucose variability, which represents the quality of fuel and oxidative stress on your body. Optimising blood glucose levels through regular monitoring can have various benefits in terms of controlling metabolism, managing weight, understanding your ideal diet, and improving athletic performance.
1.Understanding Glycemic Variability
Glycemic variability represents the quality of fuel and oxidative stress on your body. Keeping your blood glucose variability under 12% is considered ideal. Oxidative stress is defined as a disturbance in the balance between the production of reactive oxygen species (free radicals) and antioxidant defences. Free radicals fight pathogens that provoke infections. They are extremely reactive, while antioxidants stabilize the reactive nature of free radicals, creating harmony.
The process of gaining or losing weight is linked with many hormonal pathways and it is not as simple as the mere movement of calories in and out of one’s body, because different individuals can have variable glucose responses to the same foods or caloric intake.
In fact, the burning of fat is closely tied to insulin levels, which in turn depend on, or are closely related to, blood glucose. Real-time glucose measurements can help us to analyse the ways in which what we eat can affect our blood sugar levels and, by proxy, our insulin levels.
Insulin is the body’s main anabolic hormone, meaning it promotes the storage of fat rather than breaking compounds down. Insulin enables our cells to take up glucose from the blood for use, or, when there’s excess, for storage. Because weight loss generally requires us to burn this stored glucose (in the form of fats), we need to control insulin, to indicate to the body that it needs to burn fat rather than store more of it.
Monitoring our glucose levels can help us to manage that, and also provide a valuable understanding of the physiological processes that lead to glucose storage or weight loss.
3.Diet and Glucose Monitoring
Diet is the most significant determinant of our blood glucose levels. Viewing diet through the lens of blood glucose levels can be a transformative technology when it comes to personalizing food choices and optimizing overall metabolic health. The same foods can have very different glucose responses for different individuals and, thus, monitoring these responses can help to create a diet plan that is optimized for your body type.
The main goal of monitoring is to ensure that glycemic variability is not too high. Glycemic variability is defined as the range of swings in glucose levels. Research suggests that excessive peaks and dips in glucose can lead to damaging effects on our metabolic health and increased risks to cardiovascular health and the nervous system.
Although the glycemic index explained in detail below, offers rough estimates of the food’s predicted glucose impact, monitoring can help in more accurately determining. This includes the determination of which foods will help to prevent glucose spikes after meals, maintain glucose levels within a healthy range, and keep fasting glucose at a low-risk range.
4.Helps to stay within Time in Range
Time in Range (TIR) is a metric that measures the time in which the blood glucose is within the target range. This metric was introduced by the American Association of Clinical Endocrinologists (AACE) in 2017 to be used as part of its Standards of Care Guidelines, which are given to physicians and patients.
The AACE defines Time in Range as ‘the percentage of time spent at or above the lower boundary (70 mg/dL or 4 mmol/L) and below or equal to the upper boundary (180 mg/dL or 10 mmol/L) during a specified period. It is an important measurement for tracking glucose using continuous CGM systems.
Glucose levels fluctuate throughout the day, so it’s normal to see a curve with little peaks and valleys. But the gold standard is 100% TIR (which means all 24 hours). Non-diabetics, who are aiming for optimal metabolic health, would try to stay within a range of 70 to 110 mg/dL for as much of the day as possible. Keep in mind, however, that these are just targets, so they aren’t personalized to your specific situation. You should always consult a medical professional about the right TIR goals for you, which can shift for a variety of reasons, including if you’re pregnant, older, or at high risk of complications.
5.Exercise and Blood Glucose Monitoring
Physical exercise can improve the body’s ability to maintain stable, healthy glucose levels. The positive effects of exercise on metabolic fitness include an increase in glucose transporters travelling to cells (GLUT4 channels), allowing more glucose to enter and lower circulating glucose, as well as greater metabolic flexibility (the ability to switch between different ‘fuel’ sources—glucose and fat).
Real-time, personalized feedback on glucose levels can serve as motivation for people to work out more often as well as provide better insights into the best intensity and timing for an exercise routine.
For athletes, monitoring glucose levels on an ongoing basis can allow them to better control metabolism and fuelling in order to improve athletic performance. CGM sheds light on how the body uses energy before, during, and after an athletic event, and this, in turn, can help to plan for the optimum time to eat, as well as exercise, to ensure peak performance.
How to maintain blood glucose levels in four ways
You can keep your blood glucose levels at an optimum range in a number of ways. A good first step is becoming aware of where your levels stand. Glucose monitoring can provide you with great insights such as glucose variability. Keeping your blood glucose variability under 12% is considered ideal. There are various factors that can help us to maintain blood glucose levels within a low variability range, including the following:
1.Sleep helps in Maintaining Your Blood Glucose Levels
Sleep and glucose metabolismgo hand in hand. A lack of sleep can affect glucose regulation by increasing circulating cortisol (a stress hormone), leading to gluconeogenesis (the production of glucose from non-carbohydrate sources).
In a study, it was discovered that 6 days of sleep restriction was associated with an increase in evening cortisol levels and night-time growth hormone concentrations, resulting in a rapid drop in muscle glucose uptake. Due to spikes in blood glucose levels, both of these factors can also reduce insulin sensitivity. In addition, sleep duration affects hormones associated with appetite, including leptin (which soothes hunger) and ghrelin (which stimulates it).
Sleep deprivation offsets the difference between the two hormones, potentially causing metabolic irregularities that can lead to changes in food intake and cause problems like diabetes and metabolic syndrome.
2.Stress
The sympathetic nervous system controls the body’s response to danger – real and perceived. Stress stimulates the sympathetic nervous system, which releases cortisol. Besides regulating blood pressure and blood sugar levels, cortisol is the body’s natural alarm system. As a result of increased glucose levels as an immediate energy source, cortisol inhibits insulin sensitivity in stressful situations. Chronic stress and chronically elevated glucose levels cause the pancreas (which produces insulin to lower glucose levels in the blood) to become less effective at responding to a high glucose stimulus.
3.Exercise helps in Maintaining Your Blood Glucose Levels
Exercise can help us to maintain our glucose levels and also our metabolic flexibility, the ability to use both fat and glucose as energy sources, depending on what type of workout is being performed. High-intensity anaerobic workouts like high-intensity interval training (HIIT), resistance training, or low/moderate-intensity exercises use different fuel sources and thus can have varying effects on our glucose levels.
In most people, the switch in energy use from glucose to fats happens when endurance exercise is moderate or about 60% of maximum oxygen capacity (VO2 max). However, in high-intensity anaerobic activities, which usually tend to be above 80% VO2 max, glucose usually becomes the predominant fuel source. While HIIT enhances cardiometabolic metrics and bone formation, aerobic exercise is associated with fat metabolism.
4.Diet/ Nutrition for Blood Glucose Levels
Glycemic Index (GI) refers to a relative measure of the incremental glucose response per gram of carbohydrate. Consuming low GI foods are known to keep the blood sugar levels low or reduce them. GI measures how the body absorbs or digests foods, affecting the rate at which blood glucose levels rise. Low GI foods are associated with smaller fluctuations in blood glucose levels as compared to foods with high GI.
However, the GI tells only part of the story with regard to the carbohydrate content of food. Some criticize its ranking system for not reflecting a food’s overall healthfulness. In this discussion, both glycemic load and glycemic variability are relevant. Considering a food’s nutritional value as a whole is recommended. The GI ranks carbohydrates in food on a scale from 0 to 100, according to their blood-sugar-raising potential. Although the GI isn’t an exact measurement, it does indicate how the body digests or absorbs food (especially carbohydrates), influencing blood glucose levels.
According to Medicine.net, foods with low (up to 55) to moderate GI (56–69) include legumes, barley, yogurt, oats, and beans. According to a study, a low-carbohydrate diet, high in saturated fat, improved insulin-resistant dyslipoproteinemia without having adverse effects on low-density lipoprotein (LDL, or ‘bad’) cholesterol.
It is also important to avoid high levels of sugary foods and drinks, trans fats, and simple carbohydrates or foods with a high GI and glycemic load. The Mediterranean diet may also reduce insulin resistance. In this diet, the main focus is on eating seasonal foods and using plant-based fats, such as olive oil for cooking and certain fruits for desserts.
Conclusion
The level of glucose in our blood can be an important indicator of our metabolic health. The way glucose is processed and our resultant insulin levels have major implications in terms of the risk of conditions like diabetes, heart disease, and many other chronic conditions. Monitoring glucose levels consistently can help in managing our glucose levels and keeping them within the optimal range between 70 to 110 mg/dL for non-diabetics.
Low glucose variability is generally associated with better health outcomes, and glucose monitoring can help to optimize your weight management, diet, workout routine, and athletic performance. Metabolism is not a one-size-fits-all approach. Tracking our glucose levels can help us understand what makes our blood sugar levels soar and dip and may even suggest optimal times to eat and work out.
Additionally, keeping an eye on one’s sleep, stress, diet, and exercise can help with understanding ways to improve your lifestyle and avoid glucose spikes.
Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns and before undertaking a new healthcare regimen including making any dietary or lifestyle changes.
Metabolic health can be defined as the body’s ability to use food efficiently for fueling, growth and repair, as well as storing energy for periods of lesser availability of food.
Metabolism is the process by which your body uses food to carry out the above activities. Being aware of how these processes work for each person in their bodies can provide an insight into how food, exercise and sleep affect one’s health and longevity
Blood glucose commonly referred to as blood sugar, is the fuel that keeps the engines in our body running at an optimal level. Glucose is a form of sugar which we obtain from carbohydrates and fats to fuel our bodies.
Glucose gets processed in our bodies multiple times in a day and there are certain foods which can cause frequent glucose spikes in the body thereby leading to poor metabolic health.
Poor metabolic health can lead to chronic diseases such as diabetes, heart disease, high blood pressure, obesity, fatty liver disease, gallstones, PCOS, sleep apnea, gout and more.
The key biomarkers of metabolic health one should track are blood glucose, insulin sensitivity, free fatty acids, oxidative stress, gut health, blood pressure, sleep, triglyceride levels and cholesterol levels.
What if we told you that it’s possible to quantify your metabolic health with a score? A continuous glucose monitor that helps you track your blood glucose in real time can yield this figure. The Ultrahuman M1 provides a metabolic score. Let’s understand how it reflects your metabolic health.
Highlights
Metabolic health is a predictor of chronic diseases such as diabetes, heart disease, high blood pressure, obesity, fatty liver disease, gallstones, PCOS, sleep apnea, gout and more,
Blood glucose is intimately tied to metabolic health. The key determinants of this metric include glucose variability, average glucose score and time in target range,
The Ultrahuman M1 helps you monitor your blood sugar levels to optimise your metabolic health. It’s possible to quantify your metabolic health with a metabolic score. The key determinants of this metric include glucose variability, average glucose score and time in target range.
How to Apply Ultrahuman M1 CGM Sensor on your Arm and Know How it Works?
Decoding the metabolic score
A metabolic score is an indicator of overall metabolic health. It is calculated on the basis of glucose variability, average glucose as well as time in target metrics and ranges from 0-100.
Your score gets activated within an hour of scanning and applying the sensor and it can slightly vary in the first 24 hours of usage as the sensor calibrates with your body.
The scores get reset to 100 at midnight and based on your activities such as exercise, eating, stress, sleep and your body’s response to these activities- your score increases or decreases accordingly through the day.
The goal is to obtain a maximum score and the key is to maintain glucose levels within the recommended range of 70-100 mg/dl. Let’s understand its determinants.
Key Factors that drive the Metabolic Score
1. Glucose Variability
Glucose Variability can be defined as the fluctuations in your glucose levels throughout the day. It is important to maintain a low glucose variability, ideally below 12% to ensure there is less oxidative stress on your body.
Oxidative stress paves the way for cellular damage in the body and causes neurodegenerative diseases, cancer, hypertension and more.
Maintaining stable glucose levels can help one maintain improved energy levels and cognitive performance throughout the day. Research has identified glucose variability as a predictor of hypoglycemia and has been found to be related to intensive care unit mortality in non-diabetic individuals.
Blood glucose levels change throughout the day. It is the degree of fluctuation in glucose that determines a good score.
2. Glucose Spikes
When blood glucose levels rise beyond the upper limit range, glucose spikes can occur.
Glucose spikes beyond 120 mg/dl can cause hyperglycemic events in the body. Frequent hyperglycemia can eventually lead to metabolic dysfunction. Studies have shown that high blood glucose variability can accelerate the process of ageing.
Glucose spikes can also occur during exercise however these are considered healthy. During intense exercise bouts gluconeogenesis can occur due to the breakdown of muscle protein – especially during the absence of carbohydrates.
Hyperglycemia can prevent healing, elevate the risk of infections, heart attacks and strokes and cause irreversible damage to the nerves, blood vessels and organs such as eyes and kidneys and Increase the risk of heart attacks and strokes.
Postprandial or post-meal blood sugar levels exceeding the ideal range can lead to prediabetes or diabetes.
3. Glucose Crashes
A drop in blood glucose levels in the body is referred to as hypoglycemia. During such an episode, there is excess production of insulin in the body, causing the cells to absorb more blood glucose than is required to maintain the optimal level. It is marked by a blood glucose level below 70 milligrams per deciliter (mg/dL). Some symptoms include tiredness, shakiness, anxiety, sweating, hunger, irritability, fast heartbeat, pale skin, hunger etc.
4. Average Glucose Score
Another parameter which is measured by Ultrahuman M1 and which we need to optimise is our HbA1c levels also known as glycated haemoglobin.
It is a measure of your average blood glucose level over the last 2-3 months, since red blood cells live for an average of 3 months, glycated haemoglobin reflects sugar exposure to the cells over a similar time range.
HbA1c is made when the glucose in your body sticks to your red blood cells. It accumulates over time and melds with your blood when your cells can’t absorb the sugar well.
According to the American Diabetes Association, the normal range of Hba1c is between 4% to 5.6%. A range of 5.7% to 6.4% could indicate that you are pre-diabetic and susceptible to diabetes, in which case you should consult a doctor. 6.5% or higher indicates that you may have diabetes and should visit a doctor for consultation.
Ultrahuman M1 uses average glucose data points to calculate your estimated HbA1c. The average glucose is calculated from the point of scanning the sensor till midnight at 12:00 am.
So if you scan your sensor at 1:00 pm, your average glucose levels will be the average of all glucose levels from 12:00 AM to 1:00 PM on the same day. The ideal recommended range is 70-100 mg/dl
What causes variations in average glucose scores?
There are multiple factors that cause fluctuations in your average glucose score
Lack of sufficient sleep can cause a higher than normal rise in glucose levels after eating meals the next day. Since a consistent lack of sleep raises blood sugar levels beyond normal, this eventually may lead to metabolic diseases such as Type 2 diabetes.
The sympathetic nervous system regulates the body’s response to danger. Stress evokes the sympathetic nervous system thereby producing Cortisol, the body’s natural alarm system. It increases glucose levels for an immediate energy source, inhibiting sensitivity to insulin production. Over time chronic stress and chronically elevated glucose levels impair insulin sensitivity.
A lack of exercise causes fluctuations in glucose levels as your muscles are contracted during exercise and these muscles tap into glucose stores for release of energy. Exercise stimulates insulin to use glucose efficiently before and after a workout.
Foods with a high GI index such as simple sugars, can cause major spikes in blood glucose levels. Ensure that you are eating foods with a low GI index to avoid any excess spikes and subsequent crashes in blood glucose. The device will show you how your blood glucose rises or falls in response to certain foods.
Alcohol can suppress glucose response. Your sensor may show a stable glucose response while drinking, however as the body slowly begins to absorb the sugar from the alcohol, you may witness a rise in blood sugar after a couple of hours and it can take almost 12 hours for the alcohol to be flushed out of your bloodstream.
5. Time in Target Range
The ideal range of glucose levels is 70-110 mg/dl. The goal is to stay within the target score for as long as possible to maximise your score which will improve your cognitive ability through the day. The time in the target range is the metric that measures the amount of time your blood glucose is within the recommended range.
This metric is measured as a percentage. The lower the percentage i:e the lower fluctuation out of the target range, the better your score. You should aim to keep this below 12% to reduce the amount of oxidative stress on the body. Oxidative stress disrupts the necessary oxidation process that takes place in the body. It occurs when there is an imbalance between free radical activity and antioxidant activity. These free radicals are required to fight off pathogens, which can cause infections in the body.
The HbA1c test does not account for hypoglycemia (low blood sugar levels) and therefore time in target remains an important metric in measuring your metabolic score.
Why is it important to have glucose in the target range?
Improved cardiovascular health, mood and decrease in anxiety and depression,
Helps the body clear out of toxins and helps to detoxify our bodies,
Improved blood circulation by helping the body process nutrients more efficiently,
Increased muscle mass, bone density and overall energy levels,
Improved sexual health and fertility,
Lowered inflammation in the body, which eventually protects the body from metabolic diseases.
How to Remove Ultrahuman M1 CGM sensor ?
Three Metabolic vectors with the help of your metabolic score
Ultrahuman M1 computes metabolic vectors with the help of your metabolic score. There are 3 vectors reflected on the app and the goal is to enhance your metabolism along the different trajectories of the triangle.
1. Focus Vector
The Focus Vector is calculated on a score of 10 and is calculated during the productive time of the day – 8:00 AM- 10:00 PM, every 2 hours, totalling 7 rounds. Each round will calculate glucose spikes and crashes. The absence of glucose spikes or crashes will ensure that you score ‘10’ for that round.
Glucose spikes and crashes can cause glucose variability and if you experience either a spike or a crash you will receive a score of 5 for that round. If you get a spike and crash in the same round, your score will be 0.
Maximising the focus vector will ensure that we are most productive throughout the day and can help to avert lethargy. Understand the foods and activities causing spikes and crashes to maximise this vector.
2. Longevity Vector
The longevity vector tracks the impact of glucose variability on your longevity and helps you optimise it. It consists of 3 components:
1. Circadian Factor
The body’s natural 24-hour rhythm is called the circadian rhythm. The rhythms of our body are affected by light and darkness and are controlled by a part of the brain known as the suprachiasmatic nucleus. Our body has a stronger metabolism during the sunlight hours and is more insulin resistant at night. The circadian factor is measured in the % form and it is important to maximise this score by maintaining consistent glucose levels and avoiding spikes beyond 110 mg/dl to ensure that we are maximising longevity for our bodies.
2. Glucose Variability
Maintaining glucose variability at 12% and lower is considered ideal to reduce oxidative stress on the body and maximise longevity. This can be achieved by consuming foods that give you a stable glucose response, getting quality sleep, exercising regularly and keeping stress levels low.
3. Peaks above 120 mg/dl
Peaks above 120 mg/dl eventually culminate into poor metabolic health thereby increasing the chances of metabolic diseases. These peaks should be kept in check and one should aim to have 0 peaks above 120 mg/dl as this can trigger a hyperglycemic event.
3. Athletic Vector
Athletic Vector shows how well-fuelled you were for your workout. Being optimally fuelled for a workout is important so that you can ensure peak performance through the workout.
The human body sources energy for activities through carbohydrates and fats. Carbohydrates are required for higher intensity and longer duration workouts such as sprinting, HIIT or resistance training. Fats can be consumed for moderate-level activities such as walking or yoga.
Contributors to the fueling zone
Glucose Zones
Glucose zones determine your fuelling score during your workouts. Your fuelling score is dependent on the time you spend in each glucose zone.
There are 4 types of glucose zones
Underfueled- <80 mg/dl Being under-fueled for your workout means that the availability of fuel for your body i:e glucose, is restricted. Being under fuelled will hinder your performance and may affect your brain’s optimal functioning.
Low Intensity- 80-109 mg/dl Low intensity workouts such as walking, yoga, cycling do not require too much fuel and can be managed within this blood glucose range with moderate fueling.
High Intensity- 110-140 mg/dl This level of fueling is ideal for activities like HIIT, Resistance Training, Sprints, CrossFit training. These activities generally require higher levels of glucose fuelling for peak performance and allows athletes to compete at their best levels.
Overfueled- >140 mg/dl An overfueled state does not necessarily affect performance, however being in the range above 140 mg/dl can cause hyperglycemia. It is important to not be in this range for long periods as this can lead to inflammation, which is detrimental to metabolic health.
Slopes
Slopes are the trend lines of your glucose during your workout. The key is to maintain a 0% slope during your workout. Positive slopes are preferred over negative slopes, which determine lower energy and inadequate fuelling.
High quality fuelling ensures a stable glucose response throughout the workout so if you observe a negative slope ensure that you are fuelling more or better before and during your next workout.
Falls
This refers to the number of times your glucose drops by at least 10 mg/dl within 5 minutes. 1 or more falls will result in a penalty for your score.
High intensity workouts can cause rapid drops in glucose stores sometimes even below 70 mg/dl causing a hypoglycemic event. It is important to fuel efficiently before a workout to avoid falls in the workout. 0 falls is considered optimal.
4.Food Score
Food logging is a tool to help you track the food and beverages you consume in a day with the time of their intake. Logging your food intake can help you evaluate your macronutrients and micronutrients and make you mindful of your dietary patterns. Macros consist of proteins, carbohydrates and fats while micros consist of the vitamins present in the foods you eat.
Our algorithms constantly help you optimise the impact of food and drinks on your body. The food score monitors the impact of food and beverages on your blood sugar 2 hours after you have consumed them.
Certain foods react differently to people and even the timing of the day matters when eating a particular meal. One would be able to understand how food impacts blood sugar through a process of trial and error.
How do you log food in the Ultrahuman app
1. What Food you ate?
When you type in the food you eat, you would benefit from logging the specifics. Break the foods down and enter each item consumed. For instance, if you ate vegetable rice, make sure to include the names of the vegetables and the type of rice you ate. Each vegetable will translate into a different calorie count and could elicit a different glucose response. It is important to log each ingredient in to understand what is actually triggering a glucose spike if you are noticing one. You may notice that a certain type of oil is spiking your glucose levels or the quantity of rice is shooting up the blood sugar levels. Mix and match to understand the best version of the meal to stabilise your glucose levels.
2. When you ate Food?
The timing of your meal can make a significant difference in glucose reactions. For example, prior to a workout your body requires carbohydrates and fats as fuel however at lunch or dinner, your body may not require carbohydrates.
Glucose can rise in that case and cause a spike. You may find that eating a dessert after your meal may not lead to blood sugar spikes but eating a sweet breakfast may increase your blood sugar or that piece of sourdough bread may react favourably with your body prior to your workout than after it.
3. How much food you ate?
Measuring the quantity of food you eat can give you an accurate idea of your calorie count and nutrition analysis. If you eat chicken curry with rice, let’s say you eat 100 grams of chicken leg, 1 tsp groundnut oil, 200 grams bell pepper and 1 cup rice and your glucose levels are stable. Next time when the quantity of rice is 1.5 cups and your blood glucose may rise steeply.
Hence it is important to measure your food quantity to find the perfect fit for a stable glucose response. This quantity can vary based on the requirements of your body for that day. For example on days of low activity, ideally that bowl of rice should be 0.5 cups.
Food Scores
Our algorithms constantly help you optimise the impact of food and drinks on your body. Ultrahuman M1 calculates a food score based on the glucose peak (highest glucose point in the 2 hour food intake window), glucose change caused by the food and Time over the Target during the food time window.
Food scores are tracked between 0-10, a higher food score indicates that such foods are good for your metabolic health. If the food scores are between 6-8, you need to experiment with different foods or ingredients for a better metabolic score, for example an omelette with 1 tsp of oil can yield a score of 10 over one prepared with 2 tsp oil. Scores below 5 are poor metabolic scores and you will either need to change the timing of the food or probably eliminate it from your diet.
Within 2 hours of eating you will get an analysis of whether the food is in the top zone or bottom zone:
Top Zones
Foods that give you a score of 10 sit well with your body and produce a stable glucose response. However, it is important to note that the timing of such foods is also important, for example, if you eat multigrain toast and egg and work out in the morning immediately, you may get a score of 10 as your body uses the fuel for the workout.
However, if you eat the same toast and egg at midnight you are likely to score a sub-5 score as the body tends to be more resistant to insulin overnight and is metabolically more resilient during the day. Therefore it is important to track what foods are in the top zones and when is the best time to consume such foods so as to maximise your metabolic score.
A high metabolic score correlated with higher energy and productivity levels throughout your day. Getting a score of 6-8 may means that 1 or 2 ingredients in the meal are causing a fall in the overall score. For example let’s say you make a chicken salad for yourself and top it up with some mayonnaise, your score may deplete, however the quantity also matters. So, you can try to reduce the quantity to gauge the glucose response.
Bottom Zones
The bottom zone is a score that is 5 or below for certain foods. It is crucial for us to understand which foods generate poor scores in order to avoid glucose crashes and spikes that lead to an overall low metabolic score.
The trick is to identify these foods and to know at the time of the day when they were consumed. The cheesecake, for instance, may create a stable response at lunch but most probably lead to a spike at night.
Your body may not need glucose at certain points in the day so it is best to understand what kind of foods your body is accepting and at what points in the day. Food combinations can also help to avoid bottom zones. Research suggests that apple cider vinegar can lead to lower levels of post-meal glucose.
Timeline
Ultrahuman M1 lasts for a period of 2 weeks after which you have to replace the sensor with a fresh one. You will receive it based on the plan that you have subscribed for. You need to use your login id to access the data from the app. If your 2 week period expires, the next time you put on the sensor, the data is recalibrated on the 15th day of your Cyborg journey and so on. So it is important to ensure that you subscribe for a longer period so that the sensor is able to understand your body better and curate the data.
As the days progress, the sensor begins to understand your optimal glucose zones and begins to recommend the best times to workout based on your fuelling patterns. It also offers data on your pattern of average glucose – if it has been on the rise over a 3-day period and that you need to rest and recover for the day.
Just as you receive a weekly report over email for workouts, you receive a weekly report of your top zone and bottom zone foods. The data also gives information on techniques to optimise your bottom zone foods so as to avoid making the same mistakes in the next week.
And finally the most important parameter is your average weekly metabolic score which gives you a consolidated picture for the week as to how you have performed across all of your functions of nutrition, exercise and sleep.
Nudges
The Ultrahuman app consistently gives you nudges or notifications on key events of the day. The M1 live with bluetooth connectivity will give you instant updates without scanning but in case of M1 you would have to scan the sensor to receive your updates.
The Ultrahuman app gives the following updates related to the M1 sensor
Hyperglycemic events-Events which cause your blood glucose to rise above 120 mg/dl. You will receive a nudge to walk or stretch.
Glucose Crash– The app detects hypoglycemic events or incidents when your blood glucose levels plunge. It also suggests hacks to avoid crashes.
Gluconeogenesis events– These spikes occur due to workouts, they are healthy for you and help to improve your metabolic score.
Ideal Glucose Range– The app nudges you to remind you that you are having a great day and that your glucose levels are in an ideal range. If you feel good and are working at peak productivity levels then it is possible that you are within the recommended glucose range.
Epic Starts to the day– It is important to avoid spikes and crashes early in the day during when our bodies are metabolically at their most resilient state. Ultrahuman M1 motivates you to stay on track by offering information.
Primed for activity– The app sends you a notification when your glucose levels are within an ideal range for physical activity or a workout to ensure that you can crush that activity at peak performance levels.
Nocturnal activity– The app measures your glucose levels overnight and updates you on the quality of your glycemic control. Good glucose control occurs with a healthy diet, good sleep, consistent meal times and well-managed levels of stress.
We got you covered more about How Ultrahuman App will notify you & guide you in removing M1 CGM Safely.
Coaches
New Ultrahuman M1 users may be overwhelmed at the start. When they are unable to navigate the data that the tracker is offering through the app, a personalised performance coach serves as a beacon of light. These coaches are experts in the field of nutrition and fitness and are there to help you interpret the data
Even experts in the field of exercise and nutrition may have queries about their individualised glucose responses to food and exercise.
The app offers more than 200+ curated sleep sessions, workouts and guided meditations from the top experts, scientists and athletes. It’s also equipped with guided nutrition plans by coaches. Know how much Ultrahuman M1 costs and Other pricing details.
Conclusion
Poor metabolic health is a predictor of chronic diseases such as diabetes, heart disease, high blood pressure, obesity, fatty liver disease, gallstones, PCOS, sleep apnea, gout and more. Blood glucose is intimately tied to metabolic health. Ultrahuman M1 helps you monitor your blood sugar levels to optimise your metabolic health. It’s possible to quantify your metabolic health with a metabolic score. The key determinants of this metric include glucose variability, average glucose score and time in target range.
Ultrahuman M1 computes metabolic vectors like focus, longevity and athletic vector with the help of your metabolic score. While glucose zones help to determine your fuelling score, food logging enables you to track your dietary patterns and understand the glucose response to the food and drinks you consume. It also gives you data about how eating at a certain time and eating foods in certain combinations and portion sizes affect your blood sugar.
This information is received in the form of weekly reports of top and bottom food zones. It’s imperative to know that the Ultrahuman M1 needs to be replace a fresh one after a period of two weeks. Your average weekly metabolic score which gives you a consolidated picture for the week. Finally, the actionable real-time nudges that the app offers helps you correct your mistakes and prevent both blood sugar spikes and crashes.
For example, the device prompts you to take a short work to flatten the rising glucose post a carb-heavy meal. It also offers positive feedback and tells you when your blood glucose has been consistently in the recommended range. What you can measure, you can manage and improve. So are you set to start your blood glucose monitoring journey?
Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns before undertaking a new healthcare regimen including making any dietary or lifestyle changes.
In this part, let’s understand how it pushes you to act on the insights it provides about your glucose biomarkers.
According to the nudge theory, positive reinforcements and actionable insights prompt behavioural changes.
So, are you experiencing this transformation too while tracking your glucose levels?
Let’s get acquainted with the nudges.
Highlights
When you indulge in excessive quantities of simple carbs and sugar, the body is fed with more glucose than is actually required which can cause blood sugar spikes and crashes,
Hyperglycemic events cause your blood glucose to rise above 120 mg/dl.The device will prompt you to walk or stretch in the advent of such an event,
Logging your food is crucial as it helps you to get a clear understanding of what foods are causing fluctuations in your blood glucose levels.
What do nudges mean on the platform?
The Ultrahuman app consistently gives you nudges or notifications on key events of the day. The M1 live with bluetooth connectivity will give you instant updates without scanning, but it’s important to note that for the M1, you would have to scan the sensor to receive your updates. (Related: https://ultrahuman.com/)
The idea behind these nudges is to give you live updates and inform you whether you are maintaining a check on your key parameters. Nudges work as a kind of makeshift guide and motivator to ensure that you are maximizing your score and following a correct pattern of nutrition, exercise and sleep as per your body’s requirements.
Why do you see specific nudges on the app, how does that work?
The app provides you with specific nudges for multiple reasons.
1.Hyperglycemic events: These are events which cause your blood glucose to rise above 120 mg/dl. The app will give you the indication to walk or stretch should such an event arise, since experiencing raised glucose levels is detrimental to your energy levels. Frequent hyperglycemic events may also lead to the occurrence of metabolic diseases.
2.Glucose crash: Glucose crashes can occur due to certain high GI Foods and the app teaches you ways to optimize these crashes so as to avoid them in the future.
3.Gluconeogenesis events: These spikes occur due to workouts, they are healthy for you and help in improving your metabolic score.
4.Ideal glucose range: This nudge by the app reminds you that you are having a great day and that your glucose levels are in an ideal range. If you feel good, and are working at peak productivity levels, then it is possible that you are well within the recommended glucose range.
5.Epic starts to the day: It is important to avoid spikes and crashes early in the day, during sunlight hours, when our bodies are metabolically at their strongest levels. At such times, the app gives you the motivation you need to keep you on track.
6.Primed for activity: The app gives you a notification when your glucose levels are at an ideal range for physical activity or a workout to ensure that you can crush that activity at peak performance levels.
7.Nocturnal activity: The app measures your glucose levels overnight and updates you on whether your control was in check. Good glucose control occurs with a healthy diet, improved sleep quality and meal times and well-managed levels of stress.
What are Ultrahuman 30 nudges with deep health insights?
The Ultrahuman app has got your back by providing you with a comprehensive list of nudges with deep health insights to optimize your metabolism:
1.High average glucose notification
Notification: Your average glucose for yesterday was 110 mg/dL (+10 than the max target for average glucose).
This notification generally gets calibrated at 10:00 am local time. This metric provides you with a view of how your glucose levels were the previous day.
The ideal range to be in is between 70 and 100 mg/dl of blood glucose; 100 mg/dl is considered to be the upper limit, so if your glucose levels exceed this limit you will receive a notification the next day.
The rise in glucose levels could be explained by you providing your body with more glucose than it needs, maybe through carbs or simple sugar. Another reason for high glucose levels could be a high level of stress or inadequate sleep. Ensure that you are not going beyond this point so that you can maintain good metabolic health.
2.Rising average glucose levels
Notification: Your average glucose trend for the past 3 days is on an upward trend. This could happen due to low levels of rest or poor sleep quality. Take it easy today.
This notification is provided when your average glucose levels are rising over the past three days. This signifies that you have been over-fuelling your body which now requires adequate rest and recovery.
Poor sleep quality causes elevated glucose responses in your regular meals. Along with your body not getting adequate rest to recover, poor sleep causes glucose spikes and crashes which can further hamper the process of recovery.
This nudge can also provide you with data on whether you are over-fuelling your body with your workouts (over the course of three consecutive days) and hence, if you need to slow down the pace and take it easy the next day.
3.Glucose crashes
Notification: Glucose crashes can lead to subsequent hunger peaks. Optimize foods that crash your blood glucose to manage hunger levels.
Limit: One notification per food log window (two hours), as there might be multiple crashes for a food log.
Glucose crashes can occur due to certain high GI Foods and the app teaches you ways to optimize these crashes so as to avoid them in the future.
When you indulge in excessive quantities of simple carbs and sugar, the body is fed with more glucose than is actually required, which raises blood sugar levels. In an attempt to bring down the blood sugar levels, the body produces insulin to combat the rise and this causes blood glucose to decrease and cause a crash in energy levels.
This process is called a glucose crash and causes tiredness and lethargy. The mid-afternoon slump which most people experience may possibly be a glucose crash.
Glucose crashes below 70 mg/dl cause a condition called hypoglycemia and can lead to the occurrence of metabolic diseases going forward. Some symptoms include tiredness, shakiness, anxiety, sweating, hunger, irritability, fast heartbeat, pale skin, hunger etc.
There are several ways you can avoid glucose crashes. These are
Eating complex carbs including whole food grains like quinoa and whole wheat items. These do not give an excessive spike,
Adding more fibre and protein to your meals which can help smoothen the glucose response curve,
Fermented foods like yoghurt or sourdough bread may have a slightly better glucose response than the non-fermented versions,
Follow this sequence for eating – fibre > proteins> carbs > simple sugars. Eating in this order can improve your glucose response.
4.Peak trainer
Notification: You crossed the 140 mg/dL peak glucose target 16 {past peak frequency} times in the last 7 days. For the next 7 days try not to cross the 140 mg/dL peak glucose target more than 5 {new peak frequency} times.
This is a notification that provides you with insights on the week gone by. The optimal target here is to not cross the 140 mg/dl peak 0 times so you can avoid glucose spikes and subsequent hyperglycemic events and crashes.
For example, if you crossed the peak nine times during the week, the sensor learns your eating habits, exercise and nutrition patterns and gives you the target to achieve for the next week. As you progress, your final goal should be to bring this number down to 0.
5.Reminder to log food
Notification: You haven’t logged enough food entries in the past 3 days. Logging your food events during the learning phase will help you unlock more insights about your metabolic health.
We covered the importance of food logging in Part 1 of the series. Logging your food into the app is crucial as it helps you get a clear understanding of what items are causing fluctuations in your blood glucose levels. For example, foods with multiple sources of ingredients could have one item that spikes your blood sugar. The timing of the meal can also make a difference; a meal that gave you a score of 10 in the morning may not give you the same response later in the evening due to your body’s deteriorating metabolism towards the nighttime.
6.Reminder to scan data
Notification: You haven’t scanned your sensor in the last 7 hours. Please scan your sensor to avoid missing glucose readings.
If you have the Ultrahuman M1, you will need to scan the sensor to get your data.
The app nudges you as a reminder to scan your data in case you forget to do so for a couple of hours. The objective of this nudge is to keep you aware of your readings throughout the day. For example, a certain meal may have caused a sharp glucose spike which you were unaware of as you had not scanned your sensor. Post such a meal, it would be advised to take a walk or stretch it out to bring down your glucose levels back within the target range.
7.Food analysis report
Notification: Click to check how your last meal performed.
After logging in your food data into the app, it takes two hours for the sensor to provide you with your food scores after taking into account the glucose response to that particular food. Ideally, it takes about an hour or so for your food to metabolize.
8.Last meal window
Notification: Your last food intake timing for yesterday was around 10.30 pm. Try eating before 10 pm today for better sleep quality and improved metabolic score.
Ultrahuman M1 analyzes the timing of the food consumed in the night just before you go to sleep, so it can understand what time is optimal for you to eat before going to bed. After calibrating your data, this nudge will provide you with an update by 3 pm local time.
Your last meal time the previous day is taken into account as the last food log for yesterday and the data is only sent to you if the meal takes place after 8 pm. For example, if you ate at 10:30 pm and had varying nocturnal glucose and a lower metabolic score, the app may nudge you to eat at 10 pm for optimal sleep.
9.Log activity/food behind this crash
On days when the app detects a glucose crash, i.e. a fall of glucose below 70 mg/dl or more in 30 minutes and there is no log entered for that crash, you will receive a notification. It is recommended to input the data so that the app can provide you with accurate details as to what food or activity caused the crash.
10.Glucose rise
The app gives you a nudge when the average blood glucose levels rise by 20 mg/dl over the median blood glucose levels. This is an indication for you to add some form of activity to bring down the levels to a sustainable level, and it also suggests that you make tweaks in your existing diet so as to avoid this rising level of glucose.
11.Hyperglycemic event detected!
Whenever the glucose value rises above 120 mg/dL, the app will send a notification along with actionable insight.
Hyperglycemic events– These are events which cause your blood glucose to rise above 120 mg/dl. The app will give you the indication to walk or stretch should such an event arise, since experiencing this state of raised glucose levels is detrimental to your energy levels. and it is recommended for you to take a walk or stretch to bring these levels within the ideal range. Frequent hyperglycemic events may also lead to the occurrence of metabolic diseases.
12.Glucose Readings missed notification!
Notification: Your glucose data has not been received in the last 30 minutes.
If your glucose data has not been received in the last 30 minutes, make sure your glucose sensor is connected to the app. Scan the sensor again in case of a disrupted internet connection.
13.Glucose first data notification!
This is the first nudge you receive when your sensor gets connected to the app. Your cyborg journey will begin soon after.
14.Good / Great / Insane metabolic control today
This nudge provides you with the motivation you need to continue with your routine and will also inform you that you have had minimal glucose spikes and crashes. This allows you to maximize your metabolic score and various metabolic vectors.
There are 3 scores
Good: 80+
Great: 85+
Insane: 90+
15.Good /Great / Insane start the day
This nudge tells you that you have minimal spikes or crashes during the first half of the day, which helps to improve your body’s metabolic response to food throughout the rest of the day.
There are 3 scores
Good: 80+
Great: 85+
Insane: 90+
16.Your first blood glucose spike, what does it mean?
Notification: Foods that spike your blood glucose aren’t necessarily bad for you. It just means you need to understand how to optimize these foods according to your lifestyle. Read more…
This is the first notification you will receive for a glucose spike; which could be due to certain foods or stress.
There are several ways you can avoid glucose spikes. These are
Eat foods with low GI to ensure that your glucose levels do not spike beyond recommended levels, but remember that it important to eat in moderation,
Go for a short walk after every meal to bring down blood glucose levels,
Maintain lower levels of stress,
Ensure that you are doing regular exercise,
Get adequate sleep to ensure a stable response to glucose.
17.Two-day metabolic score improvement streak
This nudge tells you that your metabolic score is improving, way to go! The idea is to work towards a one-week streak and eventually a multiple-week streak.
18.Top Food Zones
Notification: Your last 3 food events had great metabolic responses and resulted in higher zone scores. Way to go!
This nudge is provided when your last three meals have a score which is ≥ 6. You will receive a notification after the third meal is processed.
Food scores are tracked between 0-10, a higher food score indicates that such foods are good for your metabolic health. If the food scores are between 6-8, you need to experiment with foods to produce a better metabolic score.
For example, an omelette with one teaspoon of oil rather than two teaspoons can produce a score of 10. Therefore, it is better to reduce the oil content. Scores below 5 elicit a poor metabolic score and you will either need to change the timing of the food consumed or probably eliminate it from your diet.
Within two hours of eating, you will get an analysis of whether the food is in the top zone or bottom zone.
19.Food zone score performance, weekly
Notification: In the last 7 days you had XYZ Top zone foods. Way to go!
This notification gives you a picture of the week gone by and the number of times your score hit the top food zones and bottom food zones. Top food scores are those ≥ 5 and bottom food scores are those which are 5 ≥. The app teaches you techniques to optimize bottom foods zones ie those foods hampering your metabolic score.
In the end, here are basic tips to optimize bottom foods
Eating your dinner 2-3 hours before bed to ensure you digest your food well and do not see higher glucose levels during sleeping hours,
Walking after a meal to stabilize glucose levels,
Portion size your bottom food zones,
Try following this sequence for meals: fibre > protein > carbs > simple sugars,
Add more low GI complex carbs instead of high GI simple carbs and sugar.
20.Average metabolic score, week over week
Your average weekly metabolic score for the week is a culmination of all the activities that you performed over the week.
The average metabolic score is calculated based on three key parameters
Glucose variability:
Glucose variability can be defined as the consistency in your glucose levels throughout the day. It is important to maintain a low glucose variability, ideally below 12%, to ensure that there is less oxidative stress on your body.
Average glucose:
Another parameter which is measured by the sensor and which we need to optimize is our HbA1c levels, which are also known as glycated haemoglobin. This is a measure of your average blood glucose level over the last two to three months.
Time in target:
The ideal range is 70-100 mg/dl. The goal is for your blood glucose range to stay within the target score for as long as possible to maximize your score, which will further improve your cognitive ability throughout the day.
21.That’s a good spike
Gluconeogenesis events: These spikes occur due to workouts, they are healthy for you and help to improve your metabolic score. It is the process of producing glucose from noncarbohydrate sources such as glycerol, lactate, pyruvate, and glucogenic amino acids.
Gluconeogenesis occurs during intense exercise bouts that can occur due to the breakdown of muscle protein – especially during the absence of carbohydrates. If you are an athlete, you can prevent the loss of muscle protein by fueling correctly and consuming enough carbs can help if you are training for long at a high intensity. Adequate protein intake could help in curbing the loss of muscle mass.
You need to input your activity data in the app without logging in to the food at the same time. It should not be a combined event.
22.Nocturnal hypoglycemia suspected!
Hypoglycemia is a situation where your glucose levels fall below the baseline of the recommended range. This generally happens when your body is under-fueled. Hypoglycemia can occur when you have not eaten for long or after consuming meals high in sugar, where your body ends up producing more insulin than it needs.
Nocturnal hypoglycemia takes place in individuals whose blood sugar drops below 70 mg/dl during sleep.
Various factors can cause blood sugar drops:
Skipping meals,
Working out close to bedtime,
Drinking alcohol before bedtime,
High altitudes, hot and humid weather conditions.
One can try to tweak the first three habits mentioned above to correct the cases of hypoglycemia. If this is taking place often, it is advised to consult with a doctor.
The app identifies this condition by measuring your blood glucose levels and providing you with a nudge for nocturnal hypoglycemia in the morning.
23.Sensor expired!
This nudge is provided when your two-week period with the sensor gets over. You need to remove the sensor and apply a new one to restart your journey.
How to Remove Ultrahuman M1 CGM sensor?
24.Oxidative stress
Oxidative stress occurs when there is an imbalance between free radical activity and antioxidant activity. These free radicals are required to fight off pathogens, which can cause infections in the body
Everyday at 11 am, the oxidative stress levels will be calculated for the previous two days and sent as a nudge.
If average glucose variability ≤ 12%, you will receive a nudge, this means that there is less oxidative stress on your body and you are advised to maintain these levels.
If average glucose variability > 12%, you will receive a nudge, this level of glucose variability can increase the oxidative stress on your body, which eventually translates into poor metabolic health.
25.Become a Cyborg again
The user will receive this nudge once the sensor has expired and the user has not applied his new sensor. One will receive it two days after the sensor has expired.
26.Nice and stable
Maintaining stable glucose levels can help one maintain improved energy levels and cognitive performance throughout the day. The ideal range of glucose levels is 70-100 mg/dl. The goal is to stay within the target score for as long as possible to maximize your score, which will improve your cognitive ability throughout the day.
This notification is provided when you are in the target range between 10 am and 5 pm.
27.Introducing the Metabolic Score
Metabolic score reflects overall metabolic health. It relies on glucose variability, average glucose and time in target metrics and varies from 0-100. The metabolic score is prompted 3.5 hours after the first time the CGM is put on. It is then calculated continuously through the day and gets reset at 12 am every day.
28.Good nocturnal glucose control
Good nocturnal glucose control ensures that your glucose levels are in the target range when you sleep. It is calculated from 12 am to 6 am. Good nocturnal glucose control ensures that you are recovering efficiently and this enhances your performance for the following day.
This is achieved when you sleep regularly on time, eat a nutritious diet and exercise regularly.
29.Milestone unlocked
Notification: You’ve unlocked a new personal best metabolic score of <88> yesterday, beating your previous best score of <85>.
This nudge is provided when you beat your highest metabolic score. The nudge is triggered every day at 9:30 am. Your aim should be to keep improving your score from the last time and ensure that you are maintaining green streaks for the week.
30.Primed for physical activity
Notification: The next 3 hours are primed for physical activity based on your recent fuelling trends. You might see improved workout performance and results for work done during these hours.
Maintaining optimal levels of glucose during your workouts helps to fuel your neuromuscular and cardiovascular systems. Poor fuelling can lead to loss of muscle protein and nutritional deficiencies.
The sensor analyses your fueling data and provides you with three-hour windows based on your optimal fueling time. Try to get in a workout for optimal performance during these three-hour ranges.
Conclusion
Real-time nudges are essential to help you better understand what foods and activities are causing variations in your blood glucose levels. Ultrahuman M1 can help you learn more about these variations by monitoring your body’s responses during various parts of the day. These variations will be different from person to person and it is important for each cyborg to follow their own journey based on their lifestyle. Understanding the variations in glucose levels will also help you feel more energised and focused and will allow you to perform better at your workouts and reduce the risk of contracting metabolic diseases.
Disclaimer: The contents of this article are for general information and educational purposes only. It neither provides any medical advice nor intends to substitute professional medical opinion on the treatment, diagnosis, prevention or alleviation of any disease, disorder or disability. Always consult with your doctor or qualified healthcare professional about your health condition and/or concerns before undertaking a new healthcare regimen including making any dietary or lifestyle changes.
