#22

How many hours between the last and the first meal?

#23

I dont have an evidence based answer to this.

#24

From my experience as a physician I can tell you that most patients don’t know how to interpret and more importantly how to use the data to make meaningful changes in therapy. I have used CGM for a little while, mainly out of curiosity and to estimate glycemic loads of the meals I prepared. I made some small adjustments, however that was based on the recommendations of the CGM manager - avoid sugar spikes at certain levels etc. Of course those parameters are not scientifically validated in terms of clinical outcomes. Given the extremely high cost of CGMs and questionable value of actionable data I agree with Stanfield. Remember Stanfield is very well versed in outcome based clinical studies AND has a ton experience with real patients. Setting up studies to created outcomes does not always translate well to real world experience. Studies have exclusion and inclusion criteria, incentives, etc… unlike actual clinical practice. This is why I tend pay more attention to well read up clinicians (like Attia or Stanfield) vs pure researchers.

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#25

You can employ the same eating window, just adjust it so that the first meal is in the morning (say 8 am). The last will be late afternoon (6 pm, if the window is ten hours).

Walter Longo wrote about it. There are many studies, if you search for intermittent fasting and circacian rhythm.

Brad Stanfield himself has a video reviewing one such study. That study is below:

Here we show that eTRF (early TRF) was more effective than mTRF (midday TRF) at improving insulin sensitivity. Furthermore, eTRF, but not mTRF, improved fasting glucose, reduced total body mass and adiposity, ameliorated inflammation, and increased gut microbial diversity.

We performed a randomized controlled trial to compare the effects of eTRF (eating during a period of no more than 8 h between 06:00 and 15:00, and fasting for the rest of the day), mTRF (eating during a period of no more than 8 h between 11:00 and 20:00.

eTRF could be 6 am 2 pm, or 7 am to 3 pm.

The last meal is too early for me. My last meal is at 6:30 pm.

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#26

My last meal is 6 - 6:30 pm and I have coffee at 9 am and breakfast at 10 am. May be my interval is too long?

#27

I used to start at 11 am, even 12 noon, when I forgot to eat. But there is some opinion that skipping breakfast may have cardiovascular effects. Walter Longo may have also opined as much. So I tried having some yogurt (Siggi’s, 5 grams carbs 100 calories) at 8:30 am. But the blood glucose went up a bit. So I went back to 11 am. As a compromise, I take a tablespoon of EVOO (about 100 calories) at 8:30 am There is also the 3 grams (12 calories 4.3 per gram) of glycine with the morning tea. I do not know if that counts as some breakfast. But I subjectively feel better this way.

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#28

Even a cup of black coffee at 8 am elevates my glucose 5-6 points. Because of that I now measure BG before I have coffee, and again 1 hour after breakfast.

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#29

I found it useful
a) To know what is going on
b) To see the changes from one year to another.

I don’t think it is worthwhile continuously wearing a CGM, but I am pleased to have some form of baseline as well. In fact between one year and the other my glucose handling improved (given the same or very similar meals).

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#30

Great, now what does that mean clinically?

#31

What kind of effects?

#32

I think this is a question to me.

I tweeted the charts a while ago.

https://twitter.com/johnhemming4mp/status/1612748480501673985

In essence glucose was peaking at 8mmol/l rather than 10mmol/l. Which I take as improving insulin sensitivity. I think this was a result of improving gene expression (and particularly transcription of mRNA).

#33

shortening of lifespan, more CVD, and association with more diabetes…

:39 to :46

But what is breakfast? How late in the morning would a meal still be considered breakfast? That is what I am searching for now.

Longo also is not an advocate of 16 hours. I currently try for 14 hours (ten hour window), based on the study by the group of Satchin Panda.

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#34

This is exactly what I was talking about in my original post. Great, that you were able to collect data. Now explain and provide evidence of how collection of this data has actually improved your health.

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#35

Firstly I think it is worth actually having baselines to indicate what should be expected. Sadly I don’t have that many.

Secondly, in the broadest sense my collection of data (of which this is part) has improved my functional health in that I function more effectively in terms of things like sleep, cognitive function, fitness etc. Looking at biomarkers things like CRP have moved in the right direction.

I learnt from the CGM that time release melatonin reduced glucose and that alcohol also reduced glucose.

I find HbA1c a bit of a broad brush biomarker. I am much happier being aware of what is going on.

Separately I have looked at the effect of Rapamycin on blood glucose.

What I like to have is data from a number of sources looking roughly at the same systems.

#36

BTW, the most convincing argument for using CGM would be the following:
Large randomized study comparing use of CGM adjusted diet vs low glycemic diet on improving outcomes in morbidity vs mortality IN NON-DIABETICS ran over several years.
CGM adjusted diet resulting in significant reduction in morbidity and mortality over low glycemic diet would be a very strong argument for using CGM. No such study exits and quite frankly I highly doubt that CGM adjusted diet would be any better than just a regular low glycemic diet.

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#37

Because I have been doing things that I am not aware of others doing one of the things I wish to do is to ensure I am not doing myself any harm.

Hence I measure things to track outcomes and where the outcome is “no change” that is a positive data point.

If the CGM was a lot more expensive it may be that I would not think it worth the cost. However, I now have a datapoint from early 2022 and early 2023. I can measure it again some time and see if my insulin sensitivity has improved or deteriorated. HbA1c varies rather a lot (my lowest is 4.18% and it is normally below 5%).

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#38

The only “hack” I do that he discusses in the video is cold plunging. I LOVE it! The main benefits I found are the dopamine kick (very very noticeable to me) and the feeling of reduced inflammation, which could be due to an actual anti-inflammatory effect or a placebo or a bonus feeling from the dopamine. Whatever the mechanism, my general aches and pains seem less when I’m cold plunging. I also think there is some forced mindfulness going on that is beneficial. It’s hard not to be present in the moment when your jumping in cold water.

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#39

Actually A1c would be the most validated measure of improvement in health.
If your A1c went from 7 to 6 due to the dietary intervention based on your CGM readings, that would be a good case study (insuch a weak evidence), but nevertheless a form of evidence of verifiable and validated health improvement.

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#40

I absolutely can’t eat in the morning. I have morning sickness since I was a child. Never had breakfast, fought my mother to have a glass of milk. Lately I usually eat around noon for the fist time. Did not know it might be detrimental to health. Will research it a bit.

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#41

Many of the things we do here are a balance of risk vs reward.

I can certainly understand that on average, given the complexity of clinical practice with a diverse set of patients, there aren’t compelling reasons to justify recommending a CGM for many people or a typical patient.

However, my argument would be that as long as the use of the CGM does not lead to negative outcomes (i.e. using it in a way that somehow leads to behaviors that negatively impact longevity), and is not financially prohibitive, I don’t see the issue with using a CGM, even continuously.

Right now, I am on my fourth CGM sensor and plan to continue for at least the next year. My cost is $0, as it is covered by my insurance, even without a diabetes diagnosis. And while I agree that the upsides have not been huge, I do think that it has provided a benefit for me so far, such as:

  • helping me determine which foods impact my blood glucose,
  • determining how rapamycin and other interventions may or may not affect glucose,
  • determining how my eating window affects glucose during the day and night (e.g. I am currently seeing unusual spikes in glucose during slow wave sleep),
  • and keeping me psychologically motivated to eat well and keep sugar use low.

If there are any potential downsides of using a CGM, other than cost or difficulty in applying the data to actionable steps, I would certainly be interested in considering them.

I do agree that it has not allowed me to lower my long-term average glucose level so far (I thought it might be easier to do with the data). So, if that is a primary metric, then it is not super helpful. Then again, my A1c is typically 4.9-5.0, so I’m not sure how much lower is feasible. But, for me, even just the psychological benefit is worth it.

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