CGMs are established devices often prescribed by doctors to diabetics so that patients can closely monitor and manage their glucose levels. Their use by healthy individuals has also exploded in recent months as they become more widely available through companies like ZOE.
In addition, the topic of blood sugar management is widely discussed and advocated online by influencers such as Stephen Bartlett and Glucose Goddess.
However, there is growing concern that the daily use of CGMs and the “gamification” of blood glucose monitoring may do more harm than good in those without metabolic conditions.
While nutritionists argue that they risk pathologizing normal blood sugar responses and may create unhealthy eating behaviors, industry experts argue that CGMs may provide a preventative tool against future metabolic conditions.
Normal versus abnormal glucose response
Clemons Cleave, nutritionist and founder of Rocket Nutrition, explained that normal blood sugar levels usually range between 3.9 and 7.8 mmol/L.
“But it’s not unusual to experience higher spikes in glucose from time to time due to factors such as time of day, level of fatigue and type of food consumed,” he noted. “These higher spikes would still be considered normal responses.
“However, if a person is experiencing spikes above 10 mmol/L regularly while eating a fairly balanced diet, it may indicate an abnormal response.”
She emphasized that while lifestyle changes can help even out these spikes, they may be symptomatic of an underlying condition and need further medical investigation.
Andy Franklin Miller, chief medical and innovation officer at Nuritas, emphasized that frequent spikes in excess glucose can cause the systemic inflammation seen in prediabetics and those with metabolic syndrome.
“More evidence is needed in the area of inflammation, long-term health and blood glucose, but there is certainly a significant body of work already highlighting the need for this to be an important area of health care and prevention,” he said.
Personalized nutrition company ZOE also addressed existing research that suggests frequent spikes in blood sugar may be linked to long-term health problems in healthy individuals. The company provides CGM as part of its personalized nutrition program.
In a statement shared with NutraIngredients, ZOE emphasized its efforts to inform customers about the science behind blood sugar levels.
“ZOE members wear a continuous glucose monitor (CGM) for two weeks, which is just one part of its clinically designed program,” it said. “During this time, members receive lessons explaining how high blood sugar is normal and healthy. The CGM, stool sample and blood fat data are then analyzed to generate personalized dietary advice.
“We do not believe that wearing a CGM is necessary in the long term for people without diabetes, but it is useful as one of the indicators to create personalized food results found in the ZOE app.”
Do we really need a CGM?
“People don’t need CGM to be healthy or even know what to eat,” Cleave said. “Over the past few months, people have been fed a narrative that they need to control their glucose spikes as much as possible. There is an element of truth to this: a diet high in refined sugar would cause many glucose spikes and could be harmful to health.”
However, she argued that CGMs were not necessary to inform consumers about the risks associated with excessive sugar intake, and said that such devices may only be necessary for those with gestational diabetes, type 1 or type 2 diabetes.
“You don’t need to micromanage every glucose response from your body,” Cleave added. “One of the main concerns with CGM is its potential to pathologize something normal, causing unnecessary anxiety and dietary restrictions.
“Furthermore, focusing solely on glucose responses can distract us from the bigger picture of a healthy diet.” People may begin to avoid nutritious foods such as fruit or grains for fear of raising their glucose, preferring glucose-stabilizing foods such as processed meats and butter. We certainly don’t want that!”
Claire Baisley, a registered dietitian and regulatory expert, agreed and stressed that the devices could cause additional health problems.
“CGMs run the risk of causing a disturbed relationship with food, where carbohydrates, including fruit, are demonized and people may begin to eliminate healthy foods from their diet entirely because of their short-term effect on blood sugar,” she said.
“They should be used with extreme caution in healthy individuals. Information should be provided to explain that increases in blood sugar are normal and not a cause for concern, and people should be encouraged not to eliminate healthy foods such as fruit and whole grains, but instead to reduce their food intake and beverages with high levels of free or added sugars where applicable.”
Miller agreed that long-term use of monitors should not be recommended, but stressed that glucose-regulating products and devices can offer a natural alternative to medication in the short term and additional support in a world where high-glycemic foods are often are difficult to avoid.
“Also, the amount of education one can get by seeing which carb-heavy foods cause a spike in glucose, which is very much on an individual level, is significant,” he said. “Two weeks with a wearable device can provide significant insight.”