From the Editor’s Desk: Hard Health Numbers for the Win (Premium)

In the June 19 edition of From the Editor’s Desk in the Thurrott Premium newsletter, I discussed my desire to get on top of my overall health by being proactive with my doctor with regard to basic health metrics (blood pressure, cholesterol, blood glucose), and my sleep apnea and the CPAP machine I need to use to treat that, with the general goal of losing weight and being generally healthier. Separately, but related, I was also diagnosed with ADHD (attention deficit hyperactivity disorder, albeit without the hyperactivity) and have taken the first steps to address that.

The biggest thing in there, for me, is the blood glucose, which is a measurement of the blood sugar levels in your blood. I’ve had borderline high blood glucose for over 20 years, with the weird caveat that it’s been roughly stable for that entire time as well. But I want this to be normal. And there are two ways you can test for high blood glucose, which indicates whether you have or are on the path to being prediabetic or have full-on Type-2 diabetes: a fasting blood sugar test, which is taken first thing in the morning, and a so-called A1C test, which indicates your blood sugar level over the past 2 to 3 months.

Most people (in the U.S.) get an A1C blood glucose test once per year as part of a routine set of bloodwork, and if things are going well, there’s usually no reason to do more. But if you are worried about this, as I am, or in harm’s way, you can get over-the-counter blood glucose testing kits in which you prick your finger to see where you’re at at any point in time. This is tedious, and it can be painful, but it can help you see what your fasting blood sugar is in the morning, and you can test yourself two hours after meals to see how particular foods impact you. Because everyone is different and we all handle different foods differently, this is crucial.

What I wanted to get was a continuous blood glucose monitor. This is a small disc that you apply to your arm—a needle inserts a filament into you, painlessly—and wear for about two weeks at a time. As its name implies, this device tests your blood glucose continuously, so you don’t just get point-in-time measurements as with the over-the-counter kit. You also get a much better idea of how foods—and sleep and exercise—impact you. For people that want hard data about this aspect of their health, as I do, a continuous blood glucose monitor is ideal: you sync its data to your phone and an associated app whenever you want and it gives you instant feedback plus, over time, an excellent understanding of where you’re at.

The problem, as I noted in that original editorial, is that our healthcare system is broken. And while my doctor loved that I was being proactive about my health, she explained that my insurance company would not pay for this device, which is expensive at about $100 a pop every two weeks. Insurance only pays for these devices when the patient has diabetes. (That is bad for the patient and the insurance company is inarguable: it’s cheaper to prevent a disease than it is to treat it over a lifetime.)

I do not have diabetes. But my A1C was 6.0 (down from 6.3 two years ago) and my fasting blood sugar the day of the test was 110 mg/Dl, both of which indicate my blood glucose levels are high, or what’s called pre-diabetic. But there’s some nuance there, as one’s blood sugar tends to be highest in the morning (the so-called “dawn phenomenon”) and after eating meals, especially if they’re full of carbohydrates and/or processed foods. Anyway, I technically have prediabetes given my A1C and fasting blood sugar results. And so I want to lower both and move into the normal range.

From my research and past experiences, I knew that removing carbohydrates and processed food from my diet would achieve this. And, as good, that it should result in weight loss, too, which is my overreaching aim here: when I went on a Keto diet in 2017—this is a semi-extreme version of a low-carb diet—I lost about 35 pounds over the first four months or so. But that’s the problem: I don’t know exactly how much weight I lost, and I didn’t ever see a direct correlation between the diet and my various health metrics. I wanted this time to be different.

I guess there are a lot of ways to explain this. But when I think back to my 2017 experience and compare it to what I’m doing now, what I see is the difference between soft numbers and hard numbers. And if you follow my write-ups about financial results, especially Microsoft’s, you know what a big deal this is to me.

That is, I did what I did in 2017 rather stupidly in retrospect, by just doing it, and hoping that I’d notice differences in appearance, or in things like tightening my belt a few notches in, and I did. But what I’m doing now is in concert with my doctor, where I’m getting tested and weighed regularly to see what the impact is over time. If all goes well, and there are already early indications that it is and will, then I should see similar results to 2017 but have a lot of data to back up and guide what I’m doing and, as important, I can more explicitly understand what’s happening and adjust as needed.

Let me be more specific.

When I walked out of my doctor’s office in June, I purchased an over-the-counter blood glucose test kit. My plan was to not alter my diet at first and see how the foods I normally eat impact me and then, over time, remove those food that were bad (caused high glucose spikes) and double-down on the foods that were good (had minimal or no spikes). I figured I’d move into what was technically a low-carb diet quickly with the caveat that, this time, I’m doing so more healthily, and so I’d be eating more vegetables, especially those at are high in fiber.

I did this for about two weeks. As expected, certain foods, like bagels (which I don’t normally eat, actually), spiked my blood sugar in egregious fashion (190 mg/Dl!) while all protein/fat meals like eggs and bacon (or any meat) did not. And that some foods that one might consider on the line, like sushi, a combination of very healthy fish and not-so-good rice, were kind of all over the map. Sushi was OK, for example (143 mg/Dl after two hours, or less with less rice), while corn, which is technically high in carbs, was a non-event, most likely because we can’t digest most of it.

I wrote about this relation between the data collected, the changes I made in my diet, and the resulting changes it made in my later results in Actionable Data (Premium) in early July. But the bigger point of that article, perhaps, was how much more profound the results of this feedback loop became when I stopped pricking my now-numb fingers with the kit and just sucked it up and got a continuous glucose monitor. For the latter part of June and all of July, or almost a month, I’ve been testing my blood sugar continuously, and enough time has gone by now that I can see some important and positive trends and results.

I have been eating healthy low-carb meals this whole time and logging them in the app I use for the monitor, called Veri. (This is not an endorsement, I’m sure there are many alternatives.) This app also imports my sleep and exercise data from Fitbit, and it overlays that data with my meals, so you can easily see on a graph which triggers glucose spikes and which does not. What started off as mostly problematic—average blood glucose levels just over 100 mg/Dl with big spikes in the morning and after some meals—has turned into something else entirely. My blood sugar is completely normal now. (Maybe for now, as it’s just as easy to eat poorly and drift in the wrong direction.)

What’s completely normal? It’s an average blood glucose reading under 100 mg/Dl. In late June, my readings for one workweek were 101, 105, 107, 101, and 101 mg/Dl. This past week they were 96, 96, 96, 95, and 89 mg/Dl. Still higher than I’d like, but trending in the right direction.

My morning fasting glucose has undergone a similar transformation. In that same week in late June, my scores were 115, 115, 101, 101, and 128 mg/Dl. But this past week, they were 88, 95, 99, 90, and 92 mg/Dl and I no longer see a big spikey bump on the graph. Instead, there’s no bump at all, or there’s a small bump that I think of as a “rolling hill.”

The app I use also measures my glucose variability and oscillation each day, and the goal with each is to keep them as low as possible as numbers that fluctuate dramatically indicate trouble. Here, again, I’ve seen positive results over time, with the averages moving from a “high” range to being “optimal.”

Another neat way to view this data even more generally is to compare the results from the first monitor I used to the second one, which I switched to after two weeks. The graphs and results from the first one show lots of variability, with yellow (high) peaks of each measurement and some greens (optimal) towards the end of the testing period. The second sensor is all greens (optimal). But the trends are all the same: everything is going down over time, in the right direction.

There is more to this, of course, than this one set of glucose-specific measurements. And while I can’t really weigh myself until I get home—we’ve been in Mexico City since July 6—I know that when I do, I will see some weight loss. I know this because my belt is already tighter and because I look and feel better to myself, and I’m my harshest critic. And I also know things will stabilize over time, especially the weight loss. But more generally, I know that I’m doing the right thing for myself. And unlike in 2017, I have the data to back it up.

I’ll have more data when I get home: we’re meeting again with the doctor in early August to go over the results and some of the other health issues mentioned above. And I’m going to get a complete blood work test every three months instead of every year, for now, to see whether my A1C and other problematic results go down during this transition as well.

So what does all this mean to you?

It means that if you have concerns about your health, you need to act proactively on your own behalf and help your doctor do the right thing for you regardless of what your insurance company wants. It means that you can and should take positive steps to correct whatever problems you have in partnership with your doctor and that you should together find what works for you—again, everyone is different—and then check in more often than usual when needed so you have the hard numbers to prove that you’re doing is working. And adjust as necessary.

What you shouldn’t do is listen to anyone—including me—who says that something explicit—a particular diet, especially—worked for them and so it will obviously work for you too. Obviously, sometimes this is true, but more often than not, different things work for different people. And this is basically my key learning in this area, as I’ve noted in the past: because everyone is different, personalization is the future of health care. But you don’t have to wait for the future, depending on what’s wrong with you, I guess. You can act proactively on your behalf now. And you should.

I only have less than a month of data with the continuous blood glucose monitor and less than 6 weeks overall measuring my blood glucose while adjusting my diet accordingly. I will keep measuring, continue checking in with my doctor, and get new blood work more frequently. And we’ll see where this goes. But I feel pretty good about it. And I hope this inspires some of you to take similar steps to help yourselves too.

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Note: I cannot stress how uncomfortable I am writing about health topics because of the obvious dangers involved. I’m not a doctor, obviously, and I am not qualified to give you health or nutrition advice. So this is a narrative about what I’m doing, which you can judge as you will. The only bits of this that I am comfortable with are being transparent about what I do and the general advice about acting proactively on your own behalf. This isn’t just common sense, it’s crucial when it comes to your health. –Paul