Why I Use A Continuous Glucose Monitor (CGM) To Manage My Multiple Sclerosis
I do not have diabetes or pre-diabetes, but I have used a continuous glucose monitor for months to learn about my metabolic health. I care a lot about my metabolic health because I have secondary progressive multiple sclerosis and have experienced depression, and poor metabolic health worsens autoimmunity and mental illness.
Metabolic health has a big impact on symptoms related to autoimmunity and mental health and can have a significant impact on the aging process. Those with poor metabolic health may experience accelerated aging, early onset cognitive decline, and frailty. And people with MS have higher rates of obesity, high blood pressure, metabolic syndrome, prediabetes, diabetes, anxiety, and depression than the public, diagnoses that further increase the risk of early disability.1,2 The same is true for other autoimmune conditions like inflammatory bowel disease and rheumatoid arthritis.3
Levels helps you see how food affects your health. By leveraging biosensors like continuous glucose monitors (CGM), Levels provides real-time feedback on how diet and lifestyle choices impact your metabolic health.
Join the Levels program today, just use my link: levels.link/DRWAHLS
I am determined to have the best health possible, which is why I pay attention to my metabolic health. I wanted to know that I was metabolically healthy, that my blood sugar was well controlled, and that I had appropriate insulin levels, so I monitored my glucose, ketones, and hemoglobin a1c regularly to be sure all was well. I knew I had very low HDL cholesterol, which was markedly improved after switching from a low-fat vegetarian diet to the Wahls™ diet. But I also knew that my backside was smaller than my belly (indicating an abnormal waist to hip ratio) even though my BMI is in the healthy range. I did not want to develop metabolic syndrome because I knew that was associated with higher risk of heart disease, diabetes, cognitive decline, and early frailty.4-8
Metabolic syndrome is often hidden. People develop insulin resistance without knowing it. Their blood sugars could be normal, and they might have a normal waist to hip ratio, but if their insulin is rising, they are at risk of developing metabolic syndrome as well as diabetes, heart disease, cognitive decline, and early disability.6,7,9,10 Metabolic syndrome includes three of five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high density lipoprotein (HDL). Having metabolic syndrome increases the probability of more aggressive autoimmune disease that is more difficult to stabilize with drug treatment.9,11,12
Millions of people have metabolic syndrome or are at risk of developing metabolic syndrome but do not know it. Millions have already slipped into pre-diabetes or diabetes without awareness. Millions of people with an autoimmune diagnosis, autoantibodies, or autoimmune processes have metabolic syndrome and do not know it. Their blood sugars and hemoglobin a1c levels are normal. They may even have a normal waist to hip ratio, normal liver enzymes, and normal blood pressure. But their blood insulin levels are climbing, which puts them at risk of developing insulin resistance. Once insulin resistance develops, metabolic health declines. In time they will develop more of the five conditions associated with metabolic syndrome (high blood pressure, high blood sugar, high serum triglycerides, low HDL, and abdominal obesity). Strategies for earlier detection of metabolic syndrome include adding elevated serum uric acid and diminished muscle strength.13
Are you at risk of developing insulin resistance? If you have a mental health problem, autoantibodies, autoimmune diagnoses, or have any of the five conditions associated with metabolic syndrome (central obesity, high blood pressure, high triglycerides, high blood sugars, or low HDL cholesterol), I suggest checking your fasting insulin and glucose level and wearing a continuous glucose monitor for a month to understand your metabolism. You will learn a lot!
If you have autoantibodies, excessive inflammation, or autoimmune disease, you are at greater risk of blood sugar problems and metabolic syndrome. You are more likely to have high triglycerides, too much belly fat, and too much fat in the liver. If your belly is bigger than your butt, you likely have too much belly fat. However, even skinny people can have too much belly fat and too much fat in the liver, a condition known as “thin on the outside, fat on the inside.” Insulin resistance accelerates aging and disease processes. This means that people with multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, or other systemic autoimmune disease who have insulin resistance have more pain, more fatigue, more brain fog, more mental health problems, and more rapid decline into severe disability. They are more likely to develop diabetes and/or heart disease as a complicating second or third illness. They are more likely to develop anxiety and/or depression as another complicating illness.
There are 25 million Americans who have an autoimmune disease and another 50 million who have autoantibodies accompanied by pain, fatigue, and/or brain fog. Those with an autoimmune disease or autoantibodies are at twice the risk of developing insulin resistance and metabolic syndrome than those in the general population. Metabolic syndrome has far-reaching impacts on the brain, making the blood-brain barrier more leaky and microglial cells more reactive, which increases the damage to myelin and brain cells, contributing to more aggressive physical and mental decline those with multiple sclerosis, Alzheimer’s, and Parkinson’s disease.14
For years I watched my hemoglobin a1c slowly climb, despite adopting a gluten-free, dairy-free diet that stressed a lot of non-starchy vegetables and eliminated added sugar. I went further, adopting a ketogenic diet and adding intermittent fasting. I monitored my glucose and my ketones regularly. When continuous glucose monitors became available, I got one, and have been wearing it for several months, allowing me to steadily improve my metabolic health and my hemoglobin a1c, which is now below 5.2%, the level that is best for my brain. If hemoglobin a1c is above 5.4%, the risk of Alzheimer’s disease and cognitive decline is increased. The device I use is called FreeStyle Libre, which takes glucose readings and sends them to software called LEVELS. During the day, I take photos of what I eat (or write it down) and record workouts. I track the continuous glucose readings I get from the glucose monitor with the foods I have eaten and my workouts. I see a score for the foods I eat and identify which cause glucose spikes, allowing me to adjust how I structure my meals and workouts to promote stable blood sugar. By linking the FreeStyle Libre device to the LEVELS software, I am able to see my metabolic health much more clearly.
My preference for my patients is to have their hemoglobin a1c at 5.2% or less. I recommend my patients with autoimmune issues, mental health issues, or with any of the five conditions associated with metabolic syndrome (central obesity, high blood pressure, high blood sugar, high triglycerides, or low HDL cholesterol) do continuous glucose monitoring and LEVELS for a month to improve their metabolic health.
Continuous glucose meters are only available with a physician’s prescription. First, you will have a virtual consult with a physician to evaluate your risk for developing metabolic syndrome. Then you will receive two FreeStyle Libre monitors (28 days of monitoring) and a link to download the software that collects glucose readings, foods and beverages you consume, and physical activity. You will also get access to a guided tour of strategies to understand your unique metabolism and how to improve it, step by step. It is an exceptional tool to uncover if you are one of the millions who are at risk and do not know it. And most importantly, if you are at risk of developing insulin resistance (or already have), this is a powerful tool to reverse the damage and improve your metabolic health. I certainly have improved mine. Learn more about LEVELS approach to improving your metabolic health here.
DISCLAIMERS + DISCLOSURES The contents of this interview are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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Tremlett H, Marrie RA. The multiple sclerosis prodrome: Emerging evidence, challenges, and opportunities. Mult Scler. 2021;27(1):6-12.
Yusuf FLA, Ng BC, Wijnands JMA, Kingwell E, Marrie RA, Tremlett H. A systematic review of morbidities suggestive of the multiple sclerosis prodrome. Expert Rev Neurother. 2020;20(8):799-819.
Moulton CD, Norton C, Powell N, Mohamedali Z, Hopkins CWP. Depression in inflammatory bowel disease: risk factor, prodrome or extraintestinal manifestation? Gut. 2020;69(3):609-610.
Eckel N, Meidtner K, Kalle-Uhlmann T, Stefan N, Schulze MB. Metabolically healthy obesity and cardiovascular events: A systematic review and meta-analysis. Eur J Prev Cardiol. 2016;23(9):956-966.
Fitzgerald KC, Salter A, Tyry T, Fox RJ, Cutter G, Marrie RA. Measures of general and abdominal obesity and disability severity in a large population of people with multiple sclerosis. Mult Scler. 2020;26(8):976-986.
Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008;31(9):1898-1904.
Gami AS, Witt BJ, Howard DE, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49(4):403-414.
Lee JS, Auyeung TW, Leung J, Kwok T, Leung PC, Woo J. Physical frailty in older adults is associated with metabolic and atherosclerotic risk factors and cognitive impairment independent of muscle mass. J Nutr Health Aging. 2011;15(10):857-862.
Loganathan A, Kamalaraj N, El-Haddad C, Pile K. Systematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis. Int J Rheum Dis. 2021;24(9):1112-1120.
Ricci G, Pirillo I, Tomassoni D, Sirignano A, Grappasonni I. Metabolic syndrome, hypertension, and nervous system injury: Epidemiological correlates. Clin Exp Hypertens. 2017;39(1):8-16.
Horreau C, Pouplard C, Brenaut E, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol. 2013;27 Suppl 3:12-29.
Pinhas-Hamiel O, Livne M, Harari G, Achiron A. Prevalence of overweight, obesity and metabolic syndrome components in multiple sclerosis patients with significant disability. Eur J Neurol. 2015;22(9):1275-1279.
Gesteiro E, Megia A, Guadalupe-Grau A, Fernandez-Veledo S, Vendrell J, Gonzalez-Gross M. Early identification of metabolic syndrome risk: A review of reviews and proposal for defining pre-metabolic syndrome status. Nutr Metab Cardiovasc Dis. 2021;31(9):2557-2574.
14. Van Dyken P, Lacoste B. Impact of Metabolic Syndrome on Neuroinflammation and the Blood-Brain Barrier. Front Neurosci. 2018;12:930.