The Levels app calculates your metabolic score based on your blood glucose response to a number of variables, most importantly what you eat. Photo courtesy of Levels
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America, Your Diet Is Killing You: Why The Glucose Crisis Will Be Worse Than The Opioid Crisis

I’ve always been fascinated by my body’s data. So when I got the chance to continually monitor my blood sugar with a new app called Levels, I jumped at the opportunity to understand my metabolic health through personalized biometric insights.

Levels is a sleek, comprehensive app that connects with an Abbott FreeStyle Libre continuous glucose monitor (CGM). These monitors—small patches with a tiny enzymes-coated wire that inserts into the skin—are familiar to many people with diabetes. CGMs help people with diabetes manage their blood sugar and keep it within a healthy range.

But these devices, along with the Levels app, are also available by prescription for people who want to monitor their metabolic health. Through behavioral insights and data analysis tools, the app shows me how what I put into my body affects my mood and my health in real-time.

“The two most fundamental levers for our health––diet and exercise––remain shrouded in generalities and unrealistic advice. By harnessing CGMs, wearables, data science, and the latest advances in biology and medicine, Levels provides critical information to help consumers take control of diet and exercise, while making real, fundamental improvements in their health,” said Vijay Pande, PhD and General Partner, a16z. “Preventing metabolic dysfunction is one of the 21st century’s greatest health challenges, and Levels addresses the epidemic head on.”

For me, the results have been game-changing. I studied metabolism in grad school, but it’s only now that I’m seeing the impact it has on my daily life. The Levels app shows me that even supposedly healthy options—like the organic juice drink I used to grab at the gym—send my blood glucose sky-high. Foods I had never suspected of being harmful turned out to be chock-full of sugar. It’s really opened my eyes to what I’m eating.

Death by Sugar and TV

Levels co-founder Casey Means, MD, says that whole foods, such as fresh vegetables, are much better for your metabolic health than ultra-processed meals. Photo courtesy of Casey Means’ Instagram

It may be hard to imagine, but sugar can be considered more deadly than opioids. Sugar has become infamous in the American diet, leading to a severe rise in cases of type 2 diabetes. Opioids kill over 100 people a day. But sugar, which is just as addictive and even more deadly. Type 2 diabetes alone kills at least twice as many Americans as opioid overdoses on any given day.

“My prediction to you is that within five years, we’re going to be talking about metabolic health in the same way that we currently talk about the opioid crisis,” says Sam Corcos, co-founder and CEO of Levels Health.

“Most of our chronic illnesses in the U.S.—obesity, diabetes, heart disease, stroke, even Alzheimer’s—are largely rooted in insulin resistance,” says Dr. Casey Means, co-founder and Chief Medical Officer at Levels. “The thing that most connects them is metabolic dysfunction.”

Means explains that much of this is linked to modern lifestyles. Sugar causes chronic inflammation when eaten in excess—but more than half of what Americans eat is ultra-processed, and that accounts for 90% of added sugar consumption. Americans are also sitting more than they ever have before, including five hours a day of watching TV. “None of what we’re doing is normal,” says Means. “We have this chronic exposure to stress, sleep deprivation, sedentary behavior, and processed food.”

Several studies have pointed out the correlation between obesity and watching TV as you eat. Watching TV as you eat is associated with higher consumption of ultra-processed foods, and furthermore watching food shows on TV has been shown to make people eat more sugary snacks.

Ultra-processed and high in added sugars, TV dinners are a big reason why more than 40% of Americans are obese, and 30 million have type 2 diabetes.

What You Drink is Just as Important as What You Eat

Along with TV dinners, sweet beverages are another major culprit in the glucose crisis. Remember that juice I said I used to drink after the gym? After drinking it, I saw my blood sugar spike to 150 mg/dL in the Levels app—way above the ideal upper limit. So I checked the label. This drink, marketed as a healthy “superjuice”, contained 51 grams of sugar. 49 grams of that sugar were added, apparently from organic agave syrup. Agave syrup is a cousin of high fructose corn syrup, and while it ranks lower than table sugar on the glycemic index, it’s no less unhealthy. The total sugar content of this beverage came to 96% of the FDA’s recommended daily allowance for an adult. In one hit.

Organic agave syrup, no healthier than its cousin high fructose corn syrup, makes up most of this purportedly healthy drink. Photo courtesy of John Cumbers

Now, glucose spiking is normal, and our bodies have a great regulatory system to handle it. But constantly elevated blood glucose is not healthy. It’s why 90 million people in the US are classed as pre-diabetic.

So why do food manufacturers add so much sugar? Sugar has similar effects on the brain as addictive drugs, releasing dopamine and other ‘reward’ molecules that get us hooked on foods and drinks all but guaranteed to give us chronic inflammation.

Many Americans are never far from a soda. Add to that the ultra-processed diet, snacks, and the endless advertisements on TV and online spurring us to eat yet more sugary foods, and it’s no surprise that we have such high national rates of chronic disease.

Learning Healthier Lifestyle Choices

“Reducing the lifestyle-dependent spikes in blood sugar is where the biggest value can be found,” says Josh Clemente, co-founder of Levels. “We studied all the literature that’s available. People who are able to maintain blood sugar control in that 70-110 mg/dL range consistently have the lowest risk of cardiovascular disease, diabetes, dementia—all the comorbidities of metabolic dysfunction.”

It’s important to note, however, that many Americans don’t have the means to alter their diets. Quick TV dinners may be all that’s practical for Americans who work long, exhausting hours at minimum wage. That doesn’t mean it’s healthy to reach for the soda to go with that TV dinner, but tackling America’s sugar addiction requires systemic change.

For me, Levels is like the angel of health on my shoulder alerting me to the sugar-laden devil in the details. Thanks to Levels, I know when my blood sugar stays elevated at levels higher than ideal, and which meals are causing this. For example, I didn’t realize just how sugary durian fruit was. Like my morning smoothie, it spiked my blood glucose right up. Maybe those weren’t so surprising—but my oat milk was. Turns out there’s added sugar in that, too.

What I have noticed, however, is that adding exercise to my routine—even just a short walk before or after a meal—keeps my blood glucose in better check. According to Means, that’s a pretty common theme among users.

“A lot of our customers find that just getting up and walking right after dinner for half an hour is almost like a free pass,” she tells me. “They find a huge, huge benefit to using that as part of their metabolic toolbox for keeping things low and steady.”

Stress: A Surprising Factor For High Blood Sugar

My breakfast smoothie caused a huge spike, but experimenting with some exercise before lunch helped keep my blood glucose within the healthy range of 70-110. Photo courtesy of Levels

Another epiphany from using Levels has been the correlation between high glucose levels and stress, but not in the way you might expect. I started using the app to try to eliminate my post-lunch afternoon sugar crash. I was able to do just that by monitoring my blood glucose levels—but it wasn’t the sugar crash that was causing my stress.

It turns out that whenever I felt tired, the Levels app showed my blood glucose crashing much as it would after consuming alcohol. But whenever I felt stressed about something, to the point where I was trying to push it out of my mind—to run from it, almost—Levels showed my blood sugar spiking really high.

For Levels co-founder David Flinner, this comes as no surprise. In response to stress, our bodies release cortisol. An infamous stress hormone, cortisol increases blood glucose levels to prime our fight or flight response. On the savannah, faced by a lion and ready to run, it’s a perfectly sensible response. Sitting at our desks faced with too many emails, not so much.

“Obviously, what we put into our bodies is a huge driver of our blood glucose levels, but there are so many other variables at play,” Flinner explains. “It’s not only what we eat, it’s when we eat it and how we eat it. Do we have some fat? And then you have the big external levers you can pull on, which are our sleep, stress, and exercise.”

It’s all interrelated. The top source of stress in the US is pressure from our jobs, followed by money and poor health. Fifth is poor nutrition. If we’re eating the wrong food, we’re more likely to be unhealthy; when we’re unhealthy, we spend more money on medical bills; and if we lose sleep worrying about it all, we’re a lot more likely to be stressed.

Should Everyone Monitor Their Glucose?

Personally, I think yes. Understanding how my body responds to stress and certain foods have transformed how I eat.

“We don’t advocate for any one diet, because we do know that we’re all different,” says Flinner, explaining that while certain foods are probably healthier across the board, we all have different genetics. Even our gut microbes play a large role in what foods cause our blood sugar to spike.

“One thing we do want to be very forward about is that it’s totally possible to eat an unhealthy diet that has perfectly good glucose control. And that is not going to be good for you,” adds Clemente.

“The big message that we’re trying to get across is that in modern society, we have a sedentary population with an extremely processed food supply. There is no feedback disrupting those decisions,” he continues. “We’re always loaded: our glycogen supplies are full, our fat stores are full, and we’re never tapping into this energy that we’re carrying around in our bodies. This is the problem plaguing our current society.”

The future is tantalizing. Synthetic biologists have already rewired bacterial enzymes to sense a whole range of nutrients and toxins in a soil or gut environment. Others have developed implantable nanotube biosensors.

Whatever the future of metabolic health holds, by the looks of these new technologies, personalized data tracking could play a major role. The biotech companies tackling these major challenges express the same goal: using the best of our scientific knowledge to bring a healthier future into the here and now.

I’m the founder of SynBioBeta, and some of the companies that I write about are sponsors of the SynBioBeta conference and weekly digest. Thank you to Peter Bickerton for additional research and reporting in this article.

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John Cumbers

John Cumbers

John Cumbers is the founder of SynBioBeta. John is passionate about education and on the use and adoption of biological technologies. He has received multiple awards and grants from NASA and the National Academy of Sciences for his work in the field. John has been involved in multiple startups such as those producing food for space, microbes to extract lunar and martian resources, and hoverboards! John is an active investor through the DCVC SynBioBeta Fund and his synthetic biology syndicate on AngelList.

Peter Bickerton

Peter Bickerton

I am a passionate communicator of science and have worked in public engagement and science comms since completing my PhD at the University of Manchester & the Marine Biological Association in Plymouth.

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