Transmutable Explorations

Category: Reviews

  • Taking My Metabolic Fitness to new ‘Levels’

    Taking My Metabolic Fitness to new ‘Levels’

    My Levels Health Review

    I’m constantly doing more research into how to increase my overall healthspan.  It’s becoming increasingly clear, that ‘metabolic flexibility‘ is key. While many of the great diseases of the western world have genetic components, research is showing that genetic predisposition is greatly enhanced by poor metabolic fitness. I started practicing time restricted feeding and experimenting with supplements in an attempt to optimize my personal metabolic flexibility. Unfortunately, short of tracking time spent fasting and using a ketone based breath analyzer, there wasn’t really a great way to easily measure how well I was doing…. until I was invited to participate in the Levels beta program.  Here’s my Levels Health Review.

    What is Levels?

    The Levels program consists of two main parts: a continuous glucose monitor (CGM), and the Levels software. They also maintain an extensive blog with lots of great information.

    The CGM is a wearable that you painlessly attach to your upper arm. It inserts a filament into the fluid beneath the skin.  Here it will monitor your blood glucose levels for 14 days before you replace it with another unit. Levels uses the Abbott FreeStyle Libre system . You read data from the device using the Abbott supplied mobile app. This is done using the near–field communication (NFC) capabilities of your mobile phone. Just hold your device over the CGM several times a day and your data is synced with the app. You need to allow Levels access to this data in order to really reap the benefits of this program and use Levels’ software.

    The Levels software pulls the raw data that is collected by the Abbott app.  It then presents it in a much nicer format. It also integrates with other fitness apps/wearables. This allows you to see your data on a timeline that incorporates all of the things that you do. The Levels software killer feature though is the Zone comparison capability that allows you to conduct your own experiments. The ability to compare Zones is the basis for a beta feature that allows you to participate in ‘challenges’ by changing a single variable in the Zone.

    Does it work?

    Like most wearables, the value in Levels isn’t really in monitoring absolute values of your data points.  It’s in comparing the relative values specific to you over time. After installing a new CGM, the relative values were accurate for the 2 week lifetime of the device after a few hour adaptation period. At this point, you could consistently see what foods/activities radically raise and lower you blood glucose.

    Monitoring your relative values isn’t really necessary though as Levels makes this easy with the concept of a Metabolic Score. This is your rating for how well you did each day. This is where the real joy of using Levels starts to set in. I found myself constantly experimenting with items from my usual routine to find out what improved the Metabolic Score and what made it worse.

    Initially, I started looking for validation for the things that I was already doing with the expectation of improving my metabolic flexibility. I pretty much got universal confirmation on all of these practices. At least for me, they work at minimizing long blood glucose spikes. Some of these things include: using cinnamon and/or apple cider vinegar or doing some resistance training before meals, taking walks after meals, eating protein before carbs during meals.

    Levels Health Review Surprises!

    While reinforcing my already existing practices, I actually noticed some surprising things that I would have never been aware prior to wearing a CGM (and monitoring my results like a maniac!).

    Sauna

    The first big surprise that I came across was how the sauna impacted my blood glucose levels. For me, some of the biggest and longest lived spikes in blood glucose came while using or immediately after using the sauna. This is something that I haven’t had a chance to really start experimenting with, but is on my to do list for the future.

    Alcohol

    I was also surprised by how alcohol impacted my readings. I expected alcohol consumption to spike my blood glucose.  Surprisingly, most alcohols actually ended up doing the opposite (Notable exception are all of those trendy lactose containing ‘beers’). Levels has a great blog post on what exactly is happening here. After noticing this and then finding and reading that blog post, I’m now super careful about drinking immediately after fasting or while in ketosis and have found that having a drink before eating my largest meal of the day actually has a beneficial impact on my blood glucose levels.

    Discoveries When Correlating Data

    The most impactful thing that I’ve learned so far occurred by making correlations between the data obtained from Levels and the data from my Oura ring. As many regular readers know, I’m always trying to optimize my sleep. I was becoming convinced that nothing I did would resolve my ‘way more frequent than I would like’ nighttime restlessness and wakeups. Honestly, Levels wasn’t helping this because the CGM can only hold 8 hours of data without syncing it, so I found myself waking up earlier than I would want, concerned about syncing my data.

    This obsession about not losing data ultimately paid off when I mapped my Oura ring data, showing wake ups, with my data from Levels. I noticed that just about every major wakeup correlated with a bout of nocturnal hypoglycemia! I could write a whole post on how I went about diagnosing the cause of this issue, but it ultimately came down to me taking the wrong supplements before bed. These supplements, coupled with my time restricted feeding (and especially alcohol), would lead to a dramatic drop in blood glucose mid-night. I switched to taking the offending supplements at a different time of day. This prevented the blood glucose drop and my sleep has improved dramatically!

    Is Levels ‘worth it’?

    Using Levels on an every day basis ends up being a pricy endeavor. You need to purchase a new CGM every 2 weeks and deal with the social implications of wearing a device on your upper arm and scanning it constantly with your cell phone. Identifying the issue that was impacting my sleep (discussed above), made the time I spent testing Levels well worth it. I’ve also thought of several new experiments that I’d like to run, but I haven’t yet purchased additional CGMs. In addition to the cost, I have a few other items that have held me back from continuing using it.

    Software Issues

    One of my biggest issues was with the Levels software. I found that it was near impossible for me to use the challenges feature with the software hooked up to Google Fit. The ‘challenges’ require pretty much a 4 hour period where nothing is occurring outside of the actual ‘challenge’ experiment that you are testing. Something as simple as walking for a few steps that shows up as a workout during this time frame will make it impossible to use the feature. A suggestion that I would have is to allow some leniency here. Allow me to identify sections of the timeline where I know that the only difference is the variable that I am testing.

    Additionally, I would love the ability for Levels to push data into Google Fit rather than only consume data from it. This capability would have made analyzing things like my sleeping issue with my Oura data much easier.

    Social Issues

    Secondly, making it known that you’re a non-diabetic using a CGM results in an unbelievable amount of hate on social media.  Even in real life, you’ll receive hate from people who believe that you are responsible for all the ills of the public health system in the US. I haven’t seen any unbiased data that either support or disprove this claim.  Because of this, I can only offer my own opinion on this subject. I’m happy to share my opinion with anyone who wants to engage in a rational conversation about it. I’m glad to be shown evidence that convinces me otherwise, but I’m not interested in name calling and false accusations. I have some ideas on how this issue can be addressed.  I’m sure that Levels has thought about this as well.  This is likely thwarted by the arcane system we have in place for ‘approval’ of medical devices.

    Device Issues

    Finally, I’m really waiting for a better device.  Some combination of making a ‘CGM’ that doesn’t require me to sync religiously every 8 hours, is less obtrusive, and/or measures additional biomarkers beyond blood glucose will make me pay the current price in a heartbeat!

    Correcting Metabolic Issues

    Even with these drawbacks, I will continue to use Levels a few times a year. I’m interested in seeing how things progress both with their software and with my own Metabolic Fitness.  The adjustments to my habits that I’ve been able to make from being a Levels user have been EXTREMELY valuable. 

    Full Disclosure: I am an investor in Levels.  The software has evolved since this original post and I will be updating my Levels Health Review soon.

  • Oura ring review

    my oura ring

    I’m fanatical about tech gadgets, but even more so for wearables and things that reliably fulfill my needs as a “Quantified Selfer“. Good quality sleep data has always been elusive. Many devices that I’ve tried were so intrusive as to ruin any chance of actually getting good sleep. Others just did a terrible job of reliably collecting the data that I wanted. I backed a Kickstarter for the Hello Sense. This was one of the first devices that really generated useful data. Not only did it track my sleep activity, but the base unit also collected data about my bedroom light levels and air quality. Sadly, the company went bust and the device ultimately became unusable after the cloud servers were shut down.

    Multiple Generations of Oura

    While looking for a replacement for my sleep tracking fix, another Kickstarter project caught my eye… the Oura ring.   I initially held off on backing the project since I’ve been burned by so many crowd funded tech gadgets in the past.  Despite this, I kept a close eye on its progress and saw many great reviews on the original ring from people I trusted. When Oura announced a gen 2, I jumped right in to purchase one as soon as I could.

    I used the Oura gen 2 for years and immediately purchased a gen 3 when it was released.  Many people panned the gen3 initially because it required a subscription in addition to the cost of the ring.  Fortunately, as a long time backer, I was given a lifetime subscription.  Both the gen2 and gen3 have experienced pretty much everything I can throw at it…. I am a HUGE fan of this thing! There isn’t much that I can complain about and I feel that it is worth every penny.

    The Oura Ecosystem

    The Oura ring system consists of the ring, a mobile app, and the Oura Cloud.

    Oura Cloud

    Oura Cloud is a web based equivalent of the mobile app which allows you to dig a bit deeper into the data.  It also includes an API that you can use to write apps for the Oura Cloud or pull the data collected by your ring into other systems.  You can also participate in crowdfunded research projects through apps that are written for the Oura Cloud.  I’ve participated in a few of these.  The most notable was in using the Oura ring as a COVID early detection device.  Ultimately, this lead to the ring being used in the NBA and UFC for this purpose.

    Oura Hardware

    The ring looks like… a ring… much more so than the first generation.  It doesn’t make you the focus of a room like wearing Google Glass did.  This is a pretty amazing feat considering all of the sensors that it packs and the fact that you can go days without needing to charge the battery. It’s waterproof and fairly resilient… I’ve definitely pushed mine to some limits that I probably shouldn’t have and it’s survived. 

    Oura Mobile App

    The ring connects to the app on your phone via Bluetooth.  You can put it into airplane mode and still have it collect data for quite some time before needing to sync it.  The Oura App displays a timeline of your data summarized by day.  The Oura app is divided into four sections: Readiness, Sleep, Activity and a Dashboard that surfaces your ‘scores’ from the other three.  You can then drill down into each section for more details.  There is also an ‘Explore’ section that contains meditations, breathwork and sleep exercises as well as additional learning material.

    Sleep Tracking

    The sleep tracking of the device is rock solid. I’ve done tons of things to wreak havoc with my sleep in order to test the ring’s ability to detect it. Every morning after destroying my sleep in the name of science, I’d check the app. It would basically tell me, “Dude, go back to bed, you need it”. There really was no fooling its sleep detection.  This has continued to improve with the third generation device and they are now beta testing a new sleep algorithm that seems to improve things even more.

    I bought the Oura Ring mainly to track sleep time and sleep quality (as measured by the amount of time spent in the different stages of sleep), but the ring is so much more than ‘just’ a sleep tracker. The Sleep section tracks a few additional items above and beyond what I bought the ring for. These include a resting heart rate trend and sleep latency.  The latest version of the hardware also includes breathing regularity (blood oxygen sensing).  After using the ring for a bit, a ‘body clock’ which displays your personalized sleep chronotype is generated.  You can use this to better align your circadian rhythms.


    Activity Tracking

    The Oura Ring is also an activity tracker. I’ve been wearing various activity trackers since the first versions were commercially available. I’ve never really been a fan of wearing anything around my wrist since they always seem to get in the way, but I’ve always overlooked that in order to get the activity data. The Oura app has recommendations for how much activity you should be getting (this changes daily based on your ‘Readiness’ which I’ll discuss later). It also tracks your progress toward your daily goal and the intensity of the activity that you do. You can also turn on notifications in the app to remind you to get up and move on a regular basis.

    For activity that gets your heart pumping, the ring does a pretty good job of tracking. I’ve noticed that it doesn’t always do the best job of tracking activity that is less vigorous. The app has the ability to manually input this type of activity.  Additionally, the Android app has Google Fit/Health Connect integration.  Most of the activity I want to track tends to get picked up by the ring, but there are certain activities (i.e. impact martial arts) where I remove the ring and need to manually track the activity. I like the fact that I can get near real time feedback about my activity intensity. This has allowed me to develop a routine that I can do frequently throughout the day that gets me into a high intensity level of activity very quickly (this is a must for any practitioner of High Intensity Interval Training).

    Readiness

    The ‘Readiness’ section of the app really pulls together information from the other two sections to give you a general idea of how much you should push yourself on any given day. It takes into account how well you’ve been sleeping and how active you’ve been and combines that with trends regarding your HRV, body temperature and respiratory rate in order to provide a suggestion for ‘pushing your activity to new levels’ or just ‘taking it easy’ on any given day. I’ve found this to be great for me to figure out when are the best times during the day for me to workout and also what supplements seem to help me recover faster. It’s also pretty effective at giving me a heads up when I might be coming down with something and gives me an extra verification point to rest instead of pushing through it.

    Expl-Oura

    The ‘Explore’ section of the app contains several guided meditations and breathwork routines that are categorized by goal.  You can also configure ‘unguided’ sessions.  This is useful if you use other meditation apps like I do.  In either case, the Oura ring tracks your HRV, Heart rate and skin temperature during your session.  There is also a ‘Learn’ section containing videos and slideshows containing information on how to use the many features and improve your scores.

    One of the most valuable features for me is the ability to add ‘tags’ throughout the day regarding things that I do with the aim of improving my scores.  You can then filter based on these in order to see the impact of these practices on your scores over time.  I would LOVE to see alignment between the Oura tags and similar functionality in Google Fit in the future.

    Conclusion

    So there you have it… my Oura ring review. It’s an awesome piece of hardware. Besides the fact that Android functionality often lags behind iOS, my only other real complaint is that I wish it came in half sizes… that would make it even less obtrusive than it already is! If anyone is interested in getting an Oura ring, let me know, I have a few discount codes that I can provide.