Levels Health Continuous Glucose Monitor — A Complete Review From A Certified Wellness Coach
Table of Contents
Part 1 — What is Levels Health: Hardware & Software
Part 2 — Pro’s, Con’s & Big Takeaways
Part 3 — Levels, Who Is It Good For?
Part 4 — Data Tracking & Wearable Devices
Part 5 —Does Levels Live Up To The Hype
Can the Levels Health continuous glucose monitor improve your metabolism, help you lose weight, and get you strong and lean? Is this tiny device stuck to your arm for a month worth the price and hassle?
This question and many more may be on your mind after reading the WSJ article about Levels Health or seeing this continuous glucose monitor on Fast Company’s World Changing Ideas list.
Watch my “Levels Log” for daily insights using the blood sugar testing program.
Before you jump on the Levels bandwagon, here is my complete no-nonsense review of the Levels Health philosophy, app, and journey through their 28-day metabolic fitness program. In this 5 part series, you will learn whether Levels Health will forever transform the way you eat or become another wearable tech destined for the dumpster.
Part 1: Levels Health Basics — What Do You Get?
For $399, you get 28 days of access to the Levels Health app and a small box that contains two Freestyle LibreLink 14-day blood sugar sensors. (This was true as of April 2021.) These sensors attach painlessness to the back of your arm. You wear the sensor one for two weeks before swapping it out for a new one. Don’t worry, taking it off is also harmless and easy (but you may have a few odd tan lines.)
Levels Health provides a high-quality protective fabric emblazoned with its logo to place over the sensor. This helps keep water out and the sensor on. This is particularly helpful when you’re showering or enjoying outdoor activities.
Beyond this basic hardware, everything else you get with the 28 Day Metabolic Fitness program is contained within the Levels Health App. When I used it in April 2021, the app was still in beta mode. New updates to the user interface were being released all the time, and expect changes to the data display to continue.
How To Check Your Blood Sugar
Once you have the sensor attached to your arm, you need to open the LibreLink app and place your phone next to the sensor. In a second, it pulls the data from your monitor into your phone and gives you a readout of your blood sugar in mg/dl.
Your body attempts to maintain blood glucose levels of about 72 to 108 mg/dL. According to the Level blog, “ Based on the data of healthy individuals wearing CGM, it appears that it is safe and healthy to strive for a fasting glucose between 72–85 mg/dL, a post-meal glucose level 110 mg/dL or lower, and an average glucose of 100 mg/dL or lower.”
While your body can tolerate dips and spikes outside of this range, elevated blood sugar, especially chronically, is associated with a host of cellular dysfunctions. Your pancreas, skeletal muscles, liver, and fat cells are all involved in regulating your blood sugar. When this gets out of whack, it’s a sign of systemic problems usually involving some degree of insulin resistance that can predispose you to diabetes.
One pain point is that using the Levels App to monitor your blood sugar actually requires two apps: Freestyle LibreLink and Levels Health. Once you’ve scanned it with LibreLink, you then need to open the Levels Health app and sync it to pull the data.
While opening two apps is not a big issue, it seems like Levels Health would benefit from designing its own way to capture data right from the sensor. I’m sure I’m not the first one to bring this up, but Levels Health should combine the data capture with the data visualization/education because everyone wants a frictionless experience. It will make a better product.
The Levels Health App
Aside from the hardware, the thing you’re really paying for is the tracking and education built into the Levels Health app. The app allows you to log food and exercise with pictures and notes.
Logging your meals with a picture is a super valuable feature by itself. It forces you to be more aware and honest about what you’re eating (something most of us are not particularly good at). Logging food also allows the app to track how your body responds to specific meal/food combinations, which it later will grade with a score.
After each logged meal, the app starts a 2-hour timer that calculates your rise in blood sugar, how high it peaks, and how long it takes to fall back to baseline. These fluctuations are turned into “Zone Scores” from 1–10 depending on how that meal impacted your blood sugar. These scores are meant to help you track how specific food and exercises impact your metabolic health. They’re nudging you to eat more foods that get a higher score and avoid those that cause unwanted spikes.
This shorthand scoring seems simple, but does it actually work? Can Level Health actually tell you what you should eat?
Does the Levels Health App Work?
If you define “work” by being able to continuously measure your blood sugar and get some simple recommendations, then yes, Level Health delivers with flying colors.
If you are buying the Levels Health metabolic fitness program for some other purpose — weight loss, athletic performance, disease management — then it ultimately depends on how willing you are to experiment with your eating and actually change your habits.
The Levels Health app makes the assumption that if you care enough to track your blood sugar and food, you care enough to do something about it. If you learn that your favorite snack sends your blood sugar through the roof, it may incline you to make a different choice in the future.
At its best, Levels Health allows you to be proactive about what you eat. If you can predict (with reasonable accuracy) how any given meal will impact your blood sugar, you can be more responsible about managing the anticipated highs and lows.
Part 2 — Big Takeaways Using The Levels Glucose Monitor
- Ongoing Movement Matters More Than Exercise: Regular activities like walking or moving around the house can help glucose uptake. Any repetitive contractions of your muscles, especially your lower body, is great for preventing blood sugar spikes. You don’t need to go for a run to get these effects. Moving throughout the day is often better than a single bout of intense exercise followed by prolonged sitting. More frequent walks, especially around meals, can help to regulate your blood sugar. Our bodies were designed to move. Honor their nature.
- Eating Slow and Chewing Makes a Difference: Eating in a hurried or stressed state does your mind and body no good. Slowing down at meals allows your nervous system to shift into a parasympathetic, “rest and digest” state better able to manage incoming sugars. While long meals may be a luxury, there’s something to be said about fighting snacking on the go-culture and relaxing into your dining experience. Chewing your food thoroughly is a recommendation that almost universally helps with digestion.
- The French Paradox: Can Alcohol Help? The French Paradox refers to the finding that, despite consuming a diet high in saturated fat, French people have relatively low levels of coronary heart disease. One hypothesis is that consumption of wine during a meal somehow mitigated the effects of their diet on heart health. While a glass of red wine cannot counterbalance a poor diet, I found that drinking a single glass of wine or beer immediately before a meal actually had favorable effects on my post-meal blood sugar.
- How does this work? Alcohol decreases the liver’s ability to make new glucose (a process called gluconeogenesis). Essentially, booze puts the brakes on your body pumping out new sugars so it can process the ethanol, which can lead to lower circulating blood sugar. If your drink and subsequent food don’t contain a lot of sugar, the alcohol can actually smooth out your post-meal glucose response. Since there are so many factors at play, this is a bit of a gamble. I’m not advocating drinking, as alcohol can lead to liver problems and other illnesses, but it was definitely an intriguing find. There might actually be some good physiological reasons for an apéritif?!?
- Stress & Sleep Are Silent Metabolic Killers: Alright, alright, I’m being a bit dramatic. Your metabolism can’t be “killed,” but a poor night’s sleep or a stressful day can throw your body into a dysfunctional tizzy. Blood sugar regulation is a complex adaptive response involving your central nervous system, liver, pancreas, muscles, and gut. When you are sleep-deprived or stressed-out, communication breaks down by changing your hormone secretion and nerve signaling. Your body becomes less responsive to internal cues and less able to digest and assimilate your meals.
LEVELS HEALTH — PROS
- Great Education: The Levels Health program is just as much an educational program as it is a wearable device. I think everyone can benefit from learning more about their physiology and nutrition. Understanding how blood sugar is measured, how it affects other systems in your body, and why it can be the linchpin that makes or breaks your health should be common knowledge. The app is chock full of great articles and explanations about these topics. They nudge you towards reading and learning something every day (See “Lesson & Education” image below). A lot of these can be found on their comprehensive blog available to the public for free.
- It’s Fun: Personally, I loved guessing what my blood sugar was and then scanning my arm. It felt like a game. Am I dipping? Am I spiking? My wife probably got tired of me asking her what she thought my blood sugar was going to be, but I didn’t.
- Holistic Paradigm: I appreciate that the Levels Health continuous glucose monitor promotes a whole-person, systemic approach to health. It tries to move people beyond the reductionist “good food/bad food” type of thinking by meeting you wherever you are at and saying, “Here’s how your favorite snack is impacting your blood sugar.” They fully acknowledge that everyone is unique and some people are more sensitive than others.
- Curiosity Driven Self-Experimentation: What if I eat breakfast before my coffee? What if I eat all my protein first and then carbs last? What if I eat homemade granola versus a store-purchased product? These are just a few of the many little experiments that I ran to see if they made a difference in my blood sugar. In fact, the app has a “Challenges” section (see image below) that invites you to A/B test your eating habits.
- Data Can Be Eye-Opening: It is certainly surprising when you eat a meal that seems low in sugar and metabolically friendly and then sends your blood sugar sky high (or vice-versa). While these are exceptions, it was helpful to be able to look a little deeper at what might be going on. The more valuable piece was beginning to correlate different blood sugar levels with subjective feelings. I began to notice how my energy levels and mood would dip when my blood sugar got too low. I became quieter and more withdrawn below 80 ng/dl. Conversely, I noticed a bit of a headache when my sugar crept above 120 ng/dl.
- Well Visualized & User Friendly: The app is super user-friendly and beautifully designed. It makes seeing how your blood sugar shifts during the day very straightforward. I wasn’t a huge fan of the Zone Scores, but I did enjoy watching the line graph adjust during the day.
LEVELS HEALTH — CONS
- Invasive & Pervasive: You have a device the size of a dollar coin stuck to your body for a month. While you typically don’t even know it’s there, there were a few times I could feel a little twinge from the sensor if I pulled my arm in a weird way. You might also want to check with your significant other before slapping the large Levels patch on your arm as it’s pretty conspicuous.
- Data Can Be Confusing: There were times when my blood sugar randomly dropped or spiked and I had no idea why. The app even sometimes prompted me to input some food/activity because it noticed a rapid change from baseline. Was this bad data from the continuous glucose monitor? (Note that the Librelink sensor uses subcutaneous, wired enzyme glucose-sensing technology that isn’t always accurate.) Was it my body doing some weird stuff? Who knows! Trying to make sense of every single dip and spike can be difficult, frustrating, and perhaps unproductive.
- Zone Scoring Isn’t Always Reliable: This 2 hour post-meal Zone Score makes sense in theory; however, in real life, the myriad of contextual factors that impact your metabolic response — stress, sleep, changes in your microbiome, etc. — make it difficult to accurately score a meal unless you’re very strict with your eating patterns. There were times I ate basically the same exact thing and got different scores. Why? Your digestion and assimilation change during the day as enzyme production ramps up or down and energy supply and demand shift due to your physical activity. One data point can only tell you so much. The scores can be helpful, but I wouldn’t start tossing out food based upon a single bad score.
- Disordered Eating Hazard: If you have a history of disordered eating or restricting food, the Levels Health app may drive you towards unhealthy behaviors. The app scoring generally favors a low carbohydrate diet with limited amounts of snacking. If you take this to an extreme, it can lead to cutting out certain foods that are actually beneficial. It may also push you into over-exercising to lower your blood sugar after a big meal or restricting food even when you’re hungry because you don’t want your blood sugar to rise. You need to be extremely aware of these pesky disordered eating habits sneaking in under the banner of “metabolic fitness.”
- Oversimplification: If you don’t have a good understanding of physiology and don’t bother to learn about it, you’re likely to fall into oversimplified explanations of the data. For instance, each day, the app gives you a Metabolic Score from 1–100%. If your afternoon snack gets a score of 6, does it mean you should never eat? What if your workout gets a lower score, should you skip it? The zone numbers alone can lead you astray. Never forget that continuous glucose monitoring is one part of many lifestyle choices that impact your metabolism, fitness, and health.
Part 3 — Levels, Who Is It Good For?
- Athletes & Fitness Buffs: If you already pay attention to your diet and exercise, Levels Health can give you new insights to better fuel your body. You can see how particular macro combinations, meal timing, and supplements impact your blood sugar. If you’re looking to manipulate your body composition, Levels Health can give a proxy of insulin release — insulin being one of the most anabolic hormones in the body — allowing you to strategically push nutrients into cells to help build muscle. Conversely, if you are looking to burn fat, keeping your blood sugar and insulin levels low can help you dip into your existing energy reserves. You can also see how exercise/sport impacts your blood sugar regulation. Along with heart rate data, Level can help train for particular metabolic effects and adjust your food intake for optimal recovery.
- Biohackers & Curious Optimizers: If you’re a fan of other biofeedback devices on the market, you’ll probably enjoy using a blood sugar program. The curious mind will love its constantly updating data stream and instant feedback. Although Levels Health doesn’t give you the same feeling of training you get from neurofeedback or breath monitoring wearables, it does essentially turn your entire lifestyle into an opportunity for optimizing blood sugar. You can experiment with things like exercising before/after eating, altering which macronutrients you eat first, or slowing down/speeding up how fast you eat to see how these toggles impact your body.
- Metabolic Syndrome/Pre-Diabetes: According to the CDC, 1–3 American adults have prediabetes (as diagnosed with elevated blood sugar A1c levels > 5.7) Perhaps even more surprising is that 84% of people with prediabetes don’t know they have it! If you suspect you have issues with your metabolic health and/or have been diagnosed with elevated blood sugar, the Levels Health continuous glucose monitor is made for you. The Levels app is a great tool that can teach you to better manage your blood sugar. It gives you the power of food tracking, as well as warnings when your blood sugar is going too high or low.
THEIR CLAIM — MONITORING BLOOD SUGAR ENHANCES METABOLIC FITNESS
Levels Health refers to themselves a “Metabolic Fitness” program that “unlocks your metabolic health” by tracking your blood glucose in real-time, so you can maximize your diet and exercise. As they say, “data is knowledge, and knowledge is power.”
Continuously monitoring your blood sugar can allow you to make better lifestyle choices if you are willing to educate yourself, experiment, and change your dietary patterns. Because you might not immediately feel the impacts of blood sugar fluctuations, you’re likely to take the data as amusing suggestions rather than imperatives to change.
As I say in 7 Signs It’s Time To Eat Like A Grown-Up, intentionally balancing your blood sugar is one facet of a mature, healthy lifestyle. The question is are you really ready for that choice and responsibility?
Not everyone cares or is willing and able to change their lifestyle to put less strain on their blood sugar regulation body. If you’re not diabetic or diagnosed with a specific health issue, measuring blood sugar may seem irrelevant. While there are long-term health consequences of poor blood sugar regulation, it goes to show that awareness itself is not sufficient for behavior change.
The truth is that altering your eating patterns is one of the hardest things for people to — at least consistently. It involves not only changing your tastebuds, but also shifting how you think about food, how you shop for ingredients, how you cook, and how you relate to your body. If you’re not willing to reassess your entrenched values around perceived notions of health, you’re unlikely to move from your long-held behaviors.
Part 4 — Data Tracking, Wearable & The Difficulty Of Starting New Habits
The Levels Health app makes no attempt to hide the complexities of true behavior change. On their blog, they list the four components that they believe lead to sustainable changes in your health decisions:
- Closed-loop systems
- Body-awareness and interoception
- Accountability
- Personal control
I wholeheartedly agree with all of these. While the Levels Health data tracking can help you attribute how you feel to a decision you’ve made, it takes additional support to build accountability and body-awareness that they talk about.
Therefore, if you want to make the most of your Levels Health metabolic fitness program, it helps to work with a health coach. I don’t say this as self-promotion — though the argument is pretty good 🙂 I say this because I don’t want anyone to be fooled into thinking that a continuous blood glucose monitor alone will dramatically change their life.
It takes training to learn why you may feel tired, energized, angry, unmotivated, depressed, or distracted. It takes a lot of mindfulness to be able to notice physical sensations without judging them or making them wrong. Plus, you need time to discuss and unpack these factors together with your other lifestyle choices. Even with the incredibly powerful health data tracking can give you, after the 28 days are over, you still need to confront how your environment and mindset are driving your decisions.
Healthy behaviors don’t exist in a vacuum. Blood sugar monitoring can add a significant piece to your self-awareness toolkit. But how you use that tool and how all pieces fit together requires a broader vision of what truly creates health and wellbeing.
HOW DOES LEVELS HEALTH COMPARE TO OTHER WEARABLE FITNESS TRACKERS
With so many wearable devices on the market, it can be confusing to know what to buy and what to track. Should you get a Whoop band, an Oura ring, or an Apple Watch? Should you measure your sleep, your steps, or your heart rate?
Costs and fashion aside, the answer is probably all of the above. Each metric will give you one important piece of the health and wellness puzzle. No single wearable on the market captures everything.
What makes Levels Health unique is that it is looking at a “closed-loop system,” which is a big step up in sophistication from simply gathering data on your steps or heart rate. With these other metrics, the input/output relationship is very clear. If you walk more, your activity bar will go up. If you start moving faster, your heart rate will increase. There’s not a whole lot of surprises.
But with your blood sugar, there is not a direct relationship between input and output. There are feedback loops that regulate how what comes in (i.e. the food you eat.) affects what goes out (i.e. your blood sugar). With Levels Health continuous glucose monitoring technology, you’re looking at your body’s ability to self-regulate — how well does your body keep your blood sugar within a favorable range. This is a much more complex, and, in my opinion, far more interesting inquiry than how many steps you took.
I’m not saying you shouldn’t track your steps or sleep, but doing so really only tells you about baselines and compliance:
- Did you take your walk today?
- Did you elevate your heart rate?
- Did you get a full night’s sleep?
If you’re below your goal, maybe it’s time to get moving (assuming your goal is actually appropriate for your body today). Tracking these data points can be helpful motivators to do what you know you should do. But Levels Health helps you discover if what you’re already doing is actually helpful or not.
Part 5 — Does Levels Live Up To The Hype
After 28 days, what did I learn from this Levels Program?
According to the app, my metabolic fitness improved by 18% over the month. As you can see by the image below, in my last week using Levels Health, I was getting much better scores. These scores are primarily looking at your median blood sugar and its variability — two markers that have been correlated with good metabolic health.
After 28 days of tracking and self-experimentation, my average blood glucose levels went down 12%. Although this is not a huge change, such an improvement seemed significant since I was already eating a low sugar diet (see image below).
Having fewer high glucose events over the course of the week is beneficial for your metabolic health. The Levels Health app allows you to track this and educate yourself about what these blood sugar numbers mean. It gives you plenty of opportunities for improvement, but it’s up to you to decide what to do with that information.
If anything, the Levels Health program left me with more questions than answers about what is metabolically healthy. I was intrigued by the way factors like sleep quality, stress levels, and microbiome health impact my ability to metabolize what I ate. But the app is not sophisticated or granular enough to tease the factors apart.
For example, did those cookies spike your blood sugar because they contained a lot of simple carbohydrates? Or did they spike your blood sugar because you didn’t sleep well last night, had a fight with your partner, and ate them too fast?
This is a mystery that the Levels Health app cannot answer by itself. To be fair, it never claimed it could.
LEVELS HEALTH GETS YOU TO SEE WHAT YOU NEVER SAW BEFORE
I enjoyed how the Levels Health program allowed me to see what is otherwise invisible — a glimpse into my metabolic health that I never had before. With the right mindset, the app empowered me to become a better caretaker of my body. It enabled me to partner with my biology rather than fight against it. I no longer needed to make decisions about food and exercise based solely upon hunches and assumptions. I had actual data to work with.
The challenge is learning how to not get overly attached to the numbers. It takes a well-balanced mind to use the numbers in wise and constructive ways. Levels Health can move you towards asking what is possible here now that I have new data. Alternatively, it can pigeonhole you into more rigid thinking about your diet or exercise. If you’re willing to let go of the need to be right and actually learn from what it’s telling you, Levels may indeed upgrade your metabolic health.
EPILOGUE: THE FUTURE OF WEARABLE DEVICES?
In the not too distant future, we will have minimally invasive devices that can capture more about our bodies than we could ever perceive.
A more complete picture of what’s going on inside of us can certainly be beneficial.
However, if we become dependent on devices to tell us how we’re feeling because we’re too disconnected to figure it out ourselves, we’re on the road to becoming disembodied cyborgs, using tech to diminish our humanity rather than enhance it.
Any data gathered from a wearable device will be crushed by an algorithm that is likely to be based on reductionist models of physiology. It certainly could measure your metabolic health, but that doesn’t capture all the mental, emotional, and spiritual facets of your wellbeing. Metabolic data will always be a partial picture of what is true regarding your quality of life.
DOES THAT MAKE DEVICES LIKE LEVELS HEALTH WORTHLESS?
No, far from it. Data only becomes dangerous when it is used to control or dominate your body. I’m not saying the Levels Health blood sugar monitor shouldn’t be used to help you maintain good blood sugar levels. I’m advocating awareness of becoming overly dependent or attached to this data.
As I say in the article Stepping Out of Fitness Reductionism, data from wearables should never dictate your behavior. They should be used in service of your wisdom, not a surrogate for it.
The objective eye of science can only take us so far into the depth of our humanity. Data can create knowledge. But knowledge that is embedded in a reductionist view of your body as a machine overlooks so much of what it means to be alive.
Until we have a way to integrate scientific knowledge from your wearable device into a whole-person approach to health, we will forever be limited. I’m not advocating less tech or data. I’m advocating more heart to guide the use of that data.
To leveling up your mind-body,
~ Jeff Siegel
Originally published at https://jeffsiegelwellness.com on May 18, 2021.
