Levels Review

Each day Levels assigns you a Metabolic Score, which "is a rating that helps you better understand the success of your daily lifestyle choices." After wearing the CGM for a few days, I casually thought to myself, "Hrm, it's pretty hard to get a good score -- say in the 80s -- if you eat essentially any carbs at all." Best I can tell -- from my own experience and from watching various testimonals on Levels from others on YouTube -- Levels' Metabolic Score is designed to encourage you not to eat anything that causes an even moderate rise in your blood sugar. This sounds -- at first -- like a very reasonable and admirable point of view. The problem is: Eating food that has any carbs at all causes a moderate rise in your blood sugar. For instance, let's say that I eat the following for breakfast:

Seems like a pretty healthy breakfast, right?

Let's also say that after eating this breakfast -- at say 7:30am -- you don't eat or drink anything until dinner time (not a single calorie), meaning you skip lunch and don't eat again until 5pm that day. You might think that, by 5pm, you'd be able to look down at your Levels Metabolic Score and see a number that would suggest you're making healthy choices that day, right? Nope.

I adopted this exact routine shown above for multiple days, and by 5pm each I'd be lucky to have a score that was 75 -- many days it would be between 70 and 75. Why? Because eating the breakfast shown above has exactly 62.6 total carbs (39.6 net carbs). And that generally causes my blood sugar to rise to about 120, and then slowly fall back down to normal levels.

For context, the International Diabetes Federation's guidelines for managing post-meal glucose levels suggests that nondiabetic people should have a glucose level of no higher than 140 mg/dl after meals, and glucose should return to pre-meal levels within 2-3 hours. So despite eating a meal that precisely falls within these guidelines, Levels scores your day as being between a C and C- -- and keep in mind that, at 5pm, I had yet to even eat my largest meal of the day (dinner).

This brings me to main problem with Levels: it is punishingly strict and opionated. At first I thought that this approach was inspring and likely to be an effective change agent in people's lives. Then, however, I realized that eating essentially anything other than protein and fat gave you less than great Metabolic Score. That is, Levels appears to be very much anti-carb. And their bias against carbs isn't limited to just simple carbs (which are of course harmful and should essentially always be avoided on any diet), but are also against complex, healthy carbs. As a result, to get a good Metabolic Score in Levels you have two choices: (1) Don't eat (I tried this, it works in Levels), or (2) Eat essentialy only protein or fat.

Now don't get me wrong, I'm not anti-keto or anti-LCHF. It's one way to live your life. I myself have adopted a LCHF diet many times in my life -- just this year I lost 26 pounds in about 100 days doing LCHF. But LCHF isn't for everyone, and it's certainly not the only diet that will bring about solid metabolic health.

Take, for example, the Mederterian Diet. Any idea how many carb grams per day this diet suggests? Here's the answer (for a person consuming 2,000 calories per day):

That's right, 238 carb grams per day (again, an important thing to note here is that virtually all of those carbs should be complex, healthy carbs -- the Mederterian Diet certainly doesn't want you eating simple carbs). Why is this interesting? Because if you eat according to the Mederterian Diet, and consume 238 grams of carbs per day, Levels will likely assign you a Metabolic Score in the 60s or possibly 50s, indicating that you are making poor choices with respect to your metabolic health.

But that's just not true, as studies have shown over and over again that the Mederterian Diet is excellent for overall metabolic health. Consider the following (bolded font added by me):

  • In 2011, Diabetes Spectrum (which is a publication of the American Diabetes Association) said: "In a meta-analysis of 17 studies, the Mediterranean-type diet was found to improve fasting glucose and A1C levels for those with type 2 diabetes15. In several studies, the Mediterranean diet lowered fasting glucose levels in those with diabetes more than did low-fat diets16,17,18." [Source]

  • In 2015, a study in Frontiers in Public Health stated: "...there is good evidence that adherence to Mediterranean diet seems to have a protective role on glycemic control as reflected by reduced HbA1c and lower fasting levels in addition to decreased insulin resistance and mortality." [Source]

  • In 2020, a study in Nutrients concluded that, "To sum up, there is consistent evidence regarding the inverse association between the adherence to a Mediterranean diet and incidence of T2D. In addition, some evidence of the association between DASH diet and T2D exists. Furthermore, the Mediterranean diet has been shown to decrease HbA1c levels compared to a control group (such as low-fat diet and low-carbohydrate diet). On the other hand, vegan and low glycemic index diets also improve HbA1c levels." [Source]

So what does all of this mean?

  • Levels has too strong of a point of view on what diet you should adopt. It is clear they have a strong bias towards low carb diets.

  • If you eat even a moderate amount of complex, healthy carbs (between 100 and 150 carb grams), Levels' will grade your metabolic health (via their Metabolic Score feature) as being between a C and C- (on the American grading scale of A to F) -- and that's assuming you eat only two meals a day, spread out by 6-9 hours of fasting in between.

  • If you eat the number of carbs required to adhere to the Mederterian Diet -- which has been proven via many high-quality studies to be correlated with improved or good metabolic health and control -- you'll get a D or an F. Why? Because consuming complex carbs increases your blood sugar. Period. And I'm not talking about giant spikes -- for me and the diet I described above I'm talking about post-prandial glucose levels around 120-125 for about 2 hours.

Now you might be saying, "Who cares? Just ignore the Metabolic Score." And that's a fair statement. But it's also reallllllllly hard to do -- it's hard not to feel really frustrated and even (at least for me) sad that eating super healthy results in a seemingly well-respected medical device telling you, "Meh, your diet kinda sucks."

Where does this leave me? It leaves me wishing that Levels -- who has designed a truly awesome App along with constructing a world-class customer support team -- badly needs to be less opionated and less harsh when it comes to grading you. Should Levels tell you not to eat simple carbs? Absolutley. Should Levels be very upfront if your data suggests that you're eating too often in the day, which is causing your blood sugar level to remain constantly elevated? For sure. Should Levels warn you if your baseline numbers are indicating that you might be pre-diabetic? No doubt. But Levels should not be telling people that consuming between 100-250 grams of complex carbs per day -- across two meals, each spread out by 9+ hours of fasting -- is worthy of a C or C- score. That's just not true, and it can trigger people to either throw up their hands and abandon the data provided by the CGM (which is a mistake) or to incorrectly believe that a LCHF diet is the only way to achieve to solid metabolic health, which is entirely false.

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