In this solo, narrated YouTube video, Nick Norwitz examines the recent FDA decision to allow over‑the‑counter sales of continuous glucose monitors (CGMs) for non‑diabetics. He first states his overarching goal: to give a balanced, nuanced overview of the controversy while clearly articulating his own pro‑CGM stance and then to excite viewers about the next wave of bio‑tracking technologies. Norwitz outlines one primary benefit—CGMs provide real‑time biofeedback that can catalyze metabolic behavior change when used by the right people—followed by three common criticisms: (1) focusing on a single biomarker (glucose) may give an incomplete metabolic picture and lead to maladaptive choices; (2) CGM use could worsen eating disorders such as anorexia or orthorexia; (3) there is a lack of long‑term randomized controlled trial (RCT) evidence showing health outcomes for non‑diabetics. For each criticism he offers a rebuttal centered on education, user‑tool matching, and harm‑reduction rather than restricting access, using analogies to hammers and bathroom scales. He discloses a sponsorship with Levels, linking his personal mission to empower metabolic health and noting his ongoing second doctoral degree. Finally, Norwitz looks ahead, describing CGMs as an “appetizer” to a broader future of at‑home multi‑omics platforms (e.g., high‑frequency longitudinal profiling from the Snyder Lab) that will enable n=1, patient‑empowered medicine. He concludes that the benefits of open CGM access outweigh the potential harms, provided education replaces patronization as the primary safeguard.
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Just months ago, the FDA cleared continuous glucose monitors for over-the-counter sale to the general public—non-diabetics—and it stirred quite the controversy. I had the pleasure of being interviewed for a BBC article on the topic, on the controversy, and wanted to take a moment now to render some further thoughts that didn't get fully communicated in the article, including arguments for and against continuous glucose monitor use for non-diabetics, and then comment on the exciting future of bio-tracking, biohacking, and citizen scientist empowerment. My goal in this video will be give you a balanced and nuanced overview of the controversy with respect to CGM use in the general public while stating clearly my opinion, and then get you pumped about what's coming beyond CGMs. So stick around till the end because I have a special treat for you, just exciting enough to maybe spike your blood sugar. Let's go! Welcome to my channel, stay curious. Now I want to run through the number one pro as well as three cons or counterarguments with respect to CGM use in the general public and then respond to those counterarguments. So the number one pro, in my opinion, really the key reason I'm for CGMs, is that CGMs can provide powerful biofeedback that inspires behavior change when used in the right people. Information is power. When you have your own data in hand and you're constantly engaging with it as part of your daily routine, you can very quickly gain insights that you wouldn't otherwise have into how your own body works, how environmental inputs, including but not exclusively food, impact your metabolism by looking through the lens of your continuous glucose curve. Granted, it's just one element of your metabolism, but it is a bellwether for what's going on in your body metabolically. And then you can use those insights, internalize them, and manifest them into behavior change. And I think that's incredibly powerful. In effect, it's citizen scientist empowerment, and it's a tool to offer people to help fan the fire of preexisting curiosity in metabolic health. Now moving on to the cons, or counterpoints, as well as my responses to them. The first is that by focusing on just one biomarker, glucose, you don't get a full picture of metabolism, and that this could lead to maladaptive behavior change. This is a fair counterpoint to an extent, but I think it's been treated with quite a bit of hyperbole. As one extreme example, some healthcare workers have argued that patients might not exercise. Because they're wearing CGMs and exercise can spike your blood sugar, and that could be scary to patients. I think this is a little bit of a hyperbolic example. You can decide for yourself. Maybe on the more realistic side, or slightly more realistic side of the spectrum, some people are worried that patients or members of the general public might be dissuaded from, say, eating blueberries because blueberries have some sugar that could spike your blood sugar relative to, say, butter or bacon. And they're afraid that people will opt for eating fewer blueberries and more butter and bacon. And even if for the sake of argument, we agree that that were bad, I think this is a limited argument. Here's my take. These aren't problems with the tool, but with user education. And that's what we should address. This is true for almost any tool. Any tool can be misused, and we should absolutely take efforts to reduce misuse. But that doesn't mean the tool is a net negative, nor should we restrict access in general if others could benefit. So by analogy, we don't restrict access to hammers just because some people might have a— well, have poor aim and miss and have a propensity to hit their finger rather than hit the nail. That's tool misuse, and it's unfortunate. But the solution isn't to restrict hammer use, but rather to try to ensure that the right people use the tool and become proficient in its use. As far as CGMs are concerned, providing harm reduction education I think is a great thing and should be part of the rollout of CGMs to the general public. One simply needs to educate people on what normal healthy glycemic variations are with respect to things like the cortisol awakening response, responses to exercise, different types of exercise, and what to expect when you eat fruit or, God forbid, have ice cream with your daughter. So in my opinion, it's about education with respect to tools use rather than restricting access to the tool. The second con or counterpoint is that CGM use could exacerbate eating disorders like anorexia nervosa or orthorexia. Again, I think this is a legitimate concern to some extent and we should have an open discussion about it. But again, I think it's a matter of matching the tool to the appropriate user. So by analogy, daily weighing on a bathroom scale can be an unhealthy behavior for someone with anorexia nervosa. And yet we tend to agree it's appropriate to give the general public access to bathroom scales while acknowledging some people can misuse the tool. And on orthorexia, which is an unhealthy, obsessive focus on healthy eating, I have some complex feelings because while I think some people can genuinely become overfocused and obsessive with respect to healthy eating choices, I think the term orthorexia right now tends to get abused and is often applied to people who are simply enthusiastic about metabolic health and healthy living and get labeled as obsessive or orthorexics because social norms are now so skewed to eating complete junk. So while I do think it's possible that a small percent of people might have exacerbations of genuine orthorexia, anorexia with CGMs, I think it's more likely that we're just going to see enhanced enthusiasm for engaging in metabolic health, and I don't see that as a bad thing. So my response to this critique regarding eating disorders is similar. Yes, it's a legitimate concern, but the potential for tool misuse does not necessitate restriction of the tool. It just means we need to find ways to better match the tool to responsible users who could actually benefit.
And now, before I get on to the final counterargument, I want to bring you a brief sponsor message, but I promise this will be authentic and I'll provide you an Easter egg in the process if you stick around. If you followed me, you know I'm passionate about making metabolic health mainstream. It's my passion, it's my career and life purpose. It's about empowering every single person with the knowledge and data to have control of their own metabolic health journey. This empowerment is the reason I'm standing here with you right now, talking to you, finishing up my second doctoral degree in a fulfilled relationship with happiness and optimism in my heart for the future. Metabolic health is the foundation of a fulfilled life. I truly believe that, and there is little more empowering than having access to your own data, which is why I'm a proud partner of Levels. Their platform gives you access to your own data, real-time biofeedback via a continuous glucose monitor, and you can couple that with the learnings you get on my channel and elsewhere to really take control of your health. Take knowledge, take your own data, combine them, and empower yourself to take control of your metabolic health journeys. Check out my link for special offers that Levels will be providing and stick around on this channel, learn more. Oh, and the Easter egg— well, it's not actually an Easter egg, it's technically it's really an ostrich egg, and it's carved with the Big Five from South Africa because I'm South African and I think it's really cool, and it's a special memento I have from my last trip to South Africa.
Sorry, not an Easter egg, an ostrich egg. The third con or counterpoint is that there aren't data that CGMs actually provide benefit for non-diabetics. And this is true, but my response is pretty simple: absence of evidence isn't evidence of absence. So to unpack that a little bit, what I mean is that just because we don't have top-tier level data in the form of long-term human RCTs in healthy people for outcome level data, like reduced incidence of new onset diabetes, decreased major adverse cardiovascular events, etc., doesn't mean CGMs can't provide some benefits. In fact, I think it's important to acknowledge that the sort of data people tend to talk about, like the RCTs, aren't really that relevant in this case, because the purpose, as I see it, of over-the-counter CGM access is to provide self-selecting potential users who are already interested and inspired to engage in their metabolic health an additional optional tool versus forcing someone and randomizing them, randomizing your average person to CGM use. Those are two very different scenarios. Furthermore, while there aren't data showing that there are outcome benefits for non-diabetics, largely because there hasn't been investment in generating those sorts of data, there also aren't data saying that this tool has any harm. If you have a tool that could help provide biofeedback to people combined with thousands of attestations from non-diabetics who have used CGMs and found them valuable, and there's no clear evidence of harm for the intervention, an intervention that's simply providing people with their own data, it's not a pharmaceutical, then I say you don't need an RCT to justify over-the-counter access. It's just a tool. But now moving on to the future, or a hint at it, because here's the deal. CGMs, they're just an appetizer, or barely that. Their main limitation, as stated previously, is that they only provide one metric, glucose, and fails to give a more comprehensive picture of an individual's metabolism. But that's going to change with a whole new era of bio-tracking innovations, and it's going to change soon. There are already companies looking to empower patients with at-home tools and kits to provide them with hundreds of biomarkers, some continuously tracked, and then couple those with general public education and data interpretation to usher in a whole new era of n=1 patient-empowered medicine. And there are also groups like the Snyder Lab at Stanford— I love this lab— doing pioneering work in longitudinal high-frequency multiomics, which means integrating information from across OMS, the genome, the microbiome, the proteome, the metabolome, the transcriptome, all the OMS, taking them at multiple time points and accumulating them into big datasets for individuals and then leveraging those to develop physiology-focused and personalized healthcare information to prevent disease and facilitate metabolic health optimization. Let's just conclude on CGMs. CGMs are a tool, one that I think can be used productively or misused, but I am personally for their over-the-counter access. Because I think the potential benefits outweigh the harms and that citizen scientists should not be restricted access to their own metabolic data for fear of insufficient scientific literacy to interpret those data. The solution in my mind is education, not patronization. And we better get educated because we are about to enter a whole new era of bio-tracking. Are you ready?
