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Integrative Psychiatry

Continuous Glucose Monitoring (CGM) and Mental Health

By January 25, 2024February 5th, 2024No Comments

The relationship between metabolism and mental-emotional wellbeing is a complex and often unrecognized aspect of psychiatric treatment, yet it is known that metabolic dysregulation is a key feature of, and clinical predictor of, stress- and trauma-related disorders like depression, anxiety, and posttraumatic stress disorder (PTSD). There is evidence that fluctuations in blood sugar levels may be associated with specific psychiatric symptoms and thus may be helpful data in exploring the mind-body connection. Among individuals with diabetes, continuous glucose monitoring is a valuable tool for making informed decisions to manage health; in addition, continuous glucose monitors (CGMs) are being employed as part of lifestyle medicine plans within the general population, acting as an instrument for personalized data collection. CGM data may be analyzed alongside other measurements to examine medical trends in both physical and psychological health.

Comorbidity in Diabetes

Individuals with diabetes are at an increased risk of worsening mental health, including the development of depression and anxiety, compared to the general population. Comorbidity of diabetes and psychiatric diagnoses seems to correspond with more negative clinical outcomes. Possible reasons for comorbidity are multilayered: underlying lifestyle factors, stress from managing a chronic illness, impacts of diabetes-related complications, medications, and physiological effects of fluctuating blood sugar levels. Likewise, individuals with a stress- or trauma-related disorder are more likely to develop type 2 diabetes, pointing to overlapping biological mechanisms underlying dis-ease.

Biological Mechanisms

Metabolic disorders share biological pathways with depression and anxiety. For example, both diabetes and depression are associated with altered hormonal signaling, autonomic nervous system activation, inflammation, dysbiosis of the gut microbiome, oxidative stress, and cardiovascular complications. From an integrative perspective, it can be challenging to isolate each of these processes and analyze them one at a time. To say one system gets perturbed before another would be too simplistic, and it might be helpful to conceptualize the interaction between physiological systems from a bidirectional approach. For example, dysregulated blood sugar levels (either too high or too low) can trigger pro-inflammatory states that lead to oxidative stress in the body, affecting brain function and emotional regulation. On the other hand, long-term psychological stress and dis-ease can activate fight or flight pathways that disrupt immune function and the gut microbiome, altering glucose regulation. 

Dementia: Type 3 Diabetes?

Dysregulated glucose levels can also have long-term effects on cognitive function. A leaky blood-brain barrier, coupled with neuroinflammation, altered bioenergetics, and impaired brain signaling impacts how efficiently information is processed. Uncontrolled and fluctuating blood sugar may lead to difficulties with memory, concentration, and decision-making, all of which can contribute to feelings of frustration and stress. In a chronic state, brain cells may take on an insulin resistance phenotype that is associated with neurodegenerative diseases such as vascular and Alzheimer’s dementia.

CGM Benefits

CGMs have advantages over other glucose monitoring devices; GCMs provide real-time feedback on how diet, physical activity, sleep, stress, and insulin dosages impact blood sugar levels. This information supports individuals in adapting to fluctuating values and regulating their blood sugar, which may help stabilize mood and reduce the risk of psychiatric symptoms. While CGMs are commonly used by persons with diabetes, continuous glucose monitoring might be of equal benefit for those without diabetes who are interested in taking a personalized medicine approach to wellness. For example, metabolic profiles are highly divergent between people, even after eating the same foods, and fasting glucose ranges are not always representative of a single person’s metabolic status. CGMs offer insight into a person’s very unique inner world, providing acute responses to lifestyle choices and longer-term observations of blood sugar variability. These data may be used to inform customized dietary or other lifestyle changes.

CGMs may be useful for recognizing patterns between physiology, perceived experience (what does my body feel like during periods of high vs low blood sugar?), and psychological wellbeing. By tracking fluctuations in blood sugar levels, these devices offer opportunities for trend analysis, especially when combined with other metrics of health. Utilization of these data correlated with mood or cognitive difficulties may promote feelings of self-efficacy, supporting patients to take preventive measures in managing both metabolic and mental health.

CGM Limitations

Currently, prescriptions are required to obtain a CGM, and the cost per month is not cheap. While the cost of CGMs is covered by insurance for individuals with diabetes, it is often not covered for prediabetes and not for general wellness. CGMs are not accessible to everybody, with data showing disparities in obtaining a CGM based on social demographics. In order for CGMs to be used effectively outside of a diabetes context, more research is needed to understand the blood sugar target ranges for healthy individuals. 

Conclusion

The correlation between diabetes and psychiatric disorders highlights the significance of metabolics in mental health. Assessing bidirectional relationships between glucose metabolism and psychiatry is one way to approach diabetes and prediabetes care holistically. Continuous glucose monitoring offers a powerful tool to bridge the gap between physical and mental health in the context of diabetes as well as the general population. CGM technology can empower individuals to take proactive steps to manage their overall health, wellbeing, and longevity. 

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.