I’m a Longevity Doctor. Using a CGM Helped Me Optimize Eating in Perimenopause

As a longevity doctor who eats clean, exercises regularly, and prioritizes sleep, I assumed I had my health dialed in. Then perimenopause hit. Seemingly overnight, my lipids crept up, and my energy dipped in unpredictable waves. I asked myself the same question I often pose to my patients: What do you think is happening beneath the surface? If my body’s biochemistry was shifting, was my blood sugar quietly following suit? 

Glycemic variability (GV), the fluctuations between high and low blood sugar, has recently emerged as a critical health marker, ¹ though it’s not often discussed in the context of perimenopause. I decided to run a personal experiment. I wore a continuous glucose monitor (CGM) for the next 30 days to see how my own physiology was responding to this hormonal transition.

Within days, data from the CGM confirmed my suspicions. Foods I’d long considered metabolically supportive, like steel-cut oats with blueberries, acai bowls, and brown rice, were triggering sharp blood sugar spikes followed by equally sharp drops.

One afternoon, after sipping what I thought was a harmless turmeric oat milk latte, my glucose spiked to a level that rivaled eating candy. That peak—165 mg/dL—was followed by a crash an hour later, leaving me sluggish and struggling to focus during patient consultations.

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The Clinical Impact of Glycemic Variability

Physicians often focus on patients’ average glucose levels in lab tests, but glycemic variability may be even more harmful to your healthspan.

From a longevity lens, glycemic variability is particularly concerning. Research, including a review published in 2021, shows GV triggers more oxidative stress and inflammation than chronically high glucose levels alone. ²

Glucose fluctuations generate free radicals that can damage cells, accelerate aging, and contribute to chronic disease, including diabetes, cardiovascular conditions, and cognitive decline. ³, ⁴

A spate of studies also shows high glycemic variability impairs endothelial function (the delicate cell lining of our blood vessels) and damages mitochondria. Over time, these fluctuations speed up cellular aging and raise the risk of cardiovascular disease and poor metabolic health. ⁵

Glycemic Variability Matters More in Perimenopause

In perimenopause, declining estrogen compounds these metabolic risks. ⁶ Estrogen helps maintain vascular elasticity and insulin sensitivity; when it falls, blood vessels stiffen, making them especially susceptible to damage from glucose spikes and dips. 

The combination of stiffening vessels and endothelial damage is dangerous. A study in Cardiovascular Diabetology⁷ found that increased glycemic variability harms endothelial cells, significantly amplifying the risk of cardiovascular disease, a target concern in perimenopause. 

Other evidence suggests that erratic fluctuations in glucose impair mitochondrial function, particularly in heart cells, further elevating the risk of diabetic cardiomyopathy (a heart condition linked to damage from poor glucose control) and other chronic diseases.

I had been advising midlife patients on these risks for years. But the realization that my diligent health practices might be insufficient to counter the hormonal upheaval of perimenopause felt deeply personal.

How I Changed My Diet Based on the Data

Armed with these insights, I adjusted my diet strategically:

• Increase fiber: Fiber’s role in stabilizing blood sugar and reducing inflammation is well established.⁸ I aimed for at least 25–30 grams per day, the same target I often recommend to my perimenopausal patients to blunt glucose spikes and support hormonal balance. Adding chia seeds or nuts, leafy greens, legumes, and cruciferous vegetables to every meal helped slow glucose absorption and minimize post-meal blood sugar surges.
  
• Pair carbohydrates with proteins or healthy fats: Rather than eating fruit or grains alone, I switched to combinations like apples with almond butter to reduce glycemic swings.
  
• Mindful Sequencing: A growing body of research suggests that eating fibrous vegetables and protein first, before you get to any starchy carbohydrates, significantly improves glycemic control, reducing insulin spikes and energy crashes.⁹ I adopted this approach and saw the impact on the CGM immediately.

Within a week of making these adjustments, I was experiencing fewer energy slumps, clearer mental focus, and renewed confidence in navigating perimenopause.

Building Metabolic Resilience in Midlife

Recognizing the broader metabolic impacts of perimenopause, I incorporated more resistance training into my weekly routine to build lean muscle mass—a key factor for maintaining insulin sensitivity and stabilizing blood sugar. Research published this year in the Journal of Clinical Endocrinology and Metabolism underscores strength training’s benefits, particularly during hormonal transitions. ¹⁰

I also took a more structured approach to stress, integrating yoga, mindfulness meditation, and daily breathwork. Since elevated cortisol can worsen glycemic instability, ¹¹ I started noticing that on days I skipped these practices, my glucose levels were noticeably more erratic, even when my meals stayed the same. The consistency and calm I gained from these routines helped smooth out those stress-induced spikes.

Aging as an Opportunity for Optimization

Initially skeptical, my CGM experience was revelatory. It gave me a clearer picture of how my physiology was evolving and illuminated the intricate connections between hormonal shifts and metabolic health.

For women in perimenopause, data like this can help us re-engage with our biology and adapt in ways that support longevity. Instead of feeling betrayed by my changing body, I gained actionable tools to proactively manage my health now and for decades to come.

The real shift wasn’t in my meals or workouts, though; it was my mindset. Flexibility and awareness are essential at every life stage, including perimenopause. Rather than resisting inevitable physiological changes, we can embrace them and leverage scientific insights to optimize our health strategies.