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9 Minute ReadFeature by Chris Stokel-Walker
Anttoni Aniebonam’s business idea came from the illness of a friend. Verneri Jäämuru had struggled with ulcerative colitis when growing up. He was bedridden for several months, and had lots of issues with his gut health. Doctors pointed the finger at ultra-processed foods. “The modern healthcare system is very topical,” says Aniebonam. “We treat the symptom, not the cause.”
The cause of his friend’s illness, Aniebonam believed, was the high-fat, high-sugar facsimiles of food that lined supermarket shelves. “Over the last 100 years, our food is much more processed, and we have excessive amounts of carbohydrate consumption,” he says. Aniebonam has cited a tenfold increase in sugar consumption in the last century. “A lot of things have happened to the human race really quickly, and our body is not adjusted at all to those changes.”
So Aniebonam and Jäämuru decided to do something about it. In 2020, they set up Veri, a company monitoring people’s metabolic health using a blood sugar sensor implanted in a wearer’s arm and linked to an iOS app. The company was established after the pair tested out any number of gadgets and gizmos to try and hack a user’s health, from DNA kits, probiotics, smart scales and Apple watches. What they hit on is an unusually popular new trend in the future-focused health hacking world, but one often despised by those of the 415 million diabetics worldwide who might have to wear one: a continuous glucose monitor.
You’ll have likely seen someone wearing the device: a coin-sized piece of white plastic that sticks small sensors just underneath your skin to measure sugar levels in your body. An estimated two million Americans wear the devices on a daily basis. They’re relatively unobtrusive and safe, while ensuring wearers can keep track of their sugar levels on a regular basis, saving them the hassle of regular stinging pinpricks on their finger to draw blood.
Veri is one of a number of companies promoting the technology as the next stage of continuous development for those looking to improve their health. The Finnish company has raised around $4 million in funding for its devices, which are worn by around 6,000 customers, each of whom pay £129 a month for two sensors that they switch out every two weeks, and access to the app that helps parse their data. Other apps, including California company Levels, charge $399 to their 10,000 customers in the United States.
It’s a significant shift for the technology, which has transformed from something to be endured to a cool device to be craved, similar to the latest iPhone model. Once the preserve of those with diabetes, who suffered the annoyance of continually having to monitor the levels of sugar in their blood through a permanently attached monitor pinned into their arm, continuous glucose monitoring has now been given a trendy Silicon Valley rebranding. It’s the latest aspirational must-have for inhabitants of the most tech-centric section of the world. Rather than something to be endured, it’s now something to be actively sought out – the latest body hacking status symbol for the 2020s.
“It’s something that’s exploded in the last two or three years in the non-diabetic community,” says Richard Bracken, professor in sport and exercise sciences at Swansea University, who has conducted research that established the world’s first standardised guidance for how people with diabetes can exercise safely using the data from glucose monitoring devices. “It appeals to people who want to know more about their body and how it works.”
Aniebonam says that Veri and other devices like it plug a gap in human knowledge – a way of giving fast feedback on the benefits and drawbacks of our nutrition. “We didn't have any way of giving fast feedback on what we ate and how our body responded to that,” he explains. Veri’s 6,000 customers come from a variety of different backgrounds, and aren’t solely drawn from the Silicon Valley biohacking community from which the firm first emerged before moving to Finland. However, most of the users are health-conscious, likely to already wear Apple watches or Oura rings – which track a wearer’s sleep patterns overnight. Aniebonam disputes the idea that Veri is the preserve solely of biohackers or quantified selfers. “These are people who are on the brink of becoming type-2 diabetics or pre-diabetics,” he says – people who have gone to a regular check up, have seen their doctor spot a higher or elevated level of blood sugar, and suggested they intervene naturally before more medical intervention through a prescription drug is required.
“They come to Veri with a very specific objective in mind,” says Aniebonam. “They say: ‘I want to lower my blood glucose levels to a certain point,’ or, ‘I want to lose weight to a specific point.’” Veri calls their users health-conscious individuals, rather than the more glitzy “biohacker” label. Shorn of that tag – which has often been reserved for slightly kooky, over-the-top tech bros looking to eke out tiny advantages in their bodies – Aniebonam hopes that the underlying technology will see wider adoption, similar to the way many people check their pulse with an oximeter today. “I definitely think that there's a world where these monitors are commonplace,” he says. “I think that the evolution of the sensor, what will happen is that the centre, like the hardware will improve a lot in multiple fronts.”
The big question is whether it works – or if it is, like many health and wellness trends, a solution looking for a problem. “I just don’t see how it's going to have a scientifically proven benefit in healthy individuals,” says Dr Shivani Misra, consultant in metabolic medicine at a London NHS hospital, who treats patients with diabetes on a daily basis. Continuous blood glucose monitoring is a boon for Misra’s patients with diabetes, preventing their bodies from entering a dangerous phase of shutting down because of sugar imbalances inside them. As for those who don’t have diabetes, she’s less sure. “It’s an evidence-free zone,” she says. “I don’t think we can say it’s useless. But I think we also can’t say it’s useful.”
Misra, like many doctors, lives her professional life by a mantra to pursue treatments only when they’re proven to do well and not to do harm. While she’s not convinced plugging a small circle with ultra-fine needles that monitor your blood sugar levels into the back of your arm would necessarily do any harm, she’s equally unconvinced about its benefit for healthy people. “If I'm going to do a test in somebody - a blood test, for example - there should be a reason for doing it,” she says. “Knowledge of that result should have some potential benefit for the person. “When you look at something like continuous glucose monitoring, it doesn't really tick many of those boxes.”
Based on her research of the services blood sugar monitoring start-ups offer, Misra believes most of them track peaks and troughs in glucose throughout the day, offering analytics about when they occur and allowing the wearer of their devices to try and hack their bodies or food intake to improve their physical performance. In this world, the small nubbins implanted in a person’s arm offer the same kind of utility as smartwatches that track your pulse rate and oxygen levels – another metric that can simply be tracked and hacked to achieve peak performance.
That’s what Aniebonam hopes will happen with the “semi-invasive” patches Veri and its competitors offer. He believes that as their use becomes more widespread, advancements in both hardware and software will provide a virtuous circle, improving future adoption as the barriers to entry decrease. “The next generation of that would be totally non-invasive sensors using technology like Raman Spectroscopy, which is a very similar technology to what we have in our Apple watches and the high-grade monitors right now,” he says.
Yet that’s not what Misra believes is likely to happen. Peaks and troughs in blood sugar levels are a part of totally normal physiology. “As far as I know, there's no evidence base to suggest that having those peaks within the normal ranges is unhealthy,” she says. She also fears the rise of the worried well, using analytics that fluctuate within a healthy range to gee themselves up into a state of nervousness about their health. “We definitely see this increasing group of people who are really anxious about their health, because they've picked up on things that we don't necessarily normally look for,” she says, citing normal variations in pulse rates that have been picked up by smart watches by users and amplified into a barrage of unnecessary tests – and plenty of anguish and anxiety.
That’s something Bracken worries about, too: “the communication needs to improve to explain what your data means,” he says. Being presented with a squiggle of a line that jumps up and down with seemingly little rationale or reasoning, shorn of contextual information or explanation, serves little purpose for the everyday person. Worse, it could lead to people taking drastic action about their health, diet and exercise that could do more harm than good based on a misreading of the data they’re provided.
Giving continuous glucose monitoring implants to 100 patients could result in some patients who had undiagnosed diabetes being picked up and helped. But it could also cause many others who have nothing wrong with them to suddenly worry about normal changes in their blood sugar over the course of the average day. “Really, as a specialist, it's hard to say anything positive about it, because unlike the tech companies who are obviously trying to market and make a profit, my opinion comes from scientific evidence. And unfortunately, we don't have any in that space.”
However, that doesn’t mean there won’t ever be independent, rigorous scientific evidence that shows the benefits of continuous glucose monitoring for those who don’t suffer from diabetes. It could be something that’s shown to be useful 10 years down the line. For Aniebonam, the future possibility is that you could customise diets and food intake to ensure that you’re keeping glucose levels on an even keel, avoiding the spikes and crashes that can be so harmful for your body and lead to the potential of diabetes further down the line. Every body is different, the makers of the Veri device reckon, and so it’s no longer enough to say that everyone should shun cookies and adopt bananas, when people have different reactions to different types of food.
That’s the point of view of the biggest boosters of the technology. But for the time being, the case is out on whether you should follow in the footsteps of the latest California cult health trend. “I think it's one of those scenarios where if a person is curious, and has been empowered with the right information, the metabolite has a useful insight into the working processes of your metabolism,” says Bracken. “But to a person who doesn't know what they should be looking for, or is maybe misguided in what they're trying to do or achieve, it may be just wasted money.”