Exploring CGMs in Sports Nutrition with Dr. Andrew Jagim of Mayo Clinic Health System

An Intro to Dr. Andrew Jagim, Director of Sports Medicine Research at Mayo Clinic Health System

In pursuing a Ph.D. from Texas A&M, Dr. Andrew Jagim found himself working in the exercise and sports nutrition lab. That’s where his research involvement in sports nutrition and sports medicine began. Eventually growing his collaboration with the Mayo Clinic, his research now explores different diet and exercise strategies that can be employed to improve body composition, performance, and health.

Registered dietitian nutritionist Heather Davis, MS, RDN, LDN talks with Dr. Jagim about how to find the best sports nutrition advice, the role of CGMs in athletic performance, and what exciting research projects are on his radar for the future. 

Heather: As we get started, it would be great if you could share with our readers a bit about the evolution of your career in terms of how you found yourself doing the research you do and the projects that you've been involved in. 

Andrew: After my Ph.D., to be honest, I didn't really know if research was the direction I wanted to go or if it was more teaching. So, the first position I took in an academic setting was at a small private school in the Northeast, very teaching-intensive. 

And then, after a year of that, I realized that wasn't necessarily the route I wanted to go. So I pivoted and looked for more of a research role. That brought me to the University of Wisconsin Lacrosse, where I did my master's. And since it’s a smaller school, you can work closely with the athletics program.

It was during that time that I got to know several of the sports medicine staff at Mayo Clinic Health System. They have a site in Lacrosse, Wisconsin, so their sports medicine staff were actually the medical providers for the athletics department. We grew our research collaboration with Mayo, so much so that it actually led to a position being created for me in which they asked us to move a lot of our research activities more under the umbrella of Mayo and have it be more of a full-time basis. So, I joined Mayo in 2018 in primarily a research-related role, though I still see some patients.

I still work very closely with the University of Wisconsin in their athletics program, just because I still know a lot of the coaches and a lot of the faculty in our institutions are about five minutes away from each other, so it lends itself well for multi-site projects and still working closely with them. And then, over the years, I also co-run a podcast with a good friend of mine who works in our department here.  

Heather: This is great. How do you find the time to do all of this? You have a podcast, too!

Andrew: A lot of them overlap. It's a nice way to get a lot of our research findings out and bridge that gap between what we find from the research and lab setting and also ask how athletes or the general population can benefit or learn from some things that we're doing.

Heather: And what’s the name of your podcast? 

Andrew: Clinically Pressed is the name of it, and my collaborator Joel kind of started a spin-off of it, too, where it's an athletic training chat. He focuses much more on the athletic training side of the sports medicine world. 

Heather: I think that probably splitting the bench and the clinical work allows each one to inform the other, and each enriches the other. Is that what you've found as well? 

Andrew: Yeah, absolutely. I think it's really important to have your boots on the ground and get a feel for what people's questions are, or what's the gap or the barrier sometimes, from implementing some of those research findings into practice. And so they absolutely direct one another. I try to use an evidence-based practice approach when I'm meeting with patients or clients, but then vice versa. Some of my research questions have come from those consults with patients, and they'll ask something that I don't know the answer to. And so it's like, let's set up a small project to try to get the answer to that question. It's really helpful to straddle that line and be on both sides of that world. 

Can These Devices Be Beneficial for Athletes?

Heather: That seems ideal. And I’m, of course, very curious what your opinions are on the growing body of research around using CGMs in athletes and specifically in the non-diabetic cohort there? It’s a new area, and I'd love to hear your perspective. 

Andrew: It could certainly be a valuable tool to use to get that feedback that you don't normally get when it comes to different feeding strategies and what may work for some or how we can dial in some of the timing recommendations. So that's a nice plus there. 

And then it's hard to know what the disadvantages will be from that. That's a common theme with a lot of wearable technology and all this cool stuff we can do, but how can we efficiently use it? What are some of the downsides of it? And we're learning as we go within a lot of this space. 

It’s such a unique opportunity to have that little piece of metabolic data that can tell us many interesting things. How do we use it to our advantage and to the athlete's advantage? I think that is the biggest question. 

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Heather: Oh, yeah, because I think it is very easy for people without training to misinterpret the data or to start to drift into territory involving sketchy recommendations like “avoid all glucose spikes,” and we say no, especially if you're an athlete, some glucose spikes will be natural. And it's just interesting to see to what degree those are normal or healthy metabolic responses versus what degree or frequency of glycemic variability will then relate to increased risk for disease or injury or other concerns over time in athletes. 

Andrew: Definitely. And it’s especially important for people who may not have that background in metabolism or physiology to make sure we inform them of what to make of some of the information they're getting. 

Where to Get the Best Sports Nutrition Advice

Heather: So, speaking of sports nutrition, I know there was a study you were involved with in 2021 where you assessed the potential benefit of having a sports dietitian as a primary source of nutrition information for athletes. Can you tell me more about what you all found and some of your conclusions there? 

Andrew: Yes, it was a series of two papers in which we distributed an electronic survey. Some of them were more food frequency-type questionnaires. Some of them were more internally developed sports nutrition habits questionnaires if you will. We were asking participants: What are some regular meal timing practices that athletes utilize? 

And then, some of the demographic questions that were in there were about whether or not they had access to a sports dietitian and how often they met outside of that. 

And so through those projects, we identified that the athletes who did have access and then met regularly with the sports dietitian seemed to exhibit more positive or healthier, just general dietary habits, certainly with specific benefits to sports performance. And so this provided strong evidence for why a sports dietitian is beneficial in those settings. 

Heather: I’m a big fan of this. I think it’s so challenging for many people to identify quality information, considering the internet and the ability to spread information so widely. It's both good and bad. We have really high-quality information that is more accessible, but we also have really poor-quality information that's not very evidence-based, more accessible. And sometimes, if those people sharing poor-quality information have more followers on Instagram or more media fanfare surrounding them, then it can be easy to believe in what they're saying when they may not have the expertise or the right information. 

Andrew: Yeah. And that's something that I usually end my talks with when I speak to different teams. I think if you're going to look online for information, follow some of these successful evidence-based practitioners out there who have the right credentials and tend to put out good content, easy-to-follow stuff. So I try to point them in that direction at least, and then that's kind of on them if they follow through with it or not. 

How CGM Insights May Guide Exercise Recommendations for Insulin Sensitivity

Heather: It’s so great you do that. I know everyone at Nutrisense is devoted to making sure members get evidence-based information from highly trained experts. That’s so important.

I also want to discuss insulin sensitivity, glucose tolerance, and exercise. One of the very interesting things I've seen more in practice now using CGMs, but also found by reading the literature on this topic, is related to how exercise impacts glucose levels and insulin sensitivity. 

We see this in terms of the U-shaped curve principle of hormesis. We see the very inactive, low physical activity group often exhibit poor insulin sensitivity or impaired glucose tolerance on one side of the U. Then we kind of see this same pattern also on the other side of the U represented by the more extreme end of intensive training or maybe even over training where you can start to see that same pattern of reduced glucose tolerance. What are some of your thoughts on that? 

Andrew: Yeah, and that's where I think it's really important to approach a lot of sports nutrition guidance at an individual level because I see this a lot as well. It's making sure that a specific person, wherever they are on that spectrum of insulin sensitivity, they're getting the nutritional advice that works for them based on their health history and unique response. And then, if you have access to tools like a CGM, it can maybe make some more data-driven recommendations for that person to, again, kind of get them the best diet or dietary recommendations that they likely need, based on all that context and information about them. 

Not only are you getting that insight with the CGM, but you're getting it throughout the day, which is different than just that snapshot view of not really knowing where they are on that time curve throughout the day. 

I'd be really curious to see what real-time glucose response looks like in wrestlers because I do a lot of work with our local wrestling team, and they go through crazy diet swings throughout. They try to make weight, yet they're training at a very intense level. And so I would imagine some of that information or some of those assessment techniques would provide some interesting feedback with that group as well. 

Heather: Oh wow, that is such a good point and makes perfect sense. I'm really curious about that now, too. 

Andrew: And that's a type of athlete that is very dependent on carbohydrate availability for the level of training that they're doing, yet it often gets restricted as part of their weight management plan. And carbs are usually the first thing they cut just to shed that weight. Especially with dropping glycogen, you shed the water. Yeah. So it's a quick tool to drop a few pounds, but at what cost? 

For me, it's literally my dream walking lab model because I have a lot of interest in sports nutrition, metabolism, and body composition, and wrestling checks every one of those boxes. All of those factors play a big role in that sport in terms of what weight they get certified to compete at. How do they cut weight? How can they still optimize performance? And so it really forces you to get really kind of specific with the nutritional recommendations and all of it. So, it's a really fascinating group to work with. 

It's made me learn a lot, too, and dig a little bit deeper beyond just some of the standard sports nutrition recommendations because you have to be so mindful of their weight throughout the week. 

Dr. Jagim's Future Research Projects

Heather: I love this. That also makes me wonder, Andrew, what are some of your upcoming research projects or the projects that, if you could do, you'd like to do? Your dream projects? What do you have on the horizon, and what would you like to have on the horizon? 

Andrew: Well, one of them right now is a monitoring study with a wrestling team where we're tracking changes in resting metabolic rate, body composition, weekly weight fluctuations, and training load. And this is kind of building off a couple of years of this. And we've gotten some internal funding now to add in some biomarkers. So now we're looking at testosterone, looking at hemoglobin. And now I want to add in the CGM element because I think that would be a really cool piece. 

Heather: Very nice! 

Andrew: Our department has gotten really involved with our local fire department. And so we're utilizing a lot of the sports science kind of research methodologies with the firefighters. We're just bringing these tools into the fire service. 

Heather: And the firefighter cohort, I feel like, is an under-supported group in so many ways. These are athletes, and I don't think many people appreciate the level of athleticism you have to have as a firefighter. It's so intense. 

Andrew: Yeah, for how understaffed some collegiate programs are for supporting sports nutrition, the fire service is probably that much worse, at least in this region. I don't think we've encountered a department that has any kind of dietitian, strength coach, or athletic trainer. We've kind of parlayed our research involvement also to serve some of those roles, to try to give them feedback along the way to, again, just help that profession because we feel it's so important. And again, it brings some interesting challenges because you'll have a 19-year-old fresh out of the academy, young, fit, otherwise healthy, and then you get a 55-year-old vet who maybe is overweight, a career of sleep disruptions, high-stress environments. Maybe they have a hip replacement. And you’ve got to try to put a program together for both of those people. 

And so, again, whether it's nutrition advice and whether or not you're trying to help them lose weight or gain weight or from a fitness programming standpoint, there's a lot of modifications and kind of individualization that needs to occur with that group. It's been a fun group to get involved with. 

Heather: No kidding. I'm imagining this challenge and also the reward of doing this. I'm so glad to hear that you all are working on that project, though. That's really exciting and impactful. 

Well, Andrew, it's been a pleasure to talk with you and gather some of your insights. I feel like I could continue this conversation for hours, and I'd never get tired of talking with you. Thank you so much for your time.

Andrew: Yes, absolutely. It’s been a pleasure. 

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If you're an athlete or fitness enthusiast and want to understand more about the potential benefits of using CGMs for athletes, check out our article here.