109. Improving Metabolic Health and Body Composition Through Better Blood Sugar Balance | with Dr. Casey Means

In this episode of EMBody Radio with host Emily Duncan, Dr. Casey Means lays out the case for why chronic illnesses can be mitigated by keeping glucose levels healthy and stable. Trained as a surgeon, she explains why health comes down to cellular biology, and why it’s important to prioritize healthy diets, workout routines, sleep, and stress patterns to maximize overall health.

Work to prevent chronic illness

Dr. Means thinks that chronic illness should be about prevention, not intervention after it reaches a critical tipping point.

I did my training in Head And Neck Surgery, Ear, Nose and Throat. And what really struck me after about five years in that world was just that so much of modern medicine and mainstream medicine is all about reacting to disease. You wait until disease gets very severe and manifest and then you diagnose it and then you do these sort of heroic treatments like surgery or long-term medication or whatnot. And that, really rubbed me the wrong way. I think there’s so much that we can do to prevent chronic illness, so many of these chronic illnesses that are plaguing our country today are largely preventable with how we eat and how we live and how we move and how we stress.

How Levels monitors glucose

Biowearables like Levels allow individuals to track their glucose in real time.

What Levels does is provide people with continuous glucose monitoring technology. A wearable device that lets them see in real-time how their food and exercise and sleep and all these things are affecting their blood sugar. And blood sugar is such an important foundational part of health. If our blood sugar is out of control, it puts us at higher risk for almost every one of the top killers facing Americans today. So, the idea behind this technology and this company and bringing it to sort of this wellness market, people who are trying to strive for health optimization, is to give people this real-time biofeedback, about biomarkers that are happening inside their blood 24 hours a day and learn how to shape your diet, your lifestyle, your exercise around optimizing blood sugar levels. In hopes of really keeping people out of that trajectory that’s becoming so common in our country towards poor metabolic health, and all the different conditions that are associated with that.

Health comes down to cellular biology

The way that our cells turn fuel into energy is the basic definition of health.

When I think about what health means, it really comes down to cellular biology. We’re these organisms that are made of 37 trillion cells and then another 39-ish trillion bacterial cells and so, to be healthy on this macro-level means that those cells have to be working properly and inside those cells are just millions of chemical reactions happening constantly. And so, that’s kind of the framework through which I think about health, it’s really about cellular health. And so, you have to step back and think, “Well, what makes a cell healthy?” You think about these foundational root cause signaling pathways and whatnot that all cells need to sort of thrive and survive. And one of the really key ones there is the metabolic processes. You hear a lot about metabolism and metabolic health. But when you think of it through this framework, it’s like, “What is metabolism?” Metabolism is actually the way inside the cells that we produce energy from food.

The downsides of a Western diet

Starvation is unlikely in the Western world where food is fairly plentiful. However, the types of food that are readily available are typically quite unhealthy.

Our modern Western diets and lifestyles, chronic low-grade stress, ultra-processed foods, high carbohydrate foods, refined sugars, 150 pounds of refined sugar per person per year, crazy amounts, sedentary behavior. These actually affect these metabolic processes deeply. They cause them to not be functional and work properly. And so, this foundational thing that drives the cell to be able to do every other process metabolism, because you can’t do any of the other processes without energy, it’s broken. It’s broken in our country. So, we are at our core level, our diet and lifestyle in the Western world is breaking down a core function of how our bodies and our cells thrive. And so, when that’s problematic and it is so easily tipped-off balanced by this crazy industrialized diet that we’re eating and sitting all day and not sleeping, very easy to throw these pathways off.

Blood sugar and metabolism

When the body is overwhelmed by too much sugar, it begins to break down.

Blood sugar, sugar is one of our primary metabolic substrates. Carbohydrates are broken down into sugar. We can convert other substrates to sugar in the body. It’s one of the key things that the cells and inside the cells, the mitochondria, converts that energy I was talking about. And when you overload the body with sugar and your blood sugar is elevated, you’re putting this monumental load on these cellular processes and they will break down. It’s like a factory that all of a sudden got 100 times the shipment it was supposed to get and it’s just like process. It’s not going to work. It’s going to break down and that’s what’s happening. A hundred years ago, we were probably eating less than a pound or two of refined sugar per year per person. Now, we’re eating 152 pounds of refined sugar per year per person. And that’s not even including refined carbohydrates like all the flour and all this stuff. That is crazy for our cells.

The ADA thresholds for fasting glucose levels

Dr. Means believes that we should monitor glucose well before it gets to the 100+ range recommended by the American Diabetes Association.

If you look at the American Diabetes Association criteria for fasting glucose, so that’s glucose in the morning after not having eaten or drink any calories for eight hours, they recommend being under 100 milligrams per deciliter that is considered non-diabetic. 100 to 125 is considered pre-diabetic, and 126 or above is considered type 2 diabetes diagnosis. That’s for fasting. 140 is for post-meal, you don’t want to go over that. If you look a little bit deeper in the research, and actually look at drilling down into what fasting glucoses are actually most likely to prevent the future risk of chronic disease, it’s probably a tighter range. When you look at research, it actually shows that as fasting glucose goes from about 70 to 100, which is all in the normal range based on the ADA criteria. You actually have an increase even within that normal range of risk of future risk.

How is food affecting you?

That’s the question that Levels seeks to answer for every individual. A “healthy” breakfast like oatmeal may actually be sending many of us into a glucose spike.

Right now, we have so little visibility into how food is affecting us. We could be eating the same thing for breakfast every single day and the box says, “This is heart-healthy. This is high-fiber.” But you don’t really know what that’s doing to you. And we see this all the time with things like oatmeal, instant oatmeal, which in our members sort of large aggregated data set, oatmeal is one of the worst scoring foods that we actually see in terms of glucose response. And I can almost guarantee that every single person eating it, is doing it because they think it’s a healthy breakfast choice for them. But for a lot of people, and oatmeal is a nuanced thing, because there are many different forms of oatmeal, but we see a lot of people spiking 60, 70, 80 points with oatmeal, and then kind of crashing down mid-morning and that’s when they might feel tired or need that second cup of coffee or feel a little bit anxious or jittery or whatever. And when they see that, it’s like all of a sudden, “Oh, okay, maybe I need to modulate this or add some protein or whatnot.” And what we really try and coach people on with Levels is that it’s not like okay, if that’s happening to you, you have to never eat oatmeal again. It’s just think deeper about it.

The impact of high-intensity workout

When you work out hard, you’ll see your glucose rise before your body switches to burning fat.

If your workout is very high intensity and is above generally like 80% VO2 max or roughly like 70, 80% of your max heart rate, that’s going to be considered like a stress signal on the body. And you’re going to release stress hormones that actually have this interesting effect of going to your liver and telling your liver to quickly mobilize its stored glucose. And so actually, in the first part of a workout, like a high-intensity workout, you may see your glucose rise on your glucose monitor. And it’s fascinating and it’s very different than a food-induced spike, because what’s actually happening is that your body is clearing out its tank of short-term. It’s like your short-term bank account. You have about a few hours’ worth of glucose stored in your liver. And your body is mobilizing it and then your muscles are right there to take it all up. So it’s like you’re shifting it and your muscles have a sink for that. And then, once you work through that glucose and you kind of burned through what you’ve got in short-term storage, that’s when that flip switches to needing to tap into fat.

How to use CGM to maximize exercise

Dr. Means uses a CGM to determine if she should eat before or after a workout, and how hard she should push herself.

The main way in my life that I’ve been using continuous glucose monitoring for athletics is it’s three things really. One is that sometimes people will say like, “You need to eat before a workout, so you have energy.” And I’ll look at my CGM and I’ll be like, “My glucose is 90. I don’t need to eat. I got plenty of glucose on board. I’m fine.” It’s like a reassurance. So, that’s one thing. The second is for sort of assessing the intensity of my workout because if I see my glucose go up, I’m like, “Yeah, I just really pushed it and sort of cleared the tank, which means I’m closer to getting into fat burning.” So, that’s kind of a signal to me that I really pushed hard. And then, I think the other thing is just understanding fueling before and after the workout. I think a lot of our sports drinks and bars and shakes, a lot of them have way too much glucose.

Other factors that impact insulin

Insulin is affected by exercise, sleep, and stress as well as by diet.

If our body is more insulin sensitive, our cells are more perky to that signal of insulin, then we will not need to produce as much insulin to get the glucose into the body when we sort of eat a meal. And lots of things affect insulin sensitivity – exercising, poor sleep increases insulin resistance, so we want to get a really good sleep, being stressed hurts our insulin signaling, and obviously those big spikes up and down. So, really just focusing on good sleep, stress management, keeping spikes down, all these things can help us sort of perk up ourselves and need to produce less insulin over time. And so that’s another way to really move towards metabolic flexibility.

Good and bad carbs

Not all carbs are bad, but simple carbs should be avoided as they are processed.

The word carb is such a tough word to use as a blanket statement, because it’s not just about the carb, it’s about what’s been done to the carb. What has been done to the carb is vastly more important than the fact that it’s just a carb. And what I mean by that is processing wheat into ultra-refined bleached white flour. Those two things are both carbs, but have a vastly different physiologic effect on the body. And so, I really focus on not really focusing on numbers or percentages, but quality of the food. And how much is it in its whole natural form. Because there are people out there who are vegan, bodybuilders and whatnot, and who are eating tons and tons of plant-based, Whole Foods plant-based carbs and are very thin and very low body fat and whatnot. So clearly, it’s more than just the macronutrient it’s the processing. And so, I would just encourage people to think a lot about that and stick to as much like whole nutrient-dense Whole Foods, complex carbohydrates as much as they can. I think it’s the simple carbohydrates that really cause the problems.

Emily Duncan: Hello, everyone and welcome back to EMBody Radio. I’m your host Emily Duncan. I hope you’re having a beautiful day wherever you are today. I typically record my podcast intros in afternoon, early evening, but the day that I’m recording this I have much on my to do list, so we’re knocking this out early in the morning, so that I don’t forget. And so, as a result, welcome to my dull set morning tones. Anyway, I hope you’re having a beautiful day wherever you are.

Emily Duncan: Today, we have an education packed episode on, and underdiscussed in my opinion, especially within the fitness industry, but incredibly important aspect of health and especially disease prevention, which is your blood sugar. So, not only is your blood sugar really important for things like body composition and performance. But like I said, very important for just longevity and disease prevention. So, today we have on the show Dr. Casey Means.

Emily Duncan: Casey is an MD and Stanford-trained physician, a Chief Medical Officer and co-founder of metabolic health company, Levels, an Associate Editor of the International Journal of Disease Reversal and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools that can inform smart, personalized and sustainable dietary and lifestyle choices. Dr. Means’ perspective has recently been featured in The Wall Street Journal, The New York Times, Men’s Health, Forbes, Business Insider, TechCrunch, Entrepreneur Magazine, The Hill, Metabolism, Endocrine Today, and more. If you can even imagine there being more. She has held past research positions at the NIH, Stanford Medical School or Stanford School of Medicine, excuse me, and NYU.

Emily Duncan: And today, we’re talking about blood sugar along with her company, Levels. So, Levels is the first bio wearable system to provide real time feedback on how food impacts your health in real time, using continuous glucose monitoring. By leveraging continuous glucose monitoring technology, the Levels program helps users close the loop between health and daily lifestyle choices around food, exercise, sleep and stress management. Their customers are losing weight, discovering their optimal diet, and improving long-term risk factors, which is huge. Actually in November 2020, Levels raised a 12 million seed round led by Andreessen Horowitz with participation from the co-founder of Netflix, Mark Randolph, Esther Dyson, the former CEO of Twitter, Dick Costolo, the founder of TechCrunch, Michael Arrington, NBA Cavaliers player, Matt Dellavedova, and others.

Emily Duncan: Levels is currently running a closed beta program focused on product development that has a waitlist of over 115,000 people. And I was lucky enough to try out Levels myself and it’s pretty cool technology. It’s really awesome to be able to see in real time what different things like what meal you just had, what training you’re doing, how your stress is, what your sleep is doing affects your blood sugar. And also starting to pair up, “Hey, I feel such and such way after I eat a certain meal. Let me see what my blood sugar is doing after that meal, too.”

Emily Duncan: And you can kind of start to pick up on trends of, “Oh, this is what happens when I eat a very carb heavy meal. This is what happens when I eat a more fibrous meal. This is what happens. Here’s how I go throughout the day. Here’s how my blood sugar fluctuates throughout the day.” It’s really interesting and important data to have. And we’ve talked about already in this intro, really important for things disease prevention, and it’s something that a lot of people overlook, simply because I don’t think they understand it very much.

Emily Duncan: I’m somebody that I’ve been keeping tabs on my blood sugar for a long time. Actually, hypoglycemia runs in my family, which is low blood sugar, and I dealt with that a lot when I was little. And then, when I got into fitness and was eating in a more healthy and balanced way, it kind of, no pun intended, leveled itself out. But it’s still an important data point to have, especially if you start noticing anything trending differently in a negative direction than what’s normal for you. You can kind of just be proactive, and catching it before it’s too late, I guess is what I’m trying to say. So, this episode is going to be jam packed.

Emily Duncan: So, before we dive into that, I wanted to give a quick shout out over to our sponsors at CURED Nutrition. Given that I am up early, knocking some workout for the day, had to take a little Rise this morning. You guys know I’ve been on a journey of decreasing and pretty much eliminating outside of one matcha per day, my caffeine and so, Rise has been a game changer. Rise is a blend of different nootropics and more medicinal mushrooms that help provide non stimulant based energy and clarity. I use it as a pre-workout. I use it as just a nice morning boost. No jitters. No crash. No nothing like that.

Emily Duncan: You guys know I’m also a huge fan of Zen, their sleep support supplement, but I figured today given the nature of the early morning, even if you’re not listening in the early morning, it’s the early morning for me. Rise deserve a bit of a shout out, so if you want to give Rise a try for yourself or Zen or any of CURED’s other amazing CBD and hemp-based products, head over to curednutrition.com/emily and use the code “Emily” at checkout. Once again, that is curednutrition.com/emily with the code “Emily” at checkout.

Emily Duncan: And now let’s get into a very nerdy episode all about blood sugar, metabolic health performance, body composition, and just getting to know your body from a nutritional standpoint with Dr. Casey Means.

Emily Duncan: All right, everyone. Welcome back to EMBody Radio. Today, we have a very special guest on the show. All of the guests are very special, but today, we have Dr. Casey Means on the show. Welcome, Dr. Casey. For everyone that is not familiar with you and the wonderful work you do, first of all, thank you for coming on the show. And second of all, introduce yourself. Tell everybody about all of your amazingness.

Dr. Casey Means: Thank you so much for having me on. So yes, my name is Casey Means. I am a medical doctor by training. I am the co-founder and Chief Medical Officer of metabolic health company, Levels. And, yeah, my real main focus as a physician and entrepreneur is helping people figure out how to be really foundationally healthy, and how to promote health in their lives. I trained as a surgeon, actually.

Emily Duncan: Cool.

Dr. Casey Means: So, I did my training in Head And Neck Surgery, Ear, Nose and Throat. And what really struck me after about five years in that world was just that so much of modern medicine and mainstream medicine is all about reacting to disease. You wait until disease gets very severe and manifest and then you diagnose it and then you do these sort of heroic treatments like surgery or long-term medication or whatnot. And that, really rubbed me the wrong way. I think there’s so much that we can do to prevent chronic illness, so many of these chronic illnesses that are plaguing our country today are largely preventable with how we eat and how we live and how we move and how we stress.

Dr. Casey Means: And I just had a real shift in gears about five years into my surgical life, saying, “Treating this stuff is fine, but how do we keep them out of operating room? How do we empower people to be as healthy as possible and just really coming to grips with a lot of the systems issues, the financial incentives, all the aspects of the healthcare system that don’t encourage doctors necessarily focus on that front end of health and health promotion. It takes a lot of time. It’s expensive to do, but it’s ultimately where I wanted to focus my energy.

Dr. Casey Means: So, I shifted gears. Left the surgical world. Started a really high-touch metabolic health focused private practice, really focused on the root cause of illness and what was linking all the symptoms my patients were having, not just treating them each in isolation. And then really thought about how do I scale this? How do we scale health promotion and potentially use technology as well, because we’re facing monumental numbers of people who are chronically ill in a country. We have 130 million Americans with prediabetes or diabetes, 74% of the country is overweight or obese. Hundreds of millions, yeah, just hundreds of thousands of people each year are dying of heart disease.

Dr. Casey Means: It’s kind of, it’s astronomical, so scaling is important. So, that really led me to Levels and teaming up with my co-founders to start a company that would help people use their own biologic data to make better choices day in and day out, that would help breed this foundational health that I cared so much about. And so, what Levels does is provide people with continuous glucose monitoring technology. A wearable device that lets them see in real time how their food and exercise and sleep and all these things are affecting their blood sugar.

Dr. Casey Means: And blood sugar is such an important foundational part of health. If our blood sugar is out of control, it puts us at higher risk for almost every one of the top killers facing Americans today. So, the idea behind this technology and this company and bringing it to sort of this wellness market, people who are trying to strive for health optimization, is to give people this real time biofeedback, about biomarkers that are happening inside their blood 24 hours a day and learn how to shape your diet, your lifestyle, your exercise around optimizing blood sugar levels. In hopes of really keeping people out of that trajectory that’s becoming so common in our country towards poor metabolic health, and all the different conditions that are associated with that. So, that’s a little bit about my background and my journey. Yeah.

Emily Duncan: You’re so clear. Oh, my God, that was such a great storytelling. First of all, the flow of it, so perfect. Well done. You can tell that you’re clear on it and then you’ve talked about it numerous times. I also love that Levels focuses on such a simple biomarker like blood sugar. It’s not anything crazy astronomical, but something that you said at the beginning that I would really love to set the tone of this episode with is you wanted to see your patients foundationally healthy. And I think especially in Western culture, the majority of us have no idea what that means, what that looks like. Whether that’s in how we feel day-to-day, in our own biofeedback, whether it’s how our labs look, whatever it is. So, if you were to try and define or create components or pillars of foundational health or being foundationally healthy, what would that look like to you?

Dr. Casey Means: It’s a great question. When I think about what health means, it really comes down to cellular biology. We’re these organisms that are made of 37 trillion cells and then another 39-ish trillion bacterial cells and so, to be healthy on this macro level means that those cells have to be working properly and inside those cells are just millions of chemical reactions happening constantly. And so, that’s kind of the framework through which I think about health, it’s really about cellular health. And so, you have to step back and think, “Well, what makes a cell healthy?” You think about these foundational root cause signaling pathways and whatnot that all cells need to sort of thrive and survive.

Dr. Casey Means: And one of the really key ones there is the metabolic processes. You hear a lot about metabolism and metabolic health. But when you think of it through this framework, it’s like, “What is metabolism?” Metabolism is actually the way inside the cells that we produce energy from food. We take in all this food, all these energetic substrates. They are broken down and these substrates go into ourselves and then we have cellular processes that convert that to energy that our cells can actually use. We can’t just use like peanut butter to fuel ourselves, we’ve got to convert it into something.

Emily Duncan: Right. We’ve got to make it into something.

Dr. Casey Means: Right. And that’s a process that every single cell in the entire body, trillions of cells use. And what’s interesting about our modern Western diets and lifestyles, chronic low-grade stress, ultra-processed foods, high carbohydrate foods, refined sugars, 150 pounds of refined sugar per person per year, crazy amounts, sedentary behavior. These actually affect these metabolic processes deeply. They cause them to not be functional and work properly. And so, this foundational thing that drives the cell to be able to do every other process metabolism, because you can’t do any of the other processes without energy, it’s broken.

Dr. Casey Means: It’s broken in our country. So, we are at our core level, our diet and lifestyle in the Western world is breaking down a core function of how our bodies and our cells thrive. And so, when that’s problematic and it is so easily tipped-off balanced by this crazy industrialized diet that we’re eating and sitting all day and not sleeping, very easy to throw these pathways off. When that’s a problem, cells don’t work properly then tissues don’t work properly, organs don’t work properly and then that’s what symptoms and disease looks like.

Emily Duncan: The [crosstalk 00:12:53] effect. Yeah.

Dr. Casey Means: Yeah. And so this is why when you think about all these conditions, related to metabolic health, what I don’t think most people realize is that everything ranging from Alzheimer’s dementia, which is now being called type three diabetes to diabetes, to obesity, to heart disease, to stroke, to chronic fatty liver disease, to erectile dysfunction, polycystic ovarian syndrome, depression, anxiety. All of these, we know, are exacerbated or directly caused by poor metabolic health. And I think, hopefully, for that framework, it makes more sense because it’s not about an organ specific issue, it’s about cells not functioning properly. That can show up anywhere.

Dr. Casey Means: If it’s in the ovary, it can show up as polycystic ovarian syndrome. If it’s in the brain, it can look like chronic pain, depression, anxiety, or Alzheimer’s dementia. If it’s happening in the vessels, it could look like erectile dysfunction, or heart disease, or stroke. And so, you got to think at this level in our current system, they’d have us think all these things are totally separate. They all need to be treated with totally separate medications or separate surgeries. But when we think about what’s actually happening cellularly, we actually realize we can treat at this very foundational level and potentially, have wide-ranging positive effects.

Dr. Casey Means: And how this relates back to blood sugar is that blood sugar, sugar is one of our primary metabolic substrates. Carbohydrates are broken down into sugar. We can convert other substrates to sugar in the body. It’s one of the key things that the cells and inside the cells, the mitochondria, converts that energy I was talking about. And when you overload the body with sugar and your blood sugar is elevated, you’re putting this monumental load on these cellular processes and they will break down. It’s like a factory that all of a sudden got 100 times the shipment it was supposed to get and it’s just like process. It’s not going to work. It’s going to break down and that’s what’s happening.

Dr. Casey Means: A hundred years ago, we were probably eating less than a pound or two of refined sugar per year per person. Now, we’re eating 152 pounds of refined sugar per year per person. And that’s not even including refined carbohydrates like all the flour and all this stuff. That is crazy for our cells. And what happens is it creates this whole hormonal cascade that goes against really all the positive things we want in our life, because what happens is when you get that blood sugar rise after eating, your insulin rises, a hormone that helps your cells take up that glucose.

Dr. Casey Means: And with that huge load, the cells are like, “This is too much. We can’t process this. We need to not take so much in.” So, you become what’s called insulin-resistant. Meaning, the body is like, “I see the hormone signal, but I’m not going to, I don’t want to get this into the cell, so pause. The in is full.” So then, the body starts pumping out more insulin to try and override that signal. So now, you have high insulin, your glucose is starting to get higher, you’re getting this dysfunction.

Dr. Casey Means: And the interesting thing about insulin is that it doesn’t just have the effect of allowing blood sugar to be taken up into the cells, it has all these other functions. It has hundreds of functions in the body. It can be like a pro-growth cancer signal. It’s an anabolic hormone. It’s about pro-growth. And so, and one of the biggest things that does is tell the body, “We’ve got a ton of sugar around, so we don’t need to use fat for energy.” So, it blocks fat oxidation. It blocks fat for energy, because glucose and fat are two main things we can use to make energy. So, for anyone thinking about weight loss or trying to burn fat, insulin is so key in that. And so, it goes back to blood sugar.

Dr. Casey Means: So, that’s kind of how that relationship between what does it mean to be foundationally healthy? Bottom line, it means our cells are healthy. And deeper to that is that the cells can produce energy properly, which is metabolism. So, I think metabolic health is really the foundation of all other parts of foundational health. But what does health look like? I think, not only just absence of symptoms, but really the sense of lightness and thriving and energy and the body functioning sort of in that optimal state. And I think we know it when we feel it, so.

Emily Duncan: Absolutely, but it makes me so sad. And I think about this way more often than I should, but it makes me so sad when I sit and think because I work as a fitness coach. When people start realizing how good they could feel and then you realize that how you said it was what, 130 million people are pre-diabetic or diabetic. And we have even more statistics with other diseases, just how many people in our own country, but across the world, have never experienced that. And they think that the way they feel is just how it’s supposed to be.

Emily Duncan: People say, “Oh, I’m just getting older” or “Oh, it’s just this. I’m a parent or this, that, the other. I have a high stress job.” It’s like no, no, no, no, no. We have all of these things most certainly, but we are meant to feel vital. We’re meant to have just an abundance of energy and joy. And I don’t think people make the connection to feeling rundown and sad and depressed and anxious and all of that to metabolic health. But that’s all we are at the end of the day. Like you said, we’re just clumps of cells, so anything off with that, and we’re going to be off in general.

Emily Duncan: So, I would love to just kind of dive into the conversation starting with just like we talked about before the show, we’ve got a lot of fitness nerds here. But before we get into the optimization side of things, starting with what does normal blood sugar rhythm look like? What should we be looking for with fasting blood sugar levels in a generally healthy person? Just kind of then starting with the nuts and bolts of just good glucose regulation.

Dr. Casey Means: Yeah. So I think, big picture, the more stable and in a healthy range our blood sugar is, the better. That is one of the biggest life hacks that we can accomplish is more stable blood sugar and blood sugar in a healthy range. When our blood sugar is going up and down like spikes and valleys, like a roller coaster that is not just happening in our blood sugar. That often is directly related to a subjective roller coaster we’re feeling in our lives, whether it’s our mood or our energy or athletic performance. So, stable is better, basically.

Dr. Casey Means: Certainly, our body is equipped to handle some variability. When we eat carbohydrates, blood sugar rises, that’s what happens. And the body, healthy pancreas is able to release insulin and bring that down. The thing is, is that when that happens over and over again, maybe multiple times per day with high magnitudes, you’re getting that cascade with the insulin that we talked about earlier. Where your body is getting exposed to all this insulin, all this glucose and can move down the spectrum of insulin resistance that ultimately can lead to type 2 diabetes and all the other conditions related to type 2 diabetes like the ones we talked about.

Dr. Casey Means: And so, while it’s not inherently damaging to have one glucose spike, doing that regularly over the course of days, weeks, months, years, decades, that is that progression towards metabolic dysfunction. And so-

Emily Duncan: Now, quick pause here. In terms of spikes, if somebody is looking at a glucometer, how many points are we looking at here to quantify a potentially concerning spike if it were to become chronic versus a normal postprandial?

Dr. Casey Means: Yeah, the truth is it’s very hard to say. There is not actually a standardized optimal range where a governing body has said like, “Hey, if you can keep your glucose under this level all the time, you’re never going to get.” But I can give some insight into if we dig into the research a little bit what it kind of says.

Dr. Casey Means: So, first things first is that the International Diabetes Federation suggests that no healthy, sort of nondiabetic individual should rarely go above 140 milligrams per deciliter after a meal. Should try and always stay below 140 milligrams per deciliter. If you look at the American Diabetes Association criteria for fasting glucose, so that’s glucose in the morning after not having eaten or drink any calories for eight hours, they recommend being under 100 milligrams per deciliter that is considered nondiabetic. 100 to 125 is considered pre diabetic, and 126 or above is considered type 2 diabetes diagnosis. That’s for fasting. 140 is for post meal, you don’t want to go over that.

Dr. Casey Means: If you look a little bit deeper in the research, and actually look at drilling down into what fasting glucoses are actually most likely to prevent the future risk of chronic disease, it’s probably a tighter range. When you look at research, it actually shows that as fasting glucose goes from about 70 to 100, which is all in the normal range based on the ADA criteria. You actually have an increase even within that normal range of risk of future risk of diabetes, development of obesity, or overweight, or stroke, both or a heart disease, so stroke, heart disease, diabetes, weight gain. As you move up within that normal range of fasting glucose, you are at higher risk of those things. So that would say to me, “I’d like to stay in the lower end of that range,” right? To have the best.

Dr. Casey Means: So to me, I recommend, I try to stay between about 72 and 85 for my fasting glucose, because but that’s my interpretation of the literature. In terms of post meal spikes, I try and stay also in a much narrower range than going up to 140. If you look at populations of young generally healthy individuals who are wearing continuous glucose monitor, so getting 24 hour glucose readings, they tend to spend the vast majority of their time between 70 and 120, so that already tightens the range.

Emily Duncan: That was true for me as well throughout the experiment.

Dr. Casey Means: Yeah, yeah. And so, I’m always really trying to stay more in that range. And I’d say, for me, I like sort of my just resting glucose during the day to be in the 80s or so. And then I really don’t want to go up more than 15 or 20 points during a meal, a meal that I’m in control of. If I’m cooking and I really know it’s going into it, that’s where I want to be. So that puts me basically between 80 and 100 or so during the day. That’s if I’m totally in control, my sleep is good, I’m exercising, I’m cooking my meals myself.

Dr. Casey Means: If I go out to dinner or to a friend’s house, there may be more of a 30 point delta in my meal where from when I start to the peak after my meal, it’s more like 30 points. I think that’s probably fine to do, but it’s really these excursions of 60, 70, 80 points after eating something. That’s where I’d be like you probably want to rein that in because that happening every day, potentially multiple times a day, that’s a lot of strain for your body.

Dr. Casey Means: And aside from the insulin pathway of the fact that when you have a high spike, you’re going to have a higher insulin spike and you’re going to kind of have that downstream effects of that, there’s also just having high blood sugar in its own right causes physiologic changes. It can cause inflammation. It can cause what’s called oxidative stress, which is too many free radicals in the body. And it can cause this process called glycation, which is where sugar, high sugar in the bloodstream sticks to things like proteins or cell membranes. And that glycation reaction is sometimes sort of can be thought of as rusting. It’s literally like rusting of the body. And so, you don’t want that. That is associated with dysfunction of whatever the glucose is sticking to and sort of accelerated aging.

Dr. Casey Means: So, you just want to keep the body more in that lower stable state for as much of the time as you can. And again, it doesn’t mean that a spike is inherently damaging, it’s more about these long-term trends. And the thing is right now, we have so little visibility into how food is affecting us. We could be eating the same thing for breakfast every single day and the box says, “This is heart healthy. This is high-fiber.” But you don’t really know what that’s doing to you. And we see this all the time with things like oatmeal, instant oatmeal, which in our members sort of large aggregated data set, oatmeal is one of the worst scoring foods that we actually see in terms of glucose response. And I can almost guarantee that every single person eating it, is doing it because they think it’s a healthy breakfast choice for them. And-

Emily Duncan: See, I love my oatmeal. And I made sure I checked when I eat oatmeal. And I was like, “Okay, we’re pretty normal, so we’re good.”

Dr. Casey Means: Yeah. But for a lot of people, and oatmeal is a nuanced thing, because there are many different forms of oatmeal, but we see a lot of people spiking 60, 70, 80 points with oatmeal, and then kind of crashing down midmorning and that’s when they might feel tired or need that second cup of coffee or feel a little bit anxious or jittery or whatever. And when they see that, it’s like all of a sudden, “Oh, okay, maybe I need to modulate this or add some protein or whatnot.” And what we really try and coach people on with Levels is that it’s not like okay, if that’s happening to you, you have to never eat oatmeal again. It’s just think deeper about it.

Dr. Casey Means: Maybe you go from rolled oats or instant oats to steel cut oats or groats, which have much more fiber, which can blunt a glucose spike. Maybe you add a lot more fat protein or fiber to that oatmeal, so that you also, that also blunts the spikes. So maybe that means a couple tablespoons of chia seeds, some almond butter, a couple of walnuts, so maybe some flax seeds, all of those have fat, protein and fiber. That can really change the glucose dynamics. And so, that education is really what we’re trying to help people with is awareness, connecting the objective data to the subjective feeling of how you feel inside after that meal. And then what can you do to modulate this so that it works better for your body?

Emily Duncan: Absolutely. I love that. And I think that’s one of my favorite things about Levels as well, because we have so many fitness companies out there now, especially on the nutrition side of things, where it’s very sneaky. It’s like, “Oh, that thing you thought was good for you, it’s really not that good for you. But we have the one that is good for you.” So there’s, “Buy our product.” But instead, you’re giving people tools, you’re empowering people with the knowledge of, “Hey, if you enjoy this food, maybe here’s just a small tweak that we can take to make this a little better for your body.”

Emily Duncan: So, it makes fitness and health and wellness a little bit less daunting, because I think what precludes a lot of people from even trying is they don’t want to give up these things that they just genuinely like. Which I understand there’s something to be said for pleasure and joy in life and through our food and that’s completely okay. So, learning how to make things work a bit better for your life and the goals and the concerns that you have is so important. So, I really commend you guys on the education that you guys are doing and all of your blogs and everything like that. I love the app. It’s so much fun. It’s so just educational, and all of that. But yes, I think that is such an important conversation to have and such an important awareness to have, as people living in these clumps of cells, we should understand them. So, that’s very valuable information.

Emily Duncan: So, general tips, as far as keeping blood sugar more stable, you touched on this already with the adding things in. But just in case listeners if you’re not picking up on it, if you’ve been having isolated carbohydrate sources, add in a fat, add in a fiber, add in a protein to help lessen that spike because a lot of times it’s when we have those carbohydrates in isolation, especially those higher glycemic carbohydrates where we get that big spike. So, really try and balance that out.

Emily Duncan: But now, kind of getting into some of maybe the less conventionally thought of side of glucose monitoring, as far as body composition and performance goes, it’s really cool that you guys are on the come up now because there’s actually, I listened to a seminar years ago, from a bodybuilding coach that actually he used glucose monitoring to pique his bodybuilding competitors. And he would adjust their meals based on their postprandial blood sugar after every meal leading into their show, so there’s been a pulse on this for a little while. So, as far as the body composition and performance side of things are concerned, let’s unpack that knapsack a little bit.

Dr. Casey Means: Yeah, absolutely. So I think the, the relationship between glucose monitoring and fitness and performance is just such an exciting area right now, as you said. It’s just so much of it right now fueling for performance is a black box. We just are going off what people say we should do or what we’ve read and experimenting, but not necessarily having the data to really finely tune it. So I think it just really gives people a potential advantage in fueling for their sport, and I think for different types of performance, you may want to approach things a little bit differently.

Dr. Casey Means: For instance, for endurance training right now like long cycling events, triathlons, marathons, things like that, there’s a community of people who are actually really focused on keeping their glucose really low during their training and implementing sort of this carb cycling philosophy or fasted training, where they’re actually working out in a low glucose state. And the purpose of that is that as you do that, you’re asking the body to generate a lot of energy in a low-insulin state. And remember that insulin is the thing that if it’s high, it’s going to tell your body to use more glucose. And if it’s low, you’re going to unlock the ability to burn fat. And we have way more fat stored in the body that we have glucose for energy.

Dr. Casey Means: And so, if you’re in that high insulin state all the time, your body is basically dependent. It’s a mouse on a wheel. You just need more glucose to keep fueling yourself or else you’re going to bonk. If you are more adapted to be able to produce energy in a low insulin state, it means you’re tapping into those fat sources and oxidizing fat for energy, which you really can’t do effectively if your insulin is high or if there’s a lot of carbohydrates on board. And so, this community is trying to basically promote performance under low glucose conditions, so that they become these master fat oxidizers. And can tap into that huge amount of fuel during a long event without being totally dependent on exogamous glucose throughout the event like constantly eating or having goos or bananas, or whatever it is.

Dr. Casey Means: And so that’s one way in which a glucose monitor could help people figure out, “This is the glucose state I am when I’m going into my workout or my performance.” And then you could potentially track ketones on the other end, which are a breakdown of fat oxidation and see if you’re really boosting your fat burning during your event. So it’s kind of-

Emily Duncan: Now, that would… yeah. Sorry to interrupt with that. Would we expect to see a dip in blood glucose and an increase in blood ketones?

Dr. Casey Means: Yes, that is one possible outcome. It’s a little bit, it’s interesting, because our glucose, and this is something interesting that you can see on glucose monitoring when you use it during a high intensity workout or a power lifting type of workout. Which is that if your workout is very high intensity and is above generally like 80% VO2 max or roughly like 70, 80% of your max heart rate, that’s going to be considered like a stress signal on the body. And you’re going to release stress hormones that actually have this interesting effect of going to your liver and telling your liver to quickly mobilize its stored glucose. And so actually, in the first part of a workout, like a high intensity workout, you may see your glucose rise on your glucose monitor.

Emily Duncan: Yeah, I did see that, yeah, with training, yeah.

Dr. Casey Means: And it’s fascinating and it’s very different than a food induced spike, because what’s actually happening is that your body is clearing out its tank of short term. It’s like your short-term bank account. You have about a few hours’ worth of glucose stored in your liver. And your body is mobilizing it and then your muscles are right there to take it all up. So it’s like you’re shifting it and your muscles have a sink for that.

Dr. Casey Means: And then, once you work through that glucose and you kind of burned through what you’ve got in short-term storage, that’s when that flip switches to needing to tap into fat. And if you are someone who is trained to be a fat oxidizer, meaning that you live at least some of your time in a low insulin state that can be an easy transition. You move through your glucose and then glucose is low and because you’re in a low insulin state, you can switch into fat burning. And that’s the beauty of metabolic flexibility. That’s what we’re trying to strive for.

Dr. Casey Means: However, if you’re the average American who’s eating six times a day, eating lots of ultra-refined processed carbohydrates, your insulin is basically always high and you have not developed that metabolic flexibility, you have not spent enough time in a low-insulin state to probably be someone who is adapted to be a fat oxidizer. And so, in that situation, after you kind of work through your short-term of glucose, you’re going to try and tap into fat, but you’re not really going to have those metabolic adaptations to do that. So, we want to kind of put our body under these different conditions to be able to utilize glucose when it’s available, but when it’s not, to be able to kind of be a fat burner.

Dr. Casey Means: And that’s why sometimes training in the lower carb state or doing other things like this is exactly what is sort of behind intermittent fasting, right? Intermittent fasting really is just giving your body more time when your glucose is low and your insulin is low to tap into fat burning and to promote that metabolic flexibility. And it’s also really behind why some people are doing morning workouts, fasted workouts like trying to get on the peloton or whatever, before they’ve had breakfast. Because you’re doing that thing that, just like we were talking about, where you’re clearing out, sort of the stored glucose and having to more quickly switch into fat burning. And over time, your body gets more effective at doing that.

Dr. Casey Means: And so, to kind of circle back to your original question, which is would you see your glucose go down and your ketones go up? It’s sort of like yes, but with that caveat that you might see it go up if it’s an intense workout in the beginning. If it’s more of a moderate like a Zone 2 workout where your heart rate is more in 50%, 40 to 60% of VO2 max, it’s not a super stressful workout, those are the types that-

Emily Duncan: Probably more like recreational lift or decent rest period, decent challenge, but not like a CrossFit WOD or something.

Dr. Casey Means: Or a jog, I would say, for more of the cardio. Exactly that or more of like a jog where you can talk easily with someone. Those are the times when I might CGM, continuous glucose monitor, I see the glucose go down during the workout and that I would see ketones go up more. So, yeah, so it’s I think the main way in my life that I ‘ve been using continuous glucose monitoring for athletics is one… it’s three things really.

Dr. Casey Means: One is that sometimes people will say like, “You need to eat before a workout, so you have energy.” And I’ll look at my CGM and I’ll be like, “My glucose is 90. I don’t need to eat. I got plenty of glucose on board. I’m fine.” It’s like a reassurance. So, that’s one thing. The second is for sort of assessing the intensity of my workout because if I see my glucose go up, I’m like, “Yeah, I just really pushed it and sort of cleared the tank, which means I’m closer to getting into fat burning.” So, that’s kind of a signal to me that I really pushed hard.

Dr. Casey Means: And then, I think the other thing is just understanding fueling before and after the workout. I think a lot of our sports drinks and bars and shakes, a lot of them have way too much glucose, I think, than they should. It’s-

Emily Duncan: Oh, no. That’s ridiculous.

Dr. Casey Means: It’s insanity. These Gatorades are basically drinking a Coke.

Emily Duncan: Soda, yeah.

Dr. Casey Means: It’s soda. And I think people think, “Oh, well, I need to replete my glycogen. And I need to build muscle. I need to have this carb source really close to my workout.” But I think we probably need a lot less than what is actually going in. And so to see a gigantic spike after a workout or right before a workout, you realize, “Wow. That just sent me on a spike and a crash, which I don’t think is helping me. Maybe I could do a much more complex carbohydrate in a smaller quantity and get a gentle rise, but not have the spike and crash.”

Dr. Casey Means: You don’t want… it’s another thing about the kind of roller coaster is that when you have those really big spikes from a Gatorade or something that, you’re releasing so much insulin that oftentimes you can crash down and really overshoot. And you don’t want that before or after your workout. So, figuring out, it’s too late.

Emily Duncan: You get so fatigued and just like, “Bleh.” Yeah. Absolutely. So, I guess this begs the question, you made a point about somebody that maybe they get that increase in glucose release when they’re having more intense workout, but they’re not metabolically flexible enough yet to transition into that more fat burning mode. Generally speaking, how can the everyday person out there, whether it’s with meal decisions, whether it’s with meal timing, whether it’s with exercise, whether it’s a combination of all of these things, start improving metabolic flexibility?

Dr. Casey Means: That’s such a great question. I mean, first thing, I’ll just caveat by saying like everyone should talk to their doctor, and figure out a plan that works for them. This is very individualized. But I think a couple strategies people can lean into and one other premise is that these things don’t happen overnight. The first time you do a fasted workout like a fasted run. You run first thing in the morning, it might feel crap, because you don’t have much glucose on board because you’ve been sleeping for eight hours. And you also might not be fully metabolically flexible, so you might just feel really low energy. And so, these are slow adaptations. This is metabolic fitness. We have to do these like ease into it.

Dr. Casey Means: But some ways to do that, one, I think is experimenting with intermittent fasting. This is our time restricted feeding, so eating in a shorter feeding window. And this is obviously such a hot topic. People are talking about this a lot, but-

Emily Duncan: Yeah. They either love it or they hate it.

Dr. Casey Means: And it’s really individualized. What’s that?

Emily Duncan: I said people either love it or hate it.

Dr. Casey Means: Right. And I’m kind of someone who loves it and hates it.

Emily Duncan: Right. [crosstalk 00:39:45] are aware of that.

Dr. Casey Means: Yeah. And I think especially for a woman as thinking about your cycle and there are different times your body… fasting is a stressor. There’s no question to that. And so, there’s times in your body doesn’t have the capacity for an extra little bit of stress. And that’s not the time to do an 18- or 20-hour fast. And so, but really what fasting is doing physiologically is giving your body this extra time where your insulin is low and you’re working through your stored energy. And so, that’s an opportunity to build metabolic flexibility because by the time you wake up in the morning, after maybe not eating for 16 hours, you have moved through a lot of your stored glucose and you are easing into likely burning fat.

Dr. Casey Means: And I love, I’ve got my Biosense ketone monitor here. I’ve got blood ketone monitor in the bathroom, and it’s just a very like one-to-one relationship. When I do a 16-hour fast multiple days in a row, my ketones just they go up. My body is burning more fat. It’s really, really interesting to see that and my glucose usually stabilizes in a lower range. And so, that’s one way to build metabolic flexibility is just keep your insulin low for longer periods of time and don’t load the body with exogenous glucose, and you have to use another fuel source.

Dr. Casey Means: And that’s it sort of a gradual, and I am someone who like I love to eat so much. And so for me, even a 12-hour fast is sometimes hard, but something I have, but I think you just have to ease into it. I don’t jump into a 24-hour fast. Start with 12 hours and then, maybe try 13 hours and then 14 hours because your body gets used to it and it becomes less difficult as you become more metabolically flexible. So that’s one thing.

Dr. Casey Means: The second thing I would say is just improving insulin sensitivity generally and you can do that by lots of different things. If our body is more insulin sensitive, our cells are more perky to that signal of insulin, then we will not need to produce as much insulin to get the glucose into the body when we sort of eat a meal. And lots of things affect insulin sensitivity – exercising, poor sleep increases insulin resistance, so we want to get a really good sleep, being stressed hurts our insulin signaling, and obviously those big spikes up and down. So, really just focusing on good sleep, stress management, keeping spikes down, all these things can help us sort of perk up ourselves and need to produce less insulin over time. And so that’s another way to really move towards metabolic flexibility.

Dr. Casey Means: And then I would say this one is more definitely one you’d want to talk to your coach or doctor about, but easing into more of the fasted workout type of thing. So, what that looks is just maybe starting, if you’re someone who’s eating a couple bananas or something before a workout right now, start eating towards more of a fat heavy snack before a workout as opposed to a carb heavy snack. Move away and then maybe even go down to really just not having a lot of carbohydrates at all on board before a workout. And what that’s going to do is force your body to first use its glucose and then move into sort of more fat burning.

Dr. Casey Means: So, what that looks for me and I think a lot of people are at the company now, at Levels, a lot of people doing like if they’re going to do a four-mile run, they’ll just do it in the morning, having not eaten or if they’re going to do a 30-minute peloton ride in the morning, they’ll do it before breakfast. And that’s been, I think, really helpful for me in terms of boosting ketone production and feeling like I’m becoming more metabolically flexible. So, those are some ways.

Emily Duncan: I love that. Now, in terms of, and obviously, I’m a coach, I know this is extremely individually variable, but as far as maybe even percentage wise beliefs around carbohydrate composition within the diet as far as how much of the total caloric load that you’re taking in throughout the day devoted to carbohydrates. I personally think that especially with how sedentary Western culture is primarily a lot of people overshoot it. Do you have any general, and guys, this is very general, general. There’s a disclaimer at the beginning podcasts, not medical advice, not nutrition advice, but general advice on potentially tweaking these percentages or the carb dominance of our diets?

Dr. Casey Means: Yeah, so I think first things first. It’s like carbs I don’t think is the problem. The word carb is such a tough word to use as a blanket statement, because it’s not just about the carb, it’s about what’s been done to the carb. What has been done to the carb is vastly more important than the fact that it’s just a carb. And what I mean by that is processing wheat into ultra-refined bleached white flour. Those two things are both carbs, but have a vastly different physiologic effect on the body. And so, I really focus on not really focusing on numbers or percentages, but quality of the food. And how much is it in its whole natural form.

Dr. Casey Means: Because there are people out there who are vegan, bodybuilders and whatnot, and who are eating tons and tons of plant-based, Whole Foods plant-based carbs and are very thin and very low body fat and whatnot. So clearly, it’s more than just the macronutrient it’s the processing. And so, I would just encourage people to think a lot about that and stick to as much like whole nutrient-dense Whole Foods, complex carbohydrates as much as they can. I think it’s the simple carbohydrates that really cause the problems.

Dr. Casey Means: Personally, I’m plant-based and I eat a lot of carbs. And a lot of people at our company and members we have at Levels are more keto-focused but what I think about because I’m obviously thinking about insulin all the time and all this stuff is really the fiber composition of the carbohydrates. It’s like I think naked carbohydrates where you’re just eating a food that is predominantly carbohydrate macronutrient dense, I think that’s probably, I’ve moved away from that.

Dr. Casey Means: So, I don’t necessarily now just eat a couple pieces of fruit by themselves. I’ll always pair it with more fiber. I’ll add chia seeds or add it to a chia pudding or flax seeds or add almond butter or something like that, so that it’s a little bit more balanced and not causing that, that huge glucose spike. So yeah, I don’t have… I think people can do well on a very high-carbohydrate diet, but it comes down to the quality of those carbohydrates, how much fiber is associated with them and really how much they’re in their whole food form.

Emily Duncan: But that’s-

Dr. Casey Means: I think most problems arise when we process them.

Emily Duncan: Yeah, but that’s excellent advice because it acknowledges the nuance of nutrition and I think for so long and I’ve even been in this position as a coach myself. Earlier on, we got into the conversation of, “Oh, it’s just calories in, calories out. That’s all that matters.” A carb is a carb, a fat is a fad, a protein is a protein, and a calorie is a calorie and carb, fat, protein, how calories are like. We got so deep into the just math of it that we forgot or just overlooked the complexities, right?

Emily Duncan: And that the environment, the food environment that we’re in now as humans is not necessarily the environment that our systems were built for. And the more we can try and return to what they were built for, which was primarily like whole nutrient-dense foods, like you’ve been talking about, the better we feel, the better we perform, the more clear we are, the less of these spikes that we get. And so, really taking that conversation to heart and saying, “Hey, maybe I just swap out the gummy bears for an apple and some peanut butter.” Just simple little things like we’ve talked about.

Dr. Casey Means: Yeah. I think that’s one of the best first steps that people can do is take stock of what they’re eating and try and just make some swaps for the processed food for stuff that is more nutrient dense. And so, pasta as an example. There’s white pasta made with whole wheat flour or whole wheat flour. And there’s 10 alternatives that you can try these days, which all might be less refined and still give you that pleasure layers. Of course like zucchini noodles, zoodles, things like that, which I love.

Dr. Casey Means: But there’s also like konjac root noodles, which are made from, it’s called New Pasta which is made from konjac root, which is a super high-fiber root vegetable. And it’s delicious pasta, but it’s super high fiber. It doesn’t really spike glucose and almost anyone I know who’s tried it. There’s hearts of palm pasta. There’s lentil pasta, which we’ve seen spikes in some people and doesn’t spike other people, but certainly more nutrient dense than wheat flour. And so, there’s just all these other interesting options. There’s tofu noodles that people can try.

Dr. Casey Means: So, I feel like it’s yeah, really not about eliminating things or types of meals that you love, but how to kind of modulate them. A lot of us now are using for burritos for instance, using nori seaweed wraps. And that is instead of a tortilla and it’s like literally feels like the exact same thing. It’s just, it’s a burrito, but it’s a little bit different. So, definitely not trying to, I hope people don’t read this as deprivation or losing what you love, but just slight modulations.

Emily Duncan: Tweaks. Absolutely. Awesome. So, last question before we start wrapping up, we know that there are going to naturally be blood sugar and insulin changes with females or people who menstruate throughout their menstrual cycles. So, what can or should menstruating individuals be looking out for and potentially trying to assist with when at different times in their cycle?

Dr. Casey Means: Yeah, so what the research shows is that in the first part of the cycle, preovulation, we tend to be more insulin sensitive, and actually our glucose tends to be a little bit lower and post ovulation tends to be a little bit higher and a little bit more insulin-resistant. So with that in mind, I think it’s just helpful to think about, “Okay, maybe in that second half of the cycle, I just need to be a little bit more incognizant of spiking. And maybe that’s potentially when you move towards a little bit of the lower carb in the evenings or something that, just to minimize your glycemic variability.

Dr. Casey Means: But it’s really quite interesting how there is this sort of cyclical phase to blood sugar that seems to be largely due to the impact of estrogen. Estrogens tends to be sort of pro-metabolic health. And that’s one of the reasons why after menopause, when estrogen goes down, women tend to start doing much, basically going off this metabolic cliff. Obesity rates go up, diabetes rates go up, Alzheimer’s rates go up after menopause. So, estrogen seems to be protective in terms of blood sugar in the estrogen to progesterone ratio. So certainly, after menopause, I think we really need to be thinking about just dialing up the awareness of what’s happening with our blood sugar.

Dr. Casey Means: And if there’s anyone listening who’s sort of going into that phase, that’s the time to be really vigilant about tracking blood sugar and knowing what’s going on with your cholesterol, insulin, glucose levels, because a lot of us kind of go down that sort of a slippery slope at that point. And it’s an unfair card, obviously, losing the estrogen.

Emily Duncan: [crosstalk 00:51:46].

Dr. Casey Means: Right. But it’s just something to be aware of.

Emily Duncan: Awesome. Awesome, wonderful. Well, Dr. Casey, this has been wonderful. It’s been informative. I know I have lots of notes. I love getting to take notes throughout my podcast episodes, because I’m like I know everybody else are going to be doing the same thing. But this has been such a pleasure. I’m so excited to continue to see what Levels does.

Emily Duncan: Just a quick snippet before we head out, let people know. Give them kind of the elevator pitch of Levels, so they know what it is. You guys have seen me trying it and just enjoying playing around with it. You guys know I’m a data nerd. And then let people know where they can find you.

Dr. Casey Means: Sure, so an elevator pitch for Levels. So, Levels breaks through the mystery of trying to guess what your perfect diet is. And we do this by empowering individuals with real-time continuous metabolic data to understand exactly how food is affecting you. And how we do this is by our customers receiving a continuous glucose monitor, which is a wearable device. These stick on the back of your arm. It’s actually doing a lab test on your arm 24 hours a day, seven days a week. You wear it for two weeks, and it’s testing actually your blood sugar inside your body. And then it sends out information to your smartphone where our Levels app helps make that data stream accessible and helps make it interpretable. And so that it can really be a learning tool and you can really learn how to optimize your body for your goals and for ideally optimal long-term health by keeping glucose levels more stable.

Dr. Casey Means: And we really aim to make this very comprehensive. This is not about just going gung-ho keto and not eating any carbs. This is about building a body, like we talked about in the beginning, that processes energy properly. And that is not just about macronutrient composition. That is about how you’re sleeping, how you’re moving, what you’re eating, how you’re stressing, how you’re managing stress. It’s also about the toxins that we’re exposing ourselves to. Environmental toxins like pesticides and chemicals in our personal care products can be metabolic disrupters.

Dr. Casey Means: Our microbiome is critically important for our metabolic health and our cellular function and the micronutrients in our body, things like zinc and magnesium. These things are also just really important co-factors for our metabolic processes. So, we’re going to be trying to take people on this journey of understanding how to build this body that does its fundamental core pathway properly, which is metabolism. And so, our goal and our mission is to reverse the metabolic disease epidemic through personal empowerment.

Dr. Casey Means: And you can find us @Levels on Instagram and Twitter and you can find us at levelshealth.com. You can sign up for our waitlist. We currently do have a waitlist for the product. If you sign up for the waitlist, you get access to our newsletter, which has really incredible information and then, big plug.

Emily Duncan: [crosstalk 00:54:37] in there.

Dr. Casey Means: Thank you. So, for people who want to learn more, too, go to levelshealth.com/blog, which is where a lot of our content lives from the best thought leaders in the metabolic health space. And then I am @Dr.CaseysKitchen on Instagram, D-R-CaseysKitchen. And I write a lot or put up a lot about plant-based metabolic health and kind of how to have the best of both worlds there. So, a little bit of a divergence from I think what people would expect, which is full on keto. But there is a way to eat a lot of plants and keep your ketones elevated, so that’s something I talk about quite a bit.

Emily Duncan: That is super cool. Yeah, because that’s very ante what you think. Well, amazing. Well, thank you so much, Dr. Casey for coming on. You have been wonderful and can’t wait to see what Levels continues to do.

Dr. Casey Means: Thank you so much. It’s great to meet you.

Emily Duncan: Wait, before you go. I just wanted to say thank you for listening to another episode of EMBody Radio. It really means a lot to have you all here. We are back on the podcast game. I’m so excited to just be here with you all. If you enjoyed this episode, if you learned something, can you do me a couple favors, pretty please? If you could screenshot this episode, share it out on social media, tag me, tag Dr. Casey, tag Levels. And if you could head over to iTunes, leave us a five-star rating and review the show that really helps the show out. It lets me know what you love, what kind of content you want to see more of.

Emily Duncan: But once again, just thank you so much for listening, and I can’t wait to see you or hear you or you hear me. I don’t know. In the next one. Bye.