160. The Biggest Red Flags In Your Current Diet

In this episode of the BossBabe podcast, host Natalie Ellis chats with Levels co-founder Dr. Casey Means. Dr. Means shares why there is no magic bullet for metabolic health. Instead, it relies on a holistic daily approach that takes into account different levers such as diet, exercise, sleep, and stress.

The problem of metabolic dysfunction

Modern diets and habits are wreaking havoc on our metabolic processes, leading to adverse consequences.

When our metabolic processes are not working efficiently, or are overloaded, or these pathways are in some way, perturbed, we have metabolic dysfunction, which means we’re not producing energy properly. And that essentially leads to cellular dysfunction, tissue dysfunction symptoms, and disease. And so really, metabolism is a foundational pathway in our body. Unfortunately, in our modern, Western world, the way that we’re eating and the way that we’re living, so our diet, and our lifestyles is really hijacking that cellular machinery that allows us to produce energy in our cells efficiently, and it’s causing huge problems.

The cause of metabolic disease

Fat and glucose are the two main factors that determine whether our metabolism is working properly.

Metabolic disease can just look like so many things. And actually, 9 of the 10 leading causes of death in the United States are related to problems with our metabolism, problems with our blood sugar. And it links back really to a lot about nutrition because fat and blood sugar, so fat and glucose. Glucose is another word for blood sugar. These are the two main things that are converted by ourselves through our metabolism to cellular energy. So these are things that we can really look at and understand what’s going on with our metabolism by tracking things like glucose. And we know that when we’re overloading our body with glucose, with sugar, with refined carbohydrates that turn to glucose, when we’re putting so much of that into our body, it can cause this dysfunction in metabolism. So, that’s the landscape of what metabolism is, why we’re having big scale problems right now with this in our country.

The result of high glucose levels

When glucose is in our body in excess, it releases the insulin hormone. And when insulin is perpetually high, cells become resistant to its effects.

When glucose is elevated, day after day, over and over again because of how we’re eating and how we’re living, what that does is that causes actually a hormone in the body to be released called insulin. Insulin is the hormone that’s released in response to glucose and tells the cells to take up that glucose from the bloodstream. So you eat the food, you digest it, the blood sugar elevates, you release insulin, it helps you take that glucose out of the bloodstream, the body wants to get back to normal levels in the blood. And then inside the cells, it’s either used to make energy or any excess is stored. And that’s where a lot of problems arise. But when that insulin gets stimulated over and over, and over and over again, day after day, year after year, like so many are doing from basically infancy these days, what happens is our cells actually become numb to the signal of insulin and they become what’s called insulin resistance.

Does hunger mean we are really hungry?

When you are dependent on glucose, you might feel hungry even when you shouldn’t.

When we are hungry, what does that really mean? It means that you have gone a few hours without food, and now your body feels like you really need food. And what’s actually happening in the body? Well, your body’s essentially probably so dependent on glucose and not really able to tap into fat for energy that when you don’t have glucose immediately onboard through like a snack or a meal, your body just says, “Oh my gosh, panic, I need to eat more.” When in fact, if our bodies were more metabolically attuned and flexible, when glucose was low between meals, our insulin would be low enough that we would just flip into fat burning. That break on fat burning would be lifted. So, I like to say hunger or really being anxious before your next mealtime, that could be a sign.

The pillars of health

Healthy bodily functions rely on multiple factors being in balance.

There are a number of pillars of health that are essentially behaviors and choices we make that we know translate into, essentially how the body functions. And there’s really seven that I tend to focus on. And all of them feed into our level of metabolic health with thousands of papers in the medical literature to support that. So, the first is food. I’ll just list them all first, and then we can talk more about any of them. But really, it’s food, stress management, sleep quality and quantity, exercise and how much we move our body, our microbiome, our micronutrient status in our bodies, and then how much exposure to toxins and pollutants we have in the body. So, those seven things all have an impact on essentially how our cells work. And within each of them, there’s a lot of nuance for really how we can optimize each pillar to make sure that we are supporting our bodies function.

The 4 food factors to keep in mind

When it comes to food, we should keep in mind what we’re eating, how, when, and in what order.

With food, it really comes down to four things. So, one is our actual food composition. What we’re eating and how we’re pairing food, how we’re balancing meals. The second is food timing, when we’re eating. The third is food sequencing. So how we’re actually sequencing things in a particular meal. Are we putting carbs first? Are we putting fat first? And then the fourth is the nutrient composition. So actually the quality of the food and how much nutrients it’s giving us. So, within the food composition, the key thing that we want to focus on is not having large glucose excursions, glucose spikes after our meals. We want our glucose in our bloodstream to be like gentle rolling hills, a little bit up after a meal, and then it comes down back to baseline.

Ways to keep glucose more stable

If you combine carbs with protein, the effect is better than eating carbs alone.

What we want to do with food is figure out how to eat in a way that keeps that glucose more stable. What that might look like for practical reasons, is really pairing our foods properly. We don’t really want to eat carbohydrates just alone. I try and avoid what I call naked carbohydrates, which is just like a big giant apple. The macronutrient that’s dominant in that is carbohydrates. So, if I’m going to eat an apple, I’m going to first of all try and eat a smaller, organically grown, maybe local apple. Has less sugar, grown in better soil, going to have better micronutrients. And then I’m going to pair it with fat, protein, and fiber because those things actually can blunt our response to the glucose load. So, for me that looks like putting almond butter or tahini on it, and then sprinkling chia seeds all over it.

Making Levels accessible

Levels provides valuable insight into real-time glucose levels. The goal is to make it readily available to anyone who wants it.

Our mission is to reverse the metabolic disease epidemic. And that might seem surprising to people because a lot of our early customers are pro athletes, people interested in performance and longevity, people who already seem healthy. But really what our goal is, is to scale this and to make these as we grow a market for these devices and this software that interprets our glucose data. This is going to become much more accessible, much cheaper, and we’re going to be able to reach that scale of people who really need this can have it and can really learn how food and lifestyle decisions are affecting them. And so, our hope really is to create a closed-loop biofeedback behavior change mechanism that gets people really excited to and get fun to understand your body, understand all these levers we can pull.

Live a clean lifestyle

Lifestyle goes beyond diet and exercise. It’s also important to be mindful of things like toxins and chemicals that are prevalent in modern life.

The last one is the toxins. So many of the personal care products we’re using, the packaging we’re using for food, the pesticides on our food have endocrine-disrupting chemicals essentially in them like phthalates and glyphosate and other things that actually just are chemicals that go into our bodies and just break our metabolic machinery. So every day, am I drinking clean water? Am I trying to expose myself to good air? Am I not using plastics, not microwaving plastics, using glass instead, using clean beauty products, trying to find shampoos and stuff that on the Environmental Working Group website aren’t filled with endocrine disruptors? Again, not going to have an impact on my glucose tomorrow, but over the course of months and years, they will have an impact on that machinery.

Seek out nutrients

Modern farming practices result in food that contained fewer nutrients. This means it’s valuable to buy organic produce and take supplements.

Our food is essentially much more micronutrient deplete than it was 50 years ago, 100 years ago. And that’s a lot in part because of our industrialized farming practices, which is essentially, we’ve sprayed our cropland in the US with pesticides that have killed a lot of the bacteria and the biodiversity of our soils. And the bacteria and the biodiversity in our soil. Soil is supposed to be a living thing. There are literally billions of bacteria in a tablespoon of soil. But when we’ve covered our soil and our cropland with all this terrible crap, basically, we’ve created sterile soil. And so we actually can’t create the nutrients in the soil that our food needs to be nutrient-rich.

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Dr. Casey Means: There is no magic bullet for metabolic health. Metabolic health is our foundational health and we ultimately just do have to live our days out to support our body’s functioning, learn about exercise, and all these other things to really just build a holistic understanding about metabolic health. Learn how specific foods are affecting you versus other people and just make smart informed decisions.

Danielle Canty: Welcome to the BossBabe podcast, a place where we share with you the real behind-the-scenes of building successful businesses, achieving peak performance, and learning how to balance it all. I’m Danielle Canty, co-founder and president of BossBabe and I am not your host of this episode but a certain lady is, do you want to introduce yourself?

Natalie Ellis: I’m Natalie, CEO of BossBabe and I am your host for this freaking amazing episode.

Danielle Canty: Okay, full disclosure, I have not listened to this episode yet but I am so freaking excited too because you and Casey dive into everything blood sugar-related and I felt this is a really under-discussed topic. So, before we start the episode, Natalie, just give us a little bit of an overview. What did you discuss? Who is Casey? Who is Levels? Tell me all the things.

Natalie Ellis: I know you are going to get so much out of this. I’m so excited for you to listen. So yeah, I interviewed Dr. Casey Means. So she is a Stanford-trained physician and she’s chief medical officer and co-founder of the metabolic health company Levels that I talk about all the time. And she’s also an associate editor of the International Journal of Disease Reversal and Prevention.

Natalie Ellis: So 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.

Natalie Ellis: I’m obsessed because I love any kind of tech tool that’s going to help me to analyze my health and just full disclosure, I have been using a CGM for a really long time and I was finding it really hard to analyze the data. So, for anyone who doesn’t know what it means, a continuous blood glucose monitor basically monitors your blood sugar.

Natalie Ellis: But for anyone that doesn’t really know a lot about blood sugar and isn’t diabetic, it can be really confusing. And so, I was getting my day and I was like, “I don’t know what this means or what I should actually be doing with it.” And I came across this company called Levels, I begged them to let me on the waitlist and once I started using it I called the founder and I was like, “I want to invest in this, I believe in what you’re doing so much,” and I’ve never stopped using it since I discovered it. It’s been incredible.

Natalie Ellis: So, I was really, really excited to this conversation. I’m glad you let me do it on my own because I got to ask all the questions I wanted to ask and particularly I think the reason that you’re going to love it is just so much behind hormones in terms of metabolic health and blood sugar.

Natalie Ellis: So often we think sex hormones are maybe the issues behind problems we’re having like moodiness or acne or all the common things but a lot of it stems to metabolic health.

Danielle Canty: Well, I’m just really excited to listen. Just before we even started recording this episode, I was just telling you that my acne has been really playing up. I actually really haven’t spoken about my acne story. We should probably do another podcast on that because I actually like you, we both have been on Roaccutane because we were suffering but I came off and it has been fine and now it’s playing up again and I definitely now I’m like, “Hang on a minute, I can’t just bandaid this again, I need to find out what’s happening with my blood sugar levels.”

Danielle Canty: So, from a selfish point of view, I’m really excited to listen to this episode because I think I’m going to get one myself so I can monitor it a little bit more because just from what you were saying and how much all of these things link up even for my medical angle, I know roughly but still wasn’t something I really dove into.

Danielle Canty: I don’t feel like it’s actually a big topic of conversation when it comes to things like acne or it comes to things like polycystic ovaries, or it comes just general well-being. It’s not the first thing that a lot of people are talking about with regards to the importance of monitoring blood sugar.

Danielle Canty: So, I think a lot of people are going to get things out of this episode, but also feel empowered then. I think that’s what’s amazing about this device is it gives a lot of empowerment to you, the user to understand your body more and make changes.

Natalie Ellis: Yeah, totally. And it’s crazy that we both have been diagnosed on some level with polycystic ovarian syndrome. We are among a lot of women that have had hormonal issues. So definitely, we’re going to get you on Levels, I’m going to send you the link right after we listen to this episode.

Natalie Ellis: And then we also need to get you doing acupuncture because that is such a game-changer. Because the thing is your diet is so clean, you exercise, you do all the things that are on paper you should be doing. But there’s so much behind that that it can be really hard to even know about if you don’t know the right things to look at or you don’t have the data. So we’re going to get you on that, we’ll keep everyone updated.

Danielle Canty: Yeah, I’ll be the next guinea pig now.

Natalie Ellis: Yeah, well, I was just telling Danielle before this episode started. So I’ve been using my CGM for a really long time. And I was used to seeing lots of spikes up and down with my blood sugar, my blood sugar was up and it was down. And it was just very, very spiky.

Natalie Ellis: And I was just telling Danielle, I am so proud because, in the last two weeks, my blood sugar has been in range, in the green approved range 100% of the time, which is massive.

Natalie Ellis: Yeah, because when I started, I was probably in range 60% of the time, and that means my blood sugar was either going too high or it was going too low. And it wasn’t in the kind of the middle greenbelt where it should be.

Natalie Ellis: And so to get that from 60% to 100%, it’s been a long journey. It definitely didn’t happen overnight. But that, to me is amazing to see. And I notice the difference. Plus doing acupuncture, healing my gut, taking the supplements, having a great diet, those things have really helped and it’s such a journey because I still get symptoms like stress is definitely the one thing that I notice flares things up for me.

Natalie Ellis: So, I’m not perfect by any means and I still get a ton of things that pop up. It feels good to see progress. That’s the main thing. It’s not perfection, it’s just progress.

Danielle Canty: Yeah, and I’m just thinking, if you really love this episode, and you’re really looking to improve your health a good little combo of listen to this episode, and then the Shawn Wells one that we did because he gave some good supplements links. So I know one of them you’ve been utilizing as well. So Shawn Wells was like a couple of weeks ago, so you can dig back and find that in the archive.

Natalie Ellis: Yeah.

Danielle Canty: But also, before we jump into the episode, I just want to share with everyone guys, this is an informative podcast. It’s not meant to be medical advice for you guys as individuals. So please make sure you can take it on board, but go and consult your own medical practitioner, or whoever that is and get a bespoke advice to you. But this is a really good informative one. So you’ll have lots of questions to ask, but make sure you do seek out professional advice. That’s so lovely.

Natalie Ellis: Very formal. And one thing I would just say too, is when you’re listening to this and you’re hearing just how many people suffer from metabolic dysfunction, if you listen to it and you realize, “Oh shit, that’s me.” It’s not about panicking. It’s not about, “Oh God, I’m in a really bad spot.” It’s about, “Oh wait great, this is amazing that I’m now putting my awareness towards this and I know that there’s something that I get to focus on and just be conscious of and not alone,” is a really big step.

Natalie Ellis: Knowledge is everything and the big thing that we always want to do with this podcast and we did it a lot with birth control is just bring awareness to things and it’s totally up to you how you decide to take it and whether you decide to action anything. But I feel like, Danielle, between me and you, we’ve been through so many things that we get to share it.

Danielle Canty: It’s so true and I love that this episode is about the real behind the scenes of business and also you’re only going to be successful in business if you’ve got good health and wellness and mental health. So, I really enjoy getting and to talk about these conversations as well and be very open about our struggles with various pieces of it. So, it’s going to be an amazing episode and like I said, I have not listened to it yet but I’m so excited.

Danielle Canty: So, let’s make sure we dive in but before we do, let’s just… If anyone loves us and if you get some really key takeaways, please make sure you share and tag us. Tag @iamnatalie and tag @bossbabe.inc because we love to hear your favorite takeaways and that always helps us form the next podcast and who we get in as well. So, we love to hear what you love.

Natalie Ellis: Yeah, and then if you are interested in trying Levels, I’m literally getting Danielle on it right now. I love it. I never ever would recommend anything that I don’t personally stand by and love and I can see hands down this device is changing my life. So, I’m going to put the link in the show notes below. You’re going to love it. Okay, Danielle, are you ready? Let’s dive in.

Danielle Canty: Let’s go.

Natalie Ellis: A BossBabe is unapologetically ambitious and paves the way for herself and other women to rise, keep going, and fighting on. She is on a mission to be her best self in all areas. It’s just believing in yourself. Confidently stepping outside her comfort zone to create her own vision of success. Welcome to the BossBabe Podcast.

Dr. Casey Means: Thank you so much, Natalie, I’m thrilled to be here.

Natalie Ellis: I’m so excited to dive into this. I’ve been looking forward to this all week. I have so many questions for you. And I really want to start at the top and just talk about, what is metabolic health? Why is it important? And why are we hearing this term thrown around?

Dr. Casey Means: Yes, this is such an important question. So really, metabolic health is our foundational health. Every single cell in our body, and we have over 30 trillion of them, requires energy to function properly. For every single one of our cells that make up our body to work, they need to produce energy. And that’s what metabolism does.

Dr. Casey Means: Metabolism converts the food we eat into energy our body can use. A currency that it can use, which is generally called ATP. And when those processes of converting food to energy are working properly, our cells can function properly. And when that happens, our organs work properly, our tissues work properly, and our bodies are functioning well.

Dr. Casey Means: When our metabolic processes are not working efficiently, or are overloaded, or these pathways are in some way, perturbed, we have metabolic dysfunction, which means we’re not producing energy properly. And that essentially leads to cellular dysfunction, tissue dysfunction symptoms, and disease.

Dr. Casey Means: And so really, metabolism is a foundational pathway in our body. Unfortunately, in our modern, Western world, the way that we’re eating and the way that we’re living, so our diet, and our lifestyles is really hijacking that cellular machinery that allows us to produce energy in our cells efficiently, and it’s causing huge problems.

Dr. Casey Means: An example of this is just the fact that we’re eating on average around 150 pounds of refined sugar per person per year. All of that sugar has to be converted by our cells to either energy or stored. About 100 years ago, we were eating maybe one pound of refined sugar per year.

Dr. Casey Means: So we’re doing 150 times what our body used to do under normal circumstances. So our processed refined foods is just overloading the cellular machinery. And that can cause a real breakdown in these processes, and create problems for us.

Dr. Casey Means: And what’s so interesting about metabolism and metabolic health is that because it’s such a core fundamental pathway to every cell in the body, when it’s not going properly, it can look like almost anything. And in that sense, it is almost the trunk of the tree of so many health conditions that we are seeing today in the Western world.

Dr. Casey Means: It’s really like where this metabolic dysfunction is showing up, is where we’re going to see symptoms. So for instance, if there is metabolic dysfunction problems with energy production in the ovaries, it could look like polycystic ovarian syndrome, which is essentially insulin resistance of the ovaries, metabolic dysfunction of the ovaries.

Dr. Casey Means: If this is happening in the brain, it could look like Alzheimer’s dementia, or it could look like other brain symptoms like depression, anxiety, chronic fatigue, chronic pain. These are all things we know that are related to metabolic dysfunction.

Dr. Casey Means: If it’s happened in the liver, it could look like fatty liver disease. If it’s happening in the blood vessels, it could look like heart disease, it could look like stroke, it could look like small vessel disease like retinopathy, or even erectile dysfunction, which is a problem with blood getting to the penis.

Dr. Casey Means: So, it’s really like where this is showing up is where symptoms emerge. So, metabolic disease can just look like so many things. And actually, 9 of the 10 leading causes of death in the United States are related to problems with our metabolism, problems with our blood sugar.

Dr. Casey Means: And it links back really to a lot about nutrition because fat and blood sugar, so fat and glucose. Glucose is another word for blood sugar. These are the two main things that are converted by ourselves through our metabolism to cellular energy. So these are things that we can really look at and understand what’s going on with our metabolism by tracking things like glucose.

Dr. Casey Means: And we know that when we’re overloading our body with glucose, with sugar, with refined carbohydrates that turn to glucose, when we’re putting so much of that into our body, it can cause this dysfunction in metabolism. So, that’s the landscape of what metabolism is, why we’re having big scale problems right now with this in our country.

Dr. Casey Means: We’re reaching epidemic-level proportions of metabolic dysfunctions, and why that core pathway is related to so many of these seemingly disparate health conditions that we’re seeing when in fact, a lot of them are very related by these core pathways.

Dr. Casey Means: Just one thing to mention just to underline the magnitude of how important this is, is that there’s a recent study in 2018 from the University of North Carolina that suggested that 88% of American adults have evidence of metabolic dysfunction. So only 12% of American adults are optimally metabolically healthy. This is almost entirely preventable. We’re not fated to have metabolic dysfunction. This is almost exclusively because of long-term dietary and lifestyle choices.

Dr. Casey Means: We also see it in our obesity and our overweight rates. We have 72% of Americans are overweight or obese. And we have 128 million Americans with diagnosed blood sugar problems with pre-diabetes or diabetes. All of this is under that heading of metabolic disease, and it’s really monumental. It is the biggest health epidemic that we’re facing globally right now. And we put a lot of different names on the manifestations of this, like PCOS and Alzheimer’s and heart disease and diabetes and obesity. But fundamentally, it’s really all related to the same dysfunction in core pathways.

Natalie Ellis: Wow. Firstly, I’ve never heard it explained so succinctly in a way that I fully understand. So I’m so grateful that you just did that. My mind is blown. So 9 out of 10 leading cause of death are metabolism-related, that is crazy. I remember my gynecologist telling me, she said, “Oh, the biggest cause of miscarriage I see is blood sugar related too.”

Dr. Casey Means: Mm-hmm (affirmative).

Natalie Ellis: This blows my mind.

Dr. Casey Means: It is, yeah. The number one cause of infertility in the United States is polycystic ovarian syndrome. And globally, it’s estimated that up to 26% of women are dealing with polycystic ovarian syndrome, which is amazing because fundamentally, this is a problem with glucose dysregulation in the body. And what happens when our glucose is dysregulated.

Dr. Casey Means: And again, going back to what we talked about in the beginning, when glucose is elevated, day after day, over and over again because of how we’re eating and how we’re living, what that does is that causes actually a hormone in the body to be released called insulin.

Dr. Casey Means: Insulin is the hormone that’s released in response to glucose and tells the cells to take up that glucose from the bloodstream. So you eat the food, you digest it, the blood sugar elevates, you release insulin, it helps you take that glucose out of the bloodstream, the body wants to get back to normal levels in the blood. And then inside the cells, it’s either used to make energy or any excess is stored. And that’s where a lot of problems arise.

Dr. Casey Means: But when that insulin gets stimulated over and over, and over and over again, day after day, year after year, like so many are doing from basically infancy these days, what happens is our cells actually become numb to the signal of insulin and they become what’s called insulin resistance.

Dr. Casey Means: They say, “Oh my gosh, there’s so much insulin around, we’re going to block the signal,” and the in is full, we can’t take any more glucose in. And so then what happens is the body overcompensates, makes more insulin to drive that glucose into the cells.

Dr. Casey Means: And this is this process of insulin resistance that ultimately leads to a lot of this metabolic dysfunction we’re talking about where there’s an overabundance of glucose in the bloodstream, but the cells are less responsive to the insulin and it can’t get in and then we end up having elevated glucose in the bloodstream.

Dr. Casey Means: How that relates to infertility is that that high insulin actually stimulates our ovaries to make testosterone. So, in our ovaries have cells called theca cells, which are insulin-responsive, and when they are stimulated by elevated insulin, they actually make male hormones, they make testosterone and androgen hormones and they also promotes the proliferation of theca cells.

Dr. Casey Means: The other thing insulin does is it reduces our level of what’s called sex hormone-binding globulin, which is a protein that binds testosterone in the bloodstream. So we end up having more free testosterone floating around, and that is what leads to menstrual irregularity, ultimately, infertility, and many of the other problematic symptoms of PCOS like acne, excess hair growth, and central abdominal fat and obesity.

Dr. Casey Means: And actually, over half of the women with PCOS will develop type 2 diabetes by the time they’re 40, which is incredible. And so, there’s been a huge amount of research showing that actually low glycaemic, low glucose stimulating diets that don’t cause those spikes in the bloodstream can really improve our insulin sensitivity and improve PCOS outcomes. There have been studies that have shown that it can really reverse the hormonal abnormalities and people can become more fertile.

Dr. Casey Means: There was an amazing study in 2020 that looked at only 12 weeks of what was a ketogenic diet. So ketogenic diet, meaning very low carb, relatively high fat, so fat doesn’t stimulate insulin very much, carbohydrates do stimulate insulin. And so it was putting these women in a situation where they were not eating a diet that stimulated much insulin.

Dr. Casey Means: And over the course of 12 weeks, they were able to, by and large, reverse their metabolic abnormalities, decrease their insulin levels, increase their insulin sensitivity, improve all their hormone levels, and decrease their weight by a very significant amount.

Dr. Casey Means: What I really loved about this study is it wasn’t just like, eat no-carb and eat high fat, like all comer diet, it was a very healthy what they called Mediterranean ketogenic diet. So it was super heavy on leafy greens, low carb vegetables, unlimited amounts of greens, and vegetables, which have all the beautiful nutrients that are going to help just with general cellular processing, and then really thoughtfully sourced fat like fish and high-quality meats and eggs and things like that. And it was actually a quite limited quantity of meat. So it was a very thoughtfully chosen ketogenic diet, which I think is partially also why they had great success.

Dr. Casey Means: So, not to belabor the point too much, but it’s just really interesting that even something like fertility, which I think the average person walking around would really not think about in relation to their diet, but the leading cause is very much related to everything we’re talking about.

Natalie Ellis: Wow. And so have you seen the best results in terms of reversing diagnosis like PCOS or insulin resistance through ketogenic diets?

Dr. Casey Means: Personally, it’s not something that I’ve addressed very much in my practice. And actually, most of my colleagues who are OB-GYNs are actually very unfamiliar with this body of literature. Because we, in the United States, in the Western world, we don’t tend to reach into our nutritional toolbox as physicians to as first-line therapy for patients.

Dr. Casey Means: It takes a long time to explain these types of diets. And we’re not taught about nutrition in medical school. It’s much easier to actually just prescribe a pill. And some of the pills that are prescribed for PCOS, not surprisingly, one is a diabetes medication, Metformin.

Dr. Casey Means: So we’re actually prescribing a diabetes medication to treat infertility, but we’re not really talking about diet. So, it’s been a really fun journey to speak with my colleagues about this. And people are very, very interested. But I think there’s a world in which nutrition is really going to become a first-line therapy for polycystic ovarian syndrome.

Dr. Casey Means: Erectile dysfunction, very similar. It’s directly related to metabolic dysfunction. So I think, actually, there’s a really interesting world around sexual health, hormonal health, and blood sugar that is going to be more mainstream, and hopefully, through conversations like this, and really getting some of that awareness out.

Natalie Ellis: Yeah, that makes so much sense. And so going back to when you were saying, this can be affecting lots of different parts of the body, from ovaries to liver to brain, does metabolic dysfunction as a whole have a number of symptoms that if anyone’s listening, could hear and think, “Oh, actually, maybe my metabolism isn’t performing the way it should be.”

Dr. Casey Means: Yeah, I think it can really… I would categorize it into the overt signs that are a little bit more obvious and then the subtle signs. So, when we talk about overt signs of like, is the body not processing energy properly or storing energy improperly? You think about things like obesity, that’s dysfunctional fat storage. We’re clearly channeling excess energy into a storage form.

Dr. Casey Means: So people who are dealing with stubborn weight can’t seem to lose weight. We know that as weight goes up, insulin levels are likely higher. And so that’s a sign of insulin resistance. And that’s not universal, but there is a trend of as weight increases that we likely have more issues with insulin resistance, which makes sense because again, insulin is that hormone that is elevated when we have excess glucose.

Dr. Casey Means: The interesting thing about insulin is that the secondary purpose of insulin is to block fat burning. So it’s a signal telling the body we have tons of glucose for energy, don’t burn fat for energy. So when it’s high, we’re not going to tap into those fat resources. And so, if we’re thinking about weight loss, we really need to be thinking about insulin.

Dr. Casey Means: So, overt things, obesity, overweight, I would say overt things would be things like diabetes and liver disease, Alzheimer’s, cardiovascular disease like heart disease and stroke, chronic kidney disease. But really the subtle things, I think are even more interesting.

Dr. Casey Means: When we think about what happens when the body’s not making energy properly? It can look like a lot of the full spectrum of daily pain points that we experience in our modern life that keep us from reaching our full potential and our goals.

Dr. Casey Means: So things like general fatigue, brain fog, moodiness, up and down mood lability during the day, maybe lack of exercise endurance, maybe some acne, maybe increased pain. “Oh, my neck always hurts, my back always hurts.” It could look like hunger.

Dr. Casey Means: When we are hungry, what does that really mean? It means that you have gone a few hours without food, and now your body feels like you really need food. And what’s actually happening in the body? Well, your body’s essentially probably so dependent on glucose and not really able to tap into fat for energy that when you don’t have glucose immediately onboard through like a snack or a meal, your body just says, “Oh my gosh, panic, I need to eat more.”

Dr. Casey Means: When in fact, if our bodies were more metabolically attuned and flexible, when glucose was low between meals, our insulin would be low enough that we would just flip into fat burning. That break on fat burning would be lifted. So, I like to say hunger or really being anxious before your next mealtime, that could be a sign.

Dr. Casey Means: If we’re getting sick all the time throughout the year, like bad flu cases, or sinusitis, or things like that, that could be a sign. We know that high blood sugar impacts our immune system and actually decreases our immunity. This actually is very relevant to COVID because it’s been known for over a year that high blood sugar is one of the key factors in increasing COVID morbidity and mortality.

Dr. Casey Means: So, I would say those more subtle things, certainly, glucose isn’t the only cause or metabolic dysfunction. But we know for everything I just mentioned fatigue, brain fog, moodiness, depression, anxiety, poor exercise endurance, acne, poor immunity, increased appetite, these things all can be related to just essentially not being able to harness energy from food properly, and we end up getting symptoms arising from where that’s showing up in the body.

Dr. Casey Means: So I like to say that glucose variability in our day tends to map on to subjective variability in our day. If my glucose is shooting up after a high carb-meal, my body is going to release tons of insulin and my glucose isn’t going to crash down. And that can often be associated with that post-meal slump, needing a little nap like a food coma, maybe a little bit of anxiousness in the afternoon.

Dr. Casey Means: So, really keeping glucose more stable not only helped us in the long-term by keeping our insulin lower and helping us really prime ourselves for insulin sensitivity but also just keeps us from going on this roller coaster during the day that can be unpleasant.

Natalie Ellis: And it sounds like so from some of those symptoms like acne or changes in mood, I think for a lot of women, we might hear that and think, “Oh, my hormones are playing up,” which blood sugar is definitely playing into. But when we think about or maybe it’s like our sex hormones playing up, are you saying actually metabolic health and insulin, that’s really the root cause? It’s not that your sex hormones are necessarily the root cause of this, but they may be impacted because of your metabolic health?

Dr. Casey Means: Yeah. So I think it’s all related in a really big and complex web of which one part of it is the glucose. So, let’s take acne, for example. This is a very interesting one. So, we know that essentially, again, glucose stimulates insulin, and also stimulates another hormone called IGF-1, which is insulin-like growth factor 1.

Dr. Casey Means: So we’re eating high glycemic diets, we’re getting a lot of insulin stimulation. Well, insulin, in the same way that it stops us from burning fat, it helps us store energy, it tells us to store glucose as energy, it tells us to not break down fat, it’s an anabolic, pro-growth hormone.

Dr. Casey Means: So, how does this play out in the skin? Well, interestingly, in our hair follicles, there is a gland called the sebaceous gland. And that’s what produces oil around the hair. And when our sebaceous glands are stimulated by insulin and IGF-1, they actually produce a lot more oil, and you get what’s called sebaceous gland hypertrophy, meaning they’re too big, they’re producing too much unregulated.

Dr. Casey Means: So that’s like an anabolic pro-growth signal in the skin. And that is thought to be part of the pathogenesis of acne. Add to this, that you’ve got excess glucose in the interstitial space or in the skin, in the tissue, in the blood, which can feed bacteria, which can then interact with that oil to create worse situations for acne. And add in the fact that high insulin stimulates testosterone production, which can also drive jawline acne.

Dr. Casey Means: So, from multiple levels, you’ve got this feeding into the complex physiology that can lead to this. When you look at interventional studies of people who are on a low glycemic, lower sugar, more blood sugar balancing diet, again, over the course of just really short-term studies.

Dr. Casey Means: I think the ones I’m thinking about are like three months studies on a low glycemic diet, people have significant improvement in their number of acne lesions. And even when they’ve taken biopsies of the skin, their sebaceous glands actually shrink in size. So, it’s pretty fascinating stuff.

Natalie Ellis: Yeah, it’s so interesting, and I’m so incredibly passionate about it because when I found out that I had PCOS and started doing my research, finding out that insulin resistance are the root cause of a lot of these things, I remember thinking like, “Why is no one talking about this? Why am I only finding out about this from reading numerous books, and digging into it?

Natalie Ellis: Like you said, it’s not something that perhaps an OB-GYN knows about right now. And hopefully, that’s going to change through conversations like this. But the fact that you’re saying 88% of Americans have metabolic dysfunction, there needs to be more discussion around this. And I’m so excited about what you guys do because it’s been such a game-changer. And we’re going to get into that.

Natalie Ellis: And I know one thing that you talk about is the pillars of health. So diet, exercise, stress, and how these relate to your metabolism. Can you speak a little bit about that so that everyone listening is like, “Okay, I definitely think I have some dysfunction going on.” We can start to talk about what they could be doing in their lifestyle to adjust that and strengthen their metabolism.

Dr. Casey Means: Sure, absolutely. And I think of everything on the level of ourselves, that’s the way my mind works. And I think it’s interesting to think about like, we’re essentially trying to make ourselves function more properly, we’re trying to make our digestive cells work properly, our insulin receptors on our cell membranes work properly, it’s all comes down to function. And it all working in harmony in the body in this unified system.

Dr. Casey Means: And so, there are a number of pillars of health that are essentially behaviors and choices we make that we know translate into, essentially how the body functions. And there’s really seven that I tend to focus on. And all of them feed into our level of metabolic health with thousands of papers in the medical literature to support that.

Dr. Casey Means: So, the first is food. I’ll just list them all first, and then we can talk more about any of them. But really, it’s food, stress management, sleep quality and quantity, exercise and how much we move our body, our microbiome, our micronutrient status in our bodies, and then how much exposure to toxins and pollutants we have in the body.

Dr. Casey Means: So, those seven things all have an impact on essentially how our cells work. And within each of them, there’s a lot of nuance for really how we can optimize each pillar to make sure that we are supporting our bodies function.

Natalie Ellis: I love that so much. And I’ve wrote them all down. And for anyone listening, I’ll link below so that we can list those out. So when it comes to taking a look at someone’s diet as a whole, or lifestyle as a whole, what are some foods or ways of eating that would be metabolically supportive? And same with exercise, things like that?

Dr. Casey Means: Well, with food, it really comes down to four things. So, one is our actual food composition. What we’re eating and how we’re pairing food, how we’re balancing meals. The second is food timing, when we’re eating. The third is food sequencing. So how we’re actually sequencing things in a particular meal. Are we putting carbs first? Are we putting fat first? And then the fourth is the nutrient composition. So actually the quality of the food and how much nutrients it’s giving us.

Dr. Casey Means: So, within the food composition, the key thing that we want to focus on is not having large glucose excursions, glucose spikes after our meals. We want our glucose in our bloodstream to be like gentle rolling hills, a little bit up after a meal, and then it comes down back to baseline, which is a little bit of insulin that has to be released to bring it back.

Natalie Ellis: Can I just ask you for the specifics? What does that look like in terms of numbers for someone that’s using a CGM?

Dr. Casey Means: Yeah. So, if we’re just going to talk about party line, what the International Diabetes Federation recommends, it’s that you generally don’t go above 140 milligrams per deciliter after a meal. So you stay below 140. If you look deeper into the medical literature, it’s probably more likely that we want to stay under about 120 milligrams per deciliter after a meal.

Dr. Casey Means: I personally don’t like to go really above over 30 points or my pre-meal baseline. So let’s say I start my glucose before lunch at 85 milligrams per deciliter. I don’t want to go 30 points above that after a meal. I want to keep it just a gentle 15 to 20 point rise and then come back down to my baseline all within about two hours.

Dr. Casey Means: And so, if you’re just out eating standard packaged foods in the grocery store, chips, french fries, breads, crackers, tortillas, it is very easy to go up 80, 90 points. We see this literally all the time. And what happens then is you’re overwhelming your bloodstream with glucose.

Dr. Casey Means: Surging out insulin, which is what is supposed to happen, your body’s trying to get it back down to baseline but it often overshoots when you’ve had that big of a spike and then you end up crashing and actually dipping below your pre-meal baseline. And that’s called reactive hypoglycemia.

Dr. Casey Means: So what’s happened is a number of things with that big glucose spike. The first is that you’ve exposed your bloodstream to all this glucose, which actually in its own right has problems. Really high glucose in the bloodstream can do three things. One, it can cause inflammation. Actually, a really big glucose spike can cause your body to be like, “What’s going on? There’s a threat or something.” So it causes inflammation.

Dr. Casey Means: That glucose can stick to things in the body, which is called glycation. And that can be a problem, that can actually cause if glucose sticks to proteins in the body, it can cause dysfunction with how they work. It can also cause oxidative stress or reactive oxygen species. So like free radicals and damaging metabolic byproducts. So that’s one thing that happens when you have a big spike.

Dr. Casey Means: The second thing is the huge insulin surge, which again, is going to overtime, if that’s happening every single day all the time could lead to insulin resistance, which is where your cells basically aren’t taking up glucose properly because the cells are becoming numb to insulin.

Dr. Casey Means: And then the third thing is that you get that crash, that reactive hypoglycemia, where your blood sugar actually goes lower than it’s supposed to after a meal which can lead to that jitteriness, that post-meal slump, brain fog, anxiety, etc. So, on every level, a huge spike is not going to be supportive of health.

Dr. Casey Means: And it’s not like one spike is going to damage your health forever, it’s just that the way we’re living where we eat three meals, we eat multiple snacks, and the vast majority of calories in the American diet come from refined and processed foods that tend to spike glucose. You can imagine after 5, 10, 20 years of this, it’s so much for the body to handle.

Dr. Casey Means: So, what we want to do with food is figure out how to eat in a way that keeps that glucose more stable. What that might look like for practical reasons, is really pairing our foods properly. We don’t really want to eat carbohydrates just alone. I try and avoid what I call naked carbohydrates, which is just like a big giant apple. The macronutrient that’s dominant in that is carbohydrates.

Dr. Casey Means: So, if I’m going to eat an apple, I’m going to first of all try and eat a smaller, organically grown, maybe local apple. Has less sugar, grown in better soil, going to have better micronutrients. And then I’m going to pair it with fat, protein, and fiber because those things actually can blunt our response to the glucose load.

Dr. Casey Means: So, for me that looks like putting almond butter or tahini on it, and then sprinkling chia seeds all over it. That’s fat protein and fiber right there. Or I’ll put it in some full-fat, non-dairy yogurt with chia seeds. And so it will really change the way my body processes that glucose.

Dr. Casey Means: The other thing that we can do is think about when we’re eating. We talked a lot about food timing earlier. We know that glucose loads later in the evening, tend to have a higher glucose response. Actually, eating carbohydrates more in the early part of the day tend to have less of a glucose response. We tend to be more insulin sensitive early in the day.

Dr. Casey Means: So thinking about when we’re eating and trying to wrap up our high carb meals well before bedtime is another strategy. And that is just identifying foods. This is where continuous glucose monitoring comes in. Identifying foods that you’re eating and finding out which ones uniquely are spiking your glucose.

Dr. Casey Means: One of the fascinating things is that you and I, Natalie could both eat the exact same food, the exact same banana, and have totally different glucose responses to it. I might go up 70 points and you might go up 10 points. So for me, it’s not the best metabolic choice and for you, it might be a better metabolic choice. And this has been studied in detail.

Dr. Casey Means: There was a great paper that came out a couple years ago called personalized nutrition by prediction of glycemic responses. And what they did was just this, they gave 800 healthy people wearing continuous glucose monitors standardized meals and looked what happened to their glucose. They saw that it was varied all over the place, even response to the same mood.

Dr. Casey Means: Then they studied why? What are the things that are causing people to respond differently? One of the big factors was microbiome composition. So how our microbiomes are actually processing that glucose before it gets into our bloodstream.

Dr. Casey Means: So that’s where CGM can be really interesting is to find out which foods are uniquely spiking you. And then you can work to either balance them better, you can reduce the portion size, you could potentially, if they’re huge spikers, eliminate them and swap them for something else that you really like. If pasta is a crazy spiker for you, try non-grain pasta like konjac root pasta, try zucchini noodles.

Dr. Casey Means: There’s ways to find out what are just massive spikers for you and then learn to swap, pair, modulate, time, etcetera with the ultimate goal of really keeping that glucose more stable, keeping that insulin more stable, and having those downstream positive effects.

Natalie Ellis: Yeah, I think that piece around how different our responses might be to food was so interesting for me. When I was chatting to your team and hearing that, I’m like, “What?” It’s so interesting how different everyone is. And I know is that to me and my husband, we both use Levels every single day and we always wear our CGMs. And we’ll have certain foods and then look at our response and it can be completely different. And it’s so interesting.

Natalie Ellis: I’m really curious, say someone… And I’ll put the links below if anyone wants to join us in Levels, but say someone’s wearing a CGM, is there any way that they could look at that and say, “Oh, I have insulin resistance, or I might not have insulin resistance.” Will the CGM tell you that?

Dr. Casey Means: That’s such a great question. The answer right now is that there’s not a one-to-one correlation between what you’re seeing on your CGM and whether you have insulin resistance. But this is actually exactly what Levels as a company is studying.

Dr. Casey Means: We have a research advisory board with faculty at Yale, Brigham Young University, University of South Florida, Thomas Jefferson University. Incredible medical advisors, Gerald Shulman, Sara Gottfried, Ben Bikman, Dom D’Agostino, who are actually studying the exact question you just asked, which is, can continuous glucose monitoring be basically a signature to tell us what’s going on? What is our underlying metabolic health based on this?

Dr. Casey Means: So right now, it would be hard to just look at a glucose curve and say, “I do or don’t have metabolic dysfunction or insulin resistance,” unless a doctor is really looking at it and digging really deep into it.

Dr. Casey Means: I would say, I can look at a glucose curve and get a sense of whether someone is insulin resistant. And some of the things that might feed into that is when they eat something high carb, a normal response is that someone spikes up, usually within 45 minutes to an hour they reach their peak, and then by two hours, they’re back down to their baseline. That means that they ate something, they secreted insulin, and their cells respond to that insulin, and then it came back down to normal.

Dr. Casey Means: For someone who is insulin resistant, they might spike quite high and then stay elevated for quite a bit longer two, three hours. And that might be a sign that their cells are resistant to that insulin signal, and they’re not able to clear that glucose as effectively. So that’s the type of thing that you might see.

Dr. Casey Means: You also might see just more general what’s called glycaemic variability, meaning just ups and downs spikes throughout the day. We know that increased glycemic variability, the up and downness of the static in the curve essentially is correlated to future risk of pre-diabetes or diabetes. So we want things to be a little bit more stable.

Dr. Casey Means: And there’s a great lab at Stanford by Professor Michael Schneider, who put out a paper last year called gluco types and it looked at this exact question, which was, can we categorize people by their glucose curves into insulin sensitivity? And it looks like we probably will be able to over time, but now it’s a little bit more of reading the tea leaves so to speak.

Dr. Casey Means: What we can learn from it that is so important is have some awareness about how food is affecting our glucose because we know that that is step one, that metabolic awareness of how we personally respond, and then how we can build out essentially a lifestyle toolbox, not just with food, but also with optimized sleep, optimized stress management, micronutrient composition, microbiome optimization, reducing toxins, moving more.

Dr. Casey Means: All those things can be at our metabolic toolbox to support that flatter and more gentle glucose line. So it gives us that awareness and that ability to build out the toolbox so it hopefully we don’t move down that spectrum and that pathway towards further metabolic dysfunction.

Dr. Casey Means: So I use it as really a biofeedback tool for all these things, as a daily reminder pf to do these health behaviors that I know are going to ultimately keep me flatter and more stable and making better choices.

Natalie Ellis: Yeah, I love that that’s coming and that’s how I use it too. And it’s the same as like wearing my WHOOP band. If I have these biofeedback tools on then I’m more likely to eat well, to exercise, to do the things I know I should be doing. It feels like it holds me accountable. Like in the window when I take my CGM off and replace it, I’m like, “Oh, well, what can we eat?”

Dr. Casey Means: Right. What’s your go-to when you don’t have the CGM on?

Natalie Ellis: Chocolate.

Dr. Casey Means: Yeah.

Natalie Ellis: Every time. You probably noticed that, that’s probably a trend where people take their CGMs off and just go nuts and then put them back on. Okay, we’re going to take a quick break right now to hear from our sponsor.

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Dr. Casey Means: I find that one of my strange weaknesses is rice crackers, I love the crunchy rice crackers. I love topping them with lots of delicious stuff, making artful arrangements. Rice crackers put me through the roof on glucose, just like-

Natalie Ellis: Oh, really?

Dr. Casey Means: … I’m like, oh my gosh. Rice, for me… Every single one of my extremely low glucose zone scores in Levels app has either rice or sweet potato in it. And so I noticed that the only time I reach for those is when I don’t have my glucose monitor on.

Dr. Casey Means: And that’s really a premise behind our company and behind what we’re trying to do. Our mission is to reverse the metabolic disease epidemic. And that might seem surprising to people because a lot of our early customers are pro athletes, people interested in performance and longevity, people who already seem healthy.

Dr. Casey Means: But really what our goal is, is to scale this and to make these as we grow a market for these devices and this software that interprets our glucose data. This is going to become much more accessible, much cheaper, and we’re going to be able to reach that scale of people who really need this can have it and can really learn how food and lifestyle decisions are affecting them.

Dr. Casey Means: And so, our hope really is to create a closed-loop biofeedback behavior change mechanism that gets people really excited to and get fun to understand your body, understand all these levers we can pull. And just really realize this is not about deprivation. This is not about not eating food. It’s not even about not eating carbs. I’m actually primarily plant-based, and I eat a ton of carbs.

Dr. Casey Means: But it’s about building a holistic approach to your life, to all aspects of your life that make your body able to process energy effectively. And that’s really my goal for everyone is to have a body that can actually create energy in the proper way so that cells can work and that bodies can work.

Natalie Ellis: And do you think you’re able to have that higher carb lifestyle because of the way all the pillars work together for you the way that you eat your food, timing, all of those things?

Dr. Casey Means: It’s all of them together, yeah. I’ve been wearing a CGM now and using Level software for about two years. So at this point, it’s almost like a no-brainer. I know that if I’m eating lentils, I’m definitely going to pair it with an almond butter sauce or a coconut milk or something like that to create that fat buffering the carbs.

Dr. Casey Means: I know that fiber to me is my secret weapon. When I have carbs that have tons of fiber, it tends to just keep me totally stable. So for me, that looks like beans, lentils as primary carb sources. So now I make pancakes actually out of mung beans because I know that beans don’t spike me. So I’ve learned to create all my favorite foods out of things that don’t spike me and then pair them with that fiber and protein to just further mitigate the spike.

Dr. Casey Means: So there’s the short-term things which is exactly what you’re choosing to eat. And I’ve learned a lot of things that really spiked me like sweet potatoes and grapes and corn and rice. And so now I just really tend to avoid those because there’s so many other vegetables and fruits and grains that are okay. And so I’ve just given up on some other really high spikers and learned some really great swaps.

Dr. Casey Means: And so, that short-term, when I eat the foods that I know work for me, my glucose is more stable, but I also have the stress, sleep, and exercise toolbox. I know that if I take a 15-minute walk after a meal, it’s going to have a huge impact on keeping my glucose more stable. So now I just do that more often. I know it’s good for my brain, it’s good for my metabolic health.

Dr. Casey Means: I know that if I’m nervous for something like giving a talk that my glucose is going to go up because we know that stress hormones like cortisol tell our liver to dump glucose into the bloodstream. So, it’s made me way more adherent about doing deep diaphragmatic breaths and looking at my WHOOP HRV data, my heart rate variability data to really like, if I am going to be nervous and I know my cortisol is going to be high, I am tapping into my toolbox of diaphragmatic breathing to hopefully lower my cortisol, I know that’s going to keep my glucose and my cells working more properly.

Dr. Casey Means: And then with sleep, that one, is just, I can’t emphasize it enough. When we get even a little bit of sleep deprivation, it throws basically all of our hormones off, it throws off insulin, cortisol, our growth hormone, our satiety hormones like ghrelin and leptin, it throws off everything. So sleep, I just make sure that that’s styled and all that, that’s my biggest struggle, I would say is consistent sleep.

Dr. Casey Means: So those are the short-term things. Food, exercise, sleep, stress, we can have an immediate impact on glucose. Then there’s the things that are more like lagging indicators that I see as building a body over time that processes glucose effectively. You don’t necessarily see the results of these choices on a day-to-day basis, but you see them over time. And that’s microbiome, micronutrients, and toxin exposure.

Dr. Casey Means: So, we know that as we build an optimal microbiome, I.e the 50 trillion bacteria in our gut, that they actually help us process food in a much more metabolically friendly way. Microbiome process fiber, turn it into short-chain fatty acids, which we absorb into our bloodstream, and they are just like little helpful, anti-inflammatory, pro metabolic regulators.

Dr. Casey Means: So, I think about food as like, how am I feeding my bacteria in my body to support my metabolic health? Similar with micronutrients. We know that all the little proteins and enzymes in our cells, like our mitochondria, which are like the powerhouse of the cell, they’re the ones that actually convert fat and glucose to energy in the cell. They require so many micronutrients to function properly, almost like locks and keys to work.

Dr. Casey Means: And this is things like magnesium, manganese, zinc, lipoic acid, omega-three fats, B vitamins, all these things that are not macronutrients like fat, protein, and fiber, but they’re micro. You don’t just eat magnesium or selenium one day and all of a sudden, all your cellular machinery is working properly. You have to do this day in and day out.

Dr. Casey Means: So, I know now which micronutrients are important for that functioning. And if a lot of the ones I just mentioned selenium and B vitamins, lipoic acid, etc. And so now when I go to the grocery store, I’m just on a micronutrient hunt of like, “I know I need these for my body to work. So how am I going to find them and eat them consistently? And this is more like the months and months of consistent decisions to build a body that works properly.

Dr. Casey Means: The last one is the toxins. So many of the personal care products we’re using, the packaging we’re using for food, the pesticides on our food have endocrine-disrupting chemicals essentially in them like phthalates and glyphosate and other things that actually just are chemicals that go into our bodies and just break our metabolic machinery.

Dr. Casey Means: So every day, am I drinking clean water? Am I trying to expose myself to good air? Am I not using plastics, not microwaving plastics, using glass instead, using clean beauty products, trying to find shampoos and stuff that on the Environmental Working Group website aren’t filled with endocrine disruptors? Again, not going to have an impact on my glucose tomorrow, but over the course of months and years, they will have an impact on that machinery.

Dr. Casey Means: So that’s getting in deeper to those seven things I talked about with the first four really being about acute responses to glucose, and then the latter three being more about building a body that is highly functional. So, that’s the big picture overview. But I think over the course of years, you get to this place where you’re just like, if your body is able to process glucose effectively.

Dr. Casey Means: And I think that’s what my journey has been. I imagine it has to do with a lot of longer-term shifts with microbiome and whatnot. But it’s really fun to think about. It gets deep into the weeds with biochemistry and all this stuff. But it’s beautiful to think about how the body works in this complex way to take all the choices we’re making every day and to basically transform them into our reality and our cellular functioning.

Natalie Ellis: I love that because it feels almost like a roadmap. So things you can do now and things you can do that are investing in the long-term picture. And when you mentioned micronutrients and making sure you get those in your food, do you primarily prefer to get nutrients from food? Do you take any supplements on top of having a varied diet?

Dr. Casey Means: Yeah. So, I think food is always the best way to get them. But I do take a bunch of supplements, to answer your question. So I’ll just briefly talk about those two things. So one thing that’s worth knowing is that our food is essentially much more micronutrient deplete than it was 50 years ago, 100 years ago.

Dr. Casey Means: And that’s a lot in part because of our industrialized farming practices, which is essentially, we’ve sprayed our cropland in the US with pesticides that have killed a lot of the bacteria and the biodiversity of our soils. And the bacteria and the biodiversity in our soil… soil is supposed to be a living thing. There are literally billions of bacteria in a tablespoon of soil.

Dr. Casey Means: But when we’ve covered our soil and our cropland with all this terrible crap, basically, we’ve created sterile soil. And so we actually can’t create the nutrients in the soil that our food needs to be nutrient-rich because that’s what those organisms did for us, they recycled these things.

Dr. Casey Means: So we’re in really a problem with their food being more nutrient deplete that never was. So even if you’re eating a beautiful plant-rich diet, you still could be nutrient deplete in our modern world. And just a plug for something I’m very interested in is the regenerative agriculture movement.

Dr. Casey Means: And this idea that we need to be going back to more traditional farming practices on a really huge scale, where we’re actually receding soil with biodiversity so that we can actually have nutrients in our food so our bodies can work. This is super tied to our chronic disease epidemics of bodies just breaking down everywhere around us.

Dr. Casey Means: So, really thoughtfully sourcing food, if you can, is one of the best recommendations I would make. And there’s lots of creative ways to do it. First of all, the easiest thing is buy organic. If you can buy regenerative, do that. But buy organic, buy local, if you can, and you can do this cheaply. You can buy frozen organic food.

Dr. Casey Means: What I like to do is I just go to the grocery store, and I’ll look for whatever’s on sale that’s organic. And I’ll just often buy that. And sometimes it’s food that I’ve never tried or seen before, but then I’ll just Google how to cook it. And I’ll end up having some really interesting new food like Romanesco or whatever.

Dr. Casey Means: And so, that’s one way to do it. You can also, there’s services like imperfect produce that will ship you organic food, but you’re going to get more nutrients from organic food, and you’re going to have less exposure to those pesticides that hurt the microbiome and hurt the body. So that’s really how I approach that nutrient question in food.

Dr. Casey Means: And then also, I’m always thinking about what each food has. So, for instance, pumpkin seeds are one of the highest sources of magnesium that we can get in our diet. And Brazil nuts are one of the highest sources of selenium we can get in our diet. Selenium and magnesium are both totally critical for metabolic processes.

Dr. Casey Means: Selenium is part of what’s called selenoproteins, which are protective against mitochondrial damage in the body. So we really want selenium so we can build selenoproteins so that we can protect our mitochondria.

Dr. Casey Means: So when I’m in the grocery store, I’m like, “Okay, I’m on a selenium hunt. I’m on a magnesium hunt. I’m on omega-three hunt, I’m on a zinc hunt. Sometimes I’ll be like, “Oh, I want to have some magnesium seeds.” Someone’s like, “What?” I’m like, “Oh, pumpkin seeds.” But in my head, I’m thinking of pumpkin seeds as my magnesium source and I’ve caught myself accidentally saying that before like, “Oh, I want to have a magnesium seed.”

Dr. Casey Means: And so I think it’s really that just really being thoughtful and you can just Google. We have a ton of content about this on the Levels blog, which micronutrients are important for metabolic health and what the sources are because it can be intimidating to figure this all out, but it’s actually fairly simple in a lot of ways when we get back to principles. High-quality food, get a diversity of food, get a lot of colorful food, and just keep it fresh and whole and unrefined.

Dr. Casey Means: Processed foods strips all these nutrients out of foods. When you take wheat even and ultra-process it into white flour, you’re just losing everything the plant had. And so, stick with as much whole foods as you possibly can. Doesn’t matter what type of diet you’re on, vegan, paleo, carnivore, whole foods is the way to go.

Dr. Casey Means: With the vitamin piece, so because we are facing an uphill battle with micronutrient depletion, and even if you’re doing really well, you still might not be getting everything you need from food.

Dr. Casey Means: I do use a test in myself and in my practice called NutrEval, which is done by Genova Diagnostics, which is a urine and blood test that looks at 150 different biomarkers in the body and essentially tells you what your nutrient status is for a lot of different things. I use that to guide my supplementation, but also my diet.

Dr. Casey Means: So it helps me know about antioxidant status, my protein, amino acid levels, my vitamin levels, my minerals. I really love that test. And I’ve supplemented based on that. If my magnesium seems to be low, I’ll just really load up on magnesium food sources, etc. So that’s one of my faves.

Natalie Ellis: Yeah. And I love that answer too because I often get asked from people what supplements I take. And I always say, “I don’t really want to tell you because this is personalized to me,” and knowing what I need, and everyone is so different that I don’t think a blanket approach is necessarily the right way to go. So I love that you mentioned that test. I’m really curious what your thoughts are on intermittent fasting.

Dr. Casey Means: Yeah, so I think intermittent fasting, and just for people who are listening, I’m sure most people are aware. But really, there’s two ways to think about. One is really time-restricted feeding, which is where you’re actually eating in a shorter eating window during the day.

Dr. Casey Means: So as opposed to snacking from eating from 8:00 am to 8:00 pm, you’re eating in a shorter feeding window, like 10:00 am to 5:00 pm. So a shorter feeding window, and then a longer time when you’re not eating.

Dr. Casey Means: Then there’s other types of intermittent fasting regimens, which is where you don’t eat for 24 hours, and then it’s a full day fast, or five days of eating and two days of not eating during the week. So there’s different ways of doing it.

Dr. Casey Means: But fundamentally, all of what this is doing is giving your body a time when you’re not putting exogenous glucose or other nutrients into the body, and therefore, you’re keeping those exogenous glucose spikes low, and therefore you’re keeping your insulin lower. You’re not stimulating your insulin.

Dr. Casey Means: So, from the perspective of giving your body a break to just process the energy that’s in your body as opposed to just using energy that you’re putting in your mouth, it’s a great opportunity. It has been shown to increase insulin sensitivity, because again, when your insulin is low, your cells are going to start to perk up to insulin again. They’re going to hopefully work against that path of insulin resistance and that numbness to insulin.

Dr. Casey Means: So, it gives your body the state of arrest from all this chemical and hormonal signaling that happens when we eat food. So, I think that it can be a really valuable tool in the toolbox to help us with our insulin sensitivity. It can be a stressor on the body, in some people.

Dr. Casey Means: If you’re already having a lot of baseline stress, or, for instance, with women, if there are certain parts of their cycle, and they’re feeling really depleted, it may actually just be too much for them at that time. It might actually exacerbate feeling stressed or high cortisol. So I think you have to use it thoughtfully and not as just like a blanket statement and really work with your body.

Dr. Casey Means: But there was a really great study that’s worth mentioning. It took two groups of healthy people, and it had them eat the exact same amount of calories per 24 hours, actually the exact same food. But one group ate all that food between 8:00 am and 2:00 pm. And one group ate all that food between 8:00 am and 8:00 pm.

Dr. Casey Means: So one group had a six-hour feeding window and one group had a 12-hour feeding window. And despite eating the exact same number of calories and food, the group with the shorter feeding window had better overall 24 hour metabolic parameters, 24-hour glucose levels, and 24-hour insulin levels, which is surprising because they did the exact same thing.

Dr. Casey Means: But when you think about what’s happening hormonally, the group that did it all between 8:00 am and 2:00 pm, they, of course, had that downstream insulin secretion, they had the glucose elevation, but they worked through it, they processed it, their body managed it, and then they had 18 hours where everything was low, and their body could just then process. When you’re eating during that 18 hours, you’re going to burn through the stored glucose in your liver, you’re going to burn through a lot of that circulating glucose.

Dr. Casey Means: And then because you’ve burned through your stored energy, your insulin is low, then you start going into fat burning. And that’s an awesome thing for the body to do. We want our body to basically work through it stored glucose, and then flip into fat burning. That’s a state called metabolic flexibility, which we know is associated with health and longevity.

Dr. Casey Means: Unfortunately, in our modern world, a lot of us never have the opportunity to burn fat because if we’re snacking all day, and our insulin is always a little bit elevated, we might never burn through all our stored glucose. And we might never have insulin low enough to burn fat. So we’re not metabolically flexible, we’re not working those pathways.

Dr. Casey Means: So fasting is this cool opportunity to essentially let your body use what it’s got. We store about three or four hours of glucose in our liver for easy accessibility. So you burn through that. And then your body starts harnessing these pathways of fat burning, mobilizing fat from your fat cells using it for energy. And that’s great. We want that.

Dr. Casey Means: So I’m a big fan of it from a physiologic perspective and insulin sensitivity perspective and metabolic flexibility perspective, but I do think it has to be used thoughtfully. Like I said, it can be a bit of a stressor on the body. So we only have a certain amount of capacity, I think each day for different stressors that we put on the body and you just have to think of intermittently fasting as one of them.

Natalie Ellis: Yeah, I love that. And I’m definitely no doctor. But I agree just based on how I feel. I don’t fast that often. But if I wake up and I’m not hungry, and I feel pretty energized, I’ll go do a fasted workout and not eat. But if I’m waking up, I’m feeling very hungry, tired, and maybe during my period, then I’m not going to fast and just playing it, that noise, being definitely very supportive for me.

Natalie Ellis: And we’ve had the same opinion and you want to ask who comes in the podcast is always the same, especially for women. A lot of these studies don’t necessarily have women at different points in their cycle. So, thinking about where you’re at and what your body means is so important. So I love that you talked about that.

Natalie Ellis: You can also tell that I have so many questions just wanting to pick your brain because there’s so many things I’m curious about. On one of our recent podcasts, it’s called The Energy Formula, if anyone’s interested. We had a leading biochemist on, he was talking about all the different supplements that excite him. And he was talking a lot about metabolic health.

Natalie Ellis: He was mentioning berberine because I brought up Metformin. Just I’ve seen quite a few studies on Metformin, and longevity, so people taking that to extend their life to live longer. And I was really curious of his thoughts and he brought up berberine, which for anyone listening, I think it does a similar thing, but it’s more natural, and you can probably correct me, but what are your thoughts on that?

Dr. Casey Means: Yeah, so berberine is a natural compound. So it’s essentially from nature that has a similar mechanism of action to Metformin, which is a medication that we use to improve insulin sensitivity. And it has been shown really in robust clinical trials to have a positive impact on blood sugar. And so it can be a nice adjunct for people.

Dr. Casey Means: I would say, while it’s a useful tool that we know about, we understand the mechanisms quite well. And it’s probably been studied better than almost any other supplement related to blood sugar. I tend to be less excited about these types of compounds that we purify, and then take in larger doses to get an outcome we want because the body is such a complex system.

Dr. Casey Means: And the framework I really like to try and emphasize is the one of thinking about the body holistically. Health comes from the hundreds of micro-decisions we make every day related to all the things we’ve talked about. It doesn’t ever come from a supplement or a pill.

Dr. Casey Means: And so, I love that it’s well studied. And I love that it’s a useful adjunct for people who need support and a boost and even for people who are just trying to stabilize their glucose, who may not have any insulin resistance. But with the caveat that it’s never going to supplement for doing the work essentially and doing the stuff day in and day out that we need to do to have a healthy body.

Dr. Casey Means: So, there’s other adjuncts like this that are worth mentioning. There’s cinnamon has been super well studied as well as something that’s an insulin sensitizer, that, I consider pretty natural and even in non-pharmacologic concentrated doses can be helpful. So I tend to try and put cinnamon in my smoothies or cook with it.

Dr. Casey Means: Also vinegar. Again, not at super-high doses, just like normal cooking doses, can be really helpful for our glucose responses to a meal. So actually, there’s been research showing that if you take even just like an ounce of vinegar, white vinegar or Apple Cider Vinegar before a carb-rich meal that it can lower glycemic responses significantly.

Dr. Casey Means: So, I think there’s ways to really use food as medicine and food as helpful adjuncts and berberine fits into that category because it’s a natural compound. So it’s certainly been well studied and appears safe and very useful. But just the take-home point I would say is that there is no magic bullet for metabolic health. Metabolic health is our foundational health, and we ultimately just do have to live our days out to support our body’s functioning.

Natalie Ellis: Yeah, that makes sense. And it sounds like it’s such a long-term thing too that slow and steady kind of thing. I want to get into Levels. And speaking of, I love mine, I’ve been wearing it for a really long time. I have to ask you a very selfish question.

Dr. Casey Means: Please.

Natalie Ellis: A few of my friends have mentioned this to me. So I think if anyone listening wears CGM might be the case for you. You might have noticed it. My blood sugar is very low at night. And so I noticed that I often drop below 70 at night, and then by the time I wake up, I’m back to normal. Is this something that you’ve seen a lot of and is there any way to support that?

Dr. Casey Means: Yeah, so there’s a number of interesting things about low glucose at night, some of which are physiologic and some of which actually just have to do with the sensor itself. So we’ll talk about the sensor one first.

Dr. Casey Means: So when we actually sleep on our sensors and put pressure on the sensors, we can have erroneously low readings, and that’s a phenomenon called pressure-induced sensor error. So, it’s been well studied and essentially if we roll over and lay on it, we will see big dips, sometimes down to the 30s or 40s. So, that’s one thing to note.

Dr. Casey Means: The second thing is that glucose actually is just lower at night and tends to be quite a bit lower during REM sleep than other phases of sleep. It’s actually really fun to correlate Levels data with WHOOP data or Fitbit data because you can sometimes see little dips that actually correlate with when you went into the REM stage. So 5% to 10% lower during REM, might see some dips.

Dr. Casey Means: And then we also know that people actually not infrequently go below a glucose of 70 milligrams per deciliter during a 24 hour period. Below 70 tend to be thought of as hypoglycemia. But when you actually just throw CGMs on large, healthy populations, and watch what happens over the course of a few days, people tend to spend not insignificant amounts of time, healthy people below 70, like in the 60s, I think in one study, it was like maybe 5% of the day or so.

Dr. Casey Means: So intermittent and dips, I think is not something to be too worried about unless you’re having hypoglycemia symptoms, which would be shakiness and irritability and sweats and mental status changes and things like that.

Dr. Casey Means: But last thing I’ll say is that when we have more glycemic variability during the day, or a really high carb meal late at night, we can sometimes throw our body into overnight roller coaster, where we’re going up and down, up and down, up and down, as our insulin is trying to control our glucose while we’re sleeping.

Dr. Casey Means: I mentioned this earlier, we tend to be more insulin resistant at night. And that’s because of the effect of melatonin, one of our pro sleep hormones on insulin function. It’s really interesting. We actually physiologically are just a little bit less sensitive to insulin at night.

Dr. Casey Means: And so, if you eat something really high carb at 10:00 pm, a dinner with bread, and then pasta, and then dessert and then sugary drink, you could just be bouncing around throughout the night up, down, up, down, up down if your body tries to calibrate. So I tend to focus on more of my “ketogenic meals” towards the later day to go into evening time with a more stable glucose.

Natalie Ellis: Yeah, that makes total sense to me. And I know as if I’m out at dinner and have a lot of bread, pasta, wine, then my blood sugar is just dancing away that night.

Dr. Casey Means: Yeah.

Natalie Ellis: So, for everyone that’s like, “I’m so confused. What is Levels?” Will you explain what Levels is?

Dr. Casey Means: Yes, absolutely. So, Levels is the first program to bring this wearable technology, this continuous glucose monitoring to a mainstream population, and to use it as a tool to essentially learn how to personalize our diet and personalize our lifestyle.

Dr. Casey Means: These continuous glucose monitors have been used for the past over 10 years, and people with diabetes both type 1 and type 2 diabetes as a treatment tool. So, these are monitors that you wear on the back of your arm, they have a tiny little probe that goes under the skin, totally painless that’s monitoring your glucose continuously 24 hours a day, seven days a week sending that information to your smartphone.

Dr. Casey Means: This was a game-changer for the diabetic community because as opposed to pricking fingers a few times a day to understand what’s going on with glucose, you just have this constant, this movie of your glucose, essentially. It’s just so much more granularity, it makes things a lot safer for management of the diseases.

Dr. Casey Means: But what we know is that the glucose affects not just people with diabetes, we need to be thinking about glucose decades before diabetes develops. The vast majority of type 2 diabetes is preventable with healthy diet and lifestyle. And so, why wouldn’t we have more awareness into this biomarker years, if not decades, before reaching these thresholds to learn how to shape our diet, shape our lifestyle, to keep things on track, to keep our metabolic health on point?

Dr. Casey Means: And so, that’s what we’re doing. So we’re bringing this really medical technology to the mainstream, and then pairing it with the software that we have created. So, the software that’s really aimed to help people come to the insights about like what we’ve been talking about throughout this whole episode, how to learn how to shape diets, pair foods, learn about exercise, and all these other things to really just build a holistic understanding about metabolic health, learn how specific foods are affecting you versus other people and just make smart informed decisions.

Dr. Casey Means: So we believe that collectively, we are going to reverse our terrible preventable chronic disease epidemic that’s costing America $4 trillion a year by empowering people with personal health information so they can make better choices day in and day out that support healthy bodies. And that’s what we’re doing at Levels.

Natalie Ellis: I’m obsessed with Levels and I actually was wearing a CGM before I found out about Levels and I was wearing it and I really, honestly had no idea what it meant. I was like, “Okay, well, I’m in the window. Oh, I’ve spiked above it. I’ve gone below and I’m guessing that’s a good or a bad thing.” I didn’t really know and I saw a friend put a screenshot of Levels on their stories. And I reached out, I’m like, “I need to get this.”

Natalie Ellis: And so I convinced your team to let me try it when there was a waitlist. And I’ve been so obsessed ever since because it gives me a way to interpret the data. Because otherwise, I feel like for me, especially the data was useful to an extent, but it wasn’t helping me make better choices or to understand where I was at.

Natalie Ellis: And I’ve seen for me a noticeable difference in my hormones and how regular my periods are. Having PCOS, I was really struggling with that beforehand, which is why I decided to get a CGM. So I’m obsessed with what you guys do. And I love that you said the price is going to come down, it’s going to be a lot more accessible.

Natalie Ellis: But right now, it’s difficult when you are at the leading edge of a technology, it’s always going to cost more because it probably costs you guys a lot more. But for me, just speaking for me, it’s worth it. It’s worth it to invest in my health, and know that this is a real long-term thing. And if I get this under control now, I think about well, when I’m in my 30s, how much healthier am I going to be than if I didn’t recognize this and get on it? And there’s really no time too late to start, I think with this stuff.

Dr. Casey Means: Absolutely. I love that. And thank you for trying it and your support. It’s wonderful, and your feedback. And yeah, our intention is to have the price of this down to $99 a month within the next year or so, that is our goal. So real slashing the price because accessibility is everything.

Dr. Casey Means: The people who are suffering the most from metabolic issues in our country, and most targeted by really what I would say unethical food marketing, and living in food deserts and all this stuff are people who probably cannot afford these high pricing.

Dr. Casey Means: So the more we can show outcomes data that push this towards potentially even covered by insurance, and really creating volume in the interest so that prices come down, that is really going to help I think us achieve our mission. And so, lots to look forward to I think over the next couple years in terms of this type of monitoring.

Natalie Ellis: Yeah, I agree. And it feels good to be an early adopter because I know without people that adopt these technologies earlier on, companies would never get the data to be able to say, “Hey, look, we’re actually doing something really meaningful over here. And this is making a difference.”

Dr. Casey Means: Exactly. Yeah. And we’ve just raised our round of funding. And we’re investing heavily into clinical research at academic universities because we really believe in this, a lot of top researchers believe in this technology as well as a tool to empower people, to help people understand their bodies better.

Dr. Casey Means: And that is just so heartening that there’s a lot of people thinking about health is not going to happen in a 15-minute doctor’s visit. It’s just where there’s no counseling about nutrition, no counseling about lifestyle, it’s going to happen in the home every single day, day in and day out when we’re making choices.

Dr. Casey Means: And so, how do we create tools that help people with choices, and then make it fun and make it liberating and make it social. And we need to be thinking differently about how we’re going to solve I think some of these massive health issues that we’re dealing with.

Dr. Casey Means: People love their data, they love data. We’re seeing wearables go through the roof. And so, I just am very hopeful about the future and really excited about all the innovation in this space.

Natalie Ellis: Me too. And I’m so grateful to you guys for doing it. And for anyone listening that wants to try Levels, I think the waitlist is over like 100,000 people now. But I have a link which will get you in the back door that I’m going to put in the show notes below. I love mine, my husband is obsessed. At first, he was like, “What is this?” And now he’s obsessed. He’s showing these numbers. So, it’s great.

Natalie Ellis: I could pick your brain for hours, but I won’t, I will let you go. I’m so grateful for you coming on the podcast and making this so understandable and easy to understand. So thank you so much for being here.

Dr. Casey Means: Thank you so much for having me. Wonderful questions. And I love chatting about this. And I hope it was useful for people listening. And yeah, I’m happy to connect with anyone who has questions afterwards. I’m @drcaseyskitchen on Instagram. And we post a lot about this at Levels on Instagram and Twitter.

Dr. Casey Means: So if people have more questions, come find us and sign up for the waitlist and get on our newsletter. There’s lots of information we’re putting out. That’s, I think, really fun and interesting. And so yeah, we’d love to connect with anyone who’s interested in learning more.

Natalie Ellis: I’ll put your Instagram link below and the blog link below too. So if anyone wants to find that, it will just be in the show notes. Thank you so much.

Dr. Casey Means: Thank you.

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