#170: How Out of Control Blood Sugar Can Cause Belly Fat, Brain Fog, and Chronic Disease

What would you do to achieve twice the energy and half the belly fat? It sounds like the opening line to a diet ad. But the real secret to taking control of your health may just be blood sugar. Previously notoriously hard to measure, that’s changing with Levels. Levels offers innovative continuous glucose monitoring tech that lets you see how your everyday choices are affecting you in real time. Dr. Casey Means joined host Dhru Purohit on the Broken Brain Podcast to explain the sugar-overloaded American health system, and what we can do about it.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out Broken Brain Podcast
• Connect with Dhru Purohit on Twitter

05:54 – What is metabolic health

The metabolic process in every cell is the breakdown of sugar and fat into energy. When this happens well, we see benefits like mental clarity, athletic endurance, stable mood, good skin, and good memory.

“We make energy by converting sugar and fat into something we can actually use, namely things like ATP. And this metabolic process of energy production is this core, fundamental pathway of every single cell in the body. And when it doesn’t work well, we see diseases and symptoms emerge. And when it does work well, we thrive and we see stable energy, we see vigor, we see mental clarity, athletic endurance, stable mood, good skin, good memory, really all the things we want. So the way this works is that when we eat carbohydrates, it’s converted to glucose and our bodies have to then release a lot of insulin to get that glucose to be taken up into the cells. And over time, if we’re eating lots and lots of carbohydrates, especially refined carbohydrates and sugars, we’re going to have our bodies required to release lots and lots of insulin. And over time, our cells actually get numb to that insulin…So we end up getting this deficit of energy inside ourselves, and you can imagine when our tissues aren’t getting the energy they need, they’re going to start falling apart.”

07:18 – What is metabolic dysfunction?

When there is insulin resistance, the body stops burning fat and leads to an energy deficit. Wherever this happens in the body, the metabolic dysfunction manifests itself as different symptoms, which are then diagnosed as different diseases.

“The secondary issue with insulin being elevated is that because it is a signal that there’s enough glucose in the blood, it says to the body, we don’t actually need fat for energy. So stop breaking that down. So it’s going to cause you to not be able to use fat as an energy source. So in two ways, that’s actually creating an energy deficit in the body. When insulin is high and we’re insulin resistant, we’re not able to process glucose effectively and we’re not tapping into fat usage. And so you can imagine anywhere this is happening in the body, you might see dysfunction. And this is why metabolic dysfunction has so many different faces clinically. If this is happening in the brain where the brain is not able to process energy effectively, it could look like poor memory. It could look like Alzheimer’s. It could look like chronic pain…So fundamentally it comes down to how we produce energy in the body. And it’s just such a core fundamental pathway. And we, unfortunately right now, don’t have a lot of insight into how this is working in our bodies. We may get our glucose, our blood sugar checked once a year at the doctor’s office, but that’s about it. It’s really hard to currently track this, measure it, and know how to improve it.”

09:20 – What eating 100x more sugar is doing to our bodies

Human bodies are not built to process excess amounts of sugar. This creates insulin resistance and causes the sugar we eat to be stored as fat.

“We’re eating about a hundred times more sugar per person now than we were about 150 years ago. And you imagine all of that sugar has to be taken out of the bloodstream through insulin, and then that sugar has to be processed by our mitochondria, the little powerhouse of the cell that actually converts that glucose to usable energy. Our bodies have absolutely no idea what to do. They are becoming dysfunctional. They’re becoming insulin resistant. We’re storing a lot of that sugar as fat. It’s just amazing how overloaded we are. And when you couple that with the fact that it’s not just about being overwhelmed by this energetic substrate, but it’s also we’re breaking down the machinery and the body through our other lifestyle behaviors. So lack of sleep, lack of exercise, chronic stress – all of these things translate into molecular information in the body that actually makes our mitochondria not function as well. So we’re not only overloading the body with this damaging substrate, but we’re also breaking down the machinery with the other things that we’re doing and living in our modern world.”

10:31 – The systemic issues in our food system

There are many political, cultural, and educational systemic dysfunctions affecting the daily choices of people in the United States. The result? The top seven leading causes of death are related to poor metabolic health.

“A lot of it comes down to the industrialized food complex and the food system, but I think there’s a lot of other systemic issues as well. Dr. Hyman’s book Food Fix really gets into a lot of these core factors of how we’ve gotten to where we are, but there are a number of things. There are cultural norms regarding nutrition and comfort food, there’s relentless food marketing and advertising, there’s the addictive nature of ultra-processed foods, there are culturally reinforced taste preferences, there are political aspects. We have farm bills that actually support the production and financing of foods that are disease-promoting. And then we have a medical education system that doesn’t focus on nutrition, and doctors aren’t given the tools of the education to really counsel or understand how important this is. But the majority of the chronic diseases we’re facing these days, actually, seven of the 10 leading causes of death in America are related to bigger control and poor metabolic health.”

13:18 – You can’t operate on the immune system

Dr. Means states that our society is systematically designed to encourage poor metabolic health, and our medical system is designed only to treat inflammation at a surface level instead of looking at its root cause.

“Why is there so much chronic inflammation at play? And why are we just reaching for our prescription pads for all sorts of heavy-duty steroids to quell the immune system, instead of asking what is actually triggering this inflammation, what’s the root cause? It’s amazing how many ways we can prescribe medication to tamp down the immune system. We’ve got nasal steroids, we’ve got IV steroids, we’ve got topical steroids. We have inhaled steroids. It’s unbelievable. And we’re not even really talking to people about the triggers. If these medications don’t work, we go to the operating room. And sure we can bust a hole in the sinus and suck the pus out, but that doesn’t actually change the underlying core physiology of inflammation. And you can’t operate on the immune system. I became interested in understanding that process and how to mitigate those triggers in order to keep people out of the operating room. And one of the key fundamental triggers of inflammation in the body is dysregulated blood sugar and metabolic dysfunction.”

17:55 – Read the label: there is sugar in everything

Learning to critically read food information is critical, because food can affect blood sugar profoundly in ways that most people don’t understand. This is compounded by the fact that almost all the food products in the supermarket have sugar in them.

“The first big problem is that there’s just added sugar in everything. You walk into the store and it’s just added sugar everywhere. It’s actually extremely challenging to go to the grocery store and buy normal products and escape added sugar. There is only one ketchup at Whole Foods that I have found that does not have sugar, Primal Kitchens, and it’s of course, much more expensive. But same with yogurts with even non-dairy milk, all of these things, salad dressings, they all frequently have sugar. So that’s just like, first things first, we have got to read the labels.”

20:00 – How to make your meals metabolically friendly

Eating carbs by themselves may cause blood sugar spikes. But that can be easily managed by pairing that carb with fat, fiber, and protein, and going for a walk afterward.

“What’s so great about experimenting with a monitoring device like a continuous glucose monitor is that it doesn’t necessarily mean that you have to eliminate these foods forever or that they’re evil, but we actually have to just think about how to make them more metabolically friendly for our body. So sweet potato is not inherently bad food, but alone sort of a naked carbohydrate, it can have some collateral damage in terms of a blood sugar spike, especially for me. And so I will add fat, fiber, protein to these types of foods now to blunt that glucose response, or I’ll make sure that I walk after a meal when I have something like that, or do a workout before a meal with a food that’s spicy to me like that. I’ll make sure that I’m really doing a mindful meal and I’m not stressed during the meal, which can make your glucose go up. So just really making sure you’re building this context for the carbohydrates you’re eating so that you can process them most effectively.”

28:11 – Put down the Gatorade

Sports drinks spike your blood sugar levels, flooding the bloodstream with insulin. This process also signals the liver to stop burning fat, making your entire workout less effective.

“We have a number of athletes on our team and we’re working with a bunch of professional athletes there, a lot of the early adopters. Something that’s been shocking is these sports drinks that people drink all the time. Things like Gatorade in particular, we’ve seen people have just massive spikes after a workout with just Gatorade. And it just really highlights that this is not the right thing for fueling a recovery. When you have a really big glucose spike like that, you’re generating inflammation, you’re generating oxidative stress, you’re promoting glycation, which is where sugar sticks to things in the body and causes problems. You’re having a huge insulin surge, which means that you’re going to be crashing your glucose down, which might drain your energy. Also, it’s going to stop you from burning fat during your workout. So for all these reasons, people have been drinking these things for years and just see it on the glucose monitor and think, oh my gosh, this is actually going against all of my efforts. It’d be much better to have just a small glucose rise with whatever your post-workout drink is. We see that especially with drinks all the time. People sometimes think of beverages as freebies, and sometimes they’re just putting you on a total glucose rollercoaster that might be really affecting your day and you don’t really realize it.”

30:17 – Why fasting is all the rage

When insulin is low for extended periods of time, the body will burn through the glucose in the bloodstream and turn to burning stored fat.

“We have been told, oh, you should eat six times a day because that’ll keep your metabolism revved up, so have multiple small meals. When you’re doing this, those meals may contain a lot of refined carbohydrates or glucose. You are basically causing a glucose spike in your blood maybe six times a day if you’re snacking a lot and having three meals. And each time that’s happening, you’re elevating your insulin levels. And that insulin is a straight block on fat burning. You can’t burn fat when your insulin is high…And if we don’t ever give ourselves a chance with that insulin going low, we’re just not going to tap into it. And this is part of why I think that the fasting movement has been very popular recently and a lot of the research that is showing that fasting may be really good for metabolic health. Because you can imagine, as opposed to those six spikes of insulin a day, you’re actually giving your body time to just not have insulin be spiked and be low. And when that insulin is low for an extended period of time, you’re going to work through that glucose in your circulation. You’re going to break down some of your stored glucose in your liver and use that for energy. And then when that’s kind of depleted, you’re going to start using your fat. And so the more we can give our body an opportunity to get into that state where it’s going to actually need to use the fat, the more we’re going to start burning through it.”

32:20 – How fasting promotes weight loss

Fasting trains the body to switch between burning glucose to burning fat. Being metabolically fit helps the body easily switch to burning fat at other times, like during a workout.

“We had an insecure food source in the past when we were in our more hunter-gathering days like it was feast or famine. We may come across a ton of energy in the form of carbohydrates one day and then not have it for a long period of time. So in those times that we did have access to it, we want our body to store all that excess glucose as fat. That’s the fuel that we can use down the road when we might not have access. But now that we have access to unlimited energy, just infinite sugar, infinite carbohydrates, so much energy, that is maladaptive at this point…So the more we can train our bodies to keep our glucose and insulin down, the more we can intermittently pop into fat burning and make ourselves metabolically flexible. And see if you can imagine if your body is trained at that, if it’s good at doing that, if you create conditions where it has to do that, then let’s say you are going 18 hours on a fast or 24 hours on a fast, or you wake up and you haven’t eaten overnight, you’re going to be using fat for energy because your body knows how to do it. And you’re not going to get that hangry, crazy desire for food that a lot of us feel when we go a few hours without snacking. It’s really just evolutionary survival pathways that are now being co-opted by a totally different level of access to sugar and carbohydrates.”

35:31 – Keto is not the only answer

How an individual’s body processes carbs depend on a variety of factors including personal genetic make-up, microbiome composition, baseline insulin sensitivity, how much visceral fat is present in the body, and the amount of exercise and sleep. There are multiple ways to improve fat loss without completely cutting off carbs.

“I think one key thing to mention is that this doesn’t mean you just have to hibernate or fast all the time. What it means is that you have to choose foods that aren’t spiking your glucose, and that doesn’t necessarily mean eating keto or eating super low carb. It means actually just knowing which types of carbohydrates, which combinations of carbohydrates actually work for your body. Carbohydrate in the mouth is not necessarily translated directly into glucose in the blood. It can be very different for different people. You and I could both eat a banana, the exact same banana, and I could spike through the roof. And you might not spike at all…What might be a good choice for you might not be a good choice for me, but it’s not just about depriving, necessarily or eliminating all carbs, but actually just creating the right context for those foods in our own body so that we don’t get those spikes and those subsequent insulin releases.”

42:33 – Why some foods cause insomnia

The hormonal cascade that happens in the body at night with melatonin, and the fact that our body temperature rises with blood sugar, makes it difficult for the body to relax and go to sleep.

“When we eat carbohydrates late at night and we’re basically setting ourselves up to not sleep well. So high carbohydrate meals late in the evening are associated with insomnia and many of our customers have seen that when they eat something high carb, late at night, like a dinner with bread and then a dessert, they’ll just see their glucose bouncing around all night. And actually, Ben Bikman’s written about this. When that happens, it actually elevates our body temperature. So when our glucose is bouncing around, it has an effect on our blood vessels. It makes it harder for us to release heat and actually raises our body temperature at night. And that is associated with poor sleep quality. So definite life hack, just don’t eat your carbohydrates at night, eat them in the earlier part of the day and stick to a higher fat higher protein meal in the evening.”

48:01 – We are eating like addicts

The human body can actually go a long time without food, by burning body fat. The American diet is actually causing constant glucose spikes in the body when it would be a lot more beneficial to keep our blood sugar stable.

“We don’t actually need to eat every two hours. People have gone 30, 40 days not eating. Valter Longo’s work looks into this. It’s very much a physiologic sort of addictive response that we have. And we’re trying to sort of fill up the tank very quickly because we’re not metabolically flexible and we’re not able to get that energy we need from that or we’re running out of glucose, and our bodies panic. And so the more that we can train our bodies to be metabolically fit, the more we can just sort of balance out those peaks and valleys throughout the day. What is under-recognized is that our glucose swings that are happening all day long up and down, up and down, up and down the standard American diet, that projects directly onto our up and downs in our day, subjectively. It maps on to our energy fluctuations, our mood fluctuations, our brain fog fluctuations. You’ll start to see as you track this stuff that, oh, I can actually have a much more stable day subjectively and psychologically and energy-wise if I keep things stable.”

01:00:55 – We are all biochemically individual

What works for one person may not work for someone else. This is particularly true for women due to the hormonal cycle.

“We are so biochemically individual, and what works for one person will not necessarily work for another person. And especially when you add in as the cyclical nature of the more hormonal cycles in women, where you have very different energetic needs in different portions of your cycle in the follicular phase, the pre-ovulation phase of the cycle. When we have a high estrogen to progesterone ratio, we tend to have better metabolic health markers. We actually see that the estrogen to progesterone ratio tends to favor insulin sensitivity and we tend to do better. And then in the second half of the cycle after ovulation, where there’s less of an estrogen-progesterone ratio, we tend to be more insulin resistant and blood sugar tends to be higher. So it just goes to show that every day is different. Every person is different. And the more we can understand the inner workings of their body, I think the more we can make smart choices over time.”

01:04:32 – COVID is not killing people

It is the immune response to COVID that kills people. This is why those with poor metabolic health and suffering as their immune response is much more exaggerated.

“It’s not actually the COVID virus that kills people. It’s the immune response to COVID that kills people. And when your cytokines are already elevated because of baseline poor metabolic health, you can imagine when you add the virus on top of that, it’s a compounding effect that’s going to make that immune response much more exaggerated and much more deadly. We need to be investing hugely in disease reversal programs and getting people access to monitoring tools like these virtual coaching programs that help people manage their metabolic health, because the reality is these are conditions that are reversible in many cases. Certainly obesity, but also diabetes and heart disease. Virta Health, an amazing company that works with type two diabetic individuals, has shown in research that they can actually get people from a diabetic to a non-diabetic glucose level in 10 weeks of an intensive dietary and coaching program. You can just imagine if we were able to make these things exceedingly accessible for our country, we may build a really good blood sugar under control and help people do better if they get the virus and ideally, you know, prevent them from contracting a severe case. And one last thing to note actually COVID is not the first virus to discriminate against people with metabolic disease. Even the common flu is five times more likely to put someone in the hospital if they have diabetes. So this is not just about COVID, it’s about any future infectious disease that we face.”

Casey Means: [00:00]        This is why metabolic dysfunction has so many different faces clinically. If this is happening in the brain, where the brain is not able to process energy effectively, it could look like poor memory. It could look like Alzheimer’s. It could look like chronic pain. It could look like fatigue. It could look like depression and anxiety. If this is happening in the ovaries, it could look like infertility, which is why polycystic ovarian syndrome, the leading cause of infertility in our country, is fundamentally a metabolic condition.

Dhru Purohit: [00:27]                           Hi everyone, Dhru Purohit here, host of the Broken Brain podcast. Today, we’re talking metabolic dysfunction with Dr. Casey Means. How you think, how much energy you have in the day, how likely you are to develop chronic disease, your sexual function, the amount of belly fat around your waist, all these things and so much more, short-term health and long-term health, go back to one central thing- metabolic dysfunction. Your blood sugar, your glucose levels, insulin resistance, all matters. And Dr. Casey Means is here to teach us how to get it all, not just under control, not just not be diabetic or pre-diabetic, but how to get it into an optimal range. It’s a fascinating conversation. If you care about this topic, you won’t want to miss this interview. This episode of the podcast is sponsored by Thrive Market- one of my favorite resources for getting healthy foods delivered right to my doorstep. Who doesn’t love that? When it comes to what I eat, I’m super intentional. You guys know this, you listen to the podcast. So, it’s extremely important for me to know exactly what I’m buying. So, I always take a deep dive into the ingredients and the company practices before adding anything new to my kitchen, my fiancé knows this. With thrive market, I’ve been able to find tons of brands I trust in one spot, like Four Sigmatic, Hu Kitchen, Artisana, and so many others for, get this, up to 25 to 50% off the retail price. You just choose from a 1-month or 12-month membership to take advantage of their amazing deals. And by the way, if you’re not into it, you have 30 days to cancel. Thrive Market has thousands of products, including gluten-free, dairy-free, organic, paleo, Fairtrade, you name it, they have it. You can get all the healthy ingredients and kitchen essentials and even clean home and body care products. They also have grass-fed beef and sustainable seafood options. So, it’s super easy to plan ahead for healthy meals and get them delivered right again to your doorstep. Right now, Thrive Market is offering my listeners an amazing deal. When you sign up for a new membership, you’ll receive a free gift, a free gift. And anytime you spend more than $49, you’ll get free carbon neutral shipping from one of their zero waste warehouses. You get to pick the gift. The zero waste happens automatically. Thrive Market makes my life so much easier. I know you’re going to love it as much as I do so I set up a special code, just go to thrivemarket.com/brokenbrain, that’s thrivemarket.com/broken brain. Sign up and start filling up your cart. You’ll see the credit automatically deducted at checkout. Okay. Now back into today’s episode. Welcome to the broken brain podcast. I’m your host Dhru Purohit, and each week my team and I bring on a new guest who we think can help you improve your brain health, feel better and most importantly, live more. This week’s guest is Dr. Casey Means. Dr. Casey Means is a Stanford-trained physician, chief medical officer and co-founder of a metabolic health company Levels. I’m wearing one right now. We’re going to talk about that later on. And associate editor of the International Journal of Disease Reversal and Prevention. Her mission in life 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, that’s really the key, personalized because not everything that works for one person works for somebody else, personalized and sustainable dietary and lifestyle choices. Doctor Means’ perspective have been featured in Forbes, Entrepreneur Magazine, The Hill, Endocrine Today, and many, many other media outlets. She’s an award-winning biomedical researcher with past research positions at the NIH, Stanford School of Medicine and NYU. Dr. Casey Means, welcome to the Broken Brain podcast.

Casey Means: [04:41]        Pleasure to be here. Thanks for having me, Dhru.

Dhru Purohit: [04:43]                           Yeah.  I’m so curious about your background and what brought you to the place that you’re in and really this conversation that we’re having about metabolic health, right. That’s what we’re going to be talking about today and going deep into really, what is it and how can the understanding of metabolic health improve your brain health, your physical performance, the amount of belly fat that’s around your waist. And I want to start off with this is that, I always wished that we had come up with a different term than metabolic health, because I almost feel like in one way, the term, it makes people feel like they think they know what it is. Oh, that’s just metabolism, I guess. But it doesn’t address the seriousness of really everything included. So, let’s even start there. What is metabolic health and maybe even what would you call it if you were going to give it a different name?

Casey Means: [05:39]        That’s such a great question. You know, I mean, it really does need a rebrand, I think. But let’s just start from the beginning- What is it? So, fundamentally our metabolism, how we produce energy from our food and the environment. We make energy by converting sugar and fat into something we can actually use, namely things like ATP. And this metabolic process of energy production is this core, fundamental pathway of every single cell in the body. And when it doesn’t work well, we see diseases and symptoms emerge. And when it does work well, we thrive, and we see stable energy. We see vigor, we see mental clarity, athletic endurance, stable mood, good skin, good memory, really all the things we want. So, the way this sort of works is that when we eat carbohydrates, it’s converted to glucose and our bodies have to then release a lot of insulin to get that glucose to be taken up into the cells. And over time, if we’re eating lots and lots of carbohydrates, especially refined carbohydrates and sugars, we’re going to have our bodies required to release lots and lots of insulin. And over time, our cells actually get numb to that insulin. They see so much of it that they actually kind of put up the block and this is a process called insulin resistance. And when that happens, our body has to release even more insulin to get the same amount of glucose into the cells. And it becomes harder over time to even get that glucose into the cells to be converted to energy. So, we end up getting this deficit of energy inside our cells, and you can imagine when our tissues aren’t getting the energy they need, they’re going to start falling apart. And the secondary issue with insulin being elevated is that because it is a signal that there’s enough glucose in the blood, it says to the body, we don’t actually need fat for energy. So, stop breaking that down. So, it’s going to cause you to not be able to use fat as an energy source. So, in two ways, that’s actually creating an energy deficit in the body when insulin is high and we’re insulin resistance. We’re not able to process glucose effectively and we’re not tapping into fat usage. And so, you can sort of imagine, well, anywhere this is happening in the body, you might see dysfunction, and this is why metabolic dysfunction has so many different faces clinically. If this is happening in the brain where the brain is not able to process energy effectively, it could look like poor memory. It could look like Alzheimer’s. It could look like chronic pain. It could look like fatigue. It could look like depression and anxiety. If this is happening in the ovaries, it could look like infertility, which is why polycystic ovarian syndrome, the leading cause of infertility in our country, is fundamentally a metabolic condition. If it’s happening in the blood vessels, it could look like high blood pressure or heart disease. If it’s happening in the liver, it could look like fatty liver disease. If it’s happening in the skin, it can look like acne. These are all conditions that are related to underlying metabolic health. So fundamentally, it comes down to how we produce energy in the body. And, you know, it’s just such a core, fundamental pathway. And we, unfortunately right now, don’t have a lot of insight into how this is working in our bodies. We may get, you know, our glucose, our blood sugar checked once a year at the doctor’s office, but that’s about it. It’s really hard to currently track this, measure it and know how to improve it.

Dhru Purohit: [08:57]                           Yeah. Let’s talk about the modern industrial revolution that we’re all living in today, modern society. How has our diet fundamentally changed and how is that impacting our metabolic health?

Casey Means: [09:11]        Yeah, absolutely. So, I mean, we have more access to essentially processed carbohydrates and sugar than we have ever in human history. We’re eating about a hundred times more sugar per person now than we were about 150 years ago.

Dhru Purohit: [09:27]                           Just to jump in there. I saw a stat of the day that, you know, the average American, like a 150 years ago was having two pounds of sugar a year and now it’s like 200 pounds of sugar a year plus.

Casey Means: [09:39]        Yeah. And you imagine, all of that sugar has to be taken out of the bloodstream through insulin, and then that sugar has to be processed by our mitochondria, the little powerhouse of the cell that actually convert that glucose to usable energy. Our bodies have absolutely no idea what to do. You know, they are becoming dysfunctional. They’re becoming insulin resistant. We’re storing a lot of that sugar as fat. It’s just amazing how overloaded we are. And when you couple that with the fact that it’s not just about being overwhelmed by this energetic substrate, but it’s also, we’re breaking down the machinery and the body through our other lifestyle behaviors. So, lack of sleep, lack of exercise, chronic stress, all of these things translate into molecular information in the body that actually makes our mitochondria not function as well. So, we’re not only overloading the body with this damaging substrate, but we’re also breaking down the machinery with the other things that we’re doing and living in our modern world. And so, I think a lot of it comes down to the industrialized food complex and the food system, but I think there’s a lot of other systemic issues as well. I think, Dr. Hyman’s book “Food Fix” really gets into a lot of these core factors of how we’ve gotten to where we are. But, you know, there’s a number of things. There’s cultural norms regarding nutrition and comfort food. There’s relentless food marketing and advertising. There’s the addictive nature of ultra-processed foods. There’s culturally reinforced taste preferences. There’s political aspects. We have farm bills that actually support, you know, the production and financing of foods that are disease-promoting. And then we have a medical education system that doesn’t focus on nutrition, and doctors actually aren’t given the tools or the education to really counsel or understand how important this is, but the majority of the chronic diseases we’re facing these days, actually 7 of the 10 leading causes of death in America are related to sugar control and poor metabolic health. And so, these are preventable conditions if we can get on top of our diet and lifestyle. And so, now’s the time to really be shifting a lot of these systems issues, and especially empowering doctors to understand nutrition in a much more nuanced way.

Dhru Purohit: [11:45]                           You were talking about doctors not getting the education that’s there. I’d love to jump into your origin story, and then we’re going to come back and go deeper into metabolic health and brain health, how it’s tied to so many factors inside the body, but you started off, in your practice, you were an ENT surgeon, right? Ear, nose and throat surgeon. And in that practice, after you had gone to your Stanford undergraduate and medical school, you started seeing a lot of patients who had these common themes that were there. They had all these disorders of inflammation, and that puts you in a place where you started asking a very powerful question. What was that question that you asked yourself when you were seeing all these different, you know, patients come in with the same sorts of issues?

Casey Means: [12:36]        Yeah. You know, I was there in my practice, and I was asking, you know, what is the root cause of this inflammation? And so, you know, like you said, I was in a surgical training program. I had gone to medical school and undergrad at Stanford. And then I went up to Oregon for my head and neck surgery residency, and I was about four and a half years into my training, treating and operating on diseases of the ear, nose and throat. And I was just like, absolutely struck by, like you said, how many of these conditions were fundamentally rooted in chronic inflammation. And, you know, it was sinusitis, laryngitis, thyroiditis, all these itises, which in medicine is the suffix that means inflammation. And I did, I just really stepped back, and I asked, you know, why is there so much chronic inflammation at play? And why are we just reaching for our prescription pads for all sorts of heavy-duty steroids to quell the immune system, instead of asking what is actually triggering this inflammation, what’s the root cause? You know, it’s amazing how many ways we can prescribe medication to tamp down the immune system. We’ve got nasal steroids, we’ve got IV steroids, we’ve got topical steroids. We have inhaled steroids. It’s unbelievable. And we’re not ever really talking to people about the triggers. What’s more, you know, then, if these medications don’t work, we go to the operating room. And sure, we can bust a hole in the sinus and suck the pus out, but that doesn’t actually change the underlying core physiology of inflammation. And you can’t operate on the immune system. So, I became interested in understanding that process and how to mitigate those triggers in order to keep people out of the operating room. And one of the key fundamental triggers of inflammation in the body is dysregulated blood sugar and metabolic dysfunction. When our blood sugar is high and it’s fluctuating up and down, big spikes and dips that triggers the immune system. And unfortunately, like we’ve talked about, our modern lifestyles make it just exceedingly difficult to escape metabolic dysfunction, with the food culture, our chronic stress, our lack of sleep, our sedentary behavior, and actually a recent UNC study estimated that 88% of Americans have at least one biomarker of metabolic dysfunction. And 88% of Americans are not optimally metabolically healthy. And so, you know, this is just astronomical and it’s mostly preventable, but it requires us to change our health behaviors. It requires us to change the choices we make every day. And so, this was very, very interesting to me thinking, you know, I need to refocus my clinical energy into thinking about how to help patients make healthier decisions and choices every day that are foundational for overall health, for metabolic health, and how do we do that at scale? Because 88% is a lot. That’s hundreds of millions of Americans and, you know, just one-to-one 15minute interactions with the doctor is probably not going to be enough to really move the needle on a comprehensive behavior-lifestyle overhaul. So, this led me to starting my company Levels, which helps people optimize their blood sugar and personalize their diet through a bio wearable called a continuous glucose monitor. And, you know, long-term, my sincere hope is that by empowering people with personal data and the ability to understand in real time how food and lifestyle is affecting their health, that we can really move the needle on people making better choices every day that are going to ultimately lead to really maximizing this foundational pathway in the body, our metabolism.

Dhru Purohit: [16:06]                           No, it’s really powerful because what we’re really talking about here with your new company Levels and I had mentioned, I have it on. I’m wearing a long sleeve, so you can’t really see it, but we’ll have a link, you know, people can check it out a little bit more, but basically what we’re talking about is instantaneous feedback, because zooming out a little bit, if you walk up to most people, right now, you’re in New York, and if you went down to times square and you just pull 10 random people and you say, Do you eat healthy? You know, most people will say, Yeah, I try to eat healthy. Right. And everybody has a different definition of what healthy is. Right? So, for somebody it’s like a two Coca-Cola’s a day is healthy because they’re not having four. For another person it’s like having a salad every day. It could be healthy and healthy is a spectrum in terms of the way that people look at it. But there’s two important things that I want the audience to understand what’s, we often don’t know because we don’t have instantaneous feedback, what is actually healthy and not, especially when it’s coming to metabolic disorder inside the body. And the other thing is, what works for one person may not work for somebody else. And that’s really key. And I want to spend a little bit of time in our interview later on to chat about that. So, let me set up a little bit of this conversation by saying, when we talk about sugar, most people, at least that have been listening to this podcast are like pretty aware about how much added sugar they’re having in terms of table sugar or going and picking up, you know, things that have added sugar to them. But what are some of the other foods that people are commonly consuming that, even if it’s not sugar, are things that can throw your blood sugar out of control and contribute to metabolic disorder?

Casey Means: [17:51]        Yeah. So, like you said, the first big problem is that there’s just added sugar in, you know, everything. You walk into the store, and it’s just added sugar everywhere. It’s actually extremely challenging to go to the grocery store and buy normal products and escape added sugar. You have to be extremely, even whole foods. Yeah. There is only one ketchup at whole foods that I have found that does not have sugar, you know, Primal Kitchens and it’s of course, much more expensive, but same with yogurts, with even non-dairy milks, all of these things, salad dressings, they all frequently have sugar. So that’s just like first things first, got to read the labels, but then like you mentioned, there are foods that can affect blood sugar profoundly, that we might not really understand. And what’s more, what affects one person might not affect another person in terms of their blood sugar. So, some of the things that we’ve seen in our, you know, healthy, non-diabetic customers using continuous glucose monitoring to personalize their diet is, you know, oatmeal has been one that’s been shocking to a lot of people. This is, you know, something that’s considered a heart-healthy breakfast, high fiber, whole grains. These are all things that the box says, but in reality, we’ve seen people’s blood glucose frequently go to 180, 200. These are essentially reaching diabetic levels, and this is without adding any sugar or fruit to it. So, it’s fascinating to see people’s response to something like that. A lot of people have this post-meal energy slump after meals, where they’re like, they need to, you know, take a nap or have another cup of coffee or, you know, have that little afternoon or mid-morning slump, need a piece of candy or something like that. And when you see that, Oh, actually my breakfast caused my glucose to go to 200. And then presumably had a big insulin release, which soaked up all the blood glucose, the glucose crashed down and dipped very low. That’s called reactive hypoglycemia. And then right after that is when I felt tired and maybe a little moody and maybe a little anxious, all of a sudden, having that objective information linked to a choice and a subjective experience, it’s just a very powerful feedback loop of understanding how a food is personally affecting you. So, oatmeal has been a big one. We’ve seen a lot of people, you know, of course with breads, even some fruits and vegetables, so like starchy vegetables, like sweet potatoes, corn grapes. These are common ones that we hear about that are surprising. Oat Milk is a big one that people find, and again, it’s not, everyone’s a little bit different, and so it’s really testing it for yourself, but what’s so great about experimenting with a monitoring device like a continuous glucose monitor is that, it doesn’t necessarily mean that you have to eliminate these foods forever or that they’re evil, but we actually have to just think about how to make them more metabolically friendly for our body. So, a sweet potato is not an inherently bad food, but alone, sort of a naked carb, it can have some collateral damage in terms of a blood sugar spike, especially for me. And so, you know, I will add fat, fiber, protein to these types of foods now, to blunt that glucose response, or I’ll make sure that I walk after a meal when I have something like that, or do a workout before a meal with a food that spikes me like that. You know, or I’ll make sure that I’m really doing a mindful meal and I’m not stressed during the meal, which can make your glucose go up. So, just really making sure you’re building this context for the carbohydrates you’re eating, so that you can process them most effectively.

Dhru Purohit: [21:25]                           I remember my grandparents. And from the time that I was young, they’ve since passed, especially on my dad’s side, I remember my grandparents, when we would spend time with them, when they would come and stay with us when we were younger, I would ask them like, why do you go on a walk after every, you know, after like dinner or after lunch. And they’re like, my grandmother did it and her grandmother did it. And you know, these traditions are baked into the way that we used to live, but nowadays, we don’t necessarily have those and we are seeing the damaging impact, because as you mentioned, it’s not just food, it’s our movement. All these things play into how our body makes and produces energy. So, there’s people that are listening that are kind of like following a little bit with the continuous glucose monitoring, but they’re like, Okay, well, what are you guys exactly talking about? So, let’s start at the basics. When you say a continuous glucose monitor, like actually on a fundamental level, what is it? What does it look like? How do you use it? Where do you wear it? Like, what are we all talking about here?

Casey Means: [22:26]        Sure. So, a continuous glucose monitor is a bio wearable. So, it is a wearable device that sticks on the back of your arm. It stays there for two weeks, and it has a little internal sensor that goes under the skin and is measuring glucose 24 hours a day, seven days a week for the two weeks that you’re wearing it. And it’s taking measurements every 15 minutes so you’re really getting a continuous data stream of this internal biomarker. And it’s able to send that data to your smartphone, so you can actually get like a fully fleshed out curve of what’s happening to this energetic bio marker all throughout the day and in response to anything you’re eating, the exercise you’re doing, stress, you know, all of these things, you’re seeing instantaneous readout on that. This is a technology that has been traditionally used for the population of individuals with Type 1 or Type 2 diabetes as a treatment tool. So previously, the way people checked their blood sugar was they’d prick their fingers and they’d get a little drop of blood and measure it on a glucometer. But you obviously can’t do that every 15 minutes. It would be very, very painful. And so, this is really a game changer moving from having three or four data points per day, to having a hundreds of data points per day. And you can imagine, like, let’s say you eat an apple and you prick your finger, 35, 40 minutes later, you know, that glucose is going to be rising in a sort of peak and then coming down on a slope and you don’t exactly know where you’re catching that with a finger stick, but with a continuous glucose monitor, you’re seeing the whole curve, where it peaked, how long it was elevated, et cetera. And so, what levels does is makes this technology mainstream. So, it takes it out of the, you know, just being sequestered to the population of people with Type 1 or Type 2 diabetes and makes this available to any health-seeking individuals who want, you know, really specific granularity on their diet in real time. And, our goal really, is to break through the mystery of trying to guess what the perfect diet is for us. You know, so much of nutrition and dieting right now is, you know, trial and error, trying different things and sort of seeing how you feel. And there’s just some really loud, dominant, voices in the nutrition space, you know, telling everyone this is the one right diet for everyone. There’s very much this mentality of one size fits all diets, but no one can seem to agree on it. And the reality is that there is probably the right diet for each individual. And by using data and a continuous data stream to test out different foods and see what you’re having, you know, causing a big glucose spike or keeping you flat and stable, which is what you want, you can start to actually create that optimal diet for yourself. So. Yeah, so the continuous glucose monitor is just an amazing tool and we’re very excited to, you know, bring this, you know, forward, for anyone who’s interested in personalizing their own diet and lifestyle plan, and figuring out the right diet for them.

Dhru Purohit: [25:33]                           Yeah. And if anybody’s familiar with sort of the space or, you know, follows, you know, some of our friends in the field, you might’ve seen, you know, starting a few years ago, people that were like biohackers starting to wear it and getting, you know, because you can’t, you need a prescription, unfortunately, right now and obviously a lot of that stuff is changing and that’s part of what Levels does is it gives you a tele-health appointment so that you can get a prescription. I’ve had friends that go to their doctors and say, Hey, can I get this? And the doctor’s like, I’m not going to write you a prescription for this. You’re not diabetic. And yet there’s so much more, you know, there’s a whole bunch of reasons to do it, even if you’re not diabetic, which is this optimal category. So, a few years ago, you started seeing these biohackers wear it and they would wear things like Dexcom, even I, a few months ago, how we ended up connecting, I think you saw on my Instagram that I was wearing a Dexcom, which is one of the monitors that’s out there, probably one of the more popular ones that a lot of diabetics wear. And I had somebody that’s close to me, that’s a doctor, write me a prescription for it, after talking to me about my goals and everything like that, and I’d been wearing it. Now, one of the challenges that was there that I was open about is, you don’t necessarily get the actionable data and insights from it. It’s really, you have to log and try to look for the patterns yourself. So, it was a great tool and I got to see how much more my blood sugar improved on days that I would work out versus days that it wouldn’t work out, but it was hard to make the connections between different foods that were there. And that’s when, you know, you and the Levels team reached out and said, Hey, we have a new software. We’re actually helping people put this data together. I said, I’m game to try it, you know, let’s, let’s go for it. And it’s been great. I’ve been wearing it since, basically like a week now and already been seeing some very interesting things through my experimentations. One that I wrote about yesterday, well, not wrote about, vlogged about on Instagram, which was I went to my favorite health food store here in Los Angeles called Erewhon, and I got a drink that I’ve had, not a ton, but I’ve had a few times. And I went and got this drink that, you know, the baristas have told me has no added sugar inside of it, is like good, you know, it’s a non-caffeinated latte, it’s called a chaga chino, and I drank it and I was like, Oh my gosh, I should check what my response is. It spiked my blood sugar more than anything else that I had that week, almost at the same level that I would see when people share the results online of having drank like a Coca-Cola or something. I’m sure you guys get that sometimes from the people that try and Levels out.

Casey Means: [28:09]        Yeah, all the time. You know, we have a number of athletes on our team and we’re working with a bunch of professional athletes, they’re a lot of the early adopters and something that’s been shocking is these sports drinks that people drink all the time, things like Gatorade in particular. You know, we’ve seen people have just massive spikes after a workout with just Gatorade and, you know, it just really highlights that this is not the right thing for fueling a recovery. When you have a really big glucose spike like that, you’re generating inflammation, you’re generating oxidative stress. You’re promoting glycation, which is where sugar sticks to things in the body and causes problems. You’re having a huge insulin surge, which means that you’re going to be crashing your glucose down, which might drain your energy, and also it’s going to stop you from burning fat during your workout. So, for all these reasons, like it’s just been, people have been drinking these things for years and just, you know, see it on the glucose monitor and think, Oh my gosh, this is actually going against really like all of my efforts. It’d be much better to have just a small glucose rise with whatever your post-workout drink is. And so it’s, yeah, we see that, especially with drinks all the time. People, I think, sometimes think of, you know, beverages as freebies, and sometimes they’re just putting you on a total glucose rollercoaster that might be really affecting your day and you don’t really realize it.

Dhru Purohit: [29:38]                           Yeah, I want to touch back on the belly fat piece because obviously a lot of people are curious about that. You know, we have one of your colleagues and friends, Ben Bikman, on the podcast and, you know, he chatted a little bit about this big picture, really talking about insulin resistance. How is it, really solidify that connection for the audience? Like how is that, even if you’re eating a healthy diet, how is it that, I know you mentioned it earlier, but how is it that the continuously spiking your glucose actually could have you tap into a place where you aren’t able to burn that fat off?

Casey Means: [30:13]        Yeah. So, you can imagine in the world that we’ve been living in, where we have been told, Oh, you should eat six times a day because this’ll keep your metabolism revved up like, this is things that we used to be, you know, told like just, you know, have multiple small meals. When you’re doing this, and those meals may contain a lot of refined carbohydrates or glucose, you are basically causing a glucose spike in your blood maybe six times a day, if you’re snacking a lot and having three meals. And each time that’s happening, you’re elevating your insulin levels. And that insulin is a straight block on fat burning. You can’t burn fat when your insulin is high. And you’re also going to preferentially use your glucose when there’s a lot of glucose around. So, we’re loading the body with glucose in the circulation, we’re storing it, and we’re storing excess as fat, and we have insulin high so we can’t actually use the fat. So, you can imagine this leads to quite a bit of, you know, visceral adiposity, abdominal fat, insulin preferentially is going to cause storage of fat in that area. And if we don’t ever give ourselves a chance with that insulin going low, we’re just not going to tap into it. And this is part of why I think the fasting, you know, movement has been very popular recently, and a lot of the research is showing that fasting may be really good for metabolic health. Because you can imagine, as opposed to those six spikes of insulin a day, you’re actually giving your body time to just not have insulin be spiked and be low. And when that insulin is low for an extended period of time, you’re going to work through that glucose in your circulation. You’re going to break down some of your stored glucose in your liver and use that for energy. And then when that’s kind of depleted, you’re going to start using your fat. And so, the more we can give our body an opportunity to get into that state where it’s going to actually need to use the fat, the more we’re going to start burning through it. So.

Dhru Purohit: [32:01]                           Interjecting for a second, help us understand evolutionarily, right, in human evolution, why was this done by the body on purpose? Like, can you give us a scenario or help put some context to it? Like why does our body do that in the context of evolution?

Casey Means: [32:18]        Well, we had an insecure food source in the past. You know, when we were in our more hunter-gathering days, like it was feast or famine, you know, we may come across a ton of energy in the form of carbohydrates one day and then not have it for a long period of time. So, in those times that we did have access to it, we want our body to store all that excess glucose as fat, that’s fuel that we can use down the road when we might not have access. But now that we have access to unlimited energy, you know, just infinite sugar, infinite carbohydrates, so much energy, that is maladaptive at this point because our body’s still telling us to store it, hold onto it, preferentially use glucose as a quick energy store, but we don’t actually need to do that anymore. And so, what we’re doing is we’re putting ourselves into a place where we are very un-metabolically flexible. We are metabolically rigid. By keeping our insulin high all the time, by what we’re eating, we aren’t tapping into this plentiful source of fuel in our body, which is fat. So, the more we can train our bodies to keep our glucose and insulin down, the more we can intermittently pop into fat burning and make ourselves metabolically flexible. And see if you can imagine, if your body is trained at that, if it’s good at doing that, if you create a conditions where it has to do that, then let’s say you are going 18 hours on a fast or 24 hours on a fast, or you wake up and, you know, you haven’t eaten overnight, you’re going to be using fat for energy because your body knows how to do it and you’re not going to get that hangry, you know, crazy desire for food that a lot of us feel when we go a few hours without snacking. So, it’s really just, you know, evolutionary survival pathways that are now being co-opted by a totally different level of access to sugar and carbohydrates.

Dhru Purohit: [34:07]                           Yeah. I remember hiking in a national park up nearby Canada, and I was with the trail guide and we were in an area where there was all these berry bushes, these bushes that had berries on them, and they were all decimated. And I was like, Oh, what was there? She was like, Yeah, it used to be a bunch of berries, but this is pre hibernation season and all the bears come, they load up on all this sugar right before they go into hibernation so they can create as much fat as possible inside of their body so they can survive through the winter. And in that same way, our body is kind of in a place where it’s like, it still thinks that we’re living out on the Sierra or in the jungle or on the plains, and it’s thinking that anytime we may not have food available to us, so let’s keep on packing it on, which is why it’s so important people to understand that even if you have excess belly fat or deposits around the body, your body doesn’t do anything by mistake. It’s doing it for a reason. Now, you have to understand why that reason is and decide, do you want to do things differently.

Casey Means: [35:08]        Yeah, absolutely. And the thing about the bears is that during the winter, they’re not eating, they’re hibernating, so their insulin is not going to be high and they’re going to, it’s going to be easy for them to tap into that fat all winter because that break of insulin is lifted and we don’t really give ourselves that opportunity to ever lift that break because we’re eating so much in so many carbs so frequently. And so, I think one key thing to mention though that this doesn’t mean that you just have to hibernate or fast all the time, you know. What it means is that you have to choose foods that aren’t spiking your glucose, and that doesn’t necessarily mean eating keto or eating super low carb. It means, actually just knowing which types of carbohydrates, which combinations of carbohydrates actually work for your body. A carbohydrate in the mouth is not necessarily translated directly into glucose in the blood. It can be very different for different people. You and I could both eat a banana, the exact same banana, and I could spike through the roof and you might not spike at all. And this has been, actually well-studied. There was an amazing paper out of the journal- Cell about five years ago, called Personalized Nutrition by Prediction of Glycemic Responses and it did just that experiment. It gave people standardized meals, healthy non-diabetic people, and put continuous glucose monitors and looked at their glucose responses, and they were all across the board for the exact same food. And some of the predictive factors of why people responded differently were things like microbiome composition, baseline insulin sensitivity, and how much visceral fat people had was predictive of how much their glucose raised, how much exercise and sleep they’d gotten. So, these factors sort of change the way we process glucose person to person. And so, you know, what might be a good choice for you might not be a good choice for me. But it’s not just about depriving, you know, necessarily or eliminating all carbs, but actually just creating the right context for those foods in our own body so that we don’t get those spikes and those subsequent insulin releases.

Dhru Purohit: [37:09]                           Yeah. The beautiful thing about this understanding and the instantaneous feedback is that we then start to get out of the diet wars, that this diet is more superior than this diet, when a lot of them have themes that work in general, and then it’s more about the personalization piece. I’d love to talk about that a little bit, you know, listeners of this podcast know that I grew up vegetarian and I was vegan for a long time, I even experimented with the raw food diet for a few years, eating almost 90% or more of my diet with raw foods. And I know you are a plant-base, you know, you only do plan-based. I’d love to take plant-based and being, so would you also say that you’re vegan mostly, right?

Casey Means: [37:54]        Yes, I am. Yeah.

Dhru Purohit: [37:56]                           I’m going to take that, right. I’d love to take something, I would love to take the vegan diet in your case, and talk about seeing it through the lens of this new approach, where we’re paying attention to balanced blood sugar and like how to do it in a way that makes sense?

Casey Means: [38:12]        Yeah. So, for me, I’ve chosen to be on a whole foods plant-based diet because it just achieves a lot of the things I want in my body, for getting me the substrates that are going to lead to optimal biologic cellular function in my body. So, it gives me the antioxidants I need. I get, you know, tons of fiber to help my microbiome be healthy. I’m getting lots of phytonutrients, you know, I get Omega-3s from nuts and seeds, et cetera. And so, to me, it’s just what helps me feel great and helps me really optimize what I know about cellular biology. But the reality is, is that even with a diet that feels very, very healthy and whole, there can be collateral damage. And what I mean by that is you might be eating lots of healthy foods, but they still might be causing, you know, massive glucose spikes in your body. And so, for me, glucose monitoring has helped me just really tailor this diet that I love and adore and make it not have that collateral damage, and just make it as finely tuned for me. And so, what that looks like personally is that I’ve been wearing a continuous glucose monitor for about 18 months, and I’ve been using them in my patients for a couple of years at this point, for me, it means there’s certain foods that I’m kind of eliminating. So, I really don’t eat a lot of grains. They just spike me so high. I don’t eat oatmeal. I’ve minimized some of the big spikers for me, which are grapes, corn, sweet potatoes and rice, and I’m getting a lot more fat, protein and fiber. So, I eat a lot of beans, and when I do, I put extra fat and fiber and protein on them. So, I’ll put beans with like tahini, and chia seeds, and flax seeds and things like that. I’m eating a lot of nuts and seeds and green leafy vegetables. I’m minimizing sort of the starchy vegetables. And I’m definitely choosing my fruits really carefully. I’ve found a number of fruits that don’t spike my glucose at all. I tend to eat less ripe fruits now. So instead of eating a super ripe, juicy pear or peach, I’ll eat sort of a less ripe version of it and that tends to do a lot better. And then I always pair my fruit with fat and fiber. So, it’s always going to have almond butter and chia seeds on it, or I’m going to put it with some full fat, cashew milk yogurt or something like that. So, what it’s done for me is help me figure out how to pair foods properly, and just really not eat carbs like all by themselves. And for me, that allows me to eat, you know, 200 plus grams of carbs per day, and barely ever have a glucose elevation. It’s pretty much just generally flat and stable all the time, but that’s been quite a bit of experimentation. And then I would say the second thing is, aside from just food pairing and learning how to, you know, mix carbs with fats and proteins and fibers, I’m also really thinking a lot about food timing. So, I’ve definitely condensed my sort of eating window during the day so that I can give my body and my pancreas a break from insulin production. I try to eat earlier in the day. We tend to process carbohydrates better earlier in the morning and in the early afternoon, as compared to evening time. Because at night, our body produces melatonin from the pineal gland to help us go to sleep and, you know, get tired, but that also affects the pancreas and actually makes us secrete less insulin. And so, for the same amount of carbohydrates, you’re going to be less quick to bring them into the cells at night, as you are in the morning, so that’s something interesting to experiment with.

Dhru Purohit: [41:44]                           Which is, just to interject on that, that point, it’s also reminiscent of the fact that, you know, growing up, I was around people that fasted all the time, in my tradition, it was part of the Hindu and my mom’s from the Jain tradition, big part of those traditions is fasting, and interestingly enough, a lot of the fasting that people would do would be in the evening. Here in the US, we sort of have this culture of fasting in the morning that’s become a thing. But, you know, talking with Valter Longo and his team, they were like, well, most of the cultures around the world, they actually fast later on at night because they need that healthy fat and maybe some of those carbs in the morning to power their brain, and then they do better. You know, it’s just interesting to see the different patterns around there.

Casey Means: [42:28]        It’s so interesting. And it’s also really interesting to see how the science now is catching up with the traditional wisdom. You know, we’re actually now being able to show molecularly what a lot of these traditions have been saying forever. And I agree with that firmly. If you’re going to fast, I tell people, you know, don’t stop eating at 9:00 PM and then just your fasting means that you’re not eating until 1:00 PM the next day. That’s going to be, in my opinion, a lot less effective as stopping eating at 5:00 PM and then just starting eating earlier in the morning the next day, because of the hormonal cascade that’s happening at night with melatonin. And another point there is that when we eat carbohydrates late at night, we’re basically setting ourselves up to not sleep well. So, high carbohydrate meals late in the evening are associated with insomnia, and many of our customers have seen that when they eat something high carb late at night, like a dinner with bread and then a dessert, they’ll just see their glucose bouncing around all night. And we know, and actually Ben Bikman’s written about this, that when that happens, it actually elevates our body temperature. So, when our glucose is bouncing around, it has an effect on our blood vessels. It makes it harder for us to release heat and actually raises our body temperature at night, and that is associated with poor sleep quality. So yeah, definite life hack, you know, just don’t eat your carbohydrates at night, eat them in the earlier part of the day and stick to a higher fat, higher protein meal in the evening, if you’re going to eat later for sure. So that’s a big one and then, you know, just making sure that you’re eating during times when your body’s primed to process glucose properly. And that means when you’re not under stress, ideally, if you’ve moved before or after the meal, so a walk before or after the meal or an exercise, you know, close to the mealtime. And, you know, and ideally, eating higher carb meals on days that you’ve gotten good sleep. One poor night of sleep can make us more insulin resistant. You can take healthy populations of people and deprive them of sleep for just a few days. There’s a study that looked at healthy young men who, for six days, got four hours of sleep per night. And they went from healthy glucose to just pre-diabetic in that amount of time. So, you just don’t want to be eating your big carb meals on days when you haven’t gotten good sleep. So, all of those learnings.

Dhru Purohit: [44:50]                           Adding one more point to that. Sorry to interrupt, but just to solidify that point, I didn’t sleep well last night and I woke up this morning, I checked my levels and my meter, and I was at the highest all week, of where my morning blood sugar was. I was hot. I ate my carbs a little bit too late last night, and I was tossing and turning a little bit and trying this experiment where I had my air filter off in my room, and through a whole host of things, I woke up with the highest starting blood sugar that I had when I started in the morning.

Casey Means: [45:28]        That is so interesting. And yeah, and not that super surprising. Those carbs late at night can just send us on a total rollercoaster. But yeah, so long story short, those are all the things that have helped me figure out how to do vegan and do plant-based without this collateral damage of the glucose spikes and it is very holistic. And I really love about this tool that because so many factors go into how we control glucose, it actually becomes a biofeedback tool for so much more than just food. It’s actually a biofeedback tool for all these other factors like stress, exercise, and sleep. And I think to your point about your morning glucose being much higher, I think we kind of think, because of the way that metabolic conditions are diagnosed in our country, you know, you go and you get a finger stick glucose and if your blood glucose is above a certain level, they say you’re pre-diabetic. And if it’s above a higher level, you’re in the diabetes category. But I think what people don’t realize is that that actually, that number can bounce around massively, day-to-day, based on what we’re doing. I’ve had indulgent Saturdays where my average glucose is 10 points higher than on the day before and including my fasting glucose. And so, you can imagine if you’re doing that type of day, day after day after day, you’re going to move in that direction. But being able to see how much variability there is with just certain choices like eating carbs late at night, it’s really empowering because you’re like, Oh, I can just change that and, you know, get things lower. So, that’s super interesting that you notice that.

Dhru Purohit: [46:56]                           And then also map it out to how you feel, because everybody’s used to the fact of, especially if you were traditionally working in the office environment or that three o’clock time period, where you feel like your energy starts to crash, you can’t focus the same way, people in let’s say corporate America, start reaching for sweets, right, and even people that are not working, that are working at home, taking care of kids, other stuff, running around, doing all the things that they need to do, especially in this day and age with COVID and homeschooling, and then you get to that three o’clock time period, if you have not managed your blood sugar well and your glucose well, you hit these patterns where you’re just like, I just feel like shit. I don’t like the way that I can focus right now. And now, you know, are you craving things or are you artificially boosting yourself back up to get, you know, to almost in a way, medicate? Right. So how much of your cravings are just you actually miss foods and how much of them are driven by biological needs where your body is tricking you to reach for that sweet or that thing that maybe isn’t the best for you?

Casey Means: [47:58]        Yeah, I think it’s absolutely the latter. You know, we don’t actually need to eat every two hours. You know, people have gone 30, 40 days not eating, you know. Valter Longo’s work like looks into this, you know, and we don’t need it. It’s very much a physiologic sort of addictive response that we have, and we’re trying to sort of fill up the tank very quickly because we’re not metabolically flexible and we’re not able to get that energy we need from that. We’re running out of glucose, you know, and our bodies kind of panic. And so, the more that we can train our bodies to, what I like to call, be metabolically fit, the more we can just sort of balance out those peaks and valleys throughout the day. I think what is under-recognized is that our glucose swings that are happening all day long, up and down, up and down, up and down, the standard American diet, that projects directly onto our up and downs in our day, subjectively. It maps on to our energy fluctuations, our mood fluctuations, our brain fog fluctuations. Like you’ll start to see as you track this stuff that, Oh, I can actually have a much more stable day subjectively and psychologically and energy-wise if I keep things stable, and that’s amazing because I think that’s what we all want. We want to feel in control, and we want to feel stable. And that starts with keeping our glucose under control.

Dhru Purohit: [49:17]                           I went to a talk one time, our buddy, Dave Asprey, was speaking and he was joking, and he made a reference that, you know, some of you feel hypogly-bitchy, when your glucose isn’t in control, all of a sudden you become hypogly-bitchy. And we’ve all had that before, whether it’s hangry, whether it’s becoming a little bitchy, we’re a little bit more irritated, other things, this is our body just reacting to the state that it’s in. Not that all of it is connected to food mindset. All these things are important, but when you take care of yourself, you feel good. When you don’t, you don’t, and not just in the short-term, in the long-term too, as you mentioned earlier. We just did an interview with Dr. Jason Fung who’s done a lot of writing in this field, and he has a new book coming on cancer, and the bottom line is that cancer is not just genetics, there’s so many factors that play into the encouragement of having healthy cells turn basically into cancer cells and, outside of smoking, one of the biggest factors there is obesity. What drives obesity? Well, out of control glucose and insulin resistance. So, whether it’s cancer or whether it’s Alzheimer’s, which we’ve talked a lot before with Dr. Dale Bredesen on the podcast, doctors like yourself and other people calling Alzheimer’s Type 3 diabetes, all chronic diseases that we’re dealing with today, they ultimately first start as being something linked to metabolic disorder.

Casey Means: [50:36]        So true. I mean, and when we think about this as energy production, like you can imagine, it can show up anywhere when we can’t tap into our energy stores effectively, because of the way we’re eating and living, things just fall apart, any tissue anywhere in the body. And so, you know, really this functional medicine perspective of root-cause, like this is the trunk of a tree with so many different branches, and in conventional medicine, we’ve liked to think of those branches as all sort of isolated silos and we end up playing whack-a-mole with all of them, with cancer and Alzheimer’s and depression and infertility and erectile dysfunction and vascular disease. And yet, you know, what we’re missing and what all of these doctors you’ve mentioned, Dale Bredesen, Jason Fung, Mark Hyman, you know, Rhonda Patrick, like, you know, it’s really getting us to, Ben Bikman of course, focus on the roots of that tree, the trunk of that tree, which is metabolic dysfunction. And of course, there’s many things that go into all of these conditions, but this is a well-established one now, and we’ve got to move clinical practice towards actually adopting that into our practice. But for the time being, you know, the good thing is we do have tools where we can track it for ourselves, but my sincere hope is that our system also moves in the direction of treating that root cause as well.

Dhru Purohit: [51:53]                           Yeah. And as we know from, you know, there’s a been a couple of big studies that the research that’s out today that’s well-established, it can take 12 to 17 years before the doctor that’s down the street that you go and visit, is incorporating into their practice. So, as you mentioned, you know, doctors don’t get that, you know, they’re all well-meaning and med school education is well-meaning, it’s all well-meaning, it’s just that things are changing and we’re understanding new aspects of the science. So, they don’t get educated in metabolic disorder, they’re not getting the education. They’re not going to the functional medicine training that doctors, like yourself, are going through. And so, what I love that you guys have done with Levels is that I always tell my friends, Yeah, do you know, you should get a continuous glucose monitor, and they’re like, Yeah, but my doctor won’t give it to me. Will your brother-in-law write me a prescription for this? I’m like, we can’t be just handing out prescriptions for this, you know, here’s a letter, give it to them, try to really make the case. But now you guys have, going back to the idea that, 12 to 17 years before your doctor’s actually practicing it or hospitals are practicing it with Levels, you know, I have no formal affiliation. I’m not an investor. I don’t get any money from this podcast. I just want to say, like, I’m passionate about it because I truly believe instantaneous feedback is the way for people to ultimately take personal responsibility in their hands and not rely on anybody else to be able to help them improve their health, like we can make the decisions ourselves. So, having access and going through Levels and being able to get the prescription and the device is really empowering in this field where, we’re still probably about, I think, you know, three to five years away before more people are getting prescriptions for continuous glucose monitors, like from their regular doctor.

Casey Means: [53:41]        Yeah. You know, I think in five years, we’re going to be talking about metabolic dysfunction like we’re talking about the opioid epidemic now. I think it’s going to become part of the zeitgeist in a major way, but, like you said, it’s going to be a few years, I think before doctors fully, you know, adopt this as part of their practice for, especially for non-diabetic individuals. We’re so used to focusing on issues once fulminant disease has emerged without realizing that in reality, the processes that are happening in the body that lead to these, you know, diagnostic thresholds have probably been happening for years, if not decades, before the day that you walk into the doctor and get that bad news. And my hope, and one of my hopes with Levels, is that we can give people this power, that they never have to walk into the doctor’s office one day and have someone say to them, Oh, you’re now diabetic. You know, we can be tracking these things years ahead of time and know that if we’re keeping our glucose stable and in a healthy range, we’re never going to walk into the doctor’s office and just get a shock about our metabolic health. And so, that’s just extremely motivating to me. Like, we have the tools now, people should have access to this information. And people are just so confused about nutrition. And I think people are very well-meaning, people want to eat healthy. We know this. The majority of Americans are going on a diet in their lifetime. And so, people want to do better and to lose the weight and to get healthy, but it is very challenging to do it when we can’t track anything about it, and we don’t have any sort of real-time objective information about how it’s going. So yeah, so I’m just on the same page.

Dhru Purohit: [55:22]                           You were talking about the confusing nature of nutrition, and I’ve really stayed away from a lot of the diet war conversations on this podcast because again, my experience, it’s so personalized and there’s different themes you can pick up. I want to talk about you, you talked about plant-based, I want to shift over to a diet that’s become very popular, because I think it’s been really addressing a lot of the concerns around, you know, glucose, and that’s the keto diet, right? That’s become very popular in the last few years. A lot of people have heard it, even if they don’t know exactly what it is. But there can be even ways that you can do keto that may not be in alignment with, let’s say, having balanced, you know, glucose. So, you were kind enough to take us through the plant-based side of how, you know, if you’re eating a lot of grains or, you know, a lot of like oats or oat milk or oatmeal, those can be things that could throw you off. How could somebody maybe be doing keto incorrectly? Are there some examples that you could share with us?

Casey Means: [56:23]        Yeah, absolutely. So, just first touching on keto, so a ketone is a by-product of fat breakdown, so I’m very inn favor of that, because we want to be, you know, breaking down fat in our body and producing ketones. That’s a sign of metabolic flexibility. If you are making ketones, it means that you have gotten to a place in your body where insulin is low enough that you’re actually moving from glucose processing to fat processing and making ketones. And ketones have been shown to be very beneficial to the body and the brain, in a number of different ways. So, personally for me, like I mentioned, I’m vegan, but I actually check my ketones almost every day and try and stay in mild nutritional ketosis, even on a vegan diet. And I can do that because I’m eating vegan foods that don’t spike my blood glucose. So, I try and stay between about 0.5 and 1 on my ketones, using a keto mojo monitor and so, that’s really where I land. Now, a keto diet is interesting because it’s very strict. There’s like a very strict set of foods that people who are on a keto diet tend to focus on. And something that’s really interesting about glucose monitoring, we have tons of keto users, who are using glucose monitoring now, and a lot of them have actually found that they’ve been able to liberalize their diet by using a glucose monitor. So, they’ve found that foods that are actually, standardly said, You shouldn’t eat them on a keto diet, things like carrots or beans, they might not actually spike their blood sugar at all and actually lets them stay in ketosis. So, that’s been very empowering for a lot of our customers, to actually go from more restricted to less restrictive. But more generally with the keto diet, where I see it go awry is when people eat a lot of processed food or, you know, nutrient-poor foods that have no glucose in them, and so they’re going to make it look like you’re not spiking your glucose at all, but they’re not actually supporting cellular physiology over the long-term. That’s my biggest. Exactly. So, there’s lots of bars out there and drinks and even, you know, poor quality meats that people can eat. And because they don’t have carbohydrates or glucose in them, it’s going to look like a win on your glucose monitor. Sure, you think you’re winning the game because your glucose is flat, but it’s just because you’re not putting any glucose in the body. What we want to do is, over time, build a body that processes carbohydrates effectively, not that just doesn’t use any carbohydrates. So, I really encourage people on a keto diet to really follow what more like Jason Fung talks about in his book, which is lots of green, leafy vegetables, lots of nutrients, antioxidants, very low carb. He talks about getting protein and eating, you know, a small amount of low-glycemic fruit, and then, you know, eating some meat and proteins and animal proteins and things like that. But the foundation of that is greens and whole foods. So to me, you know, the only way to do a keto diet right is to do a whole foods keto diet, with the foundation of that being low-glycemic vegetables and greens, because then you’re ensuring that you’re getting the micronutrients to support mitochondrial function. You’re getting the fiber to support microbiome composition, and over the long-term, are going to build a body that actually processes carbohydrates effectively. I feel like the processed route is a good way to have short-term perceived gains, but in the long-term, you’re not building a body that’s going to be metabolically healthy.

Dhru Purohit: [59:55]                           For sure. And we’ve had people like Dr. Lisa Mosconi on the podcast and other individuals who have shared that, you know, a lot of the studies that have been done, they sometimes don’t include the special needs that women might have, where they might need more carbohydrates or do better with having some carbohydrates there. So you see, anecdotally, even in our clinic in Massachusetts, The UltraWellness Center, Dr. Liz Boham, one of the doctors that’s there, that’s been on the podcast before, she talks about how sometimes women will come in, who have been following a very strict keto diet for a number of months, and in the beginning, we’re doing really well, but then start to taper off and don’t see some of the benefits or have deep, deep cravings for more sugar than they had before, because they’re not including any carbohydrates again, in there. Again, another example of just how we’re different and how even biologically our bodies need different things because there have different energy needs to do their functions properly.

Casey Means: [01:00:51]Absolutely. Yeah. I think that it’s such an important point. We are so biochemically individual, and you know, what works for one person will not necessarily work for another person, and especially when you add in the cyclical nature of the more hormonal cycles in women, where you have very different energetic needs in different portions of your cycle, in the follicular phase, the pre ovulation phase of the cycle, when we have a high estrogen to progesterone ratio, we tend to have better metabolic health markers. That high estrogen to progesterone ratio, tends to favor insulin sensitivity, and we tend to do better. And then in second half of the cycle, after ovulation, where there’s less of a estrogen progesterone ratio, we tend to be more insulin resistant and blood sugar tends to be higher. So, it just goes to show that like, we really, you know, every day is different. Every person is different. And the more we can understand, you know, the inner workings of their body, I think the more we can make smart choices over time.

Dhru Purohit: [01:01:54]                   I want to touch on a little bit sort of state of current events and in this pandemic, that’s been happening, tell me how you look at what’s going on through your lens? How do you look at the world of COVID and the countries and what people are suffering from, through the world of also metabolic disorder?

Casey Means: [01:02:16]Yes. Well, from my perspective, virtually, the top lens we should be looking at COVID through his metabolic health, because we learned very, very early on in this pandemic that COVID, the virus, discriminates against people with metabolic dysfunction, people with diabetes, heart disease, and obesity had significantly increased morbidity and mortality from the virus, and we knew this back in March. I’d published a paper in metabolism in April of this year, talking about how we needed to have a massive public health investment towards rapidly improving metabolic health in our country, if we wanted to have, you know, long-term good outcomes with this virus. And what we found was that there are many, many mechanisms through which having dysregulated blood sugar actually makes you more likely to get sick and die of the virus. One of these is that high blood sugar directly impairs our immune function. Our immune cells have to get to sites of disease in order to actually function and fight the infected cells, and actually immune cells can’t move properly when there’s high glucose. This process called chemotaxis, which is immune cells moving towards sites of infection, is stunted when there is high glucose in the body, so even movement of these cells is perturbed. We also found that people with diabetes had an upregulation of receptor on their cells called the H2-receptor. And this happened to be a receptor that COVID virus, SARS-CoV-2, these virus particles would actually use the H2-receptor to get into the cells. And so, these diabetic individuals had more of those receptors, made it more likely for the cells to get infected. We also found that lung fluid has more sugar in it in people with diabetes, and that actually makes viral replication easier. So, those are just a few of the reasons why people do worse. And then a big one actually comes back to inflammation. People with underlying diabetes, obesity and heart disease have baseline higher in inflammation in their body. They have upregulation of cytokines like TNF alpha and CRP and interleukins. And what’s interesting about the viruses is, it’s not actually the COVID virus that kills people. It’s the immune response to COVID that kills people. And when you have.

Dhru Purohit: [01:04:39]                   Cytokine storm.

Casey Means: [01:04:41]Yes, the cytokine storm. And when your cytokines are already elevated because of baseline poor metabolic health, you can imagine when you add the virus on top of that, it’s a compounding effect that’s going to make that immune response much more exaggerated and much more deadly. So, you know, I think that even now, you know, we need to be investing hugely in disease reversal programs, getting people access to monitoring tools like this, you know, virtual coaching programs that help people manage their metabolic health, because the reality is, these are conditions that are, you know, reversible in many cases, certainly obesity, but also diabetes and heart disease. Virta Health, an amazing company that works with Type 2 diabetic individuals, has shown in research that they can actually get people from a diabetic to a non-diabetic glucose level in 10 weeks of an intensive dietary and coaching program. And so, you know, you can just imagine if we were able to make these things, you know, exceedingly accessible for our country, we may build and really get blood sugar under control and help people do better with these. You know, if they get the virus and ideally, you know, prevent them from contracting a severe case. And one last thing to note actually, COVID is not the first virus to discriminate against people with metabolic disease. Even the common flu is five times more likely to put someone in the hospital if they have diabetes. So, this is not just about COVID, it’s about any future infectious disease that we face.

Dhru Purohit: [01:06:11]                   It’s so true. You know, it’s like, everybody’s talking about the flu shot right now and really, that’s fine, you know, there could be a conversation or at least a little bit of back and forth about the flu vaccine, but it’s like, why do we typically get exposed to all these viruses that we are exposed through throughout the year, but why do they take over more so in the holiday months, when we’re eating more sugar and we’re around people more and we’re indoors, but diet is a big factor of it. It’s not that to not take it seriously. It’s actually to take it more seriously and understand what’s really driving it through our dietary means. And I think that that’s the case with COVID too, because you know, it’s a very hot topic and sometimes it can be politically charged because it can feel that one group is saying, It’s not that serious of an issue, right, with the survival rate and everything like that, and another group is saying, Look how serious it is with the data that’s there. And there’s functional medicine doctors, like yourself and Dr. Hyman, are saying, Look, this is serious and we have to talk about the serious ways to address it, if we really want to get to the root, because even the world health organization has come out and said, long-term lockdown is not the solution for this. It’s going to decimate economies. It’s going to put people into poverty. But, as we’re also having the debate nationally about vaccines and other things, there’s other tools that are there, like mandatory vitamin B, you know, having glucose testing for people and having more of an honest conversation about what actually makes us sick. That doesn’t mean that you are a COVID denier. It actually means that you’re taking COVID more seriously by having that conversation.

Casey Means: [01:07:49]Absolutely. Like, no matter what people’s feelings about COVID are, we have tools at our disposal to make ourselves more biologically resilient. And every single person who’s worried about COVID or, you know, should be thinking about how to make themselves biologically resilient and hard to kill. That is critical. And it’s not a mystery. We know how to become hard to kill from a virus. We improve our metabolic health. We control our blood sugar. We get good vitamin D levels. We get good sleep. We manage our stress. We exercise every day. We have good relationships. And we reduce our exposure to environmental toxins, like persistent, organic pollutants. We do these things day in and day out, eat whole foods, we are going to make ourselves biologically resilient and harder to kill. Unfortunately, our culture makes it extremely difficult to do all of these things. And so, I think really, the onus is on individuals, but also our system to really think about this more seriously, because this is going to help us in COVID, but any future viral illness that comes our way. And not to mention, doing all these things makes people happier, and it makes people feel better and more able to also psychologically cope with the challenges that we’re dealing with right now.

Dhru Purohit: [01:09:05]                   It’s so true. Once you understand the problem that we’re in, with metabolic disorder and how pervasive it is, you start to look at social issues a little bit differently. You start to think, Wow, maybe if we actually, for especially the most underserved communities, communities that don’t have a grocery store, don’t have a lot of education about wellness or food, you know, don’t have a lot of tax dollars that are in there that are supporting the infrastructure for public health, could it actually be cheaper for us to actually give coaching and food away? You know, there’s these pilot programs of food pharmacies, where doctors are prescribing free food, vegetables, fruits, things like that to populations that don’t have access. And it would actually be the fiscal, responsible thing to do, because it’ll save our economy from the amount of healthcare bills and other things, and ultimately human beings get, you know, get the help that they need to be able to have better health. It just changes the whole dynamic, when you really start to understand all the layers that are involved in this, on the individual and on the societal level.

Casey Means: [01:10:07]Absolutely. I think if we had a broader balance sheet, where we really did do a little bit of a cost-benefit equation like that, I think we’d find that some of the highest value interventions we could possibly do right now in COVID, and by value I mean outcomes over cost, would be to be focusing on food. And, you know, I know I’m preaching to the choir on this, but there’s a lot of good data and modeling to support this. There was a study a few years ago that said if we gave every diabetic individual a thousand dollars-worth of fruits and vegetables per year, we could likely save manyfold more than that on their health care costs. So, I think we just need to get really innovative about supply chains and about our food system and think about how we can get these nutrient-dense foods to people, you know, in a scalable way. So, it’s really exciting to hear that there’s, you know, a lot of people working on this right now. But it’s unquestionably going to be part of the solution.

Dhru Purohit: [01:11:05]                   Yeah. And you know, we’re in the midst of recording this while there’s still, you know, it’s debatable, they’re trying to figure out like who the next president is and everything that’s going on with the elections, and we need all solutions, you know, it’s important to vote, but it’s also important to vote with our dollar. And it’s amazing that, you know, I’m an entrepreneur through and through, I believe in conscious capitalism as one of the things that can support people. And I think innovative companies like Levels are providing new solutions that help in that process. Yes, be politically active. Yes, be aware. Yes, you know, maybe turn off the news sometimes too. Yes, support companies that are making a difference. And also, entrepreneurs who are out there like yourself, who are trying to make tools and technology available to folks. So, you know, we’ve gone through the whole gamut. If people want to try Levels, they want to get more information, can they sign up? How do they sign up? Where should they go?

Casey Means: [01:12:00]Yeah, absolutely. Well, so you can come to www.levelshealth.com and sign up for our waitlist. We’re currently in a beta program, so we’re going to be launching likely, early next year, but we do have a code for your listeners that you can, that you’ll link, I believe, and that is actually going to get people to skip the waitlist and be able to go straight into the beta program. So, if you want to try this right now, you can, with the broken brain code and we’d be very excited to have you. If you want to learn more about metabolic health and why it’s relevant to everyone, you can also check out our blog, which is levelshealth.com/blog, and lots of amazing guests experts posting there, Dr. Ben Bikman, and many others who are writing about this. And you can find us on Instagram and Twitter at levels. And I’m at Dr. Casey’s kitchen on Instagram as well, and I talk a lot about metabolic health and plant-based diets. And so it’d be great to hear from anyone here.

Casey Means: [01:12:57]Yeah, and that code is levels.link. You can find it in the show notes or if you’re on YouTube, just scroll below- levels.link/broken brain. I think you guys have like 40,000 people or so on the waitlist. So, if you use this code, and again, I don’t make any money from this. It’s not an affiliate code. This is just something I’m passionate about and I want to share with my audience. I always like to be transparent about those things because this isn’t an infomercial for something that we’re getting paid on. This is an infomercial for something that I’m just so excited about, because I see how instantaneous feedback makes a difference. So, you can skip that waitlist of about 40,000 people and jump to the beginning and, you know, just so everybody knows, in the sort of unboxing aspect, I wish I had my box with me, but you get two sensors, right, because the sensors last 14 days, so you have to change them every 14 days. And then you’re also getting the instructions on how to download the app on your phone so that you can use the app. There’s two of the apps because you guys are using the sensor app and then there’s your app, which is a software, which is really the gold. And the way that I use it right now, like the first couple of weeks you’re just sort of gathering data on your normal routine, right, and you’re gathering data on your normal routine. And you will measure your glucose by tapping the sensor multiple times in the day, you know, morning, before you eat stuff, right, it’s before you eat stuff that you would measure it?

Casey Means: [01:14:24]You can do it before or after. The sensor actually stores eight hours of data. So, you could do it, you know, after breakfast and lunch, do it first thing in the morning, and then after breakfast and lunch, and kind of get a feedback of how your breakfast and lunch affected you, or if you want, you can also just scan it right before each meal too. I think, especially in the beginning of the program, most people scan sort of maniacally, like 50 times a day, because they want to see everything that’s happening, and I certainly did that. But yeah, after two hours after your meals, once you scan your sensor, you’ll be given a score for your meal, of basically how much it affected you. And so, that’s really fun to kind of wait and see what score you got.

Dhru Purohit: [01:15:05]                   Yeah.  And the really cool thing that I like is, you get an email the next day that gives you, you know, gives you that score and that summary. How did you do yesterday? Because, you know, so much studies out there on when you can gamify something and apply a score, then you can know. How did you do yesterday, compared to the day before? What’s your rate today? Out of a hundred percent, in terms of how well you could do, you’re at an 88 today, or you’re at a 60 today. Okay. Wow. Pay attention. Maybe get better night’s sleep tomorrow. Go to bed earlier, you know, eat earlier. So, there’s all these actionable items that come in, and then I believe, are there anything else that’s included? Is there is a consultation with one of the people on your team? Can you talk about that?

Casey Means: [01:15:47]Yeah. So, the program is a consultation with a physician in your state, which has done through the internet. It’s very simple and easy, that’s to be evaluated for a prescription, for a CGM. And then you’re shipped to prescription CGMs from our partner pharmacy. In the box, you’ve got 2 performance covers, which cover them and keep them waterproof, access to the app, and the program is one month. And in that one month, you’re going through these two sensors that each last for two weeks. So, you’ll have, you know, 24-hour access to our customer support team. If you have any questions or need help or anything like that. And yeah, we just really want to help people in that month, gain lots of metabolic awareness about their body, and then also move towards optimization. So, how do you learn what to do, learn how your diet is affecting you, try different experiments and then work to really optimize, to get that glucose as low and flat as possible.

Dhru Purohit: [01:16:40]                   It’s fantastic. Last question on that, I know a lot of people are wondering, do you have to wear this thing forever?

Casey Means: [01:16:46]Yeah. So, I think there’s, it really depends on the person. So, I think in one month you can make huge gains. You can learn so much about your current diet, what’s working, what’s not, how to pair foods properly, how exercise is affecting your glucose, and you can really be, after a month, set to just launch into, you know, V2 of your life in terms of metabolic health. I would say for a lot of people, they enjoy doing it for months on end, to really just keep experimenting, keep gaining awareness. And then, I think there’s people who are using it, who really do want to use it kind of long-term, more as an accountability partner. So, for people who are pursuing weight loss, for instance, having this on your arm is a way to know that you’re staying in that fat burning mode, keeping your glucose low. It’s a way to show your peers and your groups and whatnot, like how you’re doing and that you’re staying on track both for yourself and for others. And so, I think it’s great long-term, as an accountability tool. I know for me, and you know, sometimes I’ll have it off for a couple of days in between sensors and I know that I always choose higher carb foods when I’m not wearing it, because I know I’m not going to get that, you know, red spike that, you know, is so unpleasant to see. And then I think for people who are more in like the athletic and fitness community, a lot of them like to use it more long-term as well, since it’s really real-time fueling and recovery decisions. So, I think there’s different timelines for different segments. But I think for the average person who wants to learn and wants to optimize their diet, I think doing it for a month and then maybe doing it every six months or so, to kind of just like reboot, make sure you’re on track, is a really good cadence. But, you know, we offer any of those different timeframes. And, but the core offering is one month, as really the core metabolic awareness journey.

Dhru Purohit: [01:18:34]                   It’s fantastic. And I know you have a great team of founders that you’re working on this with, and I want to applaud you guys for really, again, creating more tools, more options, more tools, help people make better health decisions, which helps the population, which just makes everything better for everyone. So, Dr. Casey, I want to thank you so much for coming on the podcast, talking about what you’re up to. We’ll have a link to your Instagram and Levels, and all the links that we mentioned and how to skip the line in the show notes below. I truly appreciate you. And it’s been a fantastic conversation.

Casey Means: [01:19:05]Thanks so much, Dhru.

Dhru Purohit: [01:19:10]                   Hi, everyone. I hope you enjoy the interview. Just a reminder, this podcast is for educational purposes only. This podcast is not, I repeat, it’s not a substitute for professional care by a doctor or otherwise qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search there, find a provider database. It’s important that you have somebody in your corner that’s qualified, that’s trained, that’s a licensed healthcare practitioner, helping you make changes, especially when it comes to your health.

[END]