#227: Five Surprising Foods That Spike Blood Sugar and How to Make Them Healthier with Dr. Casey Means

In this episode of the Dhru Purohit podcast, Dr. Casey Means and Dhru analyze the 5 surprising worst foods for your body. They’re foods that you wouldn’t think of as unhealthy, but in reality, they are a danger to overall metabolic health thanks to their negative impact on blood sugar.

Surprising food #1: Grapes

Because grapes are typically eaten in isolation, they have a significant impact on blood sugar. Grapes was fascinating to me, because here’s a fruit. We have a lot of people logging different types of fruit, oranges, apples, berries, but grapes was just absolutely off the charts. When you look at the nutrition of grapes, they do have about 10 to 20 grams of sugar per cup, so that is a lot. I think one of the key things that might be unique about grapes is that we kind of rarely eat them with other foods. Like we don’t really pair grapes with nut butter or with yogurt even, or with oatmeal. It’s kind of unusual, so you’re often eating them alone. I’ve heard this concept of naked carbohydrates. I think grapes are often being eaten like that. They’re just being eaten naked. They’re not being paired with other things that can blunt the glucose response, and the things that really can be helpful with fruit in blunting the glucose response is adding fat, protein or fiber, so that could look like adding chia seeds or a nut butter or something like that, and we rarely do that with grapes.

Every glucose curve tells a story

When you track your glucose with a biowearable like Levels, you are able to understand the relationship between inputs and outputs.

Every glucose curve is a learning opportunity, and for me, the learning opportunity with that is think about ways to pair grapes with other things, like could you add them to some sort of fat source or fiber source like a chia pudding or something like that to maybe offset some of the glucose spike? Maybe just make sure that you’re eating your grapes before or after movement. Like when you move even for 20 minutes after a meal, you can bring down that. You can bring down that glucose spike, and so just building a context around these foods so that you’re not getting such a heavy hit of a glucose spike.

Food is molecular information

Simply put, food is fuel. You wouldn’t put water in the gas tank of your car, and you shouldn’t put unhealthy food into your body without expecting consequences down the road.

The way I really frame food is that food is molecular information. Really, when we go out and eat, we’re choosing what molecular information we want to put into our bodies, because that information is going to determine how our genes are expressed, how our hormonal pathways are signaling and how our cell biology works. Now that we understand, we’re at this exciting point in the scientific sort of world where we really understand cell biology on a very, very deep level, and how food compounds are interacting with that, and so that’s really the framework through which I go to the grocery store. I’m going to the grocery store on a micronutrient, molecular information hunt.

Surprising food #2: Oats

Long touted as “heart healthy,” oatmeal and oat milk typically have an adverse reaction in most people.

In the beginning of the company, when the five co-founders, me and my four co-founders were all together, we did an experiment, where we each had a packet of just the Quaker instant oats, so it was like plain oats in a mug, fills up like a third of the mug, and you microwave it, and universally, our glucose all went above a 60-point rise, so from baseline to the peak after the meal, it was 60 milligrams per deciliter. For context, I generally don’t really want to go above 30 points ever with a meal above my baseline. I’m trying to stay within that range of like a gentle peak, and so 60 is huge. That’s a lot of glycemic variability. Over time, if you’re doing that day after day after day for 30 years, there’s really no question that that’s going to contribute to insulin resistance.

Control can be liberating

When you understand why you feel tired or anxious, you can take steps to improve.

I think that sometimes we think of ourselves as like, oh, we’re just an anxious person or we are just someone who is always a little bit tired, I’m just tired all the time and you don’t really know why, and there’s a million wellness things to choose from, but having this data that’s like, “Okay, actually you’re feeling anxious when you crash after a glucose spike, that’s when you feel anxious.” It takes it away from like, “This is who I am,” to, “This may be related to a choice that I’m making, that I have the agency to change or to modify. I have the tools to adjust that.” And that can be really liberating like, “Okay, this is not just who I am. This is something interaction between my environment and my body that I have some control over.”

Think twice about fruit juice

In excess or concentrated forms, fruit can have negative blood sugar effects.

I drank a drink recently as an experiment called immunity fix, and it was like a $10, juice bar drink. And it did have certain components in it that are associated with improved immunity. So it had ginger and it had tumeric and things like that. So that’s great. That’s true. Those impact our immune function, but it was also just a ton of liquid fruit and my glucose went up 85 points, it was just giant mountain, giant crash. We… It’s pretty well-established that glucose spikes can impair immunity almost immediately, long-term metabolic dysfunction and having pre-diabetes or diabetes has a significant impact on our immunity, high blood sugar actually like stunts our abilities immune cells to move the process of chemo taxes, which is immune cells moving towards their target is stunted by high sugar. It also creates inflammation in the body which impairs our immune function.

Eat healthy fats

Rid your pantry of vegetable oils, and instead opt for avocado, olive, or coconut oil.

You want to get the best fat molecular information in your body. So I think the top ones I would talk about would be omega-3’s, these are fats that we know are anti-inflammatory and really important for building our cell membranes and having this nice fluidity of our cell membranes. Every single one of the 30 trillion cells in our body is wrapped in fat. And so we want that healthy fluid fat and so that’s where omega-3’s can really come in handy. So that’s going to be from things like chia seeds, flax seeds, and then the smash fish. So the sardines, mackerel and anchovies, salmon, herring, and that’s where you can really get a lot of those healthy fats. And then I really just focus on whole foods fats as much as we can. So things that are coming from nuts and seeds, things like avocado, olives and coconut, these are going to be fats that are wrapped up in all the other beautiful things that these plants have.

Surprising food #3: Sushi

Thanks to rice, sushi isn’t as healthy as it first appears.

I think sushi probably was one of our low scores is for a couple of reasons. One, rice just spikes a lot of people. White rice tends to be a really big spiker and we see that amongst a lot of our members. I personally, rice in any context gets me 40, 50 points above my baseline, so I have to be very judicious with when I’m eating rice. And now I’m a huge fan of alternatives like cauliflower rice, or broccoli rice. The other thing is that with sushi, a lot of times sushi rice is sweetened and may have some sugar and vinegar and other stuff in there to make it taste good, so that’s something to just maybe ask about when you go to certain restaurants.

Surprising food #4: Acai

Acai had a big moment over the last years, but it’s actually a fairly high-fat food.

This one was probably the most shocking to me because this was in our top 20, actually this was in our top 40, we’re scoring logs. And this is universally I think thought of, is one of the healthiest things you could have and people are paying a lot of money for these acai bowls. And we had, oh, I think, well, over a hundred people log these in their logs and it was a zone score of five, which is essentially a big, big spike. I think what’s going on here is acai itself is actually not a food with a lot of carbohydrates. It’s more of a high-fat food. I think it’s the things that people are adding to this. And so this is going to be one of those situations where potentially you’re adding tons of fruit to this bowl. You’re adding tropical fruits, which tend to be high in sugar. A lot of berries, oranges, kiwis, things like that, papaya and not really getting a lot of fat and protein in there.

Surprising food #5: Thai food

Again, thanks to rice most Asian dishes can cause a glucose spike after eating.

We lumped these all together. Thai food, pho, ramen, Chinese food because they have a lot of commonalities. And one of the big ones is noodles. All of those things are to include some sort of rice or wheat based noodle, which is essentially an ultra refined version of a carbohydrate. And these just send people through to the moon with glucose. I think what’s so neat about a lot of these, I mean, you may love the flavors and it doesn’t mean you can never eat these types of foods. It just means being a little more thoughtful when you’re looking at the menu. So maybe it’s moving away from the Pad Thai, which is going to be like a ton of noodles and maybe a sweet sauce to actually asking, Hey, do you have a Curry that’s pretty minimally sweetened. And then just eating that by itself with some good protein in there, whether it’s tofu or fish or chicken or whatever. Maybe avoiding the rice or just having a tiny bit of rice with an unsweetened curry. But ultimately if the base of the meal, like a pho or a ramen or a noodle dish, or a lo mein, is a noodles it’s going to just be, that’s like a naked carb. It’s just so much, turn straight into sugar in the bloodstream.

Dr. Casey Means: It’s pretty well-established that glucose spikes can impair immunity almost immediately. I mean, long-term metabolic dysfunction and having prediabetes or diabetes has a significant impact on our immunity. High blood sugar actually stunts our ability’s immune cells to move. The process of chemotaxis, which is immune cells moving towards their target is stunted by high sugar.

Dhru Purohit: Today, we’re talking about the 10 surprising worst foods, surprising because they’re foods that you wouldn’t think of, 10 surprising worst foods for your overall metabolic health and blood sugar. If you want to find out what they are, stay tuned. The other day, I was with a doctor who specializes in environmental toxins, and they told me that the most toxic item in our home is actually our mattress. I’m sure many of you were shocked to hear that, as I was. This is especially scary when the average person spends more than 26 years of their life sleeping.

Dhru Purohit: We spend so much time in bed, but it’s crazy that we’re more likely to splurge on an expensive car or clothes. Well, I’m advocating for a better mattress for you. Most mattresses on the market though, contain harmful chemicals and polyurethane foam, which emits things like volatile organic compounds or VOCs. They’ve been linked to respiratory issues, reproductive damage, and they can even damage your immunity. I spent a lot of time, I mean, a lot of time looking for the perfect organic mattress, and I was so happy to find the Birch Mattress by Helix.

Dhru Purohit: The Birch is made right here in the U.S. out of four, just four non-toxic natural materials, organic latex, organic cotton, New Zealand wool, and American steel springs. It feels so great to know that I’m sleeping on a mattress that uses 0000 polyurethane-based foams. That means no off-gassing. Have you ever got a new mattress and you open it up and it smells like crap? That’s called off-gassing.

Dhru Purohit: The Birch Mattress doesn’t do that, so now, I can sleep a lot better knowing that I’m not exposing myself to harmful chemicals day in and day out, and the best part is, this mattress is crazy comfortable. You don’t have to give up comfort when you choose the non-toxic option. I’ve honestly never slept better, so if you’re looking for a new mattress, I highly recommend checking out the Birch. Right now, they’re giving my community $200 off all mattresses, plus two eco-reset pillows. Just head over to Birchliving.com/dhru.

Dhru Purohit: Again, that’s $200 off and two free eco-reset pillows at Birch, B-I-R-C-H, living, L-I-V-I-N-G.com/dhru, spelled differently, D-H-R-U. If you’re worried about trying a new mattress, by the way, they have a 25-year warranty and you can try it risk-free for 100 nights. Birch also ships directly to your door for free with no contact required, and they’ll pick it up for free if you don’t love it. Check out the Birch Mattress today by Helix. Welcome to the ‎Dhru Purohit Podcast.

Dhru Purohit: Each week, we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine and mindset. This week’s guest is Dr. Casey Means. Dr. Casey Means is a Stanford-trained Physician, Chief Medical Officer and Co-founder of the metabolic health company, Levels, and an Associate Editor at the International Journal of Disease Reversal and Prevention, and she’s a lecturer at Stanford University. Casey’s mission is to maximize human potential and reverse the epidemic of preventable chronic diseases by empowering individuals with tools that can facilitate a deep understanding of their bodies and inform personalized … That’s what this podcast is all about, personalized and sustainable dietary and lifestyle choices.

Dhru Purohit: I’ve been a friend of Casey’s for a long time now, and through meeting her, I invested in her company, Levels, and today, we’re talking about a very interesting topic. We’ve done so many podcast interviews all on metabolic health and insulin resistance. Today, we’re covering 10 of the worst, absolutely worst, but surprising, the 10 worst foods for your blood sugar, the 10 worst foods that we consume on a regular basis that spike our blood sugar, which can lead to things like insulin resistance, inflammation, chronic diseases, but these are the surprising ones, so I think you’re going to find it super informative. Stay tuned. Dr. Casey Means, welcome back to the podcast.

Dr. Casey Means: So great to be here, Dhru.

Dhru Purohit: I’m so glad it’s in-person, and I’ll just jump in and I’ll tell you why. When you talk, I get so excited, and when people get excited, they tend to cut each other off because they’re so excited, and sometimes that comes across as rude, and I’m also mindful as a guy, how it comes across cutting off, especially when my podcast host is a woman, even though I equally cut off men and women at the same because I’m just as excited about them, but something beautiful happens when you’re in-person. When you’re in-person, the other person can see the visual cues and can see that you’re getting excited, and they kind of give you space to be able to jump in, so if you get excited when I’m talking about something, please, cut me off. I don’t take it as a insult, I take it as a compliment.

Dr. Casey Means: Absolutely, and I don’t think there’s any universe in which you could be considered rude, but that is very kind of you to say, and I can’t wait for this conversation.

Dhru Purohit: Well, we’re going even deeper on the topic of metabolic health. It’s been a few months now that I’ve been using the Levels monitor, and you’re one of the Co-founders and the Medical Director of Levels, and people had a really great chance on our last podcast episode to get the big picture on metabolic health. We’ll repeat some of that information, but today, I really want to focus on foods to pay attention to, and also how we can make things healthier and other aspects that also impact our glucose. I want to just jump right in, because you guys wrote a really interesting article recently, and it was called Five Surprising Blood Sugar Spikers. I think one thing that when anybody’s using a continuous glucose monitor and they’re trying to dial in their health, regardless if they’re keto, vegan, vegetarian, anything in between, pegan diet, whatever, the message from the last podcast we had and today’s podcast is you can do any diet in a optimized way or any diet can also be done in a non-optimized way.

Dhru Purohit: When you dial in your own personal diet and you get into the right blood sugar range, you’re not just focused on avoiding chronic disease because that’s a big part of it, but you’re now talking about how to create the best health ever, because you’re living in that optimal range, so let’s jump right in if that’s okay with you.

Dr. Casey Means: Absolutely.

Dhru Purohit: Okay. I’m going to walk us through these five, and we may pause and go in different directions and use it as an opportunity to explain concepts that you guys write a lot about, so five surprising blood sugar spikers, number one, grapes. Okay? Why is grapes one of the first foods that was listed as a blood sugar spiker and something that would impact your glucose in a way that maybe if grapes are a big part of your diet, you might want to be paying attention to?

Dr. Casey Means: Yeah. Grapes was fascinating to me, because here’s a fruit. We have a lot of people logging different types of fruit, oranges, apples, berries, but grapes was just absolutely off the charts. When you look at the nutrition of grapes, they do have about 10 to 20 grams of sugar per cup, so that is a lot. I think one of the key things that might be unique about grapes is that we kind of rarely eat them with other foods.

Dr. Casey Means: Like we don’t really pair grapes with nut butter or with yogurt even, or with oatmeal. It’s kind of unusual, so you’re often eating them alone. I’ve heard this concept of naked carbohydrates. I think grapes are often being eaten like that. They’re just being eaten naked. They’re not being paired with other things that can blunt the glucose response, and the things that really can be helpful with fruit in blunting the glucose response is adding fat, protein or fiber, so that could look like adding chia seeds or a nut butter or something like that, and we rarely do that with grapes.

Dr. Casey Means: I think that might be one of the big reasons for it, but it was pretty much off the charts. We actually … In writing this article, what we did was we looked at essentially, amongst our 10,000 or so beta customers, we looked at all the logs that people had written on the app of sort of what foods that they were checking with their continuous glucose monitor, and we looked at the bottom 40, so which scored the absolute worst, and yeah, grapes-

Dhru Purohit: Right, because on the app interface, we will have like a little screenshot that people can look at, you get a score for everything that you log.

Dr. Casey Means: Yeah.

Dhru Purohit: One out of 10.

Dr. Casey Means: Yeah.

Dhru Purohit: It’s not about being perfect, it’s more just giving you an idea of what is the impact to your glucose, so one is a food that if you want to use traditional words like kind of had a negative impact for you and spite you very heavily, and we don’t want these roller coasters that are there.

Dr. Casey Means: Yeah. Exactly. Our goal for optimal health, optimal longevity is to keep our glucose more flat and stable throughout the day. We do not want these huge ups and down spikes, these peaks and valleys, which is called high glycemic variability. We want to avoid that.

Dr. Casey Means: We know that glycemic variability is associated with weight gain and future risk of disease like heart disease, stroke and diabetes, and so keeping things more gentle and flat is really what we want. In the Levels app, how that’s going to show up is by getting what we call a better zone score. A zone is essentially a composite metric of what’s happening to your glucose after you eat something. Glucose will rise if there’s carbohydrates in your food, and then it’ll come back down, and we want that to be in a healthy, short period of time. We want it to go up and come down usually within about two hours, and we want that spike, that delta from before you ate to the peak after your meal to be smaller rather than larger, and so of all the fruits that people log, grapes were just off the charts, and so I think there’s a lot of learning in that. Like you said, this is not about a judgment of like, “Oh, you’re hurting your body by eating this,” or, “You should never eat these again.”

Dr. Casey Means: It’s really, I like to say that every glucose curve tells a story. Every glucose curve is a learning opportunity, and for me, the learning opportunity with that is think about ways to pair grapes with other things, like could you add them to some sort of fat source or fiber source like a chia pudding or something like that to maybe offset some of the glucose spike? Maybe just make sure that you’re eating your grapes before or after movement. Like when you move even for 20 minutes after a meal, you can bring down that. You can bring down that glucose spike, and so just building a context around these foods so that you’re not getting such a heavy hit of a glucose spike.

Dhru Purohit: What’s really interesting is that you are right, I think people just eat grapes alone, but if you think about like a charcuterie board, charcuterie board, like traditionally might have cheeses on there. It’ll have some proteins, usually some versions of salami type proteins that are there, especially in the Mediterranean. I love going to Italy, and everywhere you go, they have these different charcuterie boards. They’ll have olives, so they’ll have good quality fats. They might even have like a little honeycomb.

Dr. Casey Means: Yeah.

Dhru Purohit: That’s on there, and some herbs, depending on what region. We were down in Sicily last … Two years ago, I took my family and my parents on this big trip. We had all sorts of different herbs that they added to our charcuterie board, and then the grapes were there, but they were just one, small, little part of it.

Dr. Casey Means: Exactly, and I actually, I would bet that if people were eating these in the context of a charcuterie board, it would’ve been a better response. Something unique about this article was that we were looking for foods that were logged in isolation, so only foods that were logged by themselves, so that does change the data a little bit, but exactly what you’re talking about, that is essentially a balanced meal, in a sense, from a macronutrient perspective, the charcuterie board. Often, nuts are on there as well, and so you’re getting those healthy fats, those whole food fats, the protein, et cetera, to sort of offset some of this just huge load of glucose coming into the system.

Dhru Purohit: Yeah. Right now, you have 10,000 users that are in part of that beta. I’m one of them, and for everybody, who’s just wondering, I mean, I have long sleeves on, but you could show it on your arm. If they’re watching on YouTube, you have a sticker on, and there’s a sensor underneath. That sensor is streaming data to your phone, and on the phone, there’s the Levels app, which you and your team have created, which is basically helping you make sense of this data and giving you actual insights, because I used to use a Dexcom, which is a continuous glucose monitor.

Dhru Purohit: Most people know that because diabetics would use it to help them manage their blood sugar, but now, people who are sort of in the biohacking/optimal living community are using it too, but the challenge was, is Dexcom’s a great company, Abbott is a great company, but you can’t really get actionable insights from their apps, so you guys build an app that really help people make meaning out of this information to actually know, “Hey, this food does this,” or, “This food does that,” or, “This stress level does this,” or, “When I don’t get sleep, here’s where my blood sugar is,” and so it’s easier to make lifestyle changes.

Dr. Casey Means: Yeah, that’s exactly right. We are building a software on top of this amazing continuous data stream that helps you contextualize what’s happening and understand the holistic nature of metabolic health and glucose control. It’s not just about the amount of carbs you’re eating, because carbs affect each person differently, and we spoke about this on the last podcast, but really, the concept of biochemical individuality. You and I, we’re drinking the same juice right now, but we could have very, very different responses to that because of internal factors like microbiome composition and things like that, so knowing how it really affects you personally is important, but then, all the other lifestyle things you mentioned. How much we’re exercising and moving our bodies and our muscles each day, how much or how little sleep we’re getting and the quality of our sleep, the stress that we’re under can have a huge impact on our glucose responses to the same food.

Dr. Casey Means: Eating an apple when we’re stressed versus when we’re not stressed can look very, very different, so putting all these things into context so that we can ultimately build a metabolic toolbox, understand which tools are at our disposal to keep that glucose more flat and stable more of the time. Maybe that means taking some deep diaphragmatic breaths before you eat a higher-carb meal. Maybe it means always taking a 20 or 30-minute stroll after dinner if you know you’re eating something that spikes you. Maybe it means eating the higher-carb foods that you like after a good night of sleep, rather than after a poor night of sleep, but building that metabolic awareness, I think just really can help people have a little bit more control over this really important part of health, which is our blood sugar levels, which are becoming a problem for most Americans at this point with 128 million Americans having type 2 diabetes or prediabetes, and I think a lot of this stems from us having very little awareness or closed-loop biofeedback into how our foods are affecting our bodies, and then what we can do about it.

Dhru Purohit: We’re going through the sophistication of wellness. If we look at the ’60s movement and the hippie movement, and also, there was also Alice Waters in the farm-to-table movement that was starting around that time too, but if I would look at the earliest trends in the United States, of course, we had the demonization of fat that happened, and I think that started in about the ’50s, and we’ve done some episodes on that, and then you kind of had the rise of the low fat movement, which meant that there was putting sugar in a lot of different foods to make them taste good, and that continued … It’s still kind of continuing, but I think it probably really peaked in the ’80s, ’90s, but along with that, you also had the rise of sort of submovements of like vegetarian, so a lot of times when you’re eating healthy, people say, “Oh, are you a vegetarian?,” and I actually grew up a vegetarian. I grew up vegetarian, but I actually was a pretty processed food vegetarian, except for that one meal a night, which was my parents making good home-cooked Indian food and making … Who even knew back then, but they would be making resistant starch white rice because that just was how we made it.

Dhru Purohit: They made it in the pressure cooker, and then they kept it in the refrigerator, and then they would serve it out throughout the week, but my mom was just saving time, and they would make lentils in the pressure cooker. They would do all these things. That was the one meal that I actually got good food in, but the rest of the day, I was eating Doritos and Twix and other stuff, because I was just like a kid, not probably too different than a lot of people that were there. Anyways, I digress. We had the vegetarian movement, and then recently, we’ve had the rise of, whether it’s been things like Atkins, and then keto, and then carnivore.

Dhru Purohit: We still think of things as a dietary framework of, “Is this good or is this bad? What are you? What am I?,” and really, we’re going through the sophistication of it to say, “You can eat any way that you want to because there’s a lot of different things that go into it. Your view of how different foods impact the world.” Your feeling on animal rights and animal suffering, that’s there, because that’s a very real thing.

Dhru Purohit: Your own bio-individuality, your own genetics, your grandparents’ microbiome, that’s still kind of present inside of you, and now, it’s not anything is good or bad, it’s just about how you want to dial in, and there’s also, we’re getting away from this idea of cheat days.

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

Dhru Purohit: Right? If you want to enjoy something, if you decide to have something that’s a little bit more sugar inside of it, great. Have it. Enjoy it. Don’t think of it as something bad, but know your baseline so that you can return back to good health. Is that how you see it? Anything you want to add on top of that?

Dr. Casey Means: I think all of that is exactly right, and the way I really frame food is that food is molecular information. Really, when we go out and eat, we’re choosing what molecular information we want to put into our bodies, because that information is going to determine how our genes are expressed, how our hormonal pathways are signaling and how our cell biology works. Now that we understand, we’re at this exciting point in the scientific sort of world where we really understand cell biology on a very, very deep level, and how food compounds are interacting with that, and so that’s really the framework through which I go to the grocery store. I’m going to the grocery store on a micronutrient, molecular information hunt. Like, “How can I get these things in my body, polyphenols, antioxidants, micronutrients to serve these cellular biology pathways?,” and really, glucose fits right into that.

Dr. Casey Means: I know that high glucose spikes and big peaks and valleys in my day, that is molecular information that is damaging to my goals and my overall health and longevity, and so I’m looking for opportunities to really keep that down. I know that those big spikes are going to cause big insulin releases, change my hormonal milieu in my body. They’re going to cause oxidative stress and glycation, and potentially inflammation, and so you mentioned that wellness is becoming very sophisticated. I think that’s true, and I think it can be kind of seen as a luxury to have access to this level of sophistication, like tools, wearables, things like this, and that’s true. I think part of the reason it needs to be sophisticated is because we’re kind of dealing with a sophisticated adversary or enemy with …

Dr. Casey Means: I don’t want to use the word enemy, but we’re in a very complex food ecosystem where we are being told that so many different things are healthy. There’s loud voices in nutrition space. We have a government that subsidizes disease-promoting foods. You really can’t walk into the store. I mean, you go walk up to a box of oatmeal and it says heart-healthy, good form of fiber.

Dr. Casey Means: Well, that might be causing a 100-point glucose spike in you, so it’s a sophisticated food landscape and I do think part of the reason why I really like wearables is not because I want to be hooked up to technology for the rest of my life. It’s because I feel like it’s important to have sophisticated tools in the face of a food and just general cultural ecosystem that is essentially a treadmill towards chronic disease, unless you do something differently, unless you have a little bit more information, and so my hope is that over time, as we understand how more awareness of how food is affecting our bodies and how that molecular information is affecting our bodies, these tools will be shown to be effective prevention tools and they will become widely accessible to larger populations, so yeah.

Dhru Purohit: One of the greatest things that has happened over the last few years is you start to see wellness is going very mainstream, and with that, more people are interested, especially after a big year like last year in the pandemic, where we had an opportunistic virus that was taking advantage of all these chronic health issues that so many people had, and there’s more companies that are trying to meet that demand. Now, if you’re watching this podcast, if you’re listening to this podcast, you’re probably a consumer that’s looking for the best options. Whether you have kids or don’t have kids, you’re looking for the best way to eat healthy, but also not have it totally take over your life. The reason I love this list, and we’re going to continue walking through it, is even for me, there was a lot of things. The list is called Five Surprising.

Dhru Purohit: It’s really all part of like the sophistication of wellness and what it reminds me of a little bit is that my background is, my ancestry from India and Indians in America and it’s a very interesting group to study. And we’ve had some people on the podcast talking about it. They typically, actually are very highly educated, right? The ones that made it out here to America, they tend to be the people that were able to leave. And they got here on H-1B visas and other things like that. So they’re engineers or doctors or other stuff, not all Indians are doctors when you go to India and other places, right? So it’s not that every Indian is smart. It’s just the ones that made it out here tend to be from a particular population. They also, there’s a huge percentage of vegetarians, right?

Dhru Purohit: That are part of that, that group in the South Asian population as a whole. And they also have one of the highest incomes. They have the highest income on average for any subset population that’s inside of the United States. Why I bring all those things up is that they also suffer from the highest risk of cardiovascular health. So you see a population that is vegetarian, right? But doing it in a way that is, I’m doing eating anything but meat. So they tend to have a lot of, especially the region that I’m from a Gujarat, the South Asians here in America, they tend to have a lot of sugar in their foods. There’s a lot of sugar. They eat a lot of fried foods. That’s a lot of vegetable oils. They’re not eating actually a lot of vegetables, even though they’re vegetarian, there’s very little fresh vegetables that are part of the diet.

Dhru Purohit: They tend to be eating more processed carbohydrates. So you see now and why I wanted to create that parallel is that’s very similar to the sort of young female who is wellness forward. That made up a lot of the early wellness movement, who’s probably a little bit had access to, had education, had access to some disposable income and is trying to make the right choices for them. So you can see how two completely groups are thinking that they’re doing their best, but because they’re not looking at some of the baseline markers that are there, they actually could be suffering one group from major infertility. Another group could be suffering with heart disease and not understanding that insulin resistance is the biggest driver for both of them.

Dr. Casey Means: Absolutely, I think about my age group and some things that I was thinking about in my twenties, like things like acne, or you’re buying creams for wrinkles or you’re thinking about, oh, stuff is stress. Work is stressful, anxiety, things like this. When you start to look through the lens of how so many of these things can be related to metabolic dysfunction is actually very liberating because you think, oh, okay, as opposed to going to the dermatologist for this or whatever, and the OB GYN for this, you obviously need to see those doctors and be in touch. But knowing that actually the trunk of the tree of many of these conditions is the same thing. And that you can modulate that through diet and lifestyle. It’s very empowering. This is the foundation of systems and network biology.

Dr. Casey Means: Understand how conditions and symptoms are linked and then treat at that level as opposed to seeing all of them as isolated silos and then paying whack-a-mole with different things like antibiotic for the acne and retinol cream for the wrinkles and this and that, just to get really specific here, insulin and insulin like growth factor, which are released in response to carbohydrates glucose in the diet. Those actually directly talking about acne here, go to the hair follicle and tell the sebaceous gland, which the oil producing gland of the hair follicles to produce more oil. It’s a growth signal. Insulin is like a pro-growth signal, which is why it makes us overweight and store fat. It also tells growth signals to other things like the oil producing gland of the hair follicle.

Dr. Casey Means: When you just take away that signal through reducing the refined carbohydrates, reducing the insulin signal, your skin produces less of this oil from the spacious gland and acne clears up. That’s been shown in many, many studies that over 12 weeks you can reduce acne just by going on a healthy, lower carbohydrate diet. Similar thing is true of PCOS. The insulin is stimulating the ovaries to make these male hormones. And there’s been a number of studies showing that healthy ketogenic diets can actually reduce or reverse PCOS in as little as 12 weeks. That was a study actually that came out last year and what I loved about this particular study is it wasn’t just a low carb, super low carb like processed diet. It was a healthy, Mediterranean, low carb diet filled with vegetables and polyphenols and it was actually very low on like meat and animal protein.

Dr. Casey Means: It was much more based on greens and healthy fats and whatnot. And then, similar is true of anxiety, studies have shown that those swings of up and down glucose can lead to anxiety. And so by actually going on a low-glycemic diet, they’d been shown that you can actually reduce generalized anxiety disorders and symptoms. The hope of drawing this sort of like picture of how all these things are related from potentially root cause perspective. And not saying that it’s glucose and carbohydrates are the thing that are causing all these conditions, it’s one of the many factors that can create conditions in the body to lead to these things.

Dr. Casey Means: But that to me is just empowering to know that and that we have control over that. But you’re not going to get that information from your OB-GYN, from your dermatologist, from your mental health provider. That’s not what we’re taught. It’s, we’re not taught about nutrition. We’re not taught about how to think of things on a root cause perspective. We’re really not taught a systems biology framework to health in modern American in medical training. We’re taught to think of things as separate silos. And so, one of my hopes with these wearables and products like CGM for wellness purposes and what we’re doing at levels is that when people start to see things this way, they will actually ask more of their doctors like, Hey, I’ve been reading about all this stuff. I’ve been thinking of all of this stuff. Can we talk about it from this framework?

Dr. Casey Means: And again, just like with sort of the grassroots movement in the food industry of people asking for more, because they have their data. I think the same is going to be true of what we do with doctors. We asked that we have this information now that we can go to them and say, Hey, I’ve been reading about the links between all these conditions and blood sugar. Can we… Here’s my data. Can we talk about this in a real way? And that it might push doctors to seek out more education on this stuff and talk to their patients about it.

Dhru Purohit: What was that light bulb moment for you? Right? You’re a medical doctor. You were going through your training. We did talk a little about your origin story in the last podcast, but what was that light bulb moment for you that it’s not all these individual silos. It’s not acne is over here and PCOS is over here and they have nothing to do with each other. When did that moment click for you? That they’re all connected and you became, cause you’re an EMT. And so when did you become sort of a super generalists that understood that a lot of these things are linked together through these core systems in the past?

Dr. Casey Means: I trained, I did five years of training in ear, nose and throat head and neck surgery and then I actually left completely. I left the field because I did have some of these realizations and realized, okay, I don’t want to be operating on people, such a morbid procedure until I really figure out whether there’s more from a root cause perspective we could be doing to help people. And a lot of it came down to sort of stepping back and looking at what I was doing every day. And we talked about this a little in our first podcast, but so much of the conditions I was treating were inflammatory conditions. It was like the sinusitis, thyroiditis, laryngitis and itis is just, that means inflammation and medicine prescribing so many steroids to quell the immune system, to treat these conditions. And then when steroids and antibiotics don’t work, you take it over to the operating room.

Dr. Casey Means: And just realizing that like the opera… Doing a surgery, doesn’t change underlying upregulation of the immune system. That can only be done by addressing whatever threat the body is sensing, that’s creating an immune response. So I was really identified, trying to identify what is that threat. But the light bulb moment for me was looking all these ENT conditions and the real molecular biology of them what’s happening in the tissue, in the sinuses that makes them inflamed. Well, a lot of it is upregulation of immune cytokines. So things like TNF alpha, interferon, gamma, IL- 6. These are chemicals that immune cells are secreting and other cells are creating to essentially create an immune response. And then when you look at all these other huge killers of Americans in the United States, like sinusitis is not on the top 10 leading cause of death for Americans.

Dr. Casey Means: It’s not even close. It doesn’t kill people, but the ones that are killing Americans, which is like cancer, diabetes, heart disease, dementia, all the same cytokines. It’s the IL-6, it’s the TNF alpha, and then saying, so this is really talking again about systems biology. These sort of common cytokines, this Venn diagram between all these different conditions. I sort of stepped back and say, why aren’t we treating at that level? Why aren’t we thinking about what’s triggering these? If we could bring that down, of course there’s all these drugs that are being created to block these immune mediators, but then you start researching a little bit more. There’s a lot related to our food and our exposures and our stress that also stimulate these things. It makes sense that we would talk to patients about that and like how to actually minimize these things. Something that was fascinating about the COVID epidemic.

Dr. Casey Means: And I actually wrote about this in April of last year, I published a paper in the Journal Metabolism about the relationship between blood sugar and COVID. One of the things that blood high blood sugar does is promote these inflammatory cytokines that I’m talking about. And those were associated with worst COVID mortality, because what we learned early on was that it wasn’t the virus that’s killing people in COVID, it’s the immune response to the virus. So if you’re in an already baseline inflammatory upregulated state, and then you have the virus come on board, which is also triggering the immune system, that just is this synergistic, huge immune response that can cause the end organ damage, the lung problems, et cetera, that ultimately cause mortality. So if your baseline obese, diabetic have sinusitis, all these things, your immune system’s already rubbed up.

Dr. Casey Means: That’s obviously going to be a much bigger response when you get the virus. So it just, that was kind of the light bulb moment for me, let’s look at this Venn diagram of everything that’s going on and then treat at that level in the middle. And that’s really what systems and network biology is. It’s moving away from the reactive silo-based sort of symptom management of medicine to let’s talk about cell biology. Let’s talk about how our lifestyle and our diet is affecting cell biology and work towards creating conditions in the body that essentially help ourselves thrive. Because when our cells work, our tissues work, when our tissues work, our organs work and when our organs work, we don’t have symptoms. So, that’s really-

Dhru Purohit: Fundamental shift in how we approach medicine and even just healthy living. We’re spending billions of dollars on these drugs. Again, well-intentioned for, let’s just take, for instance, Alzheimer’s. We’re spending billions of dollars looking for that one thing that is going to make a difference for patients with Alzheimer’s and maybe even slowly decline. So far, there’s not really anything that’s working great. In fact, a lot of the drugs are actually making things worse. And we have to understand that it’s not just one thing. These systems are all communicating together. Alzheimer’s isn’t just about the brain. It’s also about the gut and our inflammatory pathways and the whole bunch of other things, including insulin resistance. So that, it’s a different framework of thinking.

Dhru Purohit: It’s been a little slow to percolate and get out there to the medical community, but that’s all things in life. It’s slow in the beginning, but there are a group of people and companies that are trying to leapfrog with technology. They often talk about one of the big concerns in Africa originally. And I was, I was born in Kenya and I remember discussions of how do we get telephone wire and internet and everything else like that, because it seems to be from what we know that when people have access to these communications, then commerce happens more, education happens more and there just wasn’t the infrastructure. And then mobile phones came in that whole leapfrog, the whole aspect of needing to put telephone wires up and down Africa and through all these different countries.

Dhru Purohit: And now through things like satellite internet, you don’t have to worry about cable. So more kids can get educated. People that don’t have a school in their area can do that. And that same way, we’re sort of leapfrogging a little bit, right? We very thankful for the medicine that’s here in the United States, but it’s also the most expensive medicine in the world. And it’s not necessarily leading to better outcomes for us. In fact, a lot of people here are sicker than other parts of the world that are there. So when you can get things like continuous glucose monitors, and you can have that directly to empower that information, you’re dealing in the category of subclinical. You go for your yearly physical and so many people have had this issue. You don’t have a disease, right? Knock on wood. You don’t have cancer yet. You don’t have Alzheimer’s, you’re not diabetic yet, but you don’t feel great. You might have a little bit of extra belly fat. Your sleep is off.

Dhru Purohit: You feel like you’re not functioning the same way that you’re doing it in your friends and your family tell you that it’s just aging, you got microbiome in your intestinal tract. You might feel bloated more often and you just chalk it up to that. And your doctor pats you on the back and says, Hey, you’re looking good. I’ll see you next year. Maybe at most they’ll tell you to lose a little weight and exercise a little bit more. And if you’re smoking tell you to stop smoking. But now we can look at all these other things between, I have full blown cancer, Alzheimer’s, heart disease and I have nothing. There’s a whole vast array in the middle, which is all about optimization, which is why I’m really excited about what you guys are doing. And you’re really empowering people to take back control of their health. And I really appreciate that.

Dr. Casey Means: Thank you. Thank you. I think Mark Hyman talks about the FLC syndrome, which is the field like crap, which I think is exactly what you’re talking about. It’s sort of that in-between and when everyone feels like crap, we can start to think that it’s normal. This is just part of living in the modern world, but it’s not normal. We all can feel amazing. We all can feel great, but we do have to, we do have to really take ownership of our health. The systems, unfortunately, are going to be slow to change whether that’s the food system, the agricultural system, the healthcare system. And so in that space, and I do think really positive forces are at play to move these industries in the right direction. But in that space, that’s where we need to kind of really take ownership and make these choices.

Dr. Casey Means: I mean, ultimately our health is a function of our choices. Like health does not come from a pill. It doesn’t come from a surgery. It does not come from the doctor’s office. It comes from the thousands of micro decisions we make every day, week, year. And so, my passion and I think so many people in the wellness industry now is how do you help people make those choices in a way that’s going to serve them, make them feel empowered and be able to create those conditions in the body that ultimately make us not feel FLC, feel like crap.

Dhru Purohit: It’s so true. I was listening to my friend, Dr. Rangan Chatterjee’s podcasts recently, and he had a gentleman on, I think his name was Gregory McCowen. I’ve quoted him a few times on my recent episodes and he had a great quote. And it said, if you don’t prioritize your life, someone else will. Right. Sometimes people who tend to be in the wellness world or other things, it can be chalked up to a grand conspiracy to try to control us with these processed foods, other stuff. When you study human nature and history, you realize that most of what’s going on is well-intentioned people working at corporations trying to do their best with the knowledge and information that they have. They themselves don’t know about how to create health for themselves or for the people that they’re serving. So a lot of the state of the world that we’re in, it’s the system has gotten out of control because it was never designed intentionally.

Dhru Purohit: It was never designed intentionally to create health and it’s gotten out of control. If you can step in and prioritize it with your own design, what do you want to design for your own life? What do you want to prioritize? It’s design-based thinking, but for yourself. And when you step into that, you become a CEO of your own health and a CEO of your own health, it can listen to people, it can weigh options, but ultimately it’s making the decisions because if you don’t make those decisions for you, somebody else is going to make those decisions upstream. And you’re just going to have to suffer with the consequences. We still have a few more to get through over here. We have one more on the list of five surprising foods, but I don’t want to make it all…

Dhru Purohit: There’s a lot of good news inside of what we’ve covered, but I also want to do, I want to touch on, you sent me a list of some of the foods that were what we call level 10, scoring foods or meals. And I want to chat about that a little bit to kind of give people hope about what really happens when you dial in your food. So let’s talk about the last one on the list of five surprising blood sugar spikers. And that was Thai food, pho, ramen, and tell us why those foods scored so low.

Dr. Casey Means: We lumped these all together. Thai food, pho, ramen, Chinese food because they have a lot of commonalities. And one of the big ones is noodles. All of those things are to include some sort of rice or wheat based noodle, which is essentially an ultra refined version of a carbohydrate. And these just send people through to the moon with glucose. I think what’s so neat about a lot of these, I mean, you may love the flavors and it doesn’t mean you can never eat these types of foods. It just means being a little more thoughtful when you’re looking at the menu.

Dr. Casey Means: So maybe it’s moving away from the Pad Thai, which is going to be like a ton of noodles and maybe a sweet sauce to actually asking, Hey, do you have a Curry that’s pretty minimally sweetened. And then just eating that by itself with some good protein in there, whether it’s tofu or fish or chicken or whatever. Maybe avoiding the rice or just having a tiny bit of rice with an unsweetened curry. But ultimately if the base of the meal, like a pho or a ramen or a noodle dish, or a lo mein, is a noodles it’s going to just be, that’s like a naked carb. It’s just so much, turn straight into sugar in the bloodstream.

Dhru Purohit: And there’s some great alternatives coming. Have you tried Miracle Noodles or like those kelp noodles?

Dr. Casey Means: There’s so many good ones. There’s kelp noodles, there’s Miracle Noodles. There’s shirataki noodles, which are made of konjac root, which is a super high fiber food. Everyone in our company has tested konjac root noodles. The brands are a Shirataki Noodles and then NuPasta and NuPasta virtually zero glucose spike. And it’s just looks identical to another type of any other type of noodle or pasta, but it’s made from a super high fiber root, basically.

Dhru Purohit: It’s one of the longest chain fibers out of any root that’s there. And so you get this, I mean, it’s so powerful that a lot of companies have actually turned it into like a supplement and stuff. There’s one that’s out there called PGX that a lot of people use and it’s an incredible fiber source for people.

Dr. Casey Means: It is amazing. So I’m going through a lot of NuPasta these days. I’m using it if I’m making pesto. I love zucchini noodles too, but if I’m doing a pesto or if I’m making a soup at home or something like that, or even with a red sauce, you can basically just swap it in. But there’s also tofu noodles. You can often ask for tofu noodles at a ramen restaurant. And then of course zucchini noodles, yellow or green squash can work as well.

Dhru Purohit: I want to switch from this list of surprising foods to pivot to the five less surprising foods. And I’m going to share an experience that I had. And I think this goes back to bio-individuality and everything. But I would be curious to see if you’ve had any similar experiences from you or anybody in your community. I don’t eat a lot of pizza. Pizza’s one of the foods that’s listed on the five less surprising blood sugar bombs. But interestingly enough, there’s a place here in L.A. That gets native wheat from Italy. It’s called Pisana, it’s in my neighborhood of Brentwood. And then they also, I think sometimes even bring cheese like mozzarella and stuff like that, that they use for some of their pizzas from Italy as well, too. So already does it have, you know it’s better quality and things like that.

Dhru Purohit: And it’s probably going to have more fiber. So I ordered a pizza from them thinking like I was going to expect this big spike. And since we were just talking about Thai food, Chinese, pho, ramen, I had one time straight up rice noodles with a little bit of the packet of whatever’s included with the rice noodles, some seasoning. And then a few days later I had this pizza and I actually got a much bigger spike from the rice noodles than I did from the pizza. Now, the pizza was like a very simple Neapolitan with this native wheat. And I think it had some buffalo mozzarella and I was really surprised it wasn’t gluten-free because previously for years I would do gluten-free.

Dhru Purohit: And then as I got, started wearing this continuous glucose monitor, I saw… I knew that gluten-free would spike often, most people have the realization that actually gluten-free spikes you way more like gluten-free breads spike you way more than traditional non gluten-free, like it just wheat based. And so it wasn’t a gluten-free pizza and I didn’t have as much of a spike from that as I thought I would. Any thoughts on that? About what was going on?

Dr. Casey Means: It’s so interesting. And I mean I would guess that some of has comes down to the wheat that’s being grown that went into that flour in Europe and then secondarily, I think the processing, the process of processing for that flour. Basically in the United States, we have genetically modified wheat to have really high gliadin concentration, which is essentially like one of the gluten proteins we, that makes the bread stickier and makes it sort of tastes better, and fluffier when we’re making, when we’re baking things. We’ve also, when we process it here, we are stripping everything from the wheat. We’re just really getting into like pure carbohydrate, non fiber source there when we’re making our white flour and bleaching it. And it’s just basically essentially the equivalent of sugar.

Dr. Casey Means: I can imagine this pizza probably was more of like a stone ground, still had its hull of the and the more of the fiber part of the wheat and probably was like you said, like a heritage wheat that was not genetically engineered or modified to kind of really concentrate the tasty stuff. That’s probably going to translate into a sugar spike and you just did a lot more natural.

Dhru Purohit: Pizza sauce, cause a lot of times we will go out and get pizza sauce and the pizza sauce here it’s not a plug for the place, but they’re just using regular. I mean, they’re making homemade, it’s not homemade, but it’s not added sugar and other stuff kind of like primal kitchens, tomato sauce and things like that. There’s not sugar added to it and it still tastes fantastic.

Dr. Casey Means: Exactly. Tomato sauce, a lot of tomato products can really have all that hidden sugar. The average Ketchup in the store has between three and seven grams of sugar per serving. It’s incredible and I think those are probably the reasons. But I mean, it’s great to know that now if you’re going to get your pizza in L.A., you know where to get it.

Dhru Purohit: Actually for anybody that is in L.A., Eataly also is one place that has native wheat, surprisingly for some of their breads and other things like that. And you can get native wheat that’s over there and this spot. But you know, just another reason why I love the monitor because you find these little surprises, you find these little surprises for you and you’re like, oh wow, that’s interesting. I really thought that that food was going to make me go bonkers. And that’s also not to say, we should add in a caveat here and you guys have written about this. Sometimes certain alcohols don’t register a very high. Meaning, they don’t spike your blood sugar, but that doesn’t mean that we’re encouraging people to have alcohol all the time. There’s other factors that are present inside of it. What are some other examples? If you could talk about alcohol, are there any other examples of foods that just because they don’t have a blood sugar impact, we might still want to be wary of how much we consume them?

Dr. Casey Means: Absolutely. I mean, I think this brings up a great point, which is that glucose is one biomarker that can tell us what food is doing to our bodies, like a continuously monitor, but the future needs to have a lot more biomarkers that tell us about how food is affecting our bodies. In this episode alone, we’ve talked about oxidative stress. For instance, like you could drink a full glass of soybean oil and your glucose is not going to spike. It’s going to be flat because that’s straight fat. But over time, those highly oxidized oils are going to cause mitochondrial damage and problems that will essentially create issues with your metabolic machinery, that down the road can lead to problems. So is that going to be picked up on the continuous glucose monitor? No, but down the road, potentially in oxidative stress type of monitor, something like that could be really interesting to sort of help deconvolute like all the different variables that foods are doing to us.

Dr. Casey Means: Another thing would be, you could eat salmon for instance, and you could eat sort of like farmed salmon or wild Alaskan salmon. The farmed salmon is going to have more toxins in it and omega-6 fats and the wild salmon is going to have more omega-3 fats and be kind of cleaner. Both of them might look like a perfect score on the glucose monitor because they don’t really have any carbohydrates, but you’re not going to have insight into that other stuff. So it’s a huge step forward, continuous glucose monitoring in terms of a wearable that gives us real-time insight into what our food is doing to our body. But it’s certainly not the end all be all. And I think the future of sort of multianalyte, more analytes that we can monitor to tell us how food is affecting our bodies is going to be really important.

Dr. Casey Means: One of the biggest ones actually would also be fructose. Interestingly about fructose, straight fructose alone does not actually change your glucose levels. So if you just drink straight fructose and I don’t mean high fructose corn syrup cause high fructose corn syrup actually is about half and half fructose and glucose. So it’s still going to cause a glucose rise. But if you just were to find straight fructose, it would not actually create a glucose or an insulin spike, which is kind of interesting. Cause we know it’s very bad for metabolic health. What it’s doing is that it’s actually telling the liver to create this fat in the liver, the de Novo lipogenesis, which creates hepatic liver insulin resistance, which causes problems down the road with how you process any form of sugar, because you’re basically generating insulin resistance. Which is then going to make you process glucose poorly in the future.

Dr. Casey Means: To be able to actually have a sensor that could tell us what fructose is doing to our body could also be a really interesting thing. And there are biomarkers like uric acid and others that can tell us about fructose breakdown. There are these things like alcohol, straight fructose, different quality sorts of fats and meats, oils and that aren’t going to necessarily be picked up on the glucose monitor, but that are important to be cognizant of. And this is we’ve really made a big effort in our content and our editorial operations with the company to be very transparent about that.

Dr. Casey Means: That glucose tells you a lot but it doesn’t tell you everything. And here are the other things you have to think about in relation to food above and beyond what your glucose monitor is showing you. And a lot of it comes down to some very, very simple principles, which is eating real whole clean foods that have been raised in a responsible way and that are minimally processed. If this is a lot of what’s in the Pegan Diet, Mark Hyman’s book, it’s the similar principles. Glucose monitor can’t tell you everything, but if you stick to some of those big picture principles, you’re going to be a lot of the way there.

Dhru Purohit: Nothing can tell you everything, but this is telling you a lot. There’s also one other topic that we talked about food pairing and we talked about how you can use fats and fibers to really help when it comes to, especially these naked carbohydrates that you used earlier, which I love that term. We didn’t touch on as much about the time restricted eating. Cause you guys have found out a lot about that area. Tell us how that also can play an impact time restricted eating, continuously eating throughout the day or versus having a little bit of a narrower window and how that impacts glucose.

Dr. Casey Means: Narrower window can be really helpful for our metabolic health. What you’re doing when you’re time restricted feeding is you’re essentially, it’s not about restricting calories. It’s just about restricting the amount of time in the 24 hour period that you’re eating those calories. And what that’s doing is that you’re giving yourself all these additional hours in that 24 hour period where you’re not spiking glucose and you’re not spiking insulin. And what that can do for you is it can improve your insulin sensitivity because you’re not continuously stimulating the cells with that insulin signal. Therefore, it can help you with that metabolic flexibility because when your insulin is low for that greater period of time in that 24 hour window. You’re going to work through your glucose stores. The glucose in the circulation, the glucose in the liver. And then you’re going to be okay, I’m out of this readily accessible glucose. I need to flip and switch into fat burning in order to get energy because I’m not eating.

Dr. Casey Means: I don’t have exogenous energy coming in and you can do that because your insulin is low. We know that insulin is a block on fat burning. When insulin is high, you’re going to use glucose for energy. You’re not going to use fat for energy. This time-restricted feeding gives you this opportunity to be in a low insulin state, work through your glucose, and then flip into fat burning and that metabolically flexible state of fat burning when you don’t have glucose around, glucose burning when there’s really accessible glucose. That is the healthy state that we want to be in.

Dr. Casey Means: There was a great study that was done, where they basically took two groups of people and they gave them the exact same number of calories in the 24 hour period. But one group ate between 8:00 AM and 2:00 PM. So a six hour feeding window and one group ate between 8:00 AM and 8:00 PM, a 12 hour feeding window. So that first group had, it was time restricted feeding. And even though they were eating the exact same number of calories between the two groups, the group that ate in the restricted portion had better overall 24 hour glucose levels, insulin levels, and just overall better metabolic parameters. The more we can narrow that window, we give our body this opportunity to essentially

PART 3 OF 4 ENDS [01:42:04]

Dr. Casey Means: So, we give our body this opportunity to essentially tap into metabolic flexibility. If we’re just eating, essentially, from breakfast right when we wake up, and like dessert an hour before we go to bed. That’s just basically keeping glucose and insulin sort of stimulated all the time, and is, unfortunately, you’re losing that opportunity to be in a low insulin state, and all the potential benefits that can come from that.

Dhru Purohit: Yeah. And again, evolutionary history, it’s not how we ate before. It’s sort of a modern luxury that we can eat that way and constantly be spiking our blood sugar. We were never really … Not designed, because I’m not saying that somebody designed us any particular way. But it wasn’t part of how our genes evolved. We didn’t have all these carbohydrates available to us. So, let’s pivot a little bit into the topic of a level 10 score. 10 is the idea that when you eat, just like when you work out, you will see some bump. Right?

Dhru Purohit: Everybody knows that. It’s not that you’re not trying to have any bump. Well, actually not everybody knows that. That’s why we’re explaining it here. So, it’s natural to have your glucose go up when you eat a little bit. Now for context, give us a little bit of the ranges because people know about getting their fasting glucose test from the doctors. Walk us through that, and let’s talk about what levels looks at as the optimal ranges. Like, where do we want our blood sugar to be when it comes to the optimal range when we’re wearing a continuous glucose monitor?

Dr. Casey Means: Yeah. So, talking sort of first about what the standard ranges are. So, these are what the governing bodies are telling us are normal. And so, when you look at fasting glucose below 100… So, 100 or below of a fasting glucose, meaning your glucose when you wake up, and you have not had any calories for eight hours. If that’s under a hundred, you’re considered normal, non-diabetic not pre-diabetic. Between 100 and 125, it’s pre-diabetic, fasting glucose range. And if you are 126 or above, you’re considered to have type two diabetes.

Dr. Casey Means: So what that means is that if you have a fasting glucose of 99 when you walk into the doctor’s office, it’s very likely the doctor’s going to say you’re normal. You have a normal fasting glucose. I think a lot of people are realizing that that might not be the way we should be looking at this because is 99 really optimal if you’re one point away from being prediabetic? Does that mean that you’re totally in the clear?

Dr. Casey Means: The answer is no. And, the research suggests that as you move higher in the normal range towards a pre-diabetic fasting glucose level, your risk for a whole host of diseases from stroke, to heart disease, to, of course, developing type two diabetes, or obesity all go up very significantly. So, if we really dig into the research, it’s probably more likely that having a fasting glucose between about 70 and 85 is going to lead to much better health outcomes than if your fasting glucose is 99, even though both are within this bucket category of normal.

Dr. Casey Means: And so, I think there’s a real opportunity in the research community to start setting some guidelines around what are optimal ranges as opposed to just normal ranges. Because, these ranges that were created, normal, pre-diabetic, diabetic. This is for risk stratification. This is for helping doctors understand when to prescribe medications, resource allocation. But it’s not actually telling us what we should be shooting for, for optimal health.

Dr. Casey Means: The same is true for post meal glucose values. So, we think about fasting glucose, which is when you haven’t eaten anything for eight hours. But then, we also think about what are the ranges for after you eat something, where do you want to be? So right now, if you look at the International Diabetes Federation, they would say that you want to stay generally under 140 milligrams per deciliter after a meal. So, let’s say your glucose is 80 before lunch, and then goes up, and stays under 140, and then comes back down. That’s considered be to be fine. Again, I would argue that, that’s probably higher than we want to go after every meal.

Dr. Casey Means: If you look at actually the literature, they’ve done quite a few studies where they’ve put continuous glucose monitors on healthy non-diabetic populations. And, the vast majority of time, like well over 90% of the day, people are actually spending their time between a range of 70 and 120. So, that’s probably closer to where we want to be, even after meals is like under 120. I tend to shoot for like under 110, or 100 or so, after meals. So, really only getting up at most to like 30 points elevated after eating something.

Dr. Casey Means: So, let’s say I start at 80, I don’t really want to go above 110. If I start at 90, I don’t really want to go above 120. So, shooting for these narrower ranges, I think, is going to ultimately lead us to feel better during the day. If I go from 80 to 140 and back down, that’s, to me, going to feel like a pretty big crash. And so-

Dhru Purohit: And, it’s all part of like a detective work to figure out how different foods respond to you. Like just being super transparent. I’m reaching here for my phone. I want to tell you kind of about my score yesterday, which was all over the place. And this was kind of… I started off the morning already, because I ate a really late meal the night before. We went out with friends. My business partner was in town. We ate with him. So at 5:30, there was a gap in my data between the night before. So, I have my earliest reading for yesterday was 5:42 AM. And, I was already at 93. Right? I slept a little bit less, and I had a late meal, which I know impacts things. So, that’s not usually where I’m at, at that time. I’m usually a lot lower.

Dhru Purohit: So, it was just good to see. Right? Around… I woke up around like 6:00 AM, and there’s a increase in glucose when you’re waking up in the morning. And then, I kind of stabilized a little bit, and I got back down to about 90. Right? But still not in my optimal direction. Then, right before you recorded your podcast with my business partner, I went and grabbed something to eat. Right? I jumped all the way up to about 135, and then I immediately slammed down all the way to basically 70.

Dr. Casey Means: Mm.

Dhru Purohit: Right. So, that’s that roller coaster that we’re talking about. Because, I hadn’t eaten anything in the morning besides coffee. And then, I ate something that spiked me up really high that I hadn’t had in a really long time. I think it was like a avocado toast, but I didn’t get the gluten free. I went for the regular one.

Dhru Purohit: It was at Bluestone Lane, which is right underneath. And, I had a few minutes before I had to jump into the next thing. And, I was also curious to see what would happen. So, I spiked up, and I went right back down. Then, this is the surprising part. I ate something. I went to one of our favorite places here in LA, [Air One 01:49:07] , which we talk about, and I had something from the hot bar. And, I’m still trying to figure out. I don’t know what spiked me up, but I basically went right back up to like about 130. Right?

Dhru Purohit: And, sometimes what happens is when people are wearing a monitor, you’re not exactly… You’re logging it, but maybe kind of retroactively. You’re logging it a little later on. So, part of my goal today is to sort of backtrack, and be a detective to see a little bit about what was that food that put me on that up and down rollercoaster. Now look, one day, as you’ve mentioned earlier… One day, a little bit here and there, things get off, and then you can reset. It’s not a big deal. But, if this is what your day looks like day in and day out, that’s when we really start to have problems.

Dr. Casey Means: Yeah, absolutely. And, I think you also bring up a really great point, which is that like you woke up yesterday morning, you had a late meal the night before. You woke up early like, and your glucose was maybe a little bit higher than normal. These fasting glucose levels bounce around a huge amount day to day. And based on our… The current way we track these things, which is you go to the doctor one time per year, and you get a fasting glucose check. You’d think that like, oh, well that probably means that these things are very static like that I’m 85 milligrams per deciliter. That’s my fasting glucose. That’s who I am. But, that’s not the way it is at all. It bounces around all the time. I could have the perfect wellness day. Like I’m eating, cooking all my food at home, really low glycemic, 10 zone squares for all my meals.

Dr. Casey Means: I do a high intensity interval training workout. I get eight and a half hours of sleep. I meditated. I took magnesium, da, da, da. And, the next day my fasting glucose is like 72. Then the next day I could get four hours of sleep, have a very high carb late meal, not work out, and be stressed. And, my fasting glucose could be 95. Like it could be that big of a difference. And to me, that is really empowering because it’s like, okay, if I dial in just like a few of these things, and make sure I’m kind of like checking off the boxes of my different wellness practices that I know impact my metabolism. I can really move the needle here.

Dr. Casey Means: It’s also, when I see that higher number, I’m like, it’s okay. This is just a reminder to me that like, things are kind of off course. Like I’m not in my homeostasis right now. If I let that happen for weeks, and months, and years where I’m doing all those behaviors that lead me to have that higher fasting glucose number. No question, that’s going to continue going up. And, that’s going to be more of a longer term problem. But-

Dhru Purohit: It reminds me of if I could just add-

Dr. Casey Means: Yeah.

Dhru Purohit: It kind of reminds me like sometimes I’ll have this conversation. I was like, people are like, I don’t want to know all the different numbers. I’m like, “Okay. How about we try this? When it comes to your bank account. How about I tell you once a year how much money is in your bank account, and then try to make financial decisions based on that.” Right? You would not know if you were hitting your budget. You wouldn’t know if you’re overspending, if you’re underspending. But at the same time too, if you splurge a little bit one week, or you have a fancy meal with your partner, a night out, and you spend a little bit more money than you wanted to spend.

Dhru Purohit: Hopefully, knock on wood, if you are in a decent position, it’s just one night that you spent a little bit more. And then, you can adjust appropriately adjust the budget. And, that’s how I see this. I don’t want to wait once a year to know how much money I have in my bank account, and to see how well I’m doing financially to make sure that I’m saving for retirement and all other goals that are there.

Dhru Purohit: And, I also don’t obsess on a daily basis of, oh my gosh, I spent so much money today. I’m just going to abandon the whole plan and just forget it. Right? You want to pay attention through the process and see the trends and the averages and see are you headed in the right direction? Do you have enough money saved for retirement? Can you buy this house that you want to buy? Can you help your parents pay off their mortgage? Can you give X amount to charity that you need to give? And, the same thing happens when it comes to our glucose meters that we have is we’re just looking at these average ones to know. And, if we are completely off course with certain things like our breakfast and other stuff, we can start making changes that are there.

Dr. Casey Means: Totally, totally. And I think that it does actually, I think, also just build some self-compassion and some self-awareness. Like, I’ve had people ask me, friends who are like, “Why do you wear a sleep tracker? Why don’t you just wake up in the morning and to see if you’re tired or not”? And it’s like, well, I think the body, it’s amazing. It has a huge ability to compensate, and sometimes like make us feel like we’re doing okay until we’re not. I know that like I’m wearing a whoop right now. And if I get six hours of sleep on one night, I might not feel tired the next day. I might be like compensating. I might have a caffeine that day, or whatever and feel kind of okay. But if that happens every night for three weeks, there’s almost no question in my mind that I will start to be a little bit more irritable.

Dr. Casey Means: I will maybe start to feel a little bit down. I will be a little bit anxious. I will not want to work out as much. But for those days leading up to that sort of slow, insidious decline towards FLC, feeling like crap. I might not realize it, whereas, but the data actually is showing me to stay on top of it before it’s an issue. Now having worn a sleep tracker for years at this point, I have a better body awareness of like what my body subtly feels like when I haven’t gotten a good night’s sleep. Like maybe I’m just a little bit more emotional, or I’m just like a little bit more quick to snap at someone, or something like that. I might not have necessarily seen those early warning signs if I didn’t connect that objective data with the subjective feelings and the choices. And so, I do think there’s… And then when those things happen, I’m like, oh, this is not me.

Dr. Casey Means: I am not a person who’s in a bad… I’m not just someone who’s negative. It’s like, I have this compassion for myself of like, oh, of course I’m a little bit more emotional today. I got six hours of sleep last night, and I know that I can connect those things now. And, I think the same is true for glucose as well. Yes. You might feel that crash, and those roller coasters, and you might be able to really feel it day to day, but there’s also people, members we have, who say, “Yeah, I go up, and I go down, and I don’t even really notice something. I don’t notice the crash. I don’t feel it.” And for them it’s like, “Yeah, I’m so glad I have some awareness into this, like so that I can make a change or intervene before 10 years pass.”

Dr. Casey Means: And then, I’m really starting to feel like crap or whatever, because things have kind of gone off the rails. So, but at this point, having the objective data with glucose, I do feel like I have a better body awareness, of tapping into those internal signals of when my glucose is going all over the place that I might not have realized before. And there’s a term for this in medicine, which is, I mean, somatic awareness is one term. Interoception is kind of the official medical term. And, I love this term. It’s basically like how clued into the internal signals of your body are you?

Dhru Purohit: Sensitivity.

Dr. Casey Means: Sensitivity. Yeah, and you can have-

Dhru Purohit: And that word is interoception?

Dr. Casey Means: Interoception. I-N-T-E-R-oception. and, you can have gut interoception. You can have… people, check it out on PubMed. It’s fascinating. There’s thousands of papers on this. Heartbeat interoception is a thing. How much can you just sit silently with yourself, and feel your heartbeat and accurate… Some people can’t do that. They can’t feel their heartbeat. Others can. And, the people who can have better cardiovascular outcomes. And, that’s not surprising to me because when you can feel the cues of your body, you can make better decisions. You can understand yourself better. So, you can imagine like if your heartbeat’s starting to speed up, and you know that, and you’re feeling anxious. You can link all those things, and have this compassion of like something’s happening. And, I need to like maybe do my breathing or whatever. But I think glucose interoception is something I’m thinking a lot about. Because it’s like, if you can start maybe even without looking at your monitor, have a sense of where you’re at. Am I high right now? Am I low right now?

Dr. Casey Means: And, sort of start to balance that out. I think it’s a really, just a really positive feedback loop. But, basically just getting into sort of circling back to what you were saying about your sleep, and kind of clueing into all these different things that led to maybe a fasting glucose being higher in the morning. When you can start to sort of like draw those links. You can start to move the levers for the next day, and not get into a situation where months and years go by where you’re just kind of letting it happen. And, you end up in in a bad situation.

Dhru Purohit: Yeah. Because I think for the most part, weight was the primary thing that people would look at to decide if you were healthy or not. Right? So, if there was a lot of excess weight, then you would say that, okay, somebody might not be healthy, at least in the traditional lens of medicine and even in society. They would look at somebody. They would say, “Okay, just because this person is on the slimmer side or trimmer side. Oh, they must be healthy.” Because, we’re judging everything based on weight.

Dhru Purohit: And, I think that glucose monitors are showing people is that, that yes, while obesity is linked with a lot of particular chronic diseases. Even people who are trim or slimmer side, I’ve always been pretty skinny, growing up and not having a lot of extra weight. You could still end up being skinny fat, or have other issues that are there, or just not feel your best, not perform your best, and not have the mental focus that you want to have, not have the energy that you want to have to show up, still getting sick on a regular basis, which is a big sign of fluctuating glucose and affecting the immune system.

Dhru Purohit: While I have you here for a few more minutes… This has been great by the way. Thank you so much. I’m glad we made this happen. I want to just hit, just from your perspective. You do a primarily plant-based diet. I eat a lot of plants, but I don’t know if I am by calories not that I care so much about calories. I don’t know if I… I probably eat a little bit more meats and fishes and other things. But I still eat a lot of plants that are there.

Dhru Purohit: Take us from your perspective, breakfast, lunch, and dinner, and or just three meals. But definitely want to hit on breakfast because that seems to be one that’s very challenging, and an example of like what a level 10 score. Right? Something that doesn’t have a crazy response on your glucose, and actually like keeps you pretty stable, which is a goal of having a lot more of those inside of our diet and our routine. So what would be a level 10 score for you for breakfast in the morning?

Dr. Casey Means: Yeah. So for me, I think I’ve shifted my view of what is a normal breakfast. Because, I think you do have to step outside the box of like, what is the media or marketing show us what breakfast should be? And, move towards like a little bit more of a broader view of that. So, and I love traveling because you start to see breakfasts from other cultures, and you realize, wait, breakfast looks a lot like dinner. And, a lot of these other cultures, like when I was in Japan, it’s like, it’s fish. It’s burdock root. It’s seaweed. It’s like miso soup for breakfast. And of course, that’s going to be all great for glucose.

Dhru Purohit: That’s like my dream. I would love to eat that for breakfast every day.

Dr. Casey Means: Exactly. So, I’ve kind of shifted in that, but if we’re talking about traditional breakfast foods. Some that have scored tens. So, 10 zone scores, meaning essentially no glucose response. Definitely the chia puddings. Those are pretty much universally tens for me. We’ve got quite a few recipes on our blog at levelshealth.com/blog. But, basically that’s like a few tablespoons of chia seeds, some unsweetened non-dairy milk, almond butter, some nuts on top, and like a little bit of low glycemic fruit, like some berries, or cherries, or raspberries, or something like that. That, for me, will be like a no glucose response. There are some grain-free granolas, like keto granolas that are pretty good. Paleonola is one that I’ve tried at Whole Foods that caused no glucose response for me. So, that on top of like unsweetened cashew yogurt with some chia seeds on top, and maybe like a couple berries. Like that’ll be a 10 zone square for me. I have tried eggs a few times, and like, basically, a couple pasture raised eggs with avocado and some greens. Zero glucose response.

Dhru Purohit: That’s pretty typical of my breakfast.

Dr. Casey Means: Yeah.

Dhru Purohit: We’ll do a little bit of like, me and my fiance, we make like a little bit of like our own version of a charcuterie plate.

Dr. Casey Means: Yeah.

Dhru Purohit: For breakfast. So, we’ll have some smoked salmon, wild caught smoked salmon. We’ll have some eggs. We’ll have some olives. Maybe even some guacamole that was left over for dinner. And, that is like my favorite type of breakfast.

Dr. Casey Means: Totally. Like for people who do eat animal products, I would say like probably the ultimate breakfast would be exactly what we were just talking about. Like a couple pastured, free range eggs, some greens, some avocado, or guacamole, or something. And then, maybe some fish like sardines, or smoked salmon or something like that. You’re getting the omega threes. You’re getting the greens, and the polyphenols. You’re getting the healthy fats from the avocado, and you’re getting tons of micronutrients. So that, in that meal, I would guess for most people, is going to have zero glucose, like five to 10 point rise on glucose. But for me, a lot of what I do when I’m on the go, actually, is I just grab like a Daily Harvest, which is a brand like a direct to consumer frozen food company. But what I love about at them is that they are mostly grain free.

Dr. Casey Means: They are organic. They support regenerative farms, and it’s all plant based. And so, I’ll just grab a harvest bowl, which are their like sort of more savory meals. And, they’re generally based on like cauliflower rice, or broccoli rice, or sometimes lentils as well. And then they just create great flavors. Like they have a cauliflower rice pesto bowl, which kind of tastes like pesto pasta, but it’s made with cauliflower rice. And, so I’ll just grab one of those, throw it in the microwave for five minutes, and then take that with me for breakfast. And, that’s usually like zero. And so, I post a lot of these on social media just to show like you can be plant based and eat these like big, beautiful meals and have very, very minimal glucose response.

Dr. Casey Means: I also throw beans into everything. Like for me, beans don’t spike me. For some people, they actually do. Beans and lentils can be spikers, but for me… And I don’t know if it’s microbiome, or maybe it’s because I’m pairing them often with fat and protein. I’ll add tahini, or I’ll make a nut butter sauce for my beans. But I love them for the fiber, and fiber tends to really keep my glucose lower. So, when I add fiber to a meal, it really, really helps. So, that’s sort of what I’ll do for breakfast is like chia, unsweetened non-dairy yogurts, or really just like a very vegetable forward type of more like savory breakfast.

Dhru Purohit: Let’s talk about some meals for later in the day. I mean, you can combine lunch and dinner because you’re probably pretty much eating similar things for those. Give us an example of maybe a couple of meals that are in that same category. Right? What are you looking to put together?

Dr. Casey Means: Yeah. So, I mean, for lunch, one of the things I love… One of the… A creative outlet for me, honestly, is thinking about like foods that I love, or foods that are common, and popular, and just how to make them more nutrient dense, cleaner, and lower glucose response. So for lunch, a lot of people want go for like a sandwich or something like that. Well, how can you really just like up level your sandwich from a nutrient perspective, but also lower glucose? Well, first thing you can do is, is you can swap out the bread for other things. So, you could do like a nut flour based bread, like an almond flour bread, or you could use greens. So, like I love using collared greens as a wrap for-

Dhru Purohit: My favorite is Napa cabbage.

Dr. Casey Means: Napa cabbage.

Dhru Purohit: It’s so structured and you can make like a taco, a sandwich out of it. Like I know that sounds crazy, people. But, this weekend we made Napa cabbage tacos. Me and my brother-in-law who’s a cardiologist. Also, rocking his continuous glucose monitor and everything. It was fantastic.

Dr. Casey Means: So good. I mean, my favorite food. I used to live in Portland, Oregon was this millet burger in a collared green wrap from this whole foods, plant-based restaurant called Pixie Retreat. And, I dream about it. I crave it. It’s got a nut, a cashew mayo. And, but it’s just a… Yeah, you’re eating multiple collared greens in this thing. And, it’s delicious. So, I think swapping out. Yeah. You mentioned Napa cabbage collared greens, just nice iceberg lettuce. You can cut it into squares and use that as like, almost like a burger like bun. And, then butter lettuce is fabulous for tacos. Like for small tacos. I also love using nori sheets, so actually seaweed. You can buy the large. They’re almost like a foot by a foot at Whole Foods, and you can use those as a burrito shell, and they have no, virtually no carbohydrates. And, seaweed has so many good nutrients for you.

Dr. Casey Means: So again, we have lots of these recommendations on the levels blog. But, there’s just so many ways to have that lunch food that you like with this alternative. So, a lot of what I do is I’ll make like veggie stir fries with beans, with tofu, and then put them in a greens wrap like this and put some tahini on top. And again, it’s just trying to get as many nutrients as possible without the glucose spike, and always trying to source as clean ingredients as I can. Organic, low pesticides, and when I can really support regenerative farms.

Dhru Purohit: Totally. And, I think one really cool thing, your business partners and co-founders have written about this on the blog, is that a lot of developments, for anybody who’s listening and is really thinking about… in Mark’s last book, Food Fix, it was all about like, how do we make this more accessible? How do we help people? Other stuff. We have to remember that most advancements in technology initially start off, and they’re going to be higher end. Right? They’re going to be not available to everybody. But as we continue to get more people involved, we start to make this available for more people. We bring the cost down, other stuff. I can imagine a world one day where health insurance companies are so excited to pay for this because they see that it makes healthier citizens, long-term. Especially the people who have the most expensive diseases that cost a lot to treat. This preventative medicine is way cheaper to do in comparison to a lot of the way that that things happen.

Dhru Purohit: And so, I’m imagining a future where anybody who wants it could have access to these glucose monitors. Maybe companies are subsidizing it. I actually think that we’ll probably see that first kind of like with Virta health and diabetes. We’ll see companies that are saying like, “Holy crap, if I give all of my employees this monitor, or at least subsidize it to a certain degree, it’s creating healthier employees, and our premiums are going to go down.” Right? So, this is the path. Is first, it starts off with education. We have to do podcasts like this, education you guys do on your blog, to make people aware of something that they previously were not aware of. And, that’s an important part of the process. Then, it’s technologies. And, technologies can be new and interesting foods or ways to deliver them. But it also can be wearables, which is where you guys are at. To give that instantaneous biofeedback, and help with the interoception process of increasing the sensitivity.

Dhru Purohit: So, that’s where we are. And, I’m very thankful that we have a device that can help people who are interested in going down that pathway to increase the sensitivity between what they eat and how they feel. And also, how they work out in their glucose, and how they sleep in their glucose. And, just make them in much more the category of optimal health. I want to help people, yes, avoid cancer, and Alzheimer’s, and those other things. But I also just as much want to help a lot of young people tap into what is the most optimal version of their health right now in this moment.

Dr. Casey Means: Absolutely. And, I think, your podcast does this just in such a monumental huge way and helps people really learn. I mean, I think knowledge is power, and both education, and also devices that help us learn about our bodies can help us with that knowledge. And, yeah, we are living in a really complex time. And, it really is an uphill battle to be healthy. You have to be going against the tide of normal culture in order to be healthy in our modern Western world. If you just go on the normal route, the normal treadmill, you will probably end up with chronic disease. And by that, I mean, eating processed food, drinking sodas, being sedentary, allowing chronic low-grade stress to dominate your life and not sleeping an adequate amount. Eating micronutrient poor foods, not supporting our microbiome, and being exposed to environmental toxins in all of our personal care products, home products, foods.

Dr. Casey Means: So, that’s the easiest way to live is just to like, basically, be exposed to all those things. And so we got… If we want to go against the tide, I think tools can be helpful. They can be something we can grasp onto to help motivate us, and help us to feel community around doing it differently. And, doing it in a way that we’re being empowered, and we’re taking control of our own health, and kind of taking that control back. And, that just really excites me a lot. I think when we understand how our bodies work, and how our environment is affecting our bodies. And, really focus on the word, understanding, anything is possible.

Dhru Purohit: You said something really interesting earlier, and it made me think there’s a financial author. His name is Dave Ramsey. And, I used a lot of his material when I was in college, and my finances were all over the place. And, I had a company, and it was doing well, but I wasn’t managing my finances. He said, “You know what? My method may look weird, but if normal is broke. Right? Most people normally are broke. They don’t have the financial resources that they want. I’d rather be weird.” And, so the same thing comes to health. If normal is sick, I’d rather be weird.

Dhru Purohit: And, I think that’s what you’re helping people do. You’re helping them get a little weird with this device that they wear in their arm. Dr. Casey Means, this has been fantastic. If people want to get a little weird with us, where can they go to, to sign up? I think we have a special link for them, for the levels website. Right now it’s invitation only. You guys still have like a beta, invite only group. But I think we have a link for our podcast listeners, which is just levelshealth.com/dhru, D-H-R-U, I believe.

Dr. Casey Means: Levels.link/dhru.

Dhru Purohit: Yes. levels.link. It’s the short version of it. levels.link. It’s the first link in the show note. And on YouTube, anybody can find it. You can click on that if you want to get weird with us. And you want to wear this, and feel your best. You can sign up for it over there. And, you guys are putting out great content. Both as a company, and also yourself, personally. Would love for you to mention where people can go if they want to continue down the education journey.

Dr. Casey Means: Yeah. levelshealth.com/blog is just an amazing resource. I mean, fabulous authors, Ben Bickman, David Perlmutter, writing incredible articles about why metabolic health is health. And how, why we all need to think about it far before the time when we might get a diagnosis of a metabolic condition like diabetes. So, check it out. There’s articles that are relevant really to anyone. If it’s acne, if it’s wrinkles, if it’s PCOS, if it’s erectile dysfunction, if it’s heart disease, it’s all there. And, it’s all research based. So, check out that levelshealth.com/blog. Can also sign up for our newsletter, which condenses a lot of this great information. And then, if you want to join the wait list, you can sign up on our homepage levelshealth.com, or use the link that Dhru mentioned.

Dr. Casey Means: And then, we’re on Instagram and Twitter at levels, which is actually really fun to follow our Instagram at levels because our members who are in the beta program are sharing the experiments they’re doing. And it can give you a lot of really interesting ideas about comparing different foods, and different athletics, and activities, and kind of get inspired by some of that. And, then I’m at Dr. Casey’s Kitchen, Dr. Casey’s Kitchen on Instagram and Twitter as well. And I post a lot about plant based metabolic health.

Dhru Purohit: I love it. We’ll have the links to all those again. And, you guys have a wait list now, but if they use the link, they can skip it.

Dr. Casey Means: They skip the wait list. Yeah.

Dhru Purohit: Okay. Great. If you want to skip it, click on the link, and you can sign up, and you can share your experiments with us. Dr. Casey Means, always a pleasure. And, I’m so glad that we got to do this podcast in person.

Dr. Casey Means: Thank you so much, Dhru.