All about Metabolic Health with Dr Casey Means

Your metabolism is what it is…right? According to Dr. Casey Means, our metabolism is actually very much within our control. And a healthy metabolism can lead to greater quality of life as a whole. That’s where Levels comes in, the company that’s hoping to put individuals in the driver’s seat when it comes to their health. On this episode of MindHub, Dr. Means shared why she’s a big believer in functional medicine, how to detect metabolic dysfunction, and how to focus on updating your diet and lifestyle in a way that’s healthy and productive.

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1:59 – The philosophy of functional medicine

Instead of fixing symptoms, functional medicine looks at the root causes of diseases on a molecular level.

“What functional medicine is it’s really a philosophical approach to health care that addresses the root causes of diseases and symptoms and aims to reverse the conditions that lead to disease and symptoms. The premise is that symptoms don’t arise out of thin air. They arise out of cellular dysfunction. Instead of just identifying and naming a symptom and then slapping a drug or a surgery on it to fix it, functional medicine takes a really deep root cause approach and thinks about what is actually going wrong in the body and then works to try and correct that. Often what’s going wrong is that the body’s just dealing with a mountain of external stressors like diet, toxins, chronic stress, sleep deprivation, lack of exercise, lack of physical activity, and all of that can really translate into biochemical reality through our nervous system, through our hormones, through all these root cause pathways that take all these stressors and lead to problems with health and causes dysfunction.”

7:37 – How to fix your metabolism

The easiest way to improve your metabolism is to control the amount of glucose in your body. When the body is overloaded or underfed, things break down. Achieving efficiency is key to a healthy metabolism.

“My perspective is that the lowest hanging fruit is to basically control how much of these energy substrates you’re putting into the body. And since glucose is the primary building block of energy, I think that’s the one that’s easiest to leverage. The analogy I like to use is, think of the body as a factory. Let’s say your body is a factory that’s making some product. You get shipped all these raw materials and then those go into the factory, and then you have to turn them into something else. That’s kind of what’s happening with the body. You put in glucose, it has to be converted to ATP. So if all of a sudden in your factory, you ship 50 times more raw materials and you have the same amount of staff and the same size building and the same conveyor belts, it’s just not going to work. The factory is going to be overloaded. The workers are gonna quit. You can’t handle that much coming in. It’s just too much. You also can’t even fit in the building, so you have to store it elsewhere. Now you have all these problems. That’s exactly what’s happening with what we’re doing to our bodies with glucose.”

13:47 – Early signs of metabolic dysfunction

Fatigue, low energy, and crashing after meals are early signs of metabolic dysfunction, which can lead to serious illnesses like Alzhiemers and even complicate cancer.

“Cancer cells are highly metabolically active. They need tons of sugar to function. The inflammation associated with metabolic disease can drive cancer and make cancer outcomes worse. Alzheimer’s disease is now being called Type Three diabetes because it’s associated with insulin resistance in the brain. And then there are much higher rates of heart attack and stroke and people with metabolic dysfunction. So those are like the heavy hitters, the stuff that people think about as big, bad diseases. But for the average person who may be not all the way there yet, but is on the spectrum of metabolic dysfunction, they have more variability in their glucose every day than they should. Their fasting glucose is starting to go up a little bit, maybe they’re having early spectrum insulin resistance. What you can see is these more subtle findings, a lot of fatigue, afternoon low energy, or feeling like you’re crashing after meals. That’s often a sign of a big glucose spike and then a big glucose drop. You can avoid that by keeping your glucose stable.”

17:02 – The link between metabolic dysfunction and cancer

Cancer cells thrive on sugar. Metabolic dysfunction feeds cancer cells and throws off the immune system, making the disease a lot more complicated.

“Cancer cells really thrive on sugar. They’re more metabolically active and cancer cells have basically uncontrolled replication. So they form tumors. High blood sugar is basically going to feed cancer cells. Separately, high blood glucose stimulates inflammation. High blood glucose tells the body that something’s wrong. Something’s not normal. That can cause this sense of threat in the body that something bad is happening if blood glucose is high. So you get this activation of the immune system and because the immune system is what controls cancer growth. You need the immune system to basically shut down cancers. That’s what in our body can control cancers. Now we’re seeing things like cancer vaccines being created. If you are throwing the immune system off course with high glucose and metabolic dysfunction, you’re going to generate some maladaptive inflammation that makes this attack less functional. There’s a couple of different pathways of how glycaemic dysfunction affects cancer. But what we know is that for a lot of cancer types, there are much worse outcomes for people who have metabolic dysfunction.”

24:31 – Should everyone take supplements?

Dr. Means recommends her patients try to get all the required nutrients from the food before moving on to supplements. That said, the most common supplement she recommends is Omega-3 fatty acids.

“I wouldn’t say there are any blanket statement supplements that I can say that work for everyone because everyone’s body is so unique and individual. And for my own practice and for my patients, I do supplements based on testing. I get this really great test called NutrEval through this lab called Genova, which basically tells you really specifically what minerals and vitamins you need for optimal biologic function. But before even supplementing, I think it’s always best to try and get it from whole foods and really try and optimize digestion and microbiome as much as possible. So you’re digesting foods properly and getting all the nutrients out of foods that you possibly can before moving to supplements. In terms of just nutrients that I think are positive for the immune system in general and not necessarily for COVID, but just for regulating inflammation, I think some of the key ones would be Omega-3 fatty acids. This is like you hear about Omega-3 fats, Omega-6 fats. Omega-3’s are the ones that typically come from walnuts, flax seeds, chia seeds, and then fish like salmon, mackerel, anchovies, sardines. These are an anti-inflammatory type of fat that actually when they’re broken down, they create these anti-inflammatory signaling molecules.”

40:52 – People react differently to food

It’s not just food choices that matter. It’s also food pairing, food timing, exercise, sleep, stress, and the microbiome, which result in individual food reactions.

“What’s interesting about the glucose data stream is that also we’ve talked about a lot of different things that affect glucose. It’s not just food, it’s food combinations. What you’re pairing together. It’s food timing, it’s exercise, it’s sleep, it’s stress, it’s the microbiome. So it’s this very multi-variate input that impacts basically how you transform food into glucose in your body and what your glucose levels are in your bloodstream. We want those to be low and stable because that’s associated with just a better experience of life now, but also better in terms of your risk profile for future disease. It’s possible that part of that pushback that you got was because, one, there’s this concept of low-glycemic diets or keto diets, and this idea that if you just eat things that are low carb, like you’re going to be fine. So why do you have to measure it? Just eat things that are low carb. But the reality, and this is really being figured out more over the past couple of years in the research, is that everyone responds to food differently. We are these biochemically unique organisms and I could eat an apple and you could eat an apple and X could eat an apple. All three of us could have vastly different glucose responses because of how we slept, how we exercise today, what our microbiome composition is, what our body type is, what our insulin sensitivity. And certainly if one of us paired it with fat, one of us paired it with protein and one of us paired it with extra sugar, we’d have even more different responses. The reality is that people respond differently to food.”

44:01 – The concept of orthorexia

Orthoerxia means unhealthily getting fixated on wellness and diet. This is only a problem when people don’t have accurate information about their own bodies and how it reacts to food. CGM can help by removing the confusion with personalized, real-time data.

“This concept of orthorexia, that’s definitely a problem these days where people are becoming so fixated on wellness and so fixated on a diet that it becomes very dominating of the psyche. And I would argue just like a slightly different perspective. Obviously, any tool can be used for good or it can be used for bad. It depends a lot on the person. But the actual experience that, I’d be curious to hear your experience, a lot of our users have had is that actually using a data-informed tool actually really liberates you in the sense that there’s less of a subjective mystery component to food, and there’s less of confusion about food. It’s actually a very efficient way to create conclusions. That in the long run, I think makes people a lot less obsessive about food. So a term that I’m toying with is this idea that it helps you build metabolic intuition over time. So yes, at first you’re kind of trying all these different foods and you’re very quickly learning what works for your body and what doesn’t, you’re also building this arsenal, this toolbox of tools that you have to basically modulate a glycemic response.”

53:52 – Helping people make sustainable changes

When people see the impact of their choices on their bodies in real-time, it becomes easy to make better choices which leads to a sustainable change in behavior.

“Nutrition has always been this open-loop feedback system. You eat something or you eat a bunch of things during a day and then you have no real feedback on what’s happening to you. You might have some nebulous symptoms, you might not feel great, but the one-to-one relationship between action and outcome is almost impossible with nutrition. I think this is the first tool that might allow people to close the loop between action and reaction. And that closed loop is so important for buying into these behavior changes. If you can really identify something and say, ‘this is the causative factor of this,’ it’s a lot easier to make a decision, versus if you’re like maybe it had something to do with it. You weigh yourself one day and you’re like, well, I’m two pounds heavier today. Maybe I should think about not eating this. How do you even look at your last day and approach what to change? It’s very, very hard. I think that the closed-loop thing is important.”

01:05:36 – What affects our microbiome

Apart from nutrient rich food, our microbiome is also affected by the pesticides in food, the amount of antibiotics we take, and stress. The microbiome takes years to repopulate, so it’s critical to maintain its health.

“At the end of the day, a lot of the recommendations I’m going to make for people are going to be pretty much the same, which is, you want to support your microbiome in every possible way. One is obviously eating whole foods, fiber, giving them all this healthy food. Most people eat about 10 grams of fiber a day. So I’m getting people on 50-75 grams a day, it really helps with the flourishing of the diversity of the microbiome. It’s also about what you take out and the things that hurt the microbiome. Taking out pesticides, which can basically kill the microbiome, taking out persistent organic pollutants pops up the diet, and just eating clean water, clean food. Making sure that you’re not putting stuff in there that’s going to hurt it. Making sure that we’re not overusing antibiotics, which can totally wipe out the microbiome. It can take months, if not years to repopulate. We know antibiotics are super important, but we overuse them. We use them excessively for things like acne, when there are other levers that we could be turning to basically help with some of these things. So I think a lot about antibiotic stewardship, about clean eating, about adding fiber, and then definitely about reducing stress and really having some good stress management tools because the microbiome, they hear all your thoughts through your nervous system and through your hormones. They are very affected by that.”

01:08:03 – What is Levels?

Levels is empowering people by giving them real time access to information about their bodies, enabling them to take control of their health and wellness through continuous glucose monitoring.

“I think on a bigger picture, this is a tool that helps people really get back in touch with their unique bodies and their biochemical individuality, and actually puts the agency and the control and the power back in your hands. I think that’s a really beautiful thing to feel like you actually are guiding the ship when it comes to nutrition and you’re making choices that you know are good for you. I think that’s a huge relief after years or decades of being confused or not feeling good, also to be able to have the power to potentially make really rapid changes in your just subjective experience of everyday life through these really simple levers and having that information handed to you on a silver platter. It’s very empowering. As a physician, I lived in a world where it was very top-down, telling people what to do. We know that when doctors do that, people often don’t do it. They don’t actually do what the doctor says even with a prescription, only about 30% of patients fill a prescription that a doctor gives them. That’s not the answer. The answer is for it to come from yourself and come motivated from within you. That involves giving people information about themselves to make the best choices for them. And I think when we reclaim that sense of understanding about our bodies and our sense of agency it’s really, really empowering and that can actually have positive effects throughout your entire life.”

Host: [00:10]                       Welcome to MindHub podcast, episode 11. And today we have a special guest who is here to talk about all things metabolic health, glucose levels, and all of the fun things that generally confuses the population, but it’s also very important. So on that note, Casey, thank you for coming on. Would you mind introducing yourself? Giving your name, giving a little background of how you got here?

Casey Means: [00:41]    Yes, absolutely. So, thank you guys so much for having me on. I am Casey Means. I’m a medical doctor. I’m the co-founder and chief medical officer of Levels. And I am a functional medicine physician and metabolic health evangelist.

Host: [01:01]                       I love that.

Host 2: [01:02]                   You wear a lot of different hats.

Host: [01:04]                       Yeah.

Casey Means: [01:05]    I do. All of them pointing towards metabolic health, but yes.

Host: [01:11]                       Which is so important. And I think one thing that probably would be good to differentiate here would be, the difference between like a functional medical like, I know you’re a medical doctor, but then also you have a different focus than, you know, the norm. Like if you go to your primary care physician, it’s different than, you know, usual. So what is the difference? How does that work in comparison?

Casey Means: [01:42]    Yeah, that’s a great question. It’s sort of a new term that a lot of people aren’t familiar with, so happy to define it. And I actually started out as a surgeon. So, I was in just like uber, you know, conventional healthcare and have transitioned into functional medicine, which has been a really wonderful journey. And what functional medicine is, is it’s really a philosophical approach to health care that addresses the root causes of diseases and symptoms and aims to reverse the conditions that lead to disease and symptoms. So the premise is kind of that symptoms don’t arise out of thin air. They arise out of cellular dysfunction. So instead of just identifying and naming a symptom and then kind of slapping a drug or a surgery on it to sort of fix it, functional medicine takes this sort of really deep root cause approach and thinks about, you know, what is actually going wrong in the body, and then works to try and correct that. And often, what’s kind of going wrong is that the body’s just dealing with a mountain of external stressors like, you know, diet, toxins, chronic stress, sleep deprivation, lack of exercise, lack of physical activity, and all of that can really translate into sort of biochemical reality through our nervous system, through our hormones, through, you know, all these sort of root cause pathways that take all these stressors and kind of lead to problems with health and causes dysfunction. So really, it’s just an approach to yeah, treating disease on a very molecular level, not looking at diseases as sort of isolated silos that you kind of have to play whack-a-mole with individually, and really seeing the connections between symptoms and diseases. And in that sense, it’s a really efficient practice. Because sometimes, when you can find the things that link diseases, a single intervention can have a lot of wide-ranging effects. So one of those sort of root causes of a lot of different symptoms would be something like glucose dysfunction or a metabolic dysfunction. So if you can, you can have a wide ranging, you know, positive effects on the body. So that’s sort of the broad overview of functional medicine.

Host: [03:56]                       That’s awesome. I love that. I don’t know why, but that just makes me feel like all warm and fuzzy inside. I’m such a nerd, but I think it’s just, you know, it’s just that something that is so important, it’s popping up more now, where people are seeking out functional medicine more so, but it’s just so different in comparison to going to a doctor and then, you know, they might just be prescribed something and it’s more of a band aid, but in your sense, you just look at everything and the body and the system, it’s all connected, that sort of stuff. I’ll stop nerding out but, on that note, when it comes to metabolism, I guess, that’s also a pretty big unknown or, but word, because everyone wants a fast metabolism. Like that’s what they just think. They’re like, I don’t know metabolism, but I know that I want it to be faster. So what is actually metabolism?

Casey Means: [05:03]    Oh man. The big question. What is metabolism? So, yeah, it’s so important. Because it is a term that we throw around all the time and it’s sort of a question of like, Well, what really, what does this mean? So I would say, big picture, metabolism is the set of cellular mechanisms that generate energy from our food and our environment. And we need that energy to power every single cell in the entire body. All cells in the body require energy, cellular energy, which is generally thought of as ATP, to function. And so having an efficient metabolism is sort of foundational for all assets of health because it’s how all cells run. So then when you think about like, how do we, you know, how does this work with food? So when we eat and when we digest foods, like we digest them into fats, carbohydrates, proteins, and micronutrients, and these are all released into the bloodstream to kind of control all aspects of our biologic function, and fat and carbohydrates are both big contributors to how we generate energy in the body. And when carbohydrates are broke down, they form glucose and glucose is this molecule that our cells take into there. And one of these little parts of the cell, the mitochondria, can convert it to this usable form of energy- ATP. And so, when this process, you know from mouth to energy, is a long process, right? I mean, it actually takes place very quickly, but there’s a lot of components involved. It’s, you know, how fast your GI motility is, how your microbiome is processing that food, how your gut line is working, how those different nutrients are traveling to the bloodstream, how the hormones in the body are being released to let things like glucose be taken up into the cells, how your mitochondria are functioning, and then how you’re actually using and storing extra energy substrates like glucose, like what you’re doing with the excess of that, all of that is involved. And so, you want that to all be working in a really efficient, synchronous harmony. And that’s kind of what it really means to be having a good metabolism, is that at every step of the process, things are like moving properly and you’re essentially, you know, utilizing, transporting, storing, and excreting energy in a really balanced way.

Host: [07:16]                       That’s awesome.

Host 2: [07:18]                   How does someone fix their metabolism if they think it’s not like working properly?

Casey Means: [07:29]    Well, that’s a complex question because there’s so many aspects to it. And my perspective is that the lowest hanging fruit is to basically control how much of these energy substrates you’re putting into the body. So that would be in primarily, since glucose is the primary sort of building block of energy, I think that’s the one that’s easily easiest to leverage. So the analogy I like to use as kind of like, think of the body as a factory. Let’s say your body is this like a factory that’s making some product. If you get shipped all these raw materials and then those go into the factory and then you have to turn them into something else and that’s kind of what’s happening with the body. You know, you put in glucose, it has to be converted to ATP. So, if all of a sudden your factory, you ship 50 times more raw materials and you have the same amount of staff and the same side as the building and the same conveyor belts like, it’s just not going to work. The factory is going to be overloaded. The workers are going to quit. Like, it’s just, you can’t handle that much coming in. It’s just too much. And you also can’t even fit in the building, so you have to store it elsewhere. So now you have all these problems. That’s exactly what’s happening with what we’re doing to our bodies with glucose. We are consuming, you know, well over 10 times more glucose than we did a hundred years ago, we used to eat about two pounds of sugar per year. Glucose is sugar, you know, and now we’re eating about 150 pounds on average of sugar per year. So that, to me, is like the lowest hanging fruit. Metabolism is very complex, but that part of things is so, so simple. Like overloading the body and having this sort of carbohydrate toxicity, there’s almost no nuanced interventions you can do unless you get on top of how much glucose your body’s like having to deal with, because you’re either going to store it as fat or you’re going to store it, you know, and cause all these problems with either obesity or other problems associated with storing fat inside organs like, which is associated with chronic disease, or you’re going to basically be consuming so much sugar that you’re constantly releasing insulin, the hormone required to take it up into cells and then your cells get numb to insulin. And now you have your, you can’t take it up as efficiently. So now you’ve got high insulin, you’ve got your blood glucose levels rising and, you know, lots of problems. So, to me, that’s the lowest hanging fruit for, you know, quote unquote improving metabolism.

Host: [10:04]                       Yeah. And I feel like that’s the thing a lot of people don’t realize, that their sugar is in everything, like absolutely everything, like soda, like all, I shouldn’t say all processed foods, like have some form of sugar and that’s something that you can really control, or that is in your control.

Casey Means: [10:22]    Absolutely.

Host: [10:22]                       Yeah. And I think one of the things. Sorry.

Casey Means: [10:27]    Oh, no, it just, it’s shocking. Like what you said, like the types of foods now that contain sugar, you know, like ketchup, and that just like don’t even need it. It’s just, it’s very strange.

Host : [10:40]                      We’ve just come to like want and need it more and more. It’s just, we’ve become so accustomed to it. That’s, basically, we just need more and more to be satisfied. But I think one of the most frustrating things, for me, when it comes to the fitness industry is that yes, calories in, calories out, sugar in and of itself is not, you know, making you fat, but that’s just not the whole picture. There’s so much like, nuance in between of what sugar can do. Like maybe, you know, it’s not going to make you fat as long as you don’t overeat it, but there are other consequences that may not be visually, like you can’t see it from the outside, but there’s a whole lot that’s going on on the inside that we might not be aware of, but they just kind of sweep over that. And they’re just like, sugar is not the devil. And it’s like, Yeah, yes. But also, it’s not the best.

Casey Means: [11:46]    Yeah.

Host: [11:47]                       Let’s see. One other thing, it would be, what would be like kind of some signs or symptoms to maybe not being so metabolically healthy? Like even if you’re a pretty fit individual and you feel like you do pretty well with eating, and you’re just kind of like, Eh, I’m good. I eat pretty healthy. I exercise. But that doesn’t automatically mean that you might be metabolically healthy. What could be some signs to look for that you still have some work to do?

Casey Means: [12:24]    That’s such a great question. You know, because I think that most people associate metabolic dysfunction with like the most overt signs of metabolic disease, so like diabetes, severe obesity, and what’s, you know, I think that’s sort of a common misconception that like, you need to have some pretty extreme, you know, level of dysfunction or clinically diagnosable disease to have signs of metabolic dysfunction. And the truth is that it can be overt like that, but it can also be very subtle. And the key point is that, since every cell type in the body needs energy, if energy pathways aren’t moving properly, you can essentially have a symptom, any type of symptom, arise from metabolic dysfunction, depending on sort of what organ system or cell type we’re dealing with here. So to kind of like, I guess, categorize them into like overt or subtle, overtly, metabolic disease looks like obesity, which is, you know, dysfunctional fat storage, insulin resistance and Type II Diabetes, which is, you know, insulin resistance. It also can be non-alcoholic fatty liver disease, which is like rising in frequency, and that’s basically when the liver has to store like all this extra sugar as fat and the liver becomes fatty. We’re starting to see this in kids now. You know, cancer is considered to be, in part, a metabolic disease. Cancer cells are highly metabolically active. They need tons of sugar to function. And the inflammation associated with metabolic disease can, you know, drive cancer and make cancer outcomes worse. Alzheimer’s disease is now being called Type III Diabetes because it’s associated with insulin resistance in the brain. And then heart attack and stroke are much, much higher. There are much higher rates of heart attack and stroke in people with metabolic dysfunction. So those are like the heavy hitter, like really, you know, the stuff that people kind of think about as big, bad diseases. But for the average person, who may be not all the way there yet but is kind of on the spectrum of metabolic dysfunction, you know, they have more variability in their glucose everyday than they should. Their fasting glucose is sort of starting to go up a little bit. Maybe they’re having early, early spectrum insulin resistance. What you can kind of see is these more subtle findings, like a lot of fatigue, like afternoon low energy, or feeling like you’re crashing after meals. That’s often a sign of a big glucose spike and then a big glucose drop. And you can avoid that, you know, by keeping your glucose stable. Also anxiety. So a big glucose spike and drop can lead to some mood symptoms- a little bit of brain fog and lack of mental clarity and just not feeling quite on your game. That’s actually been studied. And non-diabetic individuals who have poor glycemic control, report like less acute memory retention, so not like dementia, but just acutely not remembering stuff as well, especially with verbal memory. And then like brain fog and lack of mental clarity. And then when this shows up in the reproductive system, this can show up as infertility. So polycystic ovarian syndrome, that’s the most common cause of infertility in the United States, and that is very much on the metabolic spectrum. There’s a thought that high insulin levels stimulate the ovaries to make more testosterone and that actually leads to menstrual dysfunction and infertility, similar with erectile dysfunction, it’s on the spectrum of metabolic disease. High blood sugar can cause little blood vessels to become kind of narrowed and less functional, cause what’s called endothelial dysfunction. And because erections are basically, you know, blood flow to the penis, when you have metabolic dysfunction, it can cause problems with that. So, you know, that’s just like, you know, so anxiety, fatigue, post-meal slumps, you know, infertility or menstrual dysfunction, sexual dysfunction, acne, all of these things are kind of like the different faces of not being metabolically healthy. So it’s kind of amazing how wide the spectrum can be. And that’s just some of it.

Host: [16:30]                       Wow. That’s really so much.

Host 2: [16:32]                   Yeah. I wouldn’t think half of those things were like related as much as they are.

Casey Means: [16:42]    Yeah.

Host: [16:45]                       Do you mind touching a second or like a bit more on the cancer aspect of things and how that can be partially due to metabolic health and stuff?

Casey Means: [17:00]    Yeah, absolutely. So cancer cells really thrive on sugar. They need more, they’re more metabolically active and they’re constantly, like cancer cells have basically uncontrolled replication, so they form, you know, tumors. And so high blood sugar is basically going to like feed cancer cells. Then separately, cancer, sorry, high blood glucose stimulates inflammation. So high blood glucose tells the body that something’s wrong. Something’s not normal. And that can cause sort of this sense of threat in the body that something bad is happening, if blood glucose is high. And so you get this like activation of the immune system. And because of the immune system is what controls cancer growth, you know, you need the immune system to basically shut down cancers, that’s what in our body can control cancers, which is, you know, now we’re seeing things like cancer vaccines being created, if you are kind of throwing the immune system off course with high glucose and metabolic dysfunction, you’re going to generate some sort of maladaptive inflammation that makes this attack like less functional. So there’s a couple of different pathways of how glycemic dysfunction affects cancer, but what we know is that for a lot of cancer types, there’s much worse outcomes for people who have metabolic dysfunction.

Host: [18:28]                       Wow. Crazy. That’s, sorry, I just brain farted cause Dee disappeared, so I can only see you. But we’re going to keep going.

Host 2: [18:42]                   I have a question. Do you think, with everything going on in COVID and everything, do you think like that plays a part in like getting COVID or seeing like, being responsive to COVID?

Casey Means: [18:58]    Yeah. Yeah. That’s such an important question right now. And the data is really strongly supporting that metabolic disease, particularly obesity and diabetes will significantly increase the risk of mortality and morbidity from COVID. So not entirely clear that it increases your risk of getting the disease, but it is becoming very clear that it increases your risk of dying, or having a worst or prolonged outcome, like meeting mechanical ventilation or an ICU stay. So these, you know, and a lot of people sort of in the functional medicine community are reading this literature closely. There’s been hundreds of papers, since February, published in scientific journals, showing that metabolic diseases are a risk factor for worse COVID outcomes. And yet, we’re really not seeing a big movement in the medical community towards encouraging people to really focus on dietary and lifestyle strategies to improve their metabolic function. And there is a big focus on, you know, making sure you’re stocked up on your medications, making sure you’re pricking your fingers, you know, regularly, but it’s like deafeningly silent, sort of a big stance about really working on evidence-based dietary and lifestyle strategies during COVID right now. And I think we’re kind of missing a really big opportunity here, to really educate about this. And just in terms of mechanisms, so there’s a number of reasons why high blood glucose may be leading to worse outcomes with COVID. One of them is that, the way in which glucose sort of affects the immune system and impairs the immune system. So it’s well-established that if blood glucose is high, it actually kind of stuns your immune cells and immune cells go around, you know, and they basically eat other cells that are either infected with a virus, so they eat bacterial cells, that’s a process called phagocytosis, like eating another cell. And that process is just, like the cells that have to go around and eat other cells like, that is impaired with high glucose, something about the high glucose causes that movement of the cells to just not work properly. So that’s a big factor. The other big factor that’s been emerging is that, and stop me if I’m getting into like too much technical detail.

Host: [21:18]                       No, you’re good.

Casey Means: [21:20]    But high blood sugar, like I mentioned, causes this sort of maladaptive chronic inflammation in the body and the release of these particular chemicals for immune cells called cytokines, so there’s a handful of cytokines, one called Interleukin 6 and one called TNF alpha, and these basically are signals that are released from immune cells that go into the bloodstream and tell all the other immune cells to get like super active, like there’s a problem. And diabetes and obesity can do that to the body, like it tells the body to basically ramp up inflammation. But what’s interesting is that, COVID also causes these things to be up-regulated, because obviously COVID stimulated the immune system, and it’s finding that this magnification of these pro-inflammatory signals with metabolic dysfunction and COVID are basically what lead to the really bad outcomes, especially respiratory outcomes, because basically the immune system, to get immune cells to a tissue to fight infection, you have to make the blood vessels kind of like leaky so that the immune system can exit the blood vessels and get into the tissue where it needs to fight infection. So it creates permeability in the blood vessels. And that’s what some of these cytokines will do. They’ll signal the blood vessels to become leaky and let the immune cells and fluid, and that’s why you get swelling in tissues, because of that leakiness. And so basically what’s happening in the lungs is, you got all of these signals from metabolic dysfunction, all of these signals from the immune response to COVID, leading to all of this like leakiness in the lungs and basically just, you’re getting these terrible symptoms of lung inflammation and other organ systems. So, I don’t know if that makes sense, but like basically it’s compounding what’s happening with COVID and leading to this end organ damage that’s causing the actual death in COVID. So, a way to think about it is, it’s not necessarily the virus itself that is actually kind of killing people, it’s an overwhelming immune response to the virus, but it’s compounded by metabolic dysfunction. So if we could like pull the brakes on that metabolic dysfunction, I think you’d see a really, you know, a big, it’d be a really high value intervention. And we’re already seeing in data, that people have better glucose control, even if they have diabetes, are doing better with COVID than people who have poor glucose control. So super tied in and really interesting and last thing I’ll say is, sorry, that the CDC actually, just two days ago, posted for like the first time, that we should be thinking about eating healthily and nutrients during COVID. There’s been a lot of data about vitamin D and health outcomes and things like that, but it’s like, it’s been months and now we’re just starting to tell people like think about it. So, yeah.

Host: [24:07]                       Yeah.  That’s crazy. Do you have any, so supplement-wise, what would you say might actually be beneficial to think about taking if you’re concerned or if you’re not already?

Casey Means: [24:24]    So, I mean, you know, I supplement personally, I wouldn’t say there’s any like blanket statement and supplements that I can say that work for everyone because everyone’s body is so unique and individual. And I actually, for my own practice and for my patients, I do supplements based on testing. So I get this really great test called NutrEval through this lab called Genova, which basically tells you really kind of specifically like what minerals and vitamins you need for optimal biologic function. But before even supplementing, I think it’s always best to try and get it from whole foods, you know, and really try and optimize digestion and microbiome as much as possible so you’re digesting foods properly and getting all the nutrients out of foods that you possibly can, before moving to supplements. So, but in terms of just nutrients that I think are positive for the immune system in general and not necessarily for COVID, but just for like regulating inflammation. I think some of the key ones would be, you know, Omega-3 fatty acids, this is like you hear about Omega-3 fats, Omega-6 fats. Omega-3’s are the ones that typically come from like walnuts, flax seeds, chia seeds, and then fish like salmon, mackerel, anchovies, sardines. And these are an anti-inflammatory type of fat that actually, when they’re broken down, they actually create these anti-inflammatory signaling molecules. So I encourage my patients to get at least two to three grams of Omega-3 fats per day. I’m plant-based so I get mine from seeds and nuts and algae, but if you are an animal protein eater, you know, sardines, salmon, mackerel are great options for Omega-3 fats. And then there’s just a lot of anti-inflammatory nutrients out there from plants. I mean, really plant foods are, by and large, anti-inflammatory so I encourage people to get 8 to 12 servings of vegetables per day. And if I had to focus on some that are important, I would focus on plants that have very specific anti-inflammatory compounds. So turmeric, garlic, ginger, green tea, cruciferous vegetables. Those are some of my top ones, cruciferous vegetables especially. So that would be like broccoli, broccoli sprouts, bok choy, arugula. These have specific chemicals, one called sulforaphane, one called indole-3-carbinol, and these actually like change gene expression to decrease inflammation. So, you know, I would just be loading up on all those cruciferous vegetables and those anti-inflammatory herbs, you know, like I mentioned, garlic, turmeric, ginger, cruciferous veggies and sort of all veggies. And then the two other I’ll mention, that I think benefit the immune system, one is selenium. So selenium comes mostly from Brazil nuts and it is basically part of what makes us selenoprotein, which is a protein that the immune system use to have a coordinated immune response. We’re very low in selenium as a population, so that’s something to really think about- having a few Brazil nuts each day, you know, aiming for about 200 micrograms of selenium a day. And then lastly, like fiber, that one of my biggest, it’s not a vitamin or a nutrient, or it’s not a mineral, but it’s something from food. Fiber is what your microbiome, you know, eat essentially, and they process fiber and then they make these chemicals that we can use. And the chemicals that they make that we can use are amazing for the immune system. They’re amazing for metabolic function. So a lot of what I think about when I eat is how do I feed my microbiome so it can do, it can make the things that I need for health? So I shoot for 50 to 75 grams of fiber a day, mostly from beans, legumes, chia seeds, nuts, other seeds, and just generally vegetables. So.

Host 2: [28:33]                   Awesome. Yeah. I love that. I think I have a bit of a selfish question. It might be probably just me wondering. So, I am like prepping for a bodybuilding show right now, which involves getting down to very low body fat percentage and then just to basically spray-tan yourself and pose for a second and be done, but it’s very vain and ridiculous, and during the time of COVID, it doesn’t make a lot of sense because that is very stressful on the body. And obviously, it’s not the best idea to be single digit body fat with your immune system. And then I’m also going to be flying from California, which is one surge COVID center, to Texas to Houston, to Houston. Number one, am I nuts? Number two, if I do it, what precautions, whether it be like a supplementation to a more extent, because my calories are going to be lowered too, so I’m all about very minimal, like actual supplements, very much so about, you know, eating whole foods. That is what I do, like whole foods, nutrient dense. But if I’m eating lower calories, I know I’m not going to be like getting in as much as I normally would. So would that be kind of a circumstance where supplementing would be beneficial or should I even be doing this?

Casey Means: [30:23]    You know, that’s a great question. It’s cool that you’re being so thoughtful about it and I’ve definitely, I’ve seen your Instagram so I know that you are very healthy with your whole foods. I saw some like gorgeous salmon or something, I think I saw recently, but yeah. So what I would say is to think about it as like, get every bang for your buck with every calorie you’re putting in your body. How can you load the maximum amount of useful building blocks into each bite, you know, and not have anything that’s basically going to like, not serve you from a biologic function? So I think of food, one of the reasons I think that food and studying food and working with food, in my clinical practice, is so magical is because food is both building blocks, but it’s also molecular information. So it not only serves as the substrate for building every single cell in your body, it is literally the atoms that go into our body to build us. You know, you are what you eat is the adage, but it’s like, it’s true. But it’s also molecular information that goes in and tells your cells and tells your genes how to use the building blocks. So that’s kind of cool that it serves those two different roles. So when I’m thinking about, let’s say you’re having fewer calories, you want to just make sure every bite you’re taking is a good building block and good molecular information. And so, it really wouldn’t be that different from kind of what I had said before, like focusing on whole foods, really micro-nutrient dense foods, so like vegetables, fruits, etcetera, you know, if you are eating animal protein, making sure that you’re choosing foods that are going to give you a really big bang for your buck in terms of the vitamins that only, that mostly meat and animal products can give, like chromium and B vitamins. You know, you can find these things in plant sources, but they’re going to be much higher density. So, you know, maybe instead of eating, you know, a bunch of, I don’t know, chicken breast or something, or sort of low quality beef, like choosing like a really beautiful, free range, like egg or, you know, some really nice, wild game meat that’s going to have like a really high Omega-3 content, and not a bunch of just sort of like crap from a, you know, meat source that was like fed a bunch of corn and soy it’s whole life. So really just choosing calories with like the most bang for your buck. And those bangs for your buck being, you know, low-glycemic, don’t cause damage, eat things that are actually not spiking your blood glucose, and that’s where, you know obviously, Levels comes in, Omega-3’s all the way, you know, don’t get a bunch of excess Omega-6 fats that are going to kind of be pro-inflammatory and not make up good cell building blocks, getting all those healthy micronutrients from veggies, and getting tons of, you know, fiber, from really dense fiber sources, so things like the beans and the chia seeds. So yeah, that’s how I’d frame it.

Host 2: [33:28]                   Awesome. Yeah, mostly that’s, I mean, basically what I’m doing. I don’t know if, I think, I don’t know how much you dove into my Instagram, but even like my waffles that I do in the morning, those are only made of eggs and banana so it’s like, it’s all still foods. I think people look at that and they’re like, that’s not healthy. Why you eat waffles? And I’m like, it’s not actually real waffle. But yeah, so it’s basically what I’m doing or how I already do things, I think I was just kind of like, how bad is going to just be at, you know, more stressing my body more and like flying off, that stuff and should I be like extra concerned, I guess?

Casey Means: [34:17]    Well, you know, I think another thing to think about is like, really gaming like the timing of how you eat, because, as you know, like a calorie is not a calorie, right? So like, your goal is to be cutting fat? Then inherently, that means your goal is to keep insulin low, because you can’t burn fat if you’re in a high insulin state. Insulin is the hormone that obviously causes glucose to be taken up by cells but it’s also the hormone that blocks you from oxidizing fat. So that is something to consider, of like, well how can you kind of game the system to eat at different times of the day, that you’re not going to raise your insulin as much? So, we know from like scientific research that eating later at night, if you eat the same meal in the morning versus late at night, eating it late at night is going to have more of a glucose response and more of an insulin response, which means you’re probably going to start like, store more of those calories as fat. So, I mean, that’s another way to kind of think about, and using a continuous glucose monitor, using Levels can help you like sort of experiment with that. But if I were you, and I’m not recommending this to, you know, any listener that’s like medical bite, but more just thinking through the science of insulin and like what fat burn and cutting really is, and it’s keeping insulin low and you do that by not elevating your blood glucose and doing things like really short feeding windows during the day, eating earlier in the day, intermittent fasting, things like that are going to let you potentially eat the same amount of calories and not have the same amount of fat storage. So.

Host: [36:05]                                         Hm. That’s interesting. I think with, I’m thinking of like my own experience with Levels and then I’m like, yeah, let’s go into the Levels topic.

Host 2: [36:15]                   Oh yeah. I was just going to ask that. I was just going to ask her to talk about Levels a little bit. Yeah.

Host: [36:21]                       So here’s one thing, I have, you know, so I’m trans. I’ve documented my whole transition on YouTube and legit, the thing that I got the most shit for was Levels and like tracking my glucose levels. Like you can do whatever you want with transition, but when you start talking about blood glucose and nutrition and food, that’s when people are like getting all pissed off and telling me that I’m dumb. So.

Host 2: [36:57]                   Yeah. You got a lot of hate for that.

Host: [37:00]                       I did. It was weird. I was not expecting that. It was very strange.

Casey Means: [37:06]    I’d love your, what kind of feedback you got? That’s so, or we can talk about what, I mean, you might, if you want to describe, from your words, like what Levels is like, I’d love, you know, be, I’m happy to describe it or either way.

Host 2: 00:37:20]             Cody, you can talk about it since you did it.

Host: [37:24]                       Yeah. So yeah, I did Levels. For anyone listening that doesn’t know, I was monitoring my glucose for a month with your, the Levels program, which you are, you know, the creator of, as people probably heard. But when I first started and like start documenting it on YouTube, some of the criticism was just, I think they were just wrong assumptions or they didn’t watch the whole video, or just thought it was pseudoscience, to kind of just, you know, woo-woo kind of thing, which I get it because it’s new, you know, or just like new-ish to people in general, besides people who already have diabetes and are monitoring their blood sugar and all that. But I think the biggest criticism was that someone said like, I didn’t know what I was talking about, that, you know, your glucose depends on, it could be different depending on the foods you eat and stuff like that, which is an assumption that they made by just not listening, because I told like the difference, like the app, you know, it takes an account of different foods, you log absolutely everything, the timing, your exercise, just everything is included in the assessment of it. So I think it just was mostly people just thinking it was a pseudo-sciencey. So on that note, I think, I would love for you to explain it in the way of a better way than I probably could ever.

Casey Means: [38:56]    No. I think that.

Host 2: [38:57]                   I, sorry.

Casey Means: [38:58]    Go ahead.

Host 2: [38:58]                   Oh, no. I was just going to say, I think a lot has to do with, why people were hating on you for, it was because they didn’t want to recognize like what they were eating and how that might affect their blood sugar, because they see how good you eat and your blood sugar is spiking from your waffles and those just have bananas and, you know, whatever else you have in it, but they’re over here having pancakes or like, you know, bacon and things like that, that might not be as healthy. And they’re probably just like kind of scared and they don’t want to admit that. So they take it out on someone else.

Host: [39:30]                       Yeah. Yeah. That could be something too. They just aren’t ready to look at their own food, I suppose.

Casey Means: [39:39]    That’s a super interesting observation. Yeah. Well, so I’ll give this sort of big picture. So I think, you know, for people who don’t know, basically like Levels is essentially a program that gives you, it’s like a Fitbit for glucose, I would say, like in the simplest form. So you put this wearable sensor on your arm, it stays there, it sticks under your arm for two weeks, and there’s a little teeny probe there that’s measuring glucose 24 hours a day and takes a reading every 15 minutes, sends it to your phone. And then our software transforms that data into highly actionable insights to let you basically, lead you towards this personalized diet and lifestyle plan that maximizes stability of glucose levels. And we care about stability of glucose levels for all the reasons that we talked about before. If glucose levels are highly variable throughout the day and constantly bouncing up and down, we know that that, which is called glycemic variability, is associated with, you know, worse energy, more fatigue, it’s to do with, you know, acne and anxiety and all these things that we don’t want, all these pain points. It also sets you up down the road for these chronic diseases that are associated with metabolic dysfunction. And what’s interesting about the glucose data stream is that, also like we’ve talked about, a lot of different things affect glucose. It’s not just food. It’s food combinations like, what you’re pairing together. It’s food timing. It’s exercise, it’s sleep, it’s stress, it’s microbiome. So it’s this very multi-variate input that impacts basically, how you transform food into glucose in your body and what your glucose levels are in your bloodstream. And we want those to be low and stable, because that’s associated with just a better experience of life now, but also better, in terms of your risk profile for future disease. And I think, you know, it’s possible that part of that pushback that you got was because, twofold, One, there’s this concept of like low-glycemic diets or keto diets, and this idea that if you just sort of like eat things that are low carb, like you’re going to be fine so like, why do you have to measure it? Just like eat things that are low carb, like, but the reality, and this has been, really being figured out more over the past couple of years in the research is that, everyone responds to food differently. Like we’re these biochemically unique organisms. And I could eat an apple and you could eat apple and Dee could eat an apple and all three of us could have like vastly different glucose responses because of how we slept, how we exercised today, what our microbiome composition is, what our body type is, what our insulin sensitivity is, you know, and certainly if one of us paired it with fat, one of us paired it with protein and one of us paired it with extra sugar, we’d have even more different responses. So the reality is that people respond differently to food. That’s a new concept, really kind of something we’ve been learning about since like 2015. There’s a landmark paper out of a lab in Israel called Personalized Nutrition By Protection of Glycemic Responses, where they slapped continuous glucose monitors on healthy people and saw that essentially, with the same amount of carbohydrates, same food people had totally variable responses. So really, if you’re trying to keep glucose stable, trying to keep insulin low, you’re kind of just guessing if you’re not measuring it. And so that’s where data can be really, really, really helpful. So that’s one thing, people might not be aware of that concept, that there is so much variability between people and that these blanket diets, these universal diet ideas, like don’t really make that much sense. So that’s one thing.

Host: [43:23]                       Yeah. I was thinking about one other criticism, was that people were saying it was like obsessive or it was just, you know, a little bit too much. And I’m just thinking, I just liked data. I like learning about my body. So it’s just pure curiosity to me and just, I like learning. So that’s why I wanted to do it. It wasn’t to obsess over it. It was just kind of like, why wouldn’t you want to learn more about your body? I don’t know. So I think the word obsessive tends to pop up pretty quickly for people.

Casey Means: [43:59]    Yeah. And I think it’s important to think about like, there’s this concept of like orthorexia, that’s definitely a problem these days, where people are becoming like so fixated on wellness and so fixated on diet that it becomes very dominating of the psyche. And I would argue just like a slightly different perspective. Like obviously, any tool, can be used for good or it can be used for not good. It depends a lot on the person, but the actual experience that both I’ve had, and I’d be curious to hear your experience, and a lot of our users have had is that actually using a really data informed tool actually really liberates you in the sense, that there’s less of a subjective mystery component to food, and there’s less of a confusion about food and so it’s actually a very efficient way to create conclusions. And that actually, in the long run, I think makes people a lot less obsessive about food. So what I, we’re kind of, a term that I’m sort of toying with, is this idea of that it helps you build like metabolic intuition over time. So, yes, at first you’re kind of trying all these different foods and you’re very quickly learning like what works for your body and what doesn’t, you’re also building this arsenal, this toolbox of tools that you have to basically modulate a glycemic response. So for me, sweet potatoes spiked me into like, diabetic levels. Like I’m like way up at 180. I’m just like, it’s not good for me. Yeah. But if I eat less and if I put a bunch of almond butter and make sort of like a Thai sauce, a lot of fat, if I put chia seeds, which have protein and fiber on it, and if I eat it early in the day, all of those things are going to make it have much less of a glucose response for me. So, I’m like using the tool and looking at all this data and experimenting with different things. And very quickly I’ve created a toolbox. And now, I mean, I’ve been wearing a CGM, a continuous glucose monitor, for like over eight months now. And at this point, I’m pretty much, I know how to keep it stable. I’ve got this whole milieu of like tools. I know that I need to be sleeping well. I know that I need to be exercising every day. I know how to use, you know, vinegar, fat, protein, you know, all these things that are known to, cinnamon, you know, to affect glycemic response for my advantage. And then all of a sudden, you’re kind of not thinking about it anymore. You just know what works for your body. And research has shown that like 80% of people are totally confused about nutrition. We also know that most research about dieting doesn’t work. People lose a small amount of weight and almost in all studies, they gain it back after two years. So that just like long-term confusion and lack of success, I would say that leads to more obsession than just like figuring out answers and moving on with your life. So that’s, I mean, I’m biased a little bit. But like, I believe it. And I’ve seen it in our customers. I’ve seen it in my patients. I’ve seen it in myself. So.

Host 2: [46:58]                   What made you come  up with the idea of Levels?

Casey Means: [47:02]    Hm.  Well, it was not, so the actual founder-founder is Josh Clemente, so he’s one of my co-founders. And he has just like a really incredible story. He’s an aerospace engineer. He worked at SpaceX. He has built and engineered parts that went up in the most recent space mission last month. And he was, I’ll just like share his story really briefly and then I will share and share my story, but his is really, really, really interesting, but basically like he was a super fit guy his whole life, never struggled with weight. He was a CrossFit instructor, like cut this jacked guy, you know? And he had learned about glucose because you know, the astronauts that we send to space, like we have to keep them optimally healthy, right? Because like, they’re, you know, in space they don’t have access, they just have to be like very optimized and something we care a lot about is metabolic function, keeping glucose really stable. And he kind of got curious into glucose and was like, well, I wonder what’s going on with mine. Like, and so he started pricking his finger and basically realized that a lot of the day, he was spending it like, well above the healthy range. And he was shocked because he looked aesthetically just like a very fit, fit person. He eventually tried to get a continuous glucose monitor so they could track this in more fidelity. He got nervous and wanted to like, get this back on track because you know, you can very quickly improve your metabolic health through simple stuff, you know, and try to get a CGM. No one would prescribe him one because this is technology that’s traditionally used just for people with Type 1 or Type 2 diabetes, and eventually was able to get a prescription for one and basically found that he was just all over the place, very metabolically dysfunctional. And this led to just a very passionate journey towards understanding metabolic health, understanding the drivers and understanding that this is a problem that’s facing. This is not fringe. This is epidemic proportions, right? This is affecting the COVID crisis. There is 74% of people are overweight or obese. There’s 128 million Americans with pre-diabetes or diabetes. And of those with pre-diabetes, 90% do not know that they have pre-diabetes. So, this is like huge, huge, huge numbers. And so, you know, he became fixated on basically solving this problem. He also had a really interesting experience with his subjective sort of symptoms. So he was noticing in his late twenties, even though he was like, so fit, he was so fatigued. I mean, you know, it was like, Oh, maybe it’s like my job is stressful and like I’m working hard and like, but when he put the CGM on, he realized, Oh my God, this fatigue is because I’m spiking and crashing all day long. So he basically just was able to get it to more of a flat line and the fatigue just really lifted for him. So that was really powerful. So my story is like totally different. I was a surgeon. And I was an ear nose and throat surgeon, head and neck surgery. So I was doing like sinus surgery, ear surgery, vocal cord polyps, you know, thyroid surgery. And what I realized in my, like I was practicing for about five years in that field, is that almost every condition I was treating wasn’t it was inflammatory in nature. Like these are all diseases of inflammation. So sinusitis is inflammation of the sinuses. You know, chronic otitis media is inflammation of the tube that connects the ear to the nose, and you get pus build up in the ear. Thyroiditis is inflammation of the thyroid, vocal cord granulomas are inflammatory masses of the vocal cords. And I was like, Oh my God, why is everyone so inflamed? And why are we treating inflammatory disorders with surgery? Or just handing people steroids, which are just these heavy hitting anti-inflammatory medications. When we know that refined sugar, you know, environmental toxins, lack of sleep, lots of stress, lack of physical activity, all those things drive inflammation. So like, why is there no overlap in this Venn diagram between what we know about triggers of inflammation and how we’re treating ear, nose and throat inflammatory disorders? And that basically led to a long journey to really understand the root causes of these conditions and led me to a real obsession with metabolic health. And I thought, you know, I was trained for over a decade to become a doctor. And like, I, like, where do I want to devote my energy for the rest of my life? Like what is going to help the most people and how can I leverage that? And it was this. It was very clear to me. So I left surgery and I, oh, I started my functional medicine private practice, focused a lot on metabolic health. And then I realized, this is great that I’m helping, you know, 20 patients a week. But like, this is stuff that needs to be heard by more people. And how do we have that like sort of coach who can help people? Like I need to be on people’s shoulders every day, all day to help them make decisions. But I can’t do that. So how do I do that? And so digital health was a really clear solution. And so, yeah, teamed up with Josh and our other co-founders, there’s five of us with very diverse backgrounds and we just basically said, we were going to solve the metabolic health crisis and we’re going to do it through empowering people with their own data. And I’m not going to wait for the food industry or the healthcare industry to do this. So, that’s how we got here.

Host: [52:34]                       That’s awesome.

Host 2: [52:35]                   That’s cool.

Host: [52:36]                       I love it. I was just thinking back to some of my experiences with using, you know, a CGM and with, you know, what spiked me and just everything, well a few, one of the things with the, I feel like some people will have more success kind of changing their diet after using that versus, you know, the typical diet and then you gain it back, the thing is, it really forces you to connect to your body, whereas diets mostly, you know, it’s, you can still ignore what your body is actually doing on the inside, where this one just gives you that connection, that insight like, Oh, I eat this and then I physically see how, like what it is doing to my body with this, you know, the data that I am getting. So I feel like that’s probably also a good little connector to be like, Oh, this might be another factor into why this could be successful, instead of just being like, Here’s your calories. And don’t go over that. And good luck. But something I also noticed, sorry.

Casey Means: [53:45]    Yeah. I was just going to say I think you’re so right on with that. And I think the way like, we kind of frame that is like, nutrition has always been this open loop feedback system. Like you eat something or you read a bunch of things during a day, and then you have no real feedback on what’s happening to you. You might have some nebulous symptoms, you might not feel great, but the one-to-one relationship between action and outcome is, it’s almost impossible with nutrition. And I think this is kind of the first tool that might allow people to close the loop between action and reaction. And that closed loop is like so important for, you know, buying in to these behavior changes. If you can really identify something and say like, this is the causative factor of this, it’s a lot easier to make a decision, versus if you’re like maybe it had something to do with it, I, you know, you weigh yourself one day and you’re like, Well, I’m two pounds heavier today like, maybe I should think about not eating. Like how do you even look at your last day and approach what to change? It’s very, very hard. So yeah, I think that closed loop thing is important. And I also love what you said about getting in touch with your body, because yeah, I think, especially with our digital world and how busy and how fast moving we are, like we’ve sort of lost what I would call like somatic awareness, like a sense of like what’s going on inside our bodies, like hearing our bodies. And there’s something about seeing, yeah, like seeing the data that I think has people clue into, Oh, I felt this way and I ate this thing. So, you know yeah. So I think that you really like keyed into some of the things that hopefully are going to be really helpful for people to make sustainable changes.

Host: [55:35]                                         Yeah. For sure. It kind of forces you to not be able to ignore things a bit more. Something that I noticed was, two, I could, you know, the amount of, how stress affects, you know, your glucose levels as well. And it’s funny that you say that, you know, you could eat the same meal for like breakfast and dinner but you will have a bigger spike in the evening. I was the opposite, where I could eat the same thing for breakfast and dinner, but I would have less of a spike in the evening, but I think that’s because I was less stressed. Because in the morning I’m thinking like all the things I got to do, I just, you know, I’m drinking my coffee and I’m just, you know, just, you know, ready to jump out my own skin so I can get things done. And by the evening I’m already winding down. I don’t have caffeine in my system and, you know, getting ready for bed. So my blood sugar levels wouldn’t have, they would be more steady. So if I have my waffles in the morning versus the evening, which I’ve done because I’m lazy okay. It happens. It was at different hotspots and it was very fascinating.

Casey Means: [56:51]    This is so interesting. I love hearing your experience with that and like cluing into the stress thing. And, yeah. No. I mean, most of the research like does show the opposite, but it’s such an important point. Like everyone’s body is different, you know? So that’s so fascinating. Did you have any other like big takeaways that you experienced? Or like particular foods that were really, I don’t know, tough on you?

Host: [57:24]                       I think my biggest surprise was that sweet potato was so, had such an effect. Like it was probably up there with white rice, with the effect on my blood sugar. So that was the most surprising because I’m like, This has more fiber, it should be a little bit slower, but it didn’t really matter still. I think, of course anytime if I mixed in some fats, it wouldn’t be, you know, as bad, but generally, so like a post-workout meal for me, is when I have sweet potatoes. And I don’t have much fat in it besides maybe what is ever in the protein that I’m eating at the time. So there wasn’t really a lot of breaks to slow it down. So it really, that would make things spike. I could eat them also in the evening and not get as much of a spike oddly. So I don’t know.

Casey Means: [58:25]    So fascinating.

Host: [58:28]                       Yeah. So, I don’t think there was anything. It was, I might not be like the best example. So I’ve also run a few clients through Levels as a coach. They created like a dashboard for me to be able to see clients’ blood sugars and stuff like that. That was probably the hardest part for me, because I’ve seen clients levels after eating like ice cream and cookies and their blood sugars are just like nothing. Like it was fine. And I was just like, God dammit, like, how am I supposed to tell you that you shouldn’t be eating that if you’re fine and I over here eating sweet potatoes and I’m just all over the place.

Casey Means: [59:15]    Yeah. Yeah. We, it’s funny. Ice cream has been a really interesting one and in our early customers, because it is obviously a high sugar food, but it also has so much fat and protein that it often really, it’s like, in a very strange sense, it’s a balanced meal, but, you know, and so.

Host: [59:35]                       That’s not saying you should do it. Please don’t.

Casey Means: [59:38]    Yeah. No one is saying you should go eat ice cream. But, and I think we really emphasize that with our company as well, that like, this is an extremely important biomarker to measure, but like glucose is not the only thing with health that you should be caring about obviously, like for instance, like you could drink straight vodka all day and your glucose probably won’t go up, but like, you shouldn’t be doing that, you know. Like, so it is very actionable, important metric, but, you know, it’s a data point. And so I think that that’s part of the nuance of nutrition, but if you can get the majority of this dialed in with like, you know, a metabolic awareness month long program, and like really learn things that are like particular extremes for you, and then also build your toolbox of how to manage it, like knowing what workouts are best for glucose, how to manage stress better to manage glucose like, those takeaways are valuable for everyone, but yeah, certainly with some of those foods like, you know, drinking, you can drink a cup of oil and not have a glucose rise, that would not mean you should do it. So we really try and build that into, you know, essentially, the future versions of the product, of just making sure that that comes through as well. So, yeah.

Host: [01:00:56]                Yeah.  That’s a good point. It’s like, just because your glucose doesn’t go crazy with this, doesn’t mean that you should just continually eat it.

Casey Means: [01:01:05]              Wait, that’s what we can say about it is, it has a low-glycemic impact, but whether it has, what health impact it has, is a little bit slightly different question. So.

Host: [01:01:14]                Yeah. Yeah, exactly. It’s kind of like all those, the same nuance that we skipped with calories, just talking about calories in calories out, it could be the same thing with glucose, I guess. So it’s a, you always have to have the whole picture, not just pick little pieces of it, for whatever you want. On that note, when it comes to individual glucose and spikes and foods, gut health, I think you kind of touched on this a little bit, but how big of a role does that play in how someone might respond to something? You know, how you talked about, if we all ate an apple, it could be different. Is that also related to like a different gut microbiome? Or is there, what other factors could be involved in that?

Casey Means: [01:02:08]              Yeah. So the microbiome plays a huge role in metabolic health and glycemic responses. And yeah, this same paper that really showed differential responses in non-diabetic individuals, to the same carb source, this personalized nutrition by prediction of glycemic responses, they took stool from everyone and mapped out their whole microbiome and they actually found that, if you are going to predict how an individual respond to a certain food, when you include microbiome data, you can be much more accurate in generating that prediction. So it’s very, very important. And there is a lot of different, like detailed mechanisms of why this might be the case. The microbiome have an impact on hormonal secretion. There’s a set of hormone called incretins that have to do with metabolic health and the microbiome plan to those, the microbiome also, when they process fiber, they create what are called short-chain fatty acids, things like butyrate. And so they basically, the bacteria eat the fiber. They, you know, secrete short-chain fatty acids. We absorb those short-chain fatty acids and those have an impact on our metabolism and our glucose regulation. And there’s actually like a couple other mechanisms as well, one has to do with the microbiome impact on bile, metabolism, bile is the stuff that’s released from the gallbladder to basically break down fats. And so they are like just on a mechanistic level, the microbiome are super involved in how we just break down food and put it into the bloodstream, like it’s preprocessing. So you can imagine if these are what are pre-processing and digesting our fats and our carbs, our fiber, then if yours are different, if you have a totally different population, you might absorb a totally different amount of glucose at different speed. So it’s really fascinating and there’s specific strains of bacteria that are more associated with good or bad metabolic health. The two that you’ll hear about a lot, are the Bacteroidetes and the Firmicutes population. And basically, if you have a higher, there’s been studies in obesity and diabetes showing that an increased ratio of Firmicutes to Bacteroidetes, basically, is more at risk for some of the metabolic problems. So, yeah. So that’s kind of like an overview. There are specific bacteria involved. There’s a lot of really deep mechanisms about how they’re helping process our food. And we want really healthy microbiomes. So yeah, can’t, you know, pound that one hard enough.

Host: [01:05:04]                Is that something that you test for as, like in functional medicine, is that something that you tend to look at or try to improve, if someone might be low in something? And how do you do that?

Casey Means: [01:05:21]              Yeah. So I do, in my own practice, I do stool testing. That’s doo-doo, stool testing. Yeah. I have found it to be somewhat valuable. At the end of the day, a lot of the recommendations I’m going to make for people are going to be pretty much the same, which is, you know, you want to support your microbiome in every possible way. So one is, obviously, eating whole foods, fiber, giving them all this healthy food. Most people eat about 10 grams of fiber a day. So I’m getting people on 50 to 75 grams a day, you know, really helps with the flourishing of the diversity of the microbiome. It’s also about like what you take out and like the things that hurt the microbiome. So, you know, taking out pesticides, which can basically kill the microbiome, taking it out persistent organic pollutants pops sort of the diet and just eating clean, clean water, clean food, making sure that you’re not putting stuff in there that’s going to hurt it, making sure that we’re not overusing antibiotics, which can totally wipe out the microbiome. And it can take months, if not years to repopulate. Antibiotics are super important, but we overuse them. You know, we use them excessively for things like acne, I think. And when there’s other levers that we could be turning to basically, to help with some of these things. And so certainly important, but we overuse them. So I think a lot about antibiotic stewardship, about clean eating, about adding fiber and then definitely about reducing stress and really having some good stress management tools because the microbiome, they hear all your thoughts through your nervous system and through your hormones. Like they are very affected by that. And there’s crosstalk between the nervous system and the microbiome. A lot of our nervous system actually lives in our gut, What’s called our enteric nervous system and the microbiome actually make a majority of the neurotransmitters that then control our thoughts and control our actions and so that crosstalk is huge. So every minute people invest in evidence-based mindfulness strategies, getting their nervous system balance through, you know, while you’re in meditation, deep breathing, whatever works for a person.

Host: [01:07:36]                What would be your biggest kind of encouragement to say that it was worth trying out? What’s your pitch basically?

Host 2: [01:07:46]           Yeah. Elevator pitch.

Casey Means: [01:07:48]              Elevator pitch. Yeah.

Host: [01:07:49]                Yeah. Let’s hear it.

Casey Means: [01:07:52]              Well, I think we’ve definitely explored why it’s important to care about glucose. So I think that’s, you know, that goes without saying, if people have listened to the whole podcast. But I think, on a bigger picture, like this is a tool that helps people really get back in touch with their unique bodies and their biochemical individuality, and actually like puts the agency and the control and the power like back in your hands. So, I think that’s a really beautiful thing to feel, like you actually are guiding the ship when it comes to nutrition and you’re making choices that you know are good for you. I think that that’s like a huge relief, after years or decades of being confused or not feeling good. And also, to be able to have the power to potentially make really rapid changes in your just subjective experience of everyday life through these really simple levers and having that information sort of handed to you on a silver platter, it’s very empowering. And I am all about, you know, as a physician, I lived in a world where it was very top down, telling people kind of what to do. And we know that when doctors do that, people often, they don’t do it. They don’t actually do what the doctor says, you know, even with a prescription, only about 30% of patients fulfill a prescription that a doctor gives them. So that’s not the answer. The answer is for it to come from yourself and come motivated from within you. And so that involves, you know, giving people information about themselves to make the best choices for them. And I think when we reclaim that sense of understanding about our bodies and our sense of agency, it’s really, really empowering and that can actually have positive effects throughout your entire life. So that’s something that I think is really positive about having your own personal data. And the beautiful outcome of it is that, you know, it may actually help you feel really a lot better day to day. And, you know, hopefully reduce suffering down the road. So.

Host: [01:09:46]                Yeah. Awesome. Sounds really good to try it out, to me, but I’m kind of biased cause I already did it.

Casey Means: [01:09:57]              And thank you so much for.

Host: [01:09:58]                Still trying to get Dee to try it.

Host 2: [01:10:00]           I will, I think after the show, because I want to try like things that I probably shouldn’t have, like a donut or things like that. And I can’t have that right now. So, I want to like map, like things that I would normally eat on a day-to-day, not show prep, so that’s why I haven’t done it yet.

Casey Means: [01:10:17]              Ooh. Got it. Okay. Yeah. I think the first week is really fun to try all the things that you like, especially treats and stuff, and just basically build a landscape of like everything and then, you know, and then maybe optimize in the subsequent weeks of the program, but like try it all the first week. Yeah. Yeah. So. But yeah, excited to get you in.

Host: [01:10:43]                That’s awesome. Well, thank you so much for coming on here and, you know, just having a plethora of information, and I feel like it was probably, it’s just super valuable to people listening and yeah, I just, I appreciate it a lot. I appreciate your time. I know you didn’t have to do this for sure.

Casey Means: [01:11:04]              I appreciate you guys and the message that you’re putting out there. And you guys are empowering people with your platform and it’s really, really awesome. So, thank you so much for having me on.

Host: [01:11:13]                Thank you, everyone, for listening to the podcast. You can find us at MindHub podcast on Instagram, and please leave a review on Apple podcast because that is how we get our podcasts out to all of you guys. So thank you so much, and we will see you guys next week.

[END] All About Metabolic Health with Dr. Casey Means on MindHub

Host: [00:10]                       Welcome to MindHub podcast, episode 11. And today we have a special guest who is here to talk about all things metabolic health, glucose levels, and all of the fun things that generally confuses the population, but it’s also very important. So on that note, Casey, thank you for coming on. Would you mind introducing yourself? Giving your name, giving a little background of how you got here?

Casey Means: [00:41]    Yes, absolutely. So, thank you guys so much for having me on. I am Casey Means. I’m a medical doctor. I’m the co-founder and chief medical officer of Levels. And I am a functional medicine physician and metabolic health evangelist.

Host: [01:01]                       I love that.

Host 2: [01:02]                   You wear a lot of different hats.

Host: [01:04]                       Yeah.

Casey Means: [01:05]    I do. All of them pointing towards metabolic health, but yes.

Host: [01:11]                       Which is so important. And I think one thing that probably would be good to differentiate here would be, the difference between like a functional medical like, I know you’re a medical doctor, but then also you have a different focus than, you know, the norm. Like if you go to your primary care physician, it’s different than, you know, usual. So what is the difference? How does that work in comparison?

Casey Means: [01:42]    Yeah, that’s a great question. It’s sort of a new term that a lot of people aren’t familiar with, so happy to define it. And I actually started out as a surgeon. So, I was in just like uber, you know, conventional healthcare and have transitioned into functional medicine, which has been a really wonderful journey. And what functional medicine is, is it’s really a philosophical approach to health care that addresses the root causes of diseases and symptoms and aims to reverse the conditions that lead to disease and symptoms. So the premise is kind of that symptoms don’t arise out of thin air. They arise out of cellular dysfunction. So instead of just identifying and naming a symptom and then kind of slapping a drug or a surgery on it to sort of fix it, functional medicine takes this sort of really deep root cause approach and thinks about, you know, what is actually going wrong in the body, and then works to try and correct that. And often, what’s kind of going wrong is that the body’s just dealing with a mountain of external stressors like, you know, diet, toxins, chronic stress, sleep deprivation, lack of exercise, lack of physical activity, and all of that can really translate into sort of biochemical reality through our nervous system, through our hormones, through, you know, all these sort of root cause pathways that take all these stressors and kind of lead to problems with health and causes dysfunction. So really, it’s just an approach to yeah, treating disease on a very molecular level, not looking at diseases as sort of isolated silos that you kind of have to play whack-a-mole with individually, and really seeing the connections between symptoms and diseases. And in that sense, it’s a really efficient practice. Because sometimes, when you can find the things that link diseases, a single intervention can have a lot of wide-ranging effects. So one of those sort of root causes of a lot of different symptoms would be something like glucose dysfunction or a metabolic dysfunction. So if you can, you can have a wide ranging, you know, positive effects on the body. So that’s sort of the broad overview of functional medicine.

Host: [03:56]                       That’s awesome. I love that. I don’t know why, but that just makes me feel like all warm and fuzzy inside. I’m such a nerd, but I think it’s just, you know, it’s just that something that is so important, it’s popping up more now, where people are seeking out functional medicine more so, but it’s just so different in comparison to going to a doctor and then, you know, they might just be prescribed something and it’s more of a band aid, but in your sense, you just look at everything and the body and the system, it’s all connected, that sort of stuff. I’ll stop nerding out but, on that note, when it comes to metabolism, I guess, that’s also a pretty big unknown or, but word, because everyone wants a fast metabolism. Like that’s what they just think. They’re like, I don’t know metabolism, but I know that I want it to be faster. So what is actually metabolism?

Casey Means: [05:03]    Oh man. The big question. What is metabolism? So, yeah, it’s so important. Because it is a term that we throw around all the time and it’s sort of a question of like, Well, what really, what does this mean? So I would say, big picture, metabolism is the set of cellular mechanisms that generate energy from our food and our environment. And we need that energy to power every single cell in the entire body. All cells in the body require energy, cellular energy, which is generally thought of as ATP, to function. And so having an efficient metabolism is sort of foundational for all assets of health because it’s how all cells run. So then when you think about like, how do we, you know, how does this work with food? So when we eat and when we digest foods, like we digest them into fats, carbohydrates, proteins, and micronutrients, and these are all released into the bloodstream to kind of control all aspects of our biologic function, and fat and carbohydrates are both big contributors to how we generate energy in the body. And when carbohydrates are broke down, they form glucose and glucose is this molecule that our cells take into there. And one of these little parts of the cell, the mitochondria, can convert it to this usable form of energy- ATP. And so, when this process, you know from mouth to energy, is a long process, right? I mean, it actually takes place very quickly, but there’s a lot of components involved. It’s, you know, how fast your GI motility is, how your microbiome is processing that food, how your gut line is working, how those different nutrients are traveling to the bloodstream, how the hormones in the body are being released to let things like glucose be taken up into the cells, how your mitochondria are functioning, and then how you’re actually using and storing extra energy substrates like glucose, like what you’re doing with the excess of that, all of that is involved. And so, you want that to all be working in a really efficient, synchronous harmony. And that’s kind of what it really means to be having a good metabolism, is that at every step of the process, things are like moving properly and you’re essentially, you know, utilizing, transporting, storing, and excreting energy in a really balanced way.

Host: [07:16]                       That’s awesome.

Host 2: [07:18]                   How does someone fix their metabolism if they think it’s not like working properly?

Casey Means: [07:29]    Well, that’s a complex question because there’s so many aspects to it. And my perspective is that the lowest hanging fruit is to basically control how much of these energy substrates you’re putting into the body. So that would be in primarily, since glucose is the primary sort of building block of energy, I think that’s the one that’s easily easiest to leverage. So the analogy I like to use as kind of like, think of the body as a factory. Let’s say your body is this like a factory that’s making some product. If you get shipped all these raw materials and then those go into the factory and then you have to turn them into something else and that’s kind of what’s happening with the body. You know, you put in glucose, it has to be converted to ATP. So, if all of a sudden your factory, you ship 50 times more raw materials and you have the same amount of staff and the same side as the building and the same conveyor belts like, it’s just not going to work. The factory is going to be overloaded. The workers are going to quit. Like, it’s just, you can’t handle that much coming in. It’s just too much. And you also can’t even fit in the building, so you have to store it elsewhere. So now you have all these problems. That’s exactly what’s happening with what we’re doing to our bodies with glucose. We are consuming, you know, well over 10 times more glucose than we did a hundred years ago, we used to eat about two pounds of sugar per year. Glucose is sugar, you know, and now we’re eating about 150 pounds on average of sugar per year. So that, to me, is like the lowest hanging fruit. Metabolism is very complex, but that part of things is so, so simple. Like overloading the body and having this sort of carbohydrate toxicity, there’s almost no nuanced interventions you can do unless you get on top of how much glucose your body’s like having to deal with, because you’re either going to store it as fat or you’re going to store it, you know, and cause all these problems with either obesity or other problems associated with storing fat inside organs like, which is associated with chronic disease, or you’re going to basically be consuming so much sugar that you’re constantly releasing insulin, the hormone required to take it up into cells and then your cells get numb to insulin. And now you have your, you can’t take it up as efficiently. So now you’ve got high insulin, you’ve got your blood glucose levels rising and, you know, lots of problems. So, to me, that’s the lowest hanging fruit for, you know, quote unquote improving metabolism.

Host: [10:04]                       Yeah. And I feel like that’s the thing a lot of people don’t realize, that their sugar is in everything, like absolutely everything, like soda, like all, I shouldn’t say all processed foods, like have some form of sugar and that’s something that you can really control, or that is in your control.

Casey Means: [10:22]    Absolutely.

Host: [10:22]                       Yeah. And I think one of the things. Sorry.

Casey Means: [10:27]    Oh, no, it just, it’s shocking. Like what you said, like the types of foods now that contain sugar, you know, like ketchup, and that just like don’t even need it. It’s just, it’s very strange.

Host : [10:40]                      We’ve just come to like want and need it more and more. It’s just, we’ve become so accustomed to it. That’s, basically, we just need more and more to be satisfied. But I think one of the most frustrating things, for me, when it comes to the fitness industry is that yes, calories in, calories out, sugar in and of itself is not, you know, making you fat, but that’s just not the whole picture. There’s so much like, nuance in between of what sugar can do. Like maybe, you know, it’s not going to make you fat as long as you don’t overeat it, but there are other consequences that may not be visually, like you can’t see it from the outside, but there’s a whole lot that’s going on on the inside that we might not be aware of, but they just kind of sweep over that. And they’re just like, sugar is not the devil. And it’s like, Yeah, yes. But also, it’s not the best.

Casey Means: [11:46]    Yeah.

Host: [11:47]                       Let’s see. One other thing, it would be, what would be like kind of some signs or symptoms to maybe not being so metabolically healthy? Like even if you’re a pretty fit individual and you feel like you do pretty well with eating, and you’re just kind of like, Eh, I’m good. I eat pretty healthy. I exercise. But that doesn’t automatically mean that you might be metabolically healthy. What could be some signs to look for that you still have some work to do?

Casey Means: [12:24]    That’s such a great question. You know, because I think that most people associate metabolic dysfunction with like the most overt signs of metabolic disease, so like diabetes, severe obesity, and what’s, you know, I think that’s sort of a common misconception that like, you need to have some pretty extreme, you know, level of dysfunction or clinically diagnosable disease to have signs of metabolic dysfunction. And the truth is that it can be overt like that, but it can also be very subtle. And the key point is that, since every cell type in the body needs energy, if energy pathways aren’t moving properly, you can essentially have a symptom, any type of symptom, arise from metabolic dysfunction, depending on sort of what organ system or cell type we’re dealing with here. So to kind of like, I guess, categorize them into like overt or subtle, overtly, metabolic disease looks like obesity, which is, you know, dysfunctional fat storage, insulin resistance and Type II Diabetes, which is, you know, insulin resistance. It also can be non-alcoholic fatty liver disease, which is like rising in frequency, and that’s basically when the liver has to store like all this extra sugar as fat and the liver becomes fatty. We’re starting to see this in kids now. You know, cancer is considered to be, in part, a metabolic disease. Cancer cells are highly metabolically active. They need tons of sugar to function. And the inflammation associated with metabolic disease can, you know, drive cancer and make cancer outcomes worse. Alzheimer’s disease is now being called Type III Diabetes because it’s associated with insulin resistance in the brain. And then heart attack and stroke are much, much higher. There are much higher rates of heart attack and stroke in people with metabolic dysfunction. So those are like the heavy hitter, like really, you know, the stuff that people kind of think about as big, bad diseases. But for the average person, who may be not all the way there yet but is kind of on the spectrum of metabolic dysfunction, you know, they have more variability in their glucose everyday than they should. Their fasting glucose is sort of starting to go up a little bit. Maybe they’re having early, early spectrum insulin resistance. What you can kind of see is these more subtle findings, like a lot of fatigue, like afternoon low energy, or feeling like you’re crashing after meals. That’s often a sign of a big glucose spike and then a big glucose drop. And you can avoid that, you know, by keeping your glucose stable. Also anxiety. So a big glucose spike and drop can lead to some mood symptoms- a little bit of brain fog and lack of mental clarity and just not feeling quite on your game. That’s actually been studied. And non-diabetic individuals who have poor glycemic control, report like less acute memory retention, so not like dementia, but just acutely not remembering stuff as well, especially with verbal memory. And then like brain fog and lack of mental clarity. And then when this shows up in the reproductive system, this can show up as infertility. So polycystic ovarian syndrome, that’s the most common cause of infertility in the United States, and that is very much on the metabolic spectrum. There’s a thought that high insulin levels stimulate the ovaries to make more testosterone and that actually leads to menstrual dysfunction and infertility, similar with erectile dysfunction, it’s on the spectrum of metabolic disease. High blood sugar can cause little blood vessels to become kind of narrowed and less functional, cause what’s called endothelial dysfunction. And because erections are basically, you know, blood flow to the penis, when you have metabolic dysfunction, it can cause problems with that. So, you know, that’s just like, you know, so anxiety, fatigue, post-meal slumps, you know, infertility or menstrual dysfunction, sexual dysfunction, acne, all of these things are kind of like the different faces of not being metabolically healthy. So it’s kind of amazing how wide the spectrum can be. And that’s just some of it.

Host: [16:30]                       Wow. That’s really so much.

Host 2: [16:32]                   Yeah. I wouldn’t think half of those things were like related as much as they are.

Casey Means: [16:42]    Yeah.

Host: [16:45]                       Do you mind touching a second or like a bit more on the cancer aspect of things and how that can be partially due to metabolic health and stuff?

Casey Means: [17:00]    Yeah, absolutely. So cancer cells really thrive on sugar. They need more, they’re more metabolically active and they’re constantly, like cancer cells have basically uncontrolled replication, so they form, you know, tumors. And so high blood sugar is basically going to like feed cancer cells. Then separately, cancer, sorry, high blood glucose stimulates inflammation. So high blood glucose tells the body that something’s wrong. Something’s not normal. And that can cause sort of this sense of threat in the body that something bad is happening, if blood glucose is high. And so you get this like activation of the immune system. And because of the immune system is what controls cancer growth, you know, you need the immune system to basically shut down cancers, that’s what in our body can control cancers, which is, you know, now we’re seeing things like cancer vaccines being created, if you are kind of throwing the immune system off course with high glucose and metabolic dysfunction, you’re going to generate some sort of maladaptive inflammation that makes this attack like less functional. So there’s a couple of different pathways of how glycemic dysfunction affects cancer, but what we know is that for a lot of cancer types, there’s much worse outcomes for people who have metabolic dysfunction.

Host: [18:28]                       Wow. Crazy. That’s, sorry, I just brain farted cause Dee disappeared, so I can only see you. But we’re going to keep going.

Host 2: [18:42]                   I have a question. Do you think, with everything going on in COVID and everything, do you think like that plays a part in like getting COVID or seeing like, being responsive to COVID?

Casey Means: [18:58]    Yeah. Yeah. That’s such an important question right now. And the data is really strongly supporting that metabolic disease, particularly obesity and diabetes will significantly increase the risk of mortality and morbidity from COVID. So not entirely clear that it increases your risk of getting the disease, but it is becoming very clear that it increases your risk of dying, or having a worst or prolonged outcome, like meeting mechanical ventilation or an ICU stay. So these, you know, and a lot of people sort of in the functional medicine community are reading this literature closely. There’s been hundreds of papers, since February, published in scientific journals, showing that metabolic diseases are a risk factor for worse COVID outcomes. And yet, we’re really not seeing a big movement in the medical community towards encouraging people to really focus on dietary and lifestyle strategies to improve their metabolic function. And there is a big focus on, you know, making sure you’re stocked up on your medications, making sure you’re pricking your fingers, you know, regularly, but it’s like deafeningly silent, sort of a big stance about really working on evidence-based dietary and lifestyle strategies during COVID right now. And I think we’re kind of missing a really big opportunity here, to really educate about this. And just in terms of mechanisms, so there’s a number of reasons why high blood glucose may be leading to worse outcomes with COVID. One of them is that, the way in which glucose sort of affects the immune system and impairs the immune system. So it’s well-established that if blood glucose is high, it actually kind of stuns your immune cells and immune cells go around, you know, and they basically eat other cells that are either infected with a virus, so they eat bacterial cells, that’s a process called phagocytosis, like eating another cell. And that process is just, like the cells that have to go around and eat other cells like, that is impaired with high glucose, something about the high glucose causes that movement of the cells to just not work properly. So that’s a big factor. The other big factor that’s been emerging is that, and stop me if I’m getting into like too much technical detail.

Host: [21:18]                       No, you’re good.

Casey Means: [21:20]    But high blood sugar, like I mentioned, causes this sort of maladaptive chronic inflammation in the body and the release of these particular chemicals for immune cells called cytokines, so there’s a handful of cytokines, one called Interleukin 6 and one called TNF alpha, and these basically are signals that are released from immune cells that go into the bloodstream and tell all the other immune cells to get like super active, like there’s a problem. And diabetes and obesity can do that to the body, like it tells the body to basically ramp up inflammation. But what’s interesting is that, COVID also causes these things to be up-regulated, because obviously COVID stimulated the immune system, and it’s finding that this magnification of these pro-inflammatory signals with metabolic dysfunction and COVID are basically what lead to the really bad outcomes, especially respiratory outcomes, because basically the immune system, to get immune cells to a tissue to fight infection, you have to make the blood vessels kind of like leaky so that the immune system can exit the blood vessels and get into the tissue where it needs to fight infection. So it creates permeability in the blood vessels. And that’s what some of these cytokines will do. They’ll signal the blood vessels to become leaky and let the immune cells and fluid, and that’s why you get swelling in tissues, because of that leakiness. And so basically what’s happening in the lungs is, you got all of these signals from metabolic dysfunction, all of these signals from the immune response to COVID, leading to all of this like leakiness in the lungs and basically just, you’re getting these terrible symptoms of lung inflammation and other organ systems. So, I don’t know if that makes sense, but like basically it’s compounding what’s happening with COVID and leading to this end organ damage that’s causing the actual death in COVID. So, a way to think about it is, it’s not necessarily the virus itself that is actually kind of killing people, it’s an overwhelming immune response to the virus, but it’s compounded by metabolic dysfunction. So if we could like pull the brakes on that metabolic dysfunction, I think you’d see a really, you know, a big, it’d be a really high value intervention. And we’re already seeing in data, that people have better glucose control, even if they have diabetes, are doing better with COVID than people who have poor glucose control. So super tied in and really interesting and last thing I’ll say is, sorry, that the CDC actually, just two days ago, posted for like the first time, that we should be thinking about eating healthily and nutrients during COVID. There’s been a lot of data about vitamin D and health outcomes and things like that, but it’s like, it’s been months and now we’re just starting to tell people like think about it. So, yeah.

Host: [24:07]                       Yeah.  That’s crazy. Do you have any, so supplement-wise, what would you say might actually be beneficial to think about taking if you’re concerned or if you’re not already?

Casey Means: [24:24]    So, I mean, you know, I supplement personally, I wouldn’t say there’s any like blanket statement and supplements that I can say that work for everyone because everyone’s body is so unique and individual. And I actually, for my own practice and for my patients, I do supplements based on testing. So I get this really great test called NutrEval through this lab called Genova, which basically tells you really kind of specifically like what minerals and vitamins you need for optimal biologic function. But before even supplementing, I think it’s always best to try and get it from whole foods, you know, and really try and optimize digestion and microbiome as much as possible so you’re digesting foods properly and getting all the nutrients out of foods that you possibly can, before moving to supplements. So, but in terms of just nutrients that I think are positive for the immune system in general and not necessarily for COVID, but just for like regulating inflammation. I think some of the key ones would be, you know, Omega-3 fatty acids, this is like you hear about Omega-3 fats, Omega-6 fats. Omega-3’s are the ones that typically come from like walnuts, flax seeds, chia seeds, and then fish like salmon, mackerel, anchovies, sardines. And these are an anti-inflammatory type of fat that actually, when they’re broken down, they actually create these anti-inflammatory signaling molecules. So I encourage my patients to get at least two to three grams of Omega-3 fats per day. I’m plant-based so I get mine from seeds and nuts and algae, but if you are an animal protein eater, you know, sardines, salmon, mackerel are great options for Omega-3 fats. And then there’s just a lot of anti-inflammatory nutrients out there from plants. I mean, really plant foods are, by and large, anti-inflammatory so I encourage people to get 8 to 12 servings of vegetables per day. And if I had to focus on some that are important, I would focus on plants that have very specific anti-inflammatory compounds. So turmeric, garlic, ginger, green tea, cruciferous vegetables. Those are some of my top ones, cruciferous vegetables especially. So that would be like broccoli, broccoli sprouts, bok choy, arugula. These have specific chemicals, one called sulforaphane, one called indole-3-carbinol, and these actually like change gene expression to decrease inflammation. So, you know, I would just be loading up on all those cruciferous vegetables and those anti-inflammatory herbs, you know, like I mentioned, garlic, turmeric, ginger, cruciferous veggies and sort of all veggies. And then the two other I’ll mention, that I think benefit the immune system, one is selenium. So selenium comes mostly from Brazil nuts and it is basically part of what makes us selenoprotein, which is a protein that the immune system use to have a coordinated immune response. We’re very low in selenium as a population, so that’s something to really think about- having a few Brazil nuts each day, you know, aiming for about 200 micrograms of selenium a day. And then lastly, like fiber, that one of my biggest, it’s not a vitamin or a nutrient, or it’s not a mineral, but it’s something from food. Fiber is what your microbiome, you know, eat essentially, and they process fiber and then they make these chemicals that we can use. And the chemicals that they make that we can use are amazing for the immune system. They’re amazing for metabolic function. So a lot of what I think about when I eat is how do I feed my microbiome so it can do, it can make the things that I need for health? So I shoot for 50 to 75 grams of fiber a day, mostly from beans, legumes, chia seeds, nuts, other seeds, and just generally vegetables. So.

Host 2: [28:33]                   Awesome. Yeah. I love that. I think I have a bit of a selfish question. It might be probably just me wondering. So, I am like prepping for a bodybuilding show right now, which involves getting down to very low body fat percentage and then just to basically spray-tan yourself and pose for a second and be done, but it’s very vain and ridiculous, and during the time of COVID, it doesn’t make a lot of sense because that is very stressful on the body. And obviously, it’s not the best idea to be single digit body fat with your immune system. And then I’m also going to be flying from California, which is one surge COVID center, to Texas to Houston, to Houston. Number one, am I nuts? Number two, if I do it, what precautions, whether it be like a supplementation to a more extent, because my calories are going to be lowered too, so I’m all about very minimal, like actual supplements, very much so about, you know, eating whole foods. That is what I do, like whole foods, nutrient dense. But if I’m eating lower calories, I know I’m not going to be like getting in as much as I normally would. So would that be kind of a circumstance where supplementing would be beneficial or should I even be doing this?

Casey Means: [30:23]    You know, that’s a great question. It’s cool that you’re being so thoughtful about it and I’ve definitely, I’ve seen your Instagram so I know that you are very healthy with your whole foods. I saw some like gorgeous salmon or something, I think I saw recently, but yeah. So what I would say is to think about it as like, get every bang for your buck with every calorie you’re putting in your body. How can you load the maximum amount of useful building blocks into each bite, you know, and not have anything that’s basically going to like, not serve you from a biologic function? So I think of food, one of the reasons I think that food and studying food and working with food, in my clinical practice, is so magical is because food is both building blocks, but it’s also molecular information. So it not only serves as the substrate for building every single cell in your body, it is literally the atoms that go into our body to build us. You know, you are what you eat is the adage, but it’s like, it’s true. But it’s also molecular information that goes in and tells your cells and tells your genes how to use the building blocks. So that’s kind of cool that it serves those two different roles. So when I’m thinking about, let’s say you’re having fewer calories, you want to just make sure every bite you’re taking is a good building block and good molecular information. And so, it really wouldn’t be that different from kind of what I had said before, like focusing on whole foods, really micro-nutrient dense foods, so like vegetables, fruits, etcetera, you know, if you are eating animal protein, making sure that you’re choosing foods that are going to give you a really big bang for your buck in terms of the vitamins that only, that mostly meat and animal products can give, like chromium and B vitamins. You know, you can find these things in plant sources, but they’re going to be much higher density. So, you know, maybe instead of eating, you know, a bunch of, I don’t know, chicken breast or something, or sort of low quality beef, like choosing like a really beautiful, free range, like egg or, you know, some really nice, wild game meat that’s going to have like a really high Omega-3 content, and not a bunch of just sort of like crap from a, you know, meat source that was like fed a bunch of corn and soy it’s whole life. So really just choosing calories with like the most bang for your buck. And those bangs for your buck being, you know, low-glycemic, don’t cause damage, eat things that are actually not spiking your blood glucose, and that’s where, you know obviously, Levels comes in, Omega-3’s all the way, you know, don’t get a bunch of excess Omega-6 fats that are going to kind of be pro-inflammatory and not make up good cell building blocks, getting all those healthy micronutrients from veggies, and getting tons of, you know, fiber, from really dense fiber sources, so things like the beans and the chia seeds. So yeah, that’s how I’d frame it.

Host 2: [33:28]                   Awesome. Yeah, mostly that’s, I mean, basically what I’m doing. I don’t know if, I think, I don’t know how much you dove into my Instagram, but even like my waffles that I do in the morning, those are only made of eggs and banana so it’s like, it’s all still foods. I think people look at that and they’re like, that’s not healthy. Why you eat waffles? And I’m like, it’s not actually real waffle. But yeah, so it’s basically what I’m doing or how I already do things, I think I was just kind of like, how bad is going to just be at, you know, more stressing my body more and like flying off, that stuff and should I be like extra concerned, I guess?

Casey Means: [34:17]    Well, you know, I think another thing to think about is like, really gaming like the timing of how you eat, because, as you know, like a calorie is not a calorie, right? So like, your goal is to be cutting fat? Then inherently, that means your goal is to keep insulin low, because you can’t burn fat if you’re in a high insulin state. Insulin is the hormone that obviously causes glucose to be taken up by cells but it’s also the hormone that blocks you from oxidizing fat. So that is something to consider, of like, well how can you kind of game the system to eat at different times of the day, that you’re not going to raise your insulin as much? So, we know from like scientific research that eating later at night, if you eat the same meal in the morning versus late at night, eating it late at night is going to have more of a glucose response and more of an insulin response, which means you’re probably going to start like, store more of those calories as fat. So, I mean, that’s another way to kind of think about, and using a continuous glucose monitor, using Levels can help you like sort of experiment with that. But if I were you, and I’m not recommending this to, you know, any listener that’s like medical bite, but more just thinking through the science of insulin and like what fat burn and cutting really is, and it’s keeping insulin low and you do that by not elevating your blood glucose and doing things like really short feeding windows during the day, eating earlier in the day, intermittent fasting, things like that are going to let you potentially eat the same amount of calories and not have the same amount of fat storage. So.

Host: [36:05]                                         Hm. That’s interesting. I think with, I’m thinking of like my own experience with Levels and then I’m like, yeah, let’s go into the Levels topic.

Host 2: [36:15]                   Oh yeah. I was just going to ask that. I was just going to ask her to talk about Levels a little bit. Yeah.

Host: [36:21]                       So here’s one thing, I have, you know, so I’m trans. I’ve documented my whole transition on YouTube and legit, the thing that I got the most shit for was Levels and like tracking my glucose levels. Like you can do whatever you want with transition, but when you start talking about blood glucose and nutrition and food, that’s when people are like getting all pissed off and telling me that I’m dumb. So.

Host 2: [36:57]                   Yeah. You got a lot of hate for that.

Host: [37:00]                       I did. It was weird. I was not expecting that. It was very strange.

Casey Means: [37:06]    I’d love your, what kind of feedback you got? That’s so, or we can talk about what, I mean, you might, if you want to describe, from your words, like what Levels is like, I’d love, you know, be, I’m happy to describe it or either way.

Host 2: 00:37:20]             Cody, you can talk about it since you did it.

Host: [37:24]                       Yeah. So yeah, I did Levels. For anyone listening that doesn’t know, I was monitoring my glucose for a month with your, the Levels program, which you are, you know, the creator of, as people probably heard. But when I first started and like start documenting it on YouTube, some of the criticism was just, I think they were just wrong assumptions or they didn’t watch the whole video, or just thought it was pseudoscience, to kind of just, you know, woo-woo kind of thing, which I get it because it’s new, you know, or just like new-ish to people in general, besides people who already have diabetes and are monitoring their blood sugar and all that. But I think the biggest criticism was that someone said like, I didn’t know what I was talking about, that, you know, your glucose depends on, it could be different depending on the foods you eat and stuff like that, which is an assumption that they made by just not listening, because I told like the difference, like the app, you know, it takes an account of different foods, you log absolutely everything, the timing, your exercise, just everything is included in the assessment of it. So I think it just was mostly people just thinking it was a pseudo-sciencey. So on that note, I think, I would love for you to explain it in the way of a better way than I probably could ever.

Casey Means: [38:56]    No. I think that.

Host 2: [38:57]                   I, sorry.

Casey Means: [38:58]    Go ahead.

Host 2: [38:58]                   Oh, no. I was just going to say, I think a lot has to do with, why people were hating on you for, it was because they didn’t want to recognize like what they were eating and how that might affect their blood sugar, because they see how good you eat and your blood sugar is spiking from your waffles and those just have bananas and, you know, whatever else you have in it, but they’re over here having pancakes or like, you know, bacon and things like that, that might not be as healthy. And they’re probably just like kind of scared and they don’t want to admit that. So they take it out on someone else.

Host: [39:30]                       Yeah. Yeah. That could be something too. They just aren’t ready to look at their own food, I suppose.

Casey Means: [39:39]    That’s a super interesting observation. Yeah. Well, so I’ll give this sort of big picture. So I think, you know, for people who don’t know, basically like Levels is essentially a program that gives you, it’s like a Fitbit for glucose, I would say, like in the simplest form. So you put this wearable sensor on your arm, it stays there, it sticks under your arm for two weeks, and there’s a little teeny probe there that’s measuring glucose 24 hours a day and takes a reading every 15 minutes, sends it to your phone. And then our software transforms that data into highly actionable insights to let you basically, lead you towards this personalized diet and lifestyle plan that maximizes stability of glucose levels. And we care about stability of glucose levels for all the reasons that we talked about before. If glucose levels are highly variable throughout the day and constantly bouncing up and down, we know that that, which is called glycemic variability, is associated with, you know, worse energy, more fatigue, it’s to do with, you know, acne and anxiety and all these things that we don’t want, all these pain points. It also sets you up down the road for these chronic diseases that are associated with metabolic dysfunction. And what’s interesting about the glucose data stream is that, also like we’ve talked about, a lot of different things affect glucose. It’s not just food. It’s food combinations like, what you’re pairing together. It’s food timing. It’s exercise, it’s sleep, it’s stress, it’s microbiome. So it’s this very multi-variate input that impacts basically, how you transform food into glucose in your body and what your glucose levels are in your bloodstream. And we want those to be low and stable, because that’s associated with just a better experience of life now, but also better, in terms of your risk profile for future disease. And I think, you know, it’s possible that part of that pushback that you got was because, twofold, One, there’s this concept of like low-glycemic diets or keto diets, and this idea that if you just sort of like eat things that are low carb, like you’re going to be fine so like, why do you have to measure it? Just like eat things that are low carb, like, but the reality, and this has been, really being figured out more over the past couple of years in the research is that, everyone responds to food differently. Like we’re these biochemically unique organisms. And I could eat an apple and you could eat apple and Dee could eat an apple and all three of us could have like vastly different glucose responses because of how we slept, how we exercised today, what our microbiome composition is, what our body type is, what our insulin sensitivity is, you know, and certainly if one of us paired it with fat, one of us paired it with protein and one of us paired it with extra sugar, we’d have even more different responses. So the reality is that people respond differently to food. That’s a new concept, really kind of something we’ve been learning about since like 2015. There’s a landmark paper out of a lab in Israel called Personalized Nutrition By Protection of Glycemic Responses, where they slapped continuous glucose monitors on healthy people and saw that essentially, with the same amount of carbohydrates, same food people had totally variable responses. So really, if you’re trying to keep glucose stable, trying to keep insulin low, you’re kind of just guessing if you’re not measuring it. And so that’s where data can be really, really, really helpful. So that’s one thing, people might not be aware of that concept, that there is so much variability between people and that these blanket diets, these universal diet ideas, like don’t really make that much sense. So that’s one thing.

Host: [43:23]                       Yeah. I was thinking about one other criticism, was that people were saying it was like obsessive or it was just, you know, a little bit too much. And I’m just thinking, I just liked data. I like learning about my body. So it’s just pure curiosity to me and just, I like learning. So that’s why I wanted to do it. It wasn’t to obsess over it. It was just kind of like, why wouldn’t you want to learn more about your body? I don’t know. So I think the word obsessive tends to pop up pretty quickly for people.

Casey Means: [43:59]    Yeah. And I think it’s important to think about like, there’s this concept of like orthorexia, that’s definitely a problem these days, where people are becoming like so fixated on wellness and so fixated on diet that it becomes very dominating of the psyche. And I would argue just like a slightly different perspective. Like obviously, any tool, can be used for good or it can be used for not good. It depends a lot on the person, but the actual experience that both I’ve had, and I’d be curious to hear your experience, and a lot of our users have had is that actually using a really data informed tool actually really liberates you in the sense, that there’s less of a subjective mystery component to food, and there’s less of a confusion about food and so it’s actually a very efficient way to create conclusions. And that actually, in the long run, I think makes people a lot less obsessive about food. So what I, we’re kind of, a term that I’m sort of toying with, is this idea of that it helps you build like metabolic intuition over time. So, yes, at first you’re kind of trying all these different foods and you’re very quickly learning like what works for your body and what doesn’t, you’re also building this arsenal, this toolbox of tools that you have to basically modulate a glycemic response. So for me, sweet potatoes spiked me into like, diabetic levels. Like I’m like way up at 180. I’m just like, it’s not good for me. Yeah. But if I eat less and if I put a bunch of almond butter and make sort of like a Thai sauce, a lot of fat, if I put chia seeds, which have protein and fiber on it, and if I eat it early in the day, all of those things are going to make it have much less of a glucose response for me. So, I’m like using the tool and looking at all this data and experimenting with different things. And very quickly I’ve created a toolbox. And now, I mean, I’ve been wearing a CGM, a continuous glucose monitor, for like over eight months now. And at this point, I’m pretty much, I know how to keep it stable. I’ve got this whole milieu of like tools. I know that I need to be sleeping well. I know that I need to be exercising every day. I know how to use, you know, vinegar, fat, protein, you know, all these things that are known to, cinnamon, you know, to affect glycemic response for my advantage. And then all of a sudden, you’re kind of not thinking about it anymore. You just know what works for your body. And research has shown that like 80% of people are totally confused about nutrition. We also know that most research about dieting doesn’t work. People lose a small amount of weight and almost in all studies, they gain it back after two years. So that just like long-term confusion and lack of success, I would say that leads to more obsession than just like figuring out answers and moving on with your life. So that’s, I mean, I’m biased a little bit. But like, I believe it. And I’ve seen it in our customers. I’ve seen it in my patients. I’ve seen it in myself. So.

Host 2: [46:58]                   What made you come  up with the idea of Levels?

Casey Means: [47:02]    Hm.  Well, it was not, so the actual founder-founder is Josh Clemente, so he’s one of my co-founders. And he has just like a really incredible story. He’s an aerospace engineer. He worked at SpaceX. He has built and engineered parts that went up in the most recent space mission last month. And he was, I’ll just like share his story really briefly and then I will share and share my story, but his is really, really, really interesting, but basically like he was a super fit guy his whole life, never struggled with weight. He was a CrossFit instructor, like cut this jacked guy, you know? And he had learned about glucose because you know, the astronauts that we send to space, like we have to keep them optimally healthy, right? Because like, they’re, you know, in space they don’t have access, they just have to be like very optimized and something we care a lot about is metabolic function, keeping glucose really stable. And he kind of got curious into glucose and was like, well, I wonder what’s going on with mine. Like, and so he started pricking his finger and basically realized that a lot of the day, he was spending it like, well above the healthy range. And he was shocked because he looked aesthetically just like a very fit, fit person. He eventually tried to get a continuous glucose monitor so they could track this in more fidelity. He got nervous and wanted to like, get this back on track because you know, you can very quickly improve your metabolic health through simple stuff, you know, and try to get a CGM. No one would prescribe him one because this is technology that’s traditionally used just for people with Type 1 or Type 2 diabetes, and eventually was able to get a prescription for one and basically found that he was just all over the place, very metabolically dysfunctional. And this led to just a very passionate journey towards understanding metabolic health, understanding the drivers and understanding that this is a problem that’s facing. This is not fringe. This is epidemic proportions, right? This is affecting the COVID crisis. There is 74% of people are overweight or obese. There’s 128 million Americans with pre-diabetes or diabetes. And of those with pre-diabetes, 90% do not know that they have pre-diabetes. So, this is like huge, huge, huge numbers. And so, you know, he became fixated on basically solving this problem. He also had a really interesting experience with his subjective sort of symptoms. So he was noticing in his late twenties, even though he was like, so fit, he was so fatigued. I mean, you know, it was like, Oh, maybe it’s like my job is stressful and like I’m working hard and like, but when he put the CGM on, he realized, Oh my God, this fatigue is because I’m spiking and crashing all day long. So he basically just was able to get it to more of a flat line and the fatigue just really lifted for him. So that was really powerful. So my story is like totally different. I was a surgeon. And I was an ear nose and throat surgeon, head and neck surgery. So I was doing like sinus surgery, ear surgery, vocal cord polyps, you know, thyroid surgery. And what I realized in my, like I was practicing for about five years in that field, is that almost every condition I was treating wasn’t it was inflammatory in nature. Like these are all diseases of inflammation. So sinusitis is inflammation of the sinuses. You know, chronic otitis media is inflammation of the tube that connects the ear to the nose, and you get pus build up in the ear. Thyroiditis is inflammation of the thyroid, vocal cord granulomas are inflammatory masses of the vocal cords. And I was like, Oh my God, why is everyone so inflamed? And why are we treating inflammatory disorders with surgery? Or just handing people steroids, which are just these heavy hitting anti-inflammatory medications. When we know that refined sugar, you know, environmental toxins, lack of sleep, lots of stress, lack of physical activity, all those things drive inflammation. So like, why is there no overlap in this Venn diagram between what we know about triggers of inflammation and how we’re treating ear, nose and throat inflammatory disorders? And that basically led to a long journey to really understand the root causes of these conditions and led me to a real obsession with metabolic health. And I thought, you know, I was trained for over a decade to become a doctor. And like, I, like, where do I want to devote my energy for the rest of my life? Like what is going to help the most people and how can I leverage that? And it was this. It was very clear to me. So I left surgery and I, oh, I started my functional medicine private practice, focused a lot on metabolic health. And then I realized, this is great that I’m helping, you know, 20 patients a week. But like, this is stuff that needs to be heard by more people. And how do we have that like sort of coach who can help people? Like I need to be on people’s shoulders every day, all day to help them make decisions. But I can’t do that. So how do I do that? And so digital health was a really clear solution. And so, yeah, teamed up with Josh and our other co-founders, there’s five of us with very diverse backgrounds and we just basically said, we were going to solve the metabolic health crisis and we’re going to do it through empowering people with their own data. And I’m not going to wait for the food industry or the healthcare industry to do this. So, that’s how we got here.

Host: [52:34]                       That’s awesome.

Host 2: [52:35]                   That’s cool.

Host: [52:36]                       I love it. I was just thinking back to some of my experiences with using, you know, a CGM and with, you know, what spiked me and just everything, well a few, one of the things with the, I feel like some people will have more success kind of changing their diet after using that versus, you know, the typical diet and then you gain it back, the thing is, it really forces you to connect to your body, whereas diets mostly, you know, it’s, you can still ignore what your body is actually doing on the inside, where this one just gives you that connection, that insight like, Oh, I eat this and then I physically see how, like what it is doing to my body with this, you know, the data that I am getting. So I feel like that’s probably also a good little connector to be like, Oh, this might be another factor into why this could be successful, instead of just being like, Here’s your calories. And don’t go over that. And good luck. But something I also noticed, sorry.

Casey Means: [53:45]    Yeah. I was just going to say I think you’re so right on with that. And I think the way like, we kind of frame that is like, nutrition has always been this open loop feedback system. Like you eat something or you read a bunch of things during a day, and then you have no real feedback on what’s happening to you. You might have some nebulous symptoms, you might not feel great, but the one-to-one relationship between action and outcome is, it’s almost impossible with nutrition. And I think this is kind of the first tool that might allow people to close the loop between action and reaction. And that closed loop is like so important for, you know, buying in to these behavior changes. If you can really identify something and say like, this is the causative factor of this, it’s a lot easier to make a decision, versus if you’re like maybe it had something to do with it, I, you know, you weigh yourself one day and you’re like, Well, I’m two pounds heavier today like, maybe I should think about not eating. Like how do you even look at your last day and approach what to change? It’s very, very hard. So yeah, I think that closed loop thing is important. And I also love what you said about getting in touch with your body, because yeah, I think, especially with our digital world and how busy and how fast moving we are, like we’ve sort of lost what I would call like somatic awareness, like a sense of like what’s going on inside our bodies, like hearing our bodies. And there’s something about seeing, yeah, like seeing the data that I think has people clue into, Oh, I felt this way and I ate this thing. So, you know yeah. So I think that you really like keyed into some of the things that hopefully are going to be really helpful for people to make sustainable changes.

Host: [55:35]                                         Yeah. For sure. It kind of forces you to not be able to ignore things a bit more. Something that I noticed was, two, I could, you know, the amount of, how stress affects, you know, your glucose levels as well. And it’s funny that you say that, you know, you could eat the same meal for like breakfast and dinner but you will have a bigger spike in the evening. I was the opposite, where I could eat the same thing for breakfast and dinner, but I would have less of a spike in the evening, but I think that’s because I was less stressed. Because in the morning I’m thinking like all the things I got to do, I just, you know, I’m drinking my coffee and I’m just, you know, just, you know, ready to jump out my own skin so I can get things done. And by the evening I’m already winding down. I don’t have caffeine in my system and, you know, getting ready for bed. So my blood sugar levels wouldn’t have, they would be more steady. So if I have my waffles in the morning versus the evening, which I’ve done because I’m lazy okay. It happens. It was at different hotspots and it was very fascinating.

Casey Means: [56:51]    This is so interesting. I love hearing your experience with that and like cluing into the stress thing. And, yeah. No. I mean, most of the research like does show the opposite, but it’s such an important point. Like everyone’s body is different, you know? So that’s so fascinating. Did you have any other like big takeaways that you experienced? Or like particular foods that were really, I don’t know, tough on you?

Host: [57:24]                       I think my biggest surprise was that sweet potato was so, had such an effect. Like it was probably up there with white rice, with the effect on my blood sugar. So that was the most surprising because I’m like, This has more fiber, it should be a little bit slower, but it didn’t really matter still. I think, of course anytime if I mixed in some fats, it wouldn’t be, you know, as bad, but generally, so like a post-workout meal for me, is when I have sweet potatoes. And I don’t have much fat in it besides maybe what is ever in the protein that I’m eating at the time. So there wasn’t really a lot of breaks to slow it down. So it really, that would make things spike. I could eat them also in the evening and not get as much of a spike oddly. So I don’t know.

Casey Means: [58:25]    So fascinating.

Host: [58:28]                       Yeah. So, I don’t think there was anything. It was, I might not be like the best example. So I’ve also run a few clients through Levels as a coach. They created like a dashboard for me to be able to see clients’ blood sugars and stuff like that. That was probably the hardest part for me, because I’ve seen clients levels after eating like ice cream and cookies and their blood sugars are just like nothing. Like it was fine. And I was just like, God dammit, like, how am I supposed to tell you that you shouldn’t be eating that if you’re fine and I over here eating sweet potatoes and I’m just all over the place.

Casey Means: [59:15]    Yeah. Yeah. We, it’s funny. Ice cream has been a really interesting one and in our early customers, because it is obviously a high sugar food, but it also has so much fat and protein that it often really, it’s like, in a very strange sense, it’s a balanced meal, but, you know, and so.

Host: [59:35]                       That’s not saying you should do it. Please don’t.

Casey Means: [59:38]    Yeah. No one is saying you should go eat ice cream. But, and I think we really emphasize that with our company as well, that like, this is an extremely important biomarker to measure, but like glucose is not the only thing with health that you should be caring about obviously, like for instance, like you could drink straight vodka all day and your glucose probably won’t go up, but like, you shouldn’t be doing that, you know. Like, so it is very actionable, important metric, but, you know, it’s a data point. And so I think that that’s part of the nuance of nutrition, but if you can get the majority of this dialed in with like, you know, a metabolic awareness month long program, and like really learn things that are like particular extremes for you, and then also build your toolbox of how to manage it, like knowing what workouts are best for glucose, how to manage stress better to manage glucose like, those takeaways are valuable for everyone, but yeah, certainly with some of those foods like, you know, drinking, you can drink a cup of oil and not have a glucose rise, that would not mean you should do it. So we really try and build that into, you know, essentially, the future versions of the product, of just making sure that that comes through as well. So, yeah.

Host: [01:00:56]                Yeah.  That’s a good point. It’s like, just because your glucose doesn’t go crazy with this, doesn’t mean that you should just continually eat it.

Casey Means: [01:01:05]Wait, that’s what we can say about it is, it has a low-glycemic impact, but whether it has, what health impact it has, is a little bit slightly different question. So.

Host: [01:01:14]                Yeah. Yeah, exactly. It’s kind of like all those, the same nuance that we skipped with calories, just talking about calories in calories out, it could be the same thing with glucose, I guess. So it’s a, you always have to have the whole picture, not just pick little pieces of it, for whatever you want. On that note, when it comes to individual glucose and spikes and foods, gut health, I think you kind of touched on this a little bit, but how big of a role does that play in how someone might respond to something? You know, how you talked about, if we all ate an apple, it could be different. Is that also related to like a different gut microbiome? Or is there, what other factors could be involved in that?

Casey Means: [01:02:08]Yeah. So the microbiome plays a huge role in metabolic health and glycemic responses. And yeah, this same paper that really showed differential responses in non-diabetic individuals, to the same carb source, this personalized nutrition by prediction of glycemic responses, they took stool from everyone and mapped out their whole microbiome and they actually found that, if you are going to predict how an individual respond to a certain food, when you include microbiome data, you can be much more accurate in generating that prediction. So it’s very, very important. And there is a lot of different, like detailed mechanisms of why this might be the case. The microbiome have an impact on hormonal secretion. There’s a set of hormone called incretins that have to do with metabolic health and the microbiome plan to those, the microbiome also, when they process fiber, they create what are called short-chain fatty acids, things like butyrate. And so they basically, the bacteria eat the fiber. They, you know, secrete short-chain fatty acids. We absorb those short-chain fatty acids and those have an impact on our metabolism and our glucose regulation. And there’s actually like a couple other mechanisms as well, one has to do with the microbiome impact on bile, metabolism, bile is the stuff that’s released from the gallbladder to basically break down fats. And so they are like just on a mechanistic level, the microbiome are super involved in how we just break down food and put it into the bloodstream, like it’s preprocessing. So you can imagine if these are what are pre-processing and digesting our fats and our carbs, our fiber, then if yours are different, if you have a totally different population, you might absorb a totally different amount of glucose at different speed. So it’s really fascinating and there’s specific strains of bacteria that are more associated with good or bad metabolic health. The two that you’ll hear about a lot, are the Bacteroidetes and the Firmicutes population. And basically, if you have a higher, there’s been studies in obesity and diabetes showing that an increased ratio of Firmicutes to Bacteroidetes, basically, is more at risk for some of the metabolic problems. So, yeah. So that’s kind of like an overview. There are specific bacteria involved. There’s a lot of really deep mechanisms about how they’re helping process our food. And we want really healthy microbiomes. So yeah, can’t, you know, pound that one hard enough.

Host: [01:05:04]                Is that something that you test for as, like in functional medicine, is that something that you tend to look at or try to improve, if someone might be low in something? And how do you do that?

Casey Means: [01:05:21]Yeah. So I do, in my own practice, I do stool testing. That’s doo-doo, stool testing. Yeah. I have found it to be somewhat valuable. At the end of the day, a lot of the recommendations I’m going to make for people are going to be pretty much the same, which is, you know, you want to support your microbiome in every possible way. So one is, obviously, eating whole foods, fiber, giving them all this healthy food. Most people eat about 10 grams of fiber a day. So I’m getting people on 50 to 75 grams a day, you know, really helps with the flourishing of the diversity of the microbiome. It’s also about like what you take out and like the things that hurt the microbiome. So, you know, taking out pesticides, which can basically kill the microbiome, taking it out persistent organic pollutants pops sort of the diet and just eating clean, clean water, clean food, making sure that you’re not putting stuff in there that’s going to hurt it, making sure that we’re not overusing antibiotics, which can totally wipe out the microbiome. And it can take months, if not years to repopulate. Antibiotics are super important, but we overuse them. You know, we use them excessively for things like acne, I think. And when there’s other levers that we could be turning to basically, to help with some of these things. And so certainly important, but we overuse them. So I think a lot about antibiotic stewardship, about clean eating, about adding fiber and then definitely about reducing stress and really having some good stress management tools because the microbiome, they hear all your thoughts through your nervous system and through your hormones. Like they are very affected by that. And there’s crosstalk between the nervous system and the microbiome. A lot of our nervous system actually lives in our gut, What’s called our enteric nervous system and the microbiome actually make a majority of the neurotransmitters that then control our thoughts and control our actions and so that crosstalk is huge. So every minute people invest in evidence-based mindfulness strategies, getting their nervous system balance through, you know, while you’re in meditation, deep breathing, whatever works for a person.

Host: [01:07:36]                What would be your biggest kind of encouragement to say that it was worth trying out? What’s your pitch basically?

Host 2: [01:07:46]           Yeah. Elevator pitch.

Casey Means: [01:07:48]Elevator pitch. Yeah.

Host: [01:07:49]                Yeah. Let’s hear it.

Casey Means: [01:07:52]Well, I think we’ve definitely explored why it’s important to care about glucose. So I think that’s, you know, that goes without saying, if people have listened to the whole podcast. But I think, on a bigger picture, like this is a tool that helps people really get back in touch with their unique bodies and their biochemical individuality, and actually like puts the agency and the control and the power like back in your hands. So, I think that’s a really beautiful thing to feel, like you actually are guiding the ship when it comes to nutrition and you’re making choices that you know are good for you. I think that that’s like a huge relief, after years or decades of being confused or not feeling good. And also, to be able to have the power to potentially make really rapid changes in your just subjective experience of everyday life through these really simple levers and having that information sort of handed to you on a silver platter, it’s very empowering. And I am all about, you know, as a physician, I lived in a world where it was very top down, telling people kind of what to do. And we know that when doctors do that, people often, they don’t do it. They don’t actually do what the doctor says, you know, even with a prescription, only about 30% of patients fulfill a prescription that a doctor gives them. So that’s not the answer. The answer is for it to come from yourself and come motivated from within you. And so that involves, you know, giving people information about themselves to make the best choices for them. And I think when we reclaim that sense of understanding about our bodies and our sense of agency, it’s really, really empowering and that can actually have positive effects throughout your entire life. So that’s something that I think is really positive about having your own personal data. And the beautiful outcome of it is that, you know, it may actually help you feel really a lot better day to day. And, you know, hopefully reduce suffering down the road. So.

Host: [01:09:46]                Yeah. Awesome. Sounds really good to try it out, to me, but I’m kind of biased cause I already did it.

Casey Means: [01:09:57]And thank you so much for.

Host: [01:09:58]                Still trying to get Dee to try it.

Host 2: [01:10:00]           I will, I think after the show, because I want to try like things that I probably shouldn’t have, like a donut or things like that. And I can’t have that right now. So, I want to like map, like things that I would normally eat on a day-to-day, not show prep, so that’s why I haven’t done it yet.

Casey Means: [01:10:17]Ooh. Got it. Okay. Yeah. I think the first week is really fun to try all the things that you like, especially treats and stuff, and just basically build a landscape of like everything and then, you know, and then maybe optimize in the subsequent weeks of the program, but like try it all the first week. Yeah. Yeah. So. But yeah, excited to get you in.

Host: [01:10:43]                That’s awesome. Well, thank you so much for coming on here and, you know, just having a plethora of information, and I feel like it was probably, it’s just super valuable to people listening and yeah, I just, I appreciate it a lot. I appreciate your time. I know you didn’t have to do this for sure.

Casey Means: [01:11:04]I appreciate you guys and the message that you’re putting out there. And you guys are empowering people with your platform and it’s really, really awesome. So, thank you so much for having me on.

Host: [01:11:13]                Thank you, everyone, for listening to the podcast. You can find us at MindHub podcast on Instagram, and please leave a review on Apple podcast because that is how we get our podcasts out to all of you guys. So thank you so much, and we will see you guys next week.

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