Are healthy foods secretly spiking your blood sugar? | Casey Means, M.D.

In this episode, Dr. Casey Means joins Jason Wachob on the mindbodygreen podcast to discuss all things metabolic health. Dr. Means shared what factors to consider when determining if your metabolism is healthy or unhealthy, how to best tailor your diet in a world filled with sugar and refined grains, and why now is the best time to start your own metabolic health journey.

The definition of metabolic health

Metabolic health is how our body converts food into energy. When the right energy is supplied, metabolism works at its best.

How do we define metabolic health? I think stepping back, the first way I like to think about metabolic health and metabolism generally is what is metabolism. We often think about metabolism in relation to how fast is my metabolism and as a metric of whether we’re able to lose weight or not. Really what it is is how the body converts the food that we eat into energy that we can actually use and all the biochemical pathways involved in that. We have 37 trillion cells in our body, 37 trillion human cells. We have many trillion bacterial cells in our body, but 37 trillion cells. For each of those cells to work properly, they need energy to run all of the cellular signaling pathways that allow them to function and do their job. When that process doesn’t work properly, when the metabolism and the metabolic processes don’t work properly, the cells are dysfunctional. When cells are dysfunctional, the tissues that they’re a part of are dysfunctional. The organs they make up are dysfunctional. Then we see disease and symptoms.

The three measures of metabolic health

As a starting point, look to your blood pressure, waist circumference, and cholesterol and glucose levels as a measure for metabolic health.

So blood pressure, waist circumference, cholesterol and blood glucose. If you had every single one of these in the normal and healthy range, without the use of medications, you were considered metabolically healthy, and that was only 12% of Americans. If even one of these were off essentially that was considered that you were metabolically showing dysfunction. The reason we want to improve those biomarkers is because we want our cellular biology to be functioning properly. We want to be able to eat food, process it appropriately, use it to make energy and then store a little bit for extra for when we don’t have access to energy through food. The issue is that now in our modern world, we have such an abundance of access to food that we really are overwhelming these systems. The substrate that we put in, the raw material, is just so excessive. There’s evidence that Americans eat on average about 152 pounds of sugar per year. Probably about 200 years ago, this was around a pound of sugar per year.

Metabolism has both short term & long term impacts

The long terms dangers of poor metabolism are well known. But it’s also important to know about the short-term issues, such as low energy and brain fog.

Things like brain fog, not feeling as sharp as you want to – we can link that to really glycemic variability, which is just these ups and down glucose spikes that we have throughout the day from what we’re eating and how we’re living. An example that might really resonate with people is this idea of how you might feel after a really big meal like brunch. You have this post-meal crash. You eat this meal, it’s delicious, but you know 30 minutes, an hour later, you’re going to feel like crap. You’re going to want to take a nap. You might need a cup of coffee. You’re not feeling great. This crash. What’s interesting is that when you’re tracking your blood sugar and watching your blood sugar, what you can often see is that that crash is often right around the time when your blood sugar crashes. You go up after the meal as your body processes all those carbohydrates to the meal and then it comes crashing down and has a dip.

Metabolic fitness is ever-changing

Metabolic health isn’t a one-way street. Each daily choice shapes how your metabolism performs on any given day.

What we talk about when we’re thinking about metabolic fitness is really the idea that this is not a one-way street, where you are on this trajectory towards metabolic dysfunction, that’s where you’re at. Fitness implies that it’s something we work at and can improve, and that’s absolutely the way it is with metabolism. You really need to make the choices day in and day out to optimize metabolism in order to reap the benefits. It’s really about consistency and really dialing into things that keep our metabolism optimized. The way that we can do that… One of the ways that we can do that is by keeping our glucose more stable.

The cause of insulin resistance

Too much sugar in the blood results in insulin resistance, which leads to metabolic dysfunction.

What happens when we have these big influxes of blood sugar from what we’re eating, three meals a day, week after week, month after month, year after year – what happens is the body’s releasing so much insulin that the cells become numb to it, which is a process called insulin resistance, which I’m sure many of your listeners know about. The body’s basically saying, “We’re going to block this insulin signal because there’s too much sugar around.” Then what ends up happening is the body produces more insulin to help drive sugar into the cells to try and overcompensate. Over time, this is essentially the pathway towards metabolic dysfunction. What we mean by metabolic fitness is doing the reps to keep the blood sugar under control more frequently so that the body isn’t having to produce so much insulin and those cells can perk up to that signal of insulin and kind of move in the opposite direction down that spectrum of metabolic dysfunction.

Ways to offset food indulgences

When you simply must give into your donut craving, you can can steps to minimize the impacts of that choice.

There’s a lot in the cellular milieu in the body that can impact our metabolic processes, our mitochondria, the part of the cell that runs our metabolism. Let’s say you didn’t want to eat that donut, there’s many options for people to actually minimize their glycemic variability from that donut, for instance, you could make sure that you’re getting a good night’s sleep before you eat your donut, which means you’ll probably be more insulin sensitive that day. You could take a 20-minute walk after eating the donut, which we know has a really strong impact on reducing post-meal spikes. You could potentially preload that donut with some grilled chicken or tofu or another protein source, which we also know diminishes the post-meal glucose spike. It’s not just about what you’re eating, but also the context with which you’re eating it in.

Explore dessert alternatives

From modified brownies to cookies, there has never been a better time to explore healthy – and delicious – desserts options.

There’s just so many dessert alternatives that I think people get into a glucose monitoring and people in the keto world certainly discover that there’s a lot of desserts sort of alternative that don’t spike glucose. I have gotten into some things that may sound a little gross, but they’re actually delicious, but like black bean brownie is sweetened with a little… just a couple of dates. I make a chickpea cookie dough with dates in it and some really dark chocolate chips in there. At dinner parties, I’ll sometimes serve a really fancy chia pudding. Chia has tons of fiber and protein and fat, very little carbohydrates, but I’ll do some berries in a coconut cocoa chia pudding. These are just all things I know that are delicious, but do not spike my blood sugar. Finding some of those interesting alternatives.

The oatmeal experiment

Some foods traditionally thought of as healthy cause poor glucose responses in most people.

We actually did an experiment at the company where several people ate just two packets of Quaker instant oatmeal. Me personally, I had a 70-point glucose rise, which is very large. I usually try to have less than a 30-point glucose rise after a meal. 70 will create a big spike and crash. I think this one is really an interesting one because it really shows how personal tracking and understanding your personal data with a glucose monitor could really potentially change the food industry in terms of how we market foods and what we could put on packages because that box says, “Good source of whole grains, heart-healthy,” but there is no question that for my body, with a 70-point glucose rise, that is not heart-healthy for me. It’s not.

How WHOOP and Levels work together

When you look at all the data available to you, you can make the best dietary choices.

We actually just did a study with WHOOP. We’ll be putting out the results shortly. We looked at correlations between metabolic score, which is a Levels marker, and the WHOOP recovery score. There does seem to be a relationship between recovery score and metabolic score, so really dialing into some of that stuff and realizing that we are dynamic not only person to person, but also day to day in our own lives. Thinking about that bigger picture in context I think is really empowering because it allows us to have multiple levers to pull when it comes to keeping our glucose more stable and metabolic health on point. It’s not just one thing you have to commit to to be that healthiest version of yourself. There are many different areas that we could tap into. You don’t have to have all of them perfect, but you can make sure that you’re at least getting a few of these things dialed in each day.

Cultivate a “food swap” mindset

Dr. Means is constantly on the lookout for ways to make her favorite foods healthier.

I’m always looking at meals as like, “Okay, what are the good components and then what can we swap out to make the collateral damage of this meal much, much lower?” Get the good stuff, take out the bad stuff. Even with a lot of salads that people might be having for lunch, they might have 15 really great things in them, but then there’s croutons and a big piece of bread on the side or dried cranberries that are covered in sugar or raisins or a dressing with a bunch of refined seed oils in it which are not going to be great for our metabolic processes. Just really trying to identify what are the things that are the culprits in terms of the glucose spike and then just either take them out or swap them.

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Jason Wachob: Dr. Casey Means is a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company, Levels, and Associate Editor of the International Journal of Disease Reversal and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools that can inform smart, personalized and sustainable dietary and lifestyle choices. Today, we’re going to talk about all things metabolic health, blood sugar and wearables. Casey, welcome.

Dr. Casey Means: Thank you Jason. So glad to be here.

Jason Wachob: So great to have you. I figure a good place to start for this conversation is a primer on all metabolic health. We hear the term so often, especially coming out of COVID. We’ve heard this statistic so often that 88% of us are metabolic unhealthy, 12% of us are metabolically healthy. Let’s take a step back. How do you define metabolic health?

Dr. Casey Means: The key question here, yeah, how do we define metabolic health? I think stepping back, the first way I like to think about metabolic health and metabolism generally is what is metabolism. We often think about metabolism in relation to how fast is my metabolism and as a metric of whether we’re able to lose weight or not. Really what it is is how the body converts the food that we eat into energy that we can actually use and all the biochemical pathways involved in that.

Dr. Casey Means: We have 37 trillion cells in our body, 37 trillion human cells. We have many trillion bacterial cells in our body, but 37 trillion cells. For each of those cells to work properly, they need energy to run all of the cellular signaling pathways that allow them to function and do their job. When that process doesn’t work properly, when the metabolism and the metabolic processes don’t work properly, the cells are dysfunctional. When cells are dysfunctional, the tissues that they’re a part of are dysfunctional. The organs they make up are dysfunctional. Then we see disease and symptoms.

Dr. Casey Means: Fundamentally, if a cell can’t make energy, it’s the route of really a lot of symptoms and diseases that we see today that are fundamentally routed in metabolic dysfunction. The interesting thing about our modern lives in this Western world is that a lot of the things we’re doing every single day are actually hijacking our metabolic processes and making us have trouble producing that energy to allow ourselves to function. Those types of things that we’re talking about in the Western world are things like our diet, our hugely industrialized diet filled with processed sugars, processed carbohydrates, processed oils.

Dr. Casey Means: It’s the chronic low-grade stress that we’re now under. We’re not really facing these acute stressors that come and then go away like being chased by a lion, but it’s these constant low-grade stressors like email and honking and cell phone dings and things like that. It’s chronic sleep deprivation. It’s lack of physical activity. It’s lower access to micronutrients in our foods because our soils are depleted. It’s microbiome dysbiosis. It’s things like that that are actually acting on these metabolic pathways and gumming them and creating problems.

Dr. Casey Means: What we’re seeing now is the result of this, which is what you talked about. It’s the 88% of American adults showing at least one biomarker of metabolic dysfunction. That really shows you the impact of what some of these dietary and lifestyle factors are doing on the core physiology of our body that’s required for our cells to function properly. When we actually look at biomarkers like how do you define this in a doctor’s office… When you look at that study about 88% being metabolically dysfunctional, what they’re looking at is cholesterol levels. Cholesterol is involved in the metabolic processes because this is related to how we store, process and transport fats in the body, which is one of these energetic substrates.

Dr. Casey Means: Cholesterol levels, glucose levels in the body. Aside from fat, we have glucose as a source of energy. Fat and glucose, which is sugar, are the two primary substrates of energy in the body, so key to metabolism and then waist circumference and BMI, so basically looking at markers of our physical composition. That’s really how we define metabolism in some of these studies, but the core of what we’re talking about is how the body makes, uses and processes energy in the body.

Jason Wachob: We’ve got these biomarkers. If we check each box… I think it was cholesterol, BMI, glucose. What else am I missing?

Dr. Casey Means: Glucose, cholesterol levels, BMI, waist circumference are often the ones we see.

Jason Wachob: If we check all those boxes, odds are we’re in pretty good shape in terms of our metabolic health, but if we don’t, probably not so much?

Dr. Casey Means: That’s right. In this particular study, they were looking at… Oh, actually there was one more they looked at in this study, which was blood pressure. Sorry to forget that one. So blood pressure, waist circumference, cholesterol and blood glucose. If you had every single one of these in the normal and healthy range, without the use of medications, you were considered metabolically healthy, and that was only 12% of Americans. If even one of these were off essentially that was considered that you were metabolically showing dysfunction.

Jason Wachob: I think I know why we want to improve it, but from a medical perspective, why do we want to improve those biomarkers and how should we go about doing so?

Dr. Casey Means: The reason we want to improve those biomarkers is because we want our cellular biology to be functioning properly. We want to be able to eat food, process it appropriately, use it to make energy and then store a little bit for extra for when we don’t have access to energy through food. The issue is that now in our modern world, we have such an abundance of access to food that we really are overwhelming these systems. The substrate that we put in, the raw material, is just so excessive. There’s evidence that Americans eat on average about 152 pounds of sugar per year. Probably about 200 years ago, this was around a pound of sugar per year.

Dr. Casey Means: That’s just monumental increase in what the body has to process. That creates lots of issues. It creates hormonal cascade of insulin being released and leads towards insulin resistance. Then it leads to the body to store so much of that sugar because it doesn’t need to use it. We don’t need that much energy, so we end up storing it as fat and it’s leading to our overweight and obesity epidemic, which is affecting 74% of American adults.

Dr. Casey Means: Really the reason we want to improve it is because we want to feel our best. We want our bodies to work properly. What we’re seeing now is that so many of the chronic illnesses we’re facing in our country are fundamentally rooted in this core process and it’s really just the nature of the American medical system and the sort of reductionist view of the way we look at illness that we separate all them and we say, “Oh, stroke is one disease. Heart disease is another disease and diabetes is another disease. Obesity is another disease. Infertility is another disease. Alzheimer’s and dementia is another.”

Dr. Casey Means: It’s just playing this whackamole medicine. When you actually look at all those conditions I just mentioned and probably a dozen more, when you actually look at the cellular biology of what’s happening, they’re all linked by the same dysfunctional processes of metabolic dysfunction. For instance, Alzheimer’s, dementia we’re now calling type three diabetes because it’s so related to how we regulate blood sugar in our metabolic processes.

Dr. Casey Means: We want to get these pathways on point so that we can actually ideally minimize our risk for these topic killers that are leading to early morbidity and mortality in American adults, but it’s not just avoidance of chronic disease. It’s also just feeling good. Mark Hyman calls it FLC Syndrome, which is Feel Like Crap Syndrome, which I think a lot of Americans are dealing with right now, where we just are low energy. We don’t have the pep that we want. We’re just not really feeling our best and like we have the get up and go that we want to.

Dr. Casey Means: A lot of this is also I think rooted in these metabolic processes not working properly, things like brain fog, not feeling as sharp as you want to. We can link that to really glycemic variability, which is just these ups and down glucose spikes that we have throughout the day from what we’re eating and how we’re living. An example that might really resonate with people is this idea of how you might feel after a really big meal like brunch. You have this post-meal crash. You eat this meal, it’s delicious, but you know 30 minutes, an hour later, you’re going to feel like crap. You’re going to want to take a nap. You might need a cup of coffee. You’re not feeling great. This crash.

Dr. Casey Means: What’s interesting is that when you’re tracking your blood sugar and watching your blood sugar, what you can often see is that that crash is often right around the time when your blood sugar crashes. You go up after the meal as your body processes all those carbohydrates to the meal and then it comes crashing down and has a dip. That’s often when people feel fatigued, jittery, anxious, not great, certainly not wanting to get out and do a workout. Being able to understand what’s happening and how our food choices are really affecting these subjective feelings throughout the day, we can understand that actually metabolism is not just about avoiding these long-term chronic illnesses, which is a huge thing and something we certainly want to get on top of, but it’s also just about feeling good in the moment.

Dr. Casey Means: That’s where some of this tracking and ability to monitor our blood sugar levels, which is sort of a proxy for understanding our metabolism and how it’s working can help us feel good really right now, but also over the long term.

Jason Wachob: Before we go to glucose, can you also walk through metabolic fitness and talk about the difference between metabolic fitness and metabolic health and how we should be thinking about that?

Dr. Casey Means: Sure, absolutely. I think generally speaking, we can think about metabolic health as meeting those criteria that we talked about for the study of 88% of Americans being metabolically unhealthy. If your blood pressure, HGL, triglycerides, waist circumference and fasting blood sugar are all the right range without medication, then we’re talking about you’re likely in a good metabolically healthy space, but what we talk about when we’re thinking about metabolic fitness is really the idea that this is not a one-way street, where you are on this trajectory towards metabolic dysfunction, that’s where you’re at.

Dr. Casey Means: Fitness implies that it’s something we work at and can improve, and that’s absolutely the way it is with metabolism. You really need to make the choices day in and day out to optimize metabolism in order to reap the benefits. It’s really about consistency and really dialing into things that keep our metabolism optimized. The way that we can do that… One of the ways that we can do that is by keeping our glucose more stable. That is a rep in the fitness routine that we have just like going to the gym and lifting weights is one rep that we would do towards getting the gains that we want with our muscles.

Dr. Casey Means: The reasons or the biology behind why this can be helpful is because it’s not… The body is amazingly dynamic. When you do eat something that does cause a large glucose spike, the reason this affects your metabolism long term is because that glucose spike, this surge of broken down carbohydrates that gets into the blood stream as blood sugar needs to be basically taken up by the cells and cleared from the blood stream. The way the body does this is by releasing insulin from the pancreas, a hormone that helps your cells take up that blood sugar.

Dr. Casey Means: What happens when we have these big influxes of blood sugar from what we’re eating, three meals a day, week after week, month after month, year after year… What happens is the body’s releasing so much insulin that the cells become numb to it, which is a process called insulin resistance, which I’m sure many of your listeners know about. The body’s basically saying, “We’re going to block this insulin signal because there’s too much sugar around.”

Dr. Casey Means: Then what ends up happening is the body produces more insulin to help drive sugar into the cells to try and overcompensate. Over time, this is essentially the pathway towards metabolic dysfunction. What we mean by metabolic fitness is doing the reps to keep the blood sugar under control more frequently so that the body isn’t having to produce so much insulin and those cells can perk up to that signal of insulin and kind of move in the opposite direction down that spectrum of metabolic dysfunction.

Dr. Casey Means: It’s really the choices we’re making day in and day out that help us decide where we’re going to be on that spectrum. We always want to be moving in that direction of towards insulin sensitivity, more stability in our blood sugar levels, which ultimately results in that metabolic health that we talked about from that study. That’s what we’re talking about with metabolic fitness is really putting in the consistency and the reps to keep blood sugar stable.

Jason Wachob: With regards to keeping blood sugar stable, when does it become problematic? When is the occasional glucose spike okay or is it never okay? Personally speaking, I’m a fairly healthy person. I kind of live by the 80/20 rule, but come the weekend, if you’ve never had a donut in New York City, you’ve never lived. It’s the best donut in the world, and I’ll enjoy that. A blackout donut is quite good. They also have sourdough donuts. They also have a couple of vegan donuts. If I have it, I know my glucose is going to spike, and I’ll do the classic double peak, which I want you to talk about, but then it comes down. Then during the week, glucose really doesn’t do much. My question is is the goal no variation or what’s okay if you’re not prediabetic?

Dr. Casey Means: The goal is to be metabolically healthy. We know that metabolic health is going to in part be related to our glycemic variability, which how much the magnitude of our ups and downs are with glucose. It’s not a one-to-one relationship between a glucose spike and metabolic dysfunction. The body is this very complex, dynamic entity that has the ability to handle glucose going into the blood stream. Actually, we’ve evolved to do that well because traditionally, historically, we didn’t have so much abundance to food and we had to feast when we had access to the berries or whatever it was to store fat for later for when we did not have energy.

Dr. Casey Means: The body knows exactly how to handle a glucose spike and really this is more about longer term trends and adaptations the body is making. It should never be considered like a one-time thing is going to damage the body because the body’s extremely resilient. This is more talking about trends over time. In the Western world, the average person is having glucose spikes all the time. The vast majority of our calories in the United States right now come from ultra-processed grains and refined sugars. That’s totally not normal and is a totally modern phenomenon that our bodies don’t know how to deal with. One donut once a week is very different. That’s not 70% of-

Jason Wachob: When I do it, I definitely do more than one. I love those donuts.

Dr. Casey Means: But the key thing being that our body knows how to handle this. It’s a greater context that we’re thinking about. The other thing that is, I think, interesting with metabolism is that it’s not just about food. There’s a lot of things that affect our metabolism, like I mentioned in the beginning, which was that it also has to do with stress. It has to do with our physical activity. It has to do with how much sleep we’re getting, our microbiome, our micronutrient status, our exposure to environmental toxins.

Dr. Casey Means: There’s a lot in the cellular milieu in the body that can impact our metabolic processes, our mitochondria, the part of the cell that runs our metabolism. Let’s say you didn’t want to eat that donut, there’s many options for people to actually minimize their glycemic variability from that donut, for instance, you could make sure that you’re getting a good night’s sleep before you eat your donut, which means you’ll probably be more insulin sensitive that day. You could take a 20-minute walk after eating the donut, which we know has a really strong impact on reducing post-meal spikes.

Dr. Casey Means: You could potentially preload that donut with some grilled chicken or tofu or another protein source, which we also know diminishes the post-meal glucose spike. It’s not just about what you’re eating, but also the context with which you’re eating it in. I think those are some really helpful things to remember when people do want to indulge in things that they know spike their glucose is that there’s a lot of options for actually minimizing the glycemic variability you’re going to see. That’s one thing, but the second thing is to remember with the body, one time exposures like that are not going to cause lasting damage. It’s the trends. It’s the adaptations over time that cause problems.

Dr. Casey Means: Like with the conversation around insulin resistance, you can see how doing this over and over again, spiking that insulin over and over again, that creates cellular adaptations that cause the cell to become insulin resistant. That’s not going to happen one day. I will say there are things that can affect the body really strongly even with short exposures and one of those is sleep deprivation. There was a really interesting study from several years ago that took a bunch of healthy young men and basically deprived them of sleep.

Dr. Casey Means: I believe they got around four hours of sleep for six days in a row. They are probably some college students out there who are living that life, but they took them from totally healthy metabolisms, totally insulin sensitive to essentially prediabetic with just changing their sleep over the course of those six days, but when they allowed them to have as much sleep as they wanted for the next week, their bodies bounced back. So it’s really a dynamic process, but we don’t want to be cutting sleep and getting the blood glucose spikes day after day, week after week, year after year, decade after decade because that will lead towards chronic disease. But no one should ever freak out about a single glucose spike. Bottom line.

Jason Wachob: Agreed. Agreed. One of the most interesting things I found… Colleen and I both tried Levels. I did all sorts of crazy experiments. I was like, “All right, let’s see how high this thing can go. Let’s see what my baseline is.” Sleep is very important to us. Colleen has struggled with sleep for most of her adult life. She’s got it under control. It was the inspiration behind our sleep support supplement. We thought it was really interesting around dinner time in terms of what we ate, how much we ate, how late we ate and then also alcohol and tracking it, not just with Levels, but tracking it. I wear an Aura and a WHOOP. Colleen wears an Aura.

Jason Wachob: Just tracking also how that affected heart rate… everything. Essentially, our sleep suffered. Where I’m going with this is I think the connection with sleep is also really interesting. Can you talk a little bit about how we should be thinking about our meals in the evening to set ourselves up for a good night’s sleep and when dessert does happen, when alcohol does happen, what are some of those opportunities for us to maybe add something that could help mitigate that spike, which is going to cause us to maybe suffer on our sleep?

Dr. Casey Means: The relationship between metabolism and sleep and glucose and sleep is such an interesting one, as you guys discovered, using this and doing glucose tracking. I’d say some of the take-home points around sleep and glucose, the first is that probably the earlier we eat dinner and the greater distance we have between our last meal and when we sleep, the better for sleep. That’s kind of a key take-home point. We know that we actually become a little bit more insulin resistant at night. This in part is due to melatonin secretion, which help us fall asleep, which seems to make us slightly insulin resistant.

Dr. Casey Means: If you eat the exact same carb-rich meal first thing in the morning, versus right before bed, people tend to show a higher glucose response to that exact same meal later in the evening than they would in the morning. That can impact some people’s decision making by having them front load their carbohydrates or higher-carb meals earlier in the day, which also is when you might be a little bit more active as well. That’s one thing. I tend to move during the day, but towards a little bit more keto style towards the end of the day because I don’t want to essentially get this worse thing for my back later at night by eating a meal than I could have had a lower glucose response to earlier in the day.

Dr. Casey Means: We also know that ups and downs in glucose throughout the night can be associated with arousals, essentially waking up. Having a crash at night can sometimes cause the body to wake up in alarm. We don’t really want to have that midnight glucose spike because we know we’re going to come down and then it’s going to bounce around throughout the night, so keeping it more stable overnight tends to be better for sleep. Now, then the question comes to, “Well, what about life? Life happens and there is potentially alcohol and dessert and what not.”

Dr. Casey Means: I’d say you just have to really lean on your toolbox of strategies for how to keep glucose more stable, even if we’re having a high carbohydrate load. It’s some of the things I mentioned before so making sure that we’re not eating our carbohydrates alone, like naked carbohydrates or just having… A naked carbohydrate dessert, I would consider sorbet. There’s very little fat, fiber or protein, but there’s tons of sugar. If we can balance the dessert or the meal a little bit more so that there is a bit more fat, protein and fiber involved, it’s possible we can blunt that glycemic excursion. Again, it might be making sure that your meal is a bit lower carb, high in fat, fiber and protein before you’re putting the big carb load in for dessert.

Dr. Casey Means: It also could be as simple as just taking a walk after the meal before bed. A lot of cultures do this. A lot of cultures will take a post-meal walk. Just getting out and doing 30 minutes of a walk or if it’s nighttime and you’re out, have a little dance party at the end of the night. There’s definitely something I’ve incorporated into my life to try and essentially clear some of the glucose before I just lay down and am sedentary and know that it’s going to be bouncing around in my blood stream throughout the night because I know I’m already a little bit insulin resistant at night. So clear it, give it to the muscles to actually use.

Dr. Casey Means: The muscles are our best glucose sync. They take it up and they take it out of the blood stream and they actually use it. So use the muscles a little bit and then go to sleep. Then of course there’s just so many dessert alternatives that I think people get into a glucose monitoring and people in the keto world certainly discover that there’s a lot of desserts sort of alternative that don’t spike glucose. I have gotten into some things that may sound a little gross, but they’re actually delicious, but like black bean brownie is sweetened with a little… just a couple of dates. I make a chickpea cookie dough with dates in it and some really dark chocolate chips in there.

Dr. Casey Means: At dinner parties, I’ll sometimes serve a really fancy chia pudding. Chia has tons of fiber and protein and fat, very little carbohydrates, but I’ll do some berries in a coconut cocoa chia pudding. These are just all things I know that are delicious, but do not spike my blood sugar. Finding some of those interesting alternatives. Now, in our family actually our favorite birthday cake is almond and cashew flour cake with a coconut cream frosting. It’s a grain-free, nut-based flour sweetened with a couple of dates. Some people will choose to sweeten with something like allulose or monk fruit, which are more of the natural, not Nutra sweeteners, which I tend to avoid, but yeah. Kind of getting creative and figuring some alternatives that are delicious, but those are some of the ways I’d probably approach your question.

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Jason Wachob: I love this idea of avoid the naked dessert where it’s just pure sugar and carbs, no fat, no protein. What I found in this process when I was doing all of my experiments, and this was a huge win for me, chocolate and peanut better, the magic combination of chocolate and peanut butter, I basically had no response. Neither did Colleen. I was like, “This is amazing.” Chocolate and peanut butter were making the case for chocolate and peanut butter, so I could enjoy my peanut butter quinoa cups from our friend Michael Bronner at Unreal. It’s like chocolate and peanut butter, I could do this all day. This is huge. No glucose response for me.

Jason Wachob: With regards to food, I’m curious because what’s good about personalization is it’s personalized and we’re all unique individuals. We all have unique responses. I’m curious. You have access to all this data. What are some foods… I’m sure if someone just has a “naked donut,” I don’t care what’s going on, I’m sure they’re going to get a glucose spike. I think safe to say that, correct?

Dr. Casey Means: It depends on the person and the donut, I would say, but yes, I would assume with that because it’s mostly… It’s carb forward. I would say that’s probably likely, although I have discovered what are called Glonuts, which are a almond-flour donut. That’s my new go to, but yeah, donuts are probably a spike.

Jason Wachob: So donuts, we’ll just say your Dunkin Donuts probably going to spike everyone.

Dr. Casey Means: Right.

Jason Wachob: I’m curious, are there certain foods where you found wildly different responses, where people over here have no response, where people over here have a significant response. I’m curious, what are some of those foods where you see that?

Dr. Casey Means: The first thing I would say is that we have found a lot of foods in our data set that are surprising to us that are some of the worst glucose spikers in the sense that they are the two 40 worst scoring foods, but they actually are typically thought of as kind of healthy foods. One of the biggest spikers in our data set is grapes. Who knew? Grapes. A lot of fruits, minimal spikers, but grapes seem to be gigantic. I think this probably has to do with the fact that grapes have very little fiber and grapes are often eaten totally on their own.

Dr. Casey Means: You don’t often chop up grapes and put it in yogurt. You just usually pop them in. I think that lack of pairing makes it more problematic. Probably a good thing to eat on a charcuterie board, where there’s nuts and cheese and other things. That would probably be a safer way to eat them. We also saw one of our worst scoring foods in the whole Levels data set is oatmeal, which a lot of people think is a health food. A lot of doctors say, “Eat this for breakfast,” and the box says it’s heart healthy. We found really the opposite of that which is that it was one of our top 40 worst spiking foods.

Dr. Casey Means: We actually did an experiment at the company where several people ate just two packets of Quaker instant oatmeal. Me personally, I had a 70-point glucose rise, which is very large. I usually try to have less than a 30-point glucose rise after a meal. 70 will create a big spike and crash. I think this one is really an interesting one because it really shows how personal tracking and understanding your personal data with a glucose monitor could really potentially change the food industry in terms of how we market foods and what we could put on packages because that box says, “Good source of whole grains, heart healthy,” but there is no question that for my body, with a 70-point glucose rise, that is not heart healthy for me. It’s not.

Jason Wachob: Well, you’ve got to add some peanut better to it.

Dr. Casey Means: Yeah, exactly.

Jason Wachob: Peanut butter and chocolate.

Dr. Casey Means: Well, some raw cocoa powder and some almond butter and some chia seeds and some walnuts could definitely change that response. We also see the the less processed the oats, the better people do. Steel cut oats or even groats, which are like really chewy, those are going to often do better for people, but just regular all comer oatmeal tends to be something that spikes a lot of people. Again, not for everyone, but when we’re looking at the entire data set.

Dr. Casey Means: I’ve definitely met people who were like, “Oh no, I had instant oats and it didn’t do anything.” One that’s interesting… Don’t have any hard data on this, but it’s more anecdotal… is that beans tend to affect different people very differently. I’ve been plant based for a few years. I can eat a can of beans, which is about four servings, and have no glucose response. Often I’ll be putting a little bit of tahini or something like that on it, so there is fat, but there are other people who eat beans and spike through the roof. They are a no no on a keto diet, but they’re actually fine for me on a keto diet because they don’t spike my glucose. They don’t kick me out of ketosis.

Dr. Casey Means: Something interesting that I’ve heard from a few people is that… Stepping back, I personally think the reason for this is microbiome related. In this study that was done about five years ago… Really fascinating study in the Journal Cell, it was called Personalized Nutrition by Prediction of Glycemic Responses. What they did is they took 800 people without diabetes, otherwise healthy, no diagnosed metabolic issue and they put continuous glucose monitors on them and then they gave them standardized meals that were all the same in terms of the composition.

Dr. Casey Means: You would think that they would all respond exactly the same because all the meals had the same number of carbohydrates in them, but what they actually found was that people responded all across the board from no spike to huge spikes. Then they looked at essentially all the factors in the people’s bodies that seemed to lead to that, to predict what their response would be. The biggest one they found was microbiome composition. It seemed to dictate how people responded, which is not surprising. The microbiome are our first pass on food. They’re the ones who are going to break down some of those early carbohydrates before it actually goes into the body, but I tend to think that people who are used to eating lots of plants fiber probably have microbiomes that tend to process it a little bit more favorably.

Dr. Casey Means: Actually my co-founder, David, got very into fiber recently and started eating huge amounts of chia every morning before anything, just to get his fiber in. Over the course of the month, after eating all this fiber day after day, found that he no longer responded as much to beans. Lots more research that needs to happen there, but that’s one that we tend to see very variable responses that I think is pretty interesting. Those are some of the ones that we see. We see big spikes in our top 10. We published an article about top 10 most surprising foods that spike people.

Dr. Casey Means: Sushi was a big spiker in our data set, acai bowls and also really anything that had the word pho or ramen in it, pho or ramen. That one’s, I guess, not super surprising, but often people think soups are kind of lighter and what not. I think with those, you could really go into each of them and break down why this is happening, but really the pairing and bringing in less of the naked carbohydrate and more of the fat, protein and fiber can be helpful for really mitigating some of this stuff.

Dr. Casey Means: For sushi, I’ve actually switched completely to cauliflower rice sushi, which I make at home. It’s so easy and super delicious. Zero spike versus an 80-point spike if I eat regular sushi. Of course, I will still have sushi every once in a while at a great restaurant, but for the day-to-day, weekly meals at home, that’s a swap that can basically cause the spike to be gone. Little swaps you can do for all of these, but we write a lot about this on our blog because I think having just some ideas for how to mitigate some of these spikers can be really helpful.

Jason Wachob: What’s so interesting, just to build off what you were saying with beans and then your co-founder on fiber, if you’re having… Beans are great. Beans are less… I’m not talking to Dr. Gundry and going down the lectin rabbit hole, but beans are healthy. They’re a great source of iron. They’re great. If you have a significant response to beans, one, you could be eating too much, that’s another thing. I’ve found if the meal is just heavy, you’re going to get a response. Then to build off what you said earlier, I think this is interesting. It may not be your… This touches on the microbiome. Potentially the answer isn’t, “Hey, I need to avoid beans because it’s spiking my glucose.” The answer may be, “Maybe I need to eat more beans because this is good for me and I need to get my microbiome in a healthier place,” potentially.

Dr. Casey Means: Yeah, I think there’s something to that. I think what it really just draws attention to is that these are not static things where we just correspond the exact same every day of our life, throughout the course of our lives to the food. I do think it’s very dynamic. What’s interesting is that you can even see within your own body yourself responding differently to the same meal on two different days. Between Monday and Tuesday, you might have a totally different response to the same meal.

Dr. Casey Means: This really does come down to some of these other contextual lifestyle factors. If I get poor sleep, I’m going to spike more to the same food the next day. That’s really motivating for me because like you, I also wear the WHOOP and I track all this stuff. When you can see that I got six hours of sleep and now I’m baseline 10 points higher than I was on the day when I got eight hours of sleep, it is hyper motivating to me to prioritize my sleep. I’m really seeing that connection.

Dr. Casey Means: We actually just did a study with WHOOP. We’ll be putting out the results shortly. We looked at correlations between metabolic score, which is a Levels marker, and the WHOOP recovery score. There does seem to be a relationship between recovery score and metabolic score, so really dialing into some of that stuff and realizing that we are dynamic not only person to person, but also day to day in our own lives. Thinking about that bigger picture in context I think is really empowering because it allows us to have multiple levers to pull when it comes to keeping our glucose more stable and metabolic health on point. It’s not just one thing you have to commit to to be that healthiest version of yourself. There are many different areas that we could tap into. You don’t have to have all of them perfect, but you can make sure that you’re at least getting a few of these things dialed in each day.

Jason Wachob: What about coffee? My favorite.

Dr. Casey Means: Coffee is a really interesting one. There’s sort of two parts to this. One is that caffeine does appear to call a glucose rise acutely, and this is thought to be in part because caffeine creates like a cortisol catecholamine response, which is sort of a stress response in the body. Any stressor in the body is actually going to tell the liver to break down, so if it’s stored glucose, we have a little bit of stored glucose in the liver, sort of our short-term quick energy source, and stress is going to cause your liver to break down some of that glucose, so you have this rapid influx of glucose in the body to feed your muscles and essentially escape whatever threat is causing the stress.

Dr. Casey Means: You can imagine if you’re being chased by a lion, you’d have a stress response, your liver would break down some glucose to feed the muscles, you can run away. That is a little bit what’s happening when caffeine enters the body so glucose can go up after a cup of coffee at a café, but in the long run, it appears that people who drink a moderate amount of coffee tend to actually have better metabolic health over the long term. I think this is in part because of all the antioxidant components that we find in food, the polyphenols and what not, which tend to be protective of our mitochondria, our energy producing factors in the cell, and actually protect them from some of that oxidative stress that is really at the root cause of metabolic dysfunction. So short term, may see a little bit of a glucose bump, long term, a small to moderate amount of coffee over the lifetime does not seem to be detrimental to metabolic health.

Jason Wachob: For me, it was interesting. I love coffee. I start with two double espressos in the morning and then I get a black coffee on the way to work. Then I’ll do an espresso in the afternoon. I’m also six foot seven, 200 plus pounds. I’m not an average-sized human, and it’s black. I don’t put anything in it. My response was negligible. Nothing.

Dr. Casey Means: Wow. Very interesting.

Jason Wachob: Then I was like, “I’m done with the test. I’m done with Levels.” I was like, “That’s it. That’s all… I’m so happy.

Dr. Casey Means: Keep drinking the coffee. Keep drinking it.

Jason Wachob: Chocolate, peanut butter and coffee, I’m good.

Dr. Casey Means: We’re set. Love Level.

Jason Wachob: We’re set. We’ll all good. We’re all good. I am curious, touching on beverages, alcohol, what role does alcohol play? I did some fun experiments on frozen margaritas last summer, which I think we all know what the result of that would be. Nonetheless, I still did very thorough experimenting. What role does alcohol play?

Dr. Casey Means: Alcohol has a really fascinating effect on glucose levels. It’s worth people knowing about because it’s pretty counterintuitive. Straight alcohol, a spirit like a hard alcohol or even beer, no mixers, no sweet additions will often cause glucose to actually decrease on the glucose monitor. For people who are drinking wine or hard alcohol like a martini with a meal, they’ll often see that their response to the meal is lower than it would have been, what they expected or what it would have been without alcohol.

Dr. Casey Means: The reason for this is because of alcohol’s effect on the liver. It’s not necessarily… This is not a hack to use to keep glucose levels lower because it’s a very different physiologic response, but what’s happening is that the body basically has like three ways of putting glucose into the blood stream. The body needs there to be a certain amount of glucose in the blood stream at all time to keep us safe essentially. You don’t want it to be too high. You don’t want it to be too low, so the body has all these redundant mechanisms towards keeping it in a fairly tight range. One of those is through circulating glucose, which is like what we’ve eaten that’s entering into the blood stream by the digestive tract.

Dr. Casey Means: Then we’ve got stored glucose in the liver called glycogen, which is the short-term, quick access bank of glucose that could be broken down when needed, but then the liver can also make new glucose, which is called gluconeogenesis, which is made from other substrates in the body like lactate. It can actually just produce new glucose. There’s all these different ways. Alcohol blocks that third pathway. It blocks gluconeogenesis, so one of these three faucets of getting glucose into the blood stream is essentially blocked by alcohol. So you’re going to see that… what it looks like in the blood stream is going to be lower.

Dr. Casey Means: The interesting thing about alcohol is that the epidemiologic research of large populations shows that people who drink about one drink on average per day tend to have the best metabolic health. People who drink zero actually seem to have higher risk of type two diabetes. People who drink about one drink have the lower risk. Then it goes up essentially exponentially after that. It’s called a J-shaped curve. It’s highest risk and zero, then dips and then goes higher as you go above one to two depending on gender. It’s really quite interesting… Not a reason to take up drinking one drink at each meal, one drink a day, but it’s pretty interesting in the literature.

Jason Wachob: Obviously… When I did my test, it was a frozen margarita, so obviously lots of sugar, agave, I got a spike, but if I’m understanding correctly, if you’re going to have a glass of wine, a beer, a martini, a shot of tequila for dinner, you’re probably good.

Dr. Casey Means: Yeah, certainly those would be better options than a fancy mixed drink with a bunch of sweeteners, simple syrup and what not or a bunch of fruit juice. Sticking with making sure it’s being consumed with food and then really avoiding those extra sweeteners is the way to go. For people who are on a ketogenic diet, they’re already ultra low carb and they’re glycogen stores in the liver are already lower and they’re probably on the lower end of circulating glucose.

Dr. Casey Means: These are people who are need to definitely be more cognizant of when they’re drinking and making sure they’re drinking with food and ideally with a little bit more carbohydrates onboard because if you think about people who are in that state, already low glycogen, low carbohydrates coming in through digestion. They’re relying on gluconeogenesis to get the glucose in their blood stream. Blocking that pathway can actually be dangerous. People who have been fasting for a long time or have been on a ketogenic diet for a long time need to be extra careful with alcohol consumption because you’re blocking essentially a core redundant pathway to get glucose into the blood stream. So just something to be cognizant. I would never drink alcohol when I’m a 36-hour fast or something like that.

Jason Wachob: Common sense. I love coming off fasts and going straight to a martini says nobody. Or I’m sure someone said that, but not good obviously. I know there’s a huge element of personalization, but I’m curious with all the data you have, what are the staples of a good breakfast, a good lunch, of a good dinner. Dessert we’ve talked about ad nauseum. You’ve got some great recipes and I’m just all about chocolate and peanut butter, but what are the staples of a good breakfast, lunch and dinner, if you could walk us through.

Dr. Casey Means: Absolutely, I think breakfast is the key one that I would focus on optimizing if you’re new to this whole glucose metabolism eating space. The biggest shift I would say is switching from a sweet breakfast to a savory breakfast. That is one of the best life hacks I think that you can do. Sweet breakfast, I’d include things like pastries, donuts on a weekday, pancakes, cereal, things that are basically based on refined grains.

Dr. Casey Means: Savory, I’m thinking about things like a free range egg scramble with avocado and some sauteed greens. That would be a really good breakfast, maybe some smoked salmon with eggs and some greens. I love to do a tofu scramble with some nutritional yeast and a bunch of veggies, maybe even some beans. It’s really about leaning into that savory, lower carbohydrate, less sweet. Then if you are someone who’s loved the oatmeal or the pancakes or whatever and you do want something sweet, I think the best option is chia pudding with some berries and some almond butter and some walnuts.

Dr. Casey Means: Chia pudding is an alternative to cereal or oatmeal is an awesome life hack. chia is such an amazing super food. It’s got so much fiber and protein in just two tablespoons. You basically just mix it with some milk or unsweetened non dairy milk, put it in the fridge overnight, maybe put some cocoa. If you want it a little sweeter, you could add some allulose or monk fruit, which aren’t going to affect blood sugar and then add some berries like some blackberries, raspberries, blueberries and then some nice little toppings, almond butter or whatever. That tends to really not spike people, but still gives you that bowl of delicious sort of sweet goodness.

Dr. Casey Means: When I’m thinking about really any meal, I’m thinking about what components I want to get into my body for optimal cellular health. For me, that is that with almost every meal, I’m focusing mostly on micronutrients. I want to get as many micronutrients as possible, so that means plants. It means colorful foods that come from the earth. That’s really one of my top priorities. I’m also thinking about omega-3s in every meal. I want to get those omega-3 fats that are going to build healthy cell membranes and be anti inflammatory. I want fiber to feed my microbiome, which I know is going to impact all aspects of my biology.

Dr. Casey Means: I want some healthy sources of protein. I want some whole-food fats so things like unrefined fat sources like a fish or a tahini or nuts or nut butters or what not. I think more in modular ways when I’m thinking about building a meal and less about the exact dish. I think when you think that way, it frees you up to… You don’t necessarily have to eat a breakfast food. You can eat something that includes components that you like that gives you those basic building blocks that are going to help with your core biology.

Dr. Casey Means: Those are some of the ideas for breakfast. Another thing I just want to plug. If you are someone who’s like, “I love pancakes. I’m not going to get away from pancakes or pastries,” there’s so many great non-grain alternatives these days. There’s amazing keto pancakes on the market that are made with tiger nut flour, coconut flour, almond flour, and they taste delicious. You can put blueberries in them and what not and instead of using syrup, use almond butter or just something a little bit different.

Dr. Casey Means: Those are some breakfast ideas and just getting in the mindset of what if breakfast actually looked more like dinner? If you’re someone who… Just moving away from the box of what breakfast has to look like. All of those things that I just mentioned are traditional breakfast type ideas, but also why not just have salmon and a salad for breakfast? It can really be anything you want, but the best thing you want to avoid is a big glucose spike because that’ll just start your day off poorly.

Jason Wachob: Another one which I’ll throw in, it used to be the case that yogurt would be terrible, there’d be so much sugar, but that’s also another alternative. There are yogurts out there that have decent amount of protein. They’ve got great healthy fat. They’re grass fed and there’s low sugar. That’s actually another alternative I was going to throw out as well.

Dr. Casey Means: Totally. I love Forager organic cashew yogurt, throw a bunch of chia seeds, walnuts, almond butter, some berries on there. That’s a great low spiking breakfast. I love that idea.

Jason Wachob: Then what about for lunch?

Dr. Casey Means: For lunch, this is where I think swaps can be really helpful. Let’s think about a typical lunch, sandwich, a wrap or maybe sushi, just a lot of things that are going to have big glucose spiking bombs in there like bread and tortillas, maybe tacos. Really there’s so many ways… Often the meals will have a lot of good stuff in them. A sandwich might have vegetables and hummus and some nice protein in there, but then it’s the bread or the wrap or whatever’s around it that essentially drives the glucose spike.

Dr. Casey Means: I’m always looking at meals as like, “Okay, what are the good components and then what can we swap out to make the collateral damage of this meal much, much lower?” Get the good stuff, take out the bad stuff. Even with a lot of salads that people might be having for lunch, they might have 15 really great things in them, but then there’s croutons and a big piece of bread on the side or dried cranberries that are covered in sugar or raisins or a dressing with a bunch of refined seed oils in it which are not going to be great for our metabolic processes.

Dr. Casey Means: Just really trying to identify what are the things that are the culprits in terms of the glucose spike and then just either take them out or swap them. That’s the framework I would approach lunch with. If it’s a wrap, think about wrap alternatives. There are now grain-free tortillas like the Siete brand. They actually have now burrito sized cashew or almond-flour tortillas. Those actually still have cassava flour in them, which is a root vegetable which does spike some people, but they’re certainly going to be better than a flour or a whole wheat tortilla.

Dr. Casey Means: You can also use collard greens. I make a lot of my wraps now in collard greens. They are so delicious. You can use butter lettuce for taco. You can use shaved jicama for taco shells. Trader Joe’s actually sells now jicama tortillas that are just straight shaved jicama that you can use as a tortilla shell. I’ve made nori-wrap burritos, which are made of large seaweed sheets that you can just buy at Whole Foods and use them in place of a tortilla. There’s lots of ways to get the same thing that you love, but without the glucose spike.

Dr. Casey Means: The same is true of bread. Use some ice berg lettuce as your burger bun. Use nori as a burger bun. There’s great, great… And of course grain-free breads. You want to use nut-flour breads that are going to essentially have very little carbohydrates like an almond flour bread or something like that. You want to be wary of a lot of the things out there that say grain free because a lot of them are just going to replace them with other carbohydrates like rice or oat flour, but the nut-based ones tend to be quite low carb.

Jason Wachob: Can we stay on bread for a moment? If you’re going to… You’ve got the keto breads. You’ve got the grain free. I just want to stay on bread. Sourdough, for example, a lot of people would say that, “Hey, if you’re going to have bread, sourdough’s probably the best.” Then in terms of blood sugar, if you’re going to have “regular bread,” is there an option that is better? Is it rye? Is it sourdough? If you’re going to get a great… Let’s just say. It’s not like Wonder Bread, it’s a great bread from your local farmer’s market. It’s organic. There’s not a lot of processed crap in it. Is it rye? Is it sourdough? Is it something else that is the better option?

Dr. Casey Means: I don’t have a good answer to that question to be honest. We haven’t looked into this deeply in our data set, although we have seen a lot of people say that they don’t spike as high on sourdough, so that’s definitely one thing to keep in mind, but in terms of rye or pumpernickel or sourdough, I don’t have a definite answer for that. One thing that we know is super clear is that the less refined the flour is the better. White flour is just ultra refined. You’ve taken away all the fiber and a lot of the nutrients. That’s usually going to cause the biggest glucose spike, but more of the whole grain… Basically, the breads that have a bit more oomph to them when you bite into them, a little bit chewier, a little bit rougher, they’re probably going to tend to be lower in terms of your glycemic response, but ultimately, it’s really about testing it.

Jason Wachob: How do you think about… I wear all these trackers. You wear a lot of trackers. How do you think about the balance between data and actionable insights and TMI and maybe taking the joy out of life, out of meals with loved ones, out of celebrations just in general? I’ve struggled with this from time to time. Information is empowerment, but sometimes it’s just too much. Got to park it. I had a great psychiatrist on here, Judd Brewer, who specializes in addiction. This is a great line, I’ll never forget. He’s like, “If you’re wearing your Fitbit and doing laps around your house at night to make sure you get enough steps, you’ve got a problem.”

Dr. Casey Means: That’s interesting. I have to say I think I disagree with that.

Jason Wachob: Walking in circles.

Dr. Casey Means: I’ve done that and I love it. One of my favorite memories of my trip to Japan was I went with a girl who’s done like 30 marathons. She’s been a great running inspiration for me. We walked around the plane probably like 50 times. I think we did get to 10,000 steps on the airplane. We made a bunch of friends doing it. A bunch of people joined in. The flight attendants loved it. It was fun. It was about community. It was about being healthy together and not sitting for 15 hours.

Jason Wachob: That’s good because you can get a pulmonary embolism on a flight and there are lots of other good reasons why you need to walk around on a long flight, but…

Dr. Casey Means: Right. I totally understand the concept of we don’t want to take the joy out of life, but from what I’ve seen as a physician and just person living in this world, the number one thing that takes joy out of life is chronic illness and dying prematurely from chronic disease. I’m not saying trackers are the answer to that, but anything we can do to be empowered and take control of our health will ultimately, in my opinion, breed more joy over the long term, both mental and physical.

Dr. Casey Means: The chronic diseases we’re facing in our country today are mostly preventable. Being born in the United States, there is more… Just following the normal culture, doing what’s normal in our country, you are more likely than not going to develop a chronic disease, be on multiple medications and die earlier than you needed to. I’m not in anyway trying to fear monger, but that’s the reality of American life and I’ve seen it first hand in the hospitals, day in and day out. The reason I’m doing what I’m doing at Levels is because I believe that people need to understand their bodies better if we’re going to be able to face the monumental challenges we’re facing living in the modern Western world with what is put in front of us as normal, which is eating, most of our calories from industrialized, processed foods, cutting short on sleep, just being addicted to performance and stress and who can work the longest and the hardest and this and that and sitting all day.

Dr. Casey Means: That’s just normal. If you go to school as a child in America, you’re going to be sitting all day and being fed food that is going to hurt you. School lunches in the average school are abysmal. It’s really about empowerment in my opinion, giving people information so they can make better choices. Any tool is going to have potentially positive things and it’s going to have potentially… Any tool can cause benefit and can cause harm. What we’re doing at Levels is trying to really strike that balance towards benefit, making it not something that people feel addicted to or shamed by or it’s the thing on their shoulder telling them that they’re making bad decisions, but really just helping to empower people to understand what’s going on, not be scared of the data, but learn how to potentially make small changes that will ultimately improve their life.

Dr. Casey Means: That’s really the core of why I’m doing what I’m doing is to empower people with their own information so that they can make better choices and ultimately live healthier happier lives, but I think in terms of the bigger picture of wearables, the wearables that I think are most effective are the ones that really give you actionable information. As you said, actionable is key. Data without interpretation or an understanding of how to do better I think can be where it’s really frustrating. I think weight on a scale is an example of that.

Dr. Casey Means: You see it, it may be a pound higher than yesterday. What do you do with that information? There’s a million options. You don’t know what to do and it can be really disempowering and frustrating. Whereas one of the things I love about WHOOP in the monthly reports because I’ve logged in my journal on WHOOP every morning, it actually tells me whether my magnesium that I took improved or harmed my recovery score. That was actually one of the big surprises for me. I was taking my magnesium right before bed, and it told me that that was actually associated with a lower recovery score for me when I took the magnesium. Hard to know if that’s totally right, but everyone thinks magnesium before bed is better for sleep.

Dr. Casey Means: In my case, over the course of many months, it seemed to be associated with not positive recovery score so I stopped doing it and that was an actionable change that I could make. There are also ones that were very obvious like when I drink alcohol, my recovery score completely plummets, so I have been more selective about when I choose to drink and certainly if I have something important to do the next day and I really need to be super sharp, WHOOP has helped me understand that it’s not a good option for me to drink more than one drink the night before or something like that because my recovery score is going to be bad and I’ve learned to associate my recovery score with not feeling as mentally sharp.

Dr. Casey Means: That to me is very, very useful information. I see Levels in a similar vein which is understanding which foods are affecting your glucose and then learning alternatives and other lifestyle habits to mitigate that. Then a third wearable that I’ve found really affective for me is actually a device that you put right on your chest that measures heart rate variability. It’s called Lief Therapeutics and it’s like a little EKG. It takes you through meditations that show you in real time how your heart-rate variability is changing in a way that WHOOP and Aura and others are not doing in the real time.

Dr. Casey Means: What I’ve learned from that device is that when I meditate in a particular way with my breath, I can totally change my heart-rate variability in real time. To me, that’s like nothing but empowering, and you could say, “Well, isn’t it scary or bothersome when you see the data that your heart arrhythmia is low when you start meditation?” It’s like sure, you could look at any of this as like, “Isn’t this scary or disempowering to see where you’re starting, but that comes down to more of a growth mindset.” That is more something that I think people have to show up to the wearables with and also the software that goes along with the wearables can help encourage a growth mindset. That’s really where I like to see companies go, help people understand the room for improvement and how exactly to do it.

Jason Wachob: Regarding your magnesium comment, we’re going to have to give you our sleep support cross product and we’ll do a test. When I see you, we’re going to give their product and we’ll do a test.

Dr. Casey Means: Love to try it because I was doing just 800 milligrams straight magnesium.

Jason Wachob: That’s a lot.

Dr. Casey Means: It’s a lot.

Jason Wachob: That’s a lot.

Dr. Casey Means: I think I may have just been like shocking.

Jason Wachob: That’s a lot. Ours is a combination and this is all rooted, developed from Colleen’s chronic pretty bad sleeping. We do 120 milligrams of bisglycinate plus 225 of jujube, which is like the magic and then 100 of pharmaGABA. It’s that magic combination, which is what we say is the nudge. It’s the gentle nudge that you need, but to be continued. When we see you, we’ll give it to you, and we’ll do a test. Casey, thank you so much.

Dr. Casey Means: Thank you so much for having me on, Jason.