Discover YOUR Optimal Diet and Lifestyle Through Data: Dr Casey Means on PYP 443

Many people wake up after a poor night of sleep, drink an extra cup of coffee, eat a package of instant oatmeal, and sit at a desk all day. Sound familiar? Unfortunately, what we consider to be simple, everyday, or even healthy routines are sometimes harmful for our glucose levels. And when our glucose levels are out of whack, our weight, energy, and overall health can suffer dramatically over time. Dr. Casey Means spoke with host Howard Jacobson on the Plant Yourself podcast, where she explained how small personalized choices using Levels CGM technology can impact both us personally, and our society as a whole.

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out the Plant Yourself Podcast
• Connect with Howard Jacobson on LinkedIn

03:22 – Solving the mystery of the perfect diet

With a continuous glucose monitor, you can obtain real time data on how your food choices are affecting your body, empowering you to eat the foods that work best.

“Simply put, Levels is a program that breaks the mystery of trying to guess what the perfect diet is. And we do this by empowering people with real-time, continuous metabolic data, to understand how food is affecting their individual bodies. So our members receive a continuous glucose monitor. This is a tiny wearable sensor that goes on the back of the arm and it tracks our blood sugar in real-time. And it actually takes a reading of your blood sugar every 15 minutes and sends that information to your smartphone. And then we build software that makes that data stream really interpretable. So you can really learn exactly what foods and what lifestyle activities are right for your body. You can think of it as a Fitbit for glucose, but there are a lot of loud voices in the nutrition space these days. There are people saying you’ve gotta be carnivore, you’ve gotta be vegan, you’ve gotta be keto. But the reality is that there’s probably no one size fits all diet for everyone.”

05:05 – The relationship between choice and action

When someone takes an action and gets quick feedback on how it’s affecting them, it becomes very easy to modify behavior based on that feedback.

“So open-loop systems are where you make a choice and then it is very unclear what the outcome is. It’s very hard to attribute a one-to-one relationship between a choice and an action. It is in many cases like life, but if you look at behavior change research, there’s a suggestion that the closer you can link an action with a reaction, that actually is very useful for us in terms of categorizing and helping us understand the implications of what we’re doing. So for instance, you get on the treadmill and you have a heart rate monitor on and you see that your heart rate goes up to 170. That is a clear indication that you’re at probably the strenuous end of your workout. You’re pushing almost as hard as you can, so it takes away the subjectivity of life. Am I going hard? Is this enough? We should definitely listen to our bodies and what our bodies are saying. Sometimes that little extra push of knowing where we are objectively can be very helpful in understanding. We’ve never really had something like that for nutrition.”

06:20 – Why we should close the loop early

When someone has a bad night of sleep, they compensate by having extra coffee. But when that happens night after night, your body can go into a downward spiral.

“We’ve had sleep monitors that tell us when we wake up, you had this much deep sleep, this much REM, this is the time that you were in bed, this is the time that you were actually asleep, and that is helpful closed-loop feedback. People could say, Oh, but you just can know whether you’re tired or not. And why not just focus on that? But the reality is if we get a bad night’s sleep, we might be fine. The next day we compensate, we have an extra cup of coffee. We kind of push through. But if that happens night after night after night, you will end up having health problems. And so having that tracking and closing that loop early in each day can help you just make slightly different decisions the next day before maybe your body catches up and realizes subjectively that you’re actually having a problem. So it’s like logging into your bank account and seeing a really low balance before the moving truck comes up to repossess your furniture. Right? Exactly. So it’s nice to have that for nutrition.”

07:31 – Heart healthy foods are not for everyone

Some foods, while fiber-rich and considered heart healthy, can cause glucose spikes for individuals with pre-diabetic levels.

“A lot of people have a high refined carb, high sugar breakfast because those are often marketed as normal things, like cereal and a pastry or even instant oatmeal. And so you’ll see people who have their instant oatmeal with a continuous glucose monitor on and they see their glucose skyrocket up to potentially pre-diabetic or diabetic levels. When that happens, it usually comes crashing down afterward, because your body compensates to get all that glucose out of the bloodstream and it can crash. And that’s a process called a hyperglycemic spike and a reactive hypoglycemia episode. And a lot of people will have been eating this breakfast for years since the box says it’s heart-healthy and the box says it’s got a good source of fiber. So they think it’s healthy, but for their particular body, it’s actually not. Those types of spikes are never healthy. And then they realize, oh, every morning around 11:00 AM. I feel like I need a second cup of coffee and I feel tired and I’ve always just thought that it’s my mid-morning slump. And that’s just what happens. And my coffee is not strong enough and I’m not getting enough sleep. So when you can actually attribute in action to a reaction, the reaction being that you had a spike and you subjectively felt crappy and realize and not misattribute it to actually say this was related to the food I ate and then change that. That’s really empowering. And that closed-loop feedback between an action objective data and a subjective experience, I think is really at the core of sustainable behavior change.”

10:29 – It’s not what you eat, but what you eat it with

Eating even healthy food at the wrong time can be detrimental. Even carbs, when paired with protein or fat, can be healthy, especially if you go for a walk instead of sitting on the couch after eating.

“So eating what I would call a naked carb, which is just a carbohydrate source all by itself, like a big plate of sweet potato or a bunch of fruit altogether, those are healthy foods, unquestionably. They have many compounds in them that are going to be very useful for our health. But when eaten alone, or at the wrong time of the day, or in the context of being very sedentary that day, you could have a completely different response. And if you pair them differently, for instance, if you pair the carbohydrate with a protein, fat, or fiber source, or if you make sure that when you’re eating your higher carb foods, you’re doing on a day when you are very active, when you’re moving around, when you’re stimulating muscle stimulated glucose uptake, it’s going to give a totally different response to an apple when you’ve been sitting on the couch all day, versus when you’ve been walking around and moving during the day. So having that feedback with a glucose monitor can help you tweak even a very, very generally healthy diet to make sure you’re not getting the collateral damage.”

13:05 – What else causes glucose spikes?

Sleep deprivation, a high-stress environment, lack of physical exercise, environmental toxins, lack of micronutrients in the microbiome, bad food pairings, and bad food timing can also cause glucose spikes.

“It is not just food that leads to our glucose change in the body. Glucose is actually the centralizing metric, around it is food, food pairing, food timing, and our stress management. When we’re stressed, our liver actually produces glucose to help feed us in a time of stress. But because most of our stresses these days are psychological in nature, we actually don’t need that glucose in the bloodstream. It’s not like we’re being chased by a lion. That’s very maladaptive. Similarly, sleep deprivation causes an increase in cortisol levels in the blood and actually can cause us to get our glucose high, and lack of exercise, of course, is going to change our insulin sensitivity. And even one workout can improve our insulin sensitivity that day and the next day. And so you think about sleep, stress management, exercise, food, food pairing, food timing, all these things make a difference. Those are just the behavioral choices. There’s also some of the other factors that go into it, like micronutrient status in our microbiome and our environmental toxins.”

16:22 – The boomerang effect

In the US, the food culture, lifestyle, food marketing, addiction to technology, and sedentary lifestyle has led to 88% of the adult population being metabolically unhealthy. Josh hopes that Levels’ technology will bring people back to more wholesome ways of living.

“The food culture, the lifestyle culture, the food marketing, what is put in stores and marketed as healthy, like we’re kind of up a creek here. And I don’t love technology either, to be honest, I’d like to be in the garden with my hands deep in the dirt and just like taking hikes and camping. But the reality is like we are in a really bad position, but given our culture and our marketing and having a little bit of recourse in that when 88% of the country is metabolically dysfunctional is what I am passionate about. And I actually think we’re going to see a boomerang effect where technology is going to actually help bring us back to body awareness, to get close to the earth. Because when you actually wear one of these things, and I’ve been wearing it for 18 months while building this company, you realize, Oh, it’s all the basics. It’s like really getting back to ancestral living. That is what is going to be healthy for my body. It’s walking, it’s being in the forest, it’s managing my stress, it’s getting good sleep, it’s moving all throughout the day. The longer-term thing, it’s getting my microbiome on point, which means being close to the earth, eating food near to its original source, getting the bacteria in your body, its micro micronutrients, which means whole foods, it means plants. My hope is that we will see this boomerang effect where this data wakes people up and then gets back to a lot of the traditional things that are so important for us.”

20:23 – Changing the pleasure equation

A lot of food products that are marketed as healthy are causing insulin resistance in consumers. Buying these products tricks people into thinking they made a healthy choice, but they could potentially be contributing to anxiety and depression.

“We think that something is bringing us pleasure now that the dopaminergic reward system in the brain is very, very powerful and very, very primal. And these foods are marketed as potentially healthy, and these processed foods are filling our grocery stores. They are designed to take people to their bliss point in terms of their reward circuitry, to literally hijack these primal evolutionary drives in our body to make people purchase and consume more of these foods and think they’re making them happy when in fact blood sugar spikes and ultimately insulin-resistant metabolic disease actually are significantly associated with anxiety and depression. These foods don’t make us happy long-term and we get decreasing reward when we eat them frequently. These are receptors in our brain change and we actually need more of them to get the same amount of pleasure. The thought is with this type of technology in the face of these realities, how do you actually change that pleasure equation?”

27:02 – The secret reason people don’t lose weight

The currently accepted recommendation in the US is to eat six meals a day. This often stops even those who are eating healthy from losing weight. With GCM, people can see what is actually healthy for them and tweak their diet accordingly.

“I’ve had so many conversations with patients, just like you said, where it’s just like, I’m so confused, I don’t know why things aren’t working. Like for instance, with weight loss, we know that to burn fat, you have to keep your insulin down. Insulin blocks fat burning. And in our culture, insulin is essentially always high because insulin is released after the blood glucose rises to help take glucose into the cells. And we’ve been told we should eat six small meals a day. And the majority of calories that people are getting in the US come from refined sugar and carbohydrates. So we never really have a moment during the day, except maybe at the end of sleep where our insulin actually comes down enough to burn fat. So imagine then someone’s eating a pretty healthy diet, but they’re not losing weight. And they’re very confused and it’s very frustrating and it creates tension between the doctor and the patient because the doctor’s recommendations aren’t working and all of this stuff happens. Now imagine putting a glucose monitor on that person and they see that like all this stuff they’re eating, that they thought was healthy actually is causing these low blood glucose spikes throughout the day. And they just need to make some tweaks to get that lower.”

31:20 – Looking at our environment through the lens of metabolic health

Current farming and animal husbandry practices are creating metabolic disruptors in food and hurting microbial diversity in the body. For better metabolic health, it’s critical to look at how these choices are affecting the environment.

“The awesome thing is that when people’s metabolic health is optimal, it’s associated with making choices that are good for the environment. And so what I mean by that is, pesticides, for instance, hurt our microbiome and they actually are metabolic disruptors. So if we really were able to take this and get people to really think holistically about their diet, they’d be eating foods with no pesticides chemicals on them. Additionally, antibiotics kill our microbiome, hurt our microbial diversity, and that is going to affect our metabolic health. If people are eating meat that takes antibiotic injected animals and milk off the table. So now we’re getting to better animal raising practices. We also know that micronutrients are made in large part by the bacteria in the soil. And right now we’re having a huge crisis environmentally with our soil depletion. Our soil is turning into sterile dirt and our food is becoming less nutrient-dense because of that. That’s because of our terrible monocropping pesticide-riddled farming practices, and the way our farm bill in the US actually promotes this type of unsustainable farming. If we think through the lens of metabolic health, we need those nutrients, we need the bacteria. This is going to be on the individual day-to-day level. This is not like what our app is telling people. But if you think the bigger picture to actually get to the end goal that you want with metabolic health, you actually have to make the choices that are better for the environment.”

38:18 – Why we need shorter feedback loops

Most people get feedback on their health and fitness when they go to a doctor once a year. The advice to eat healthy and exercise, once a year, does not help anyone stay healthy throughout the year.

“I think there are so many different ways to approach the issue and all of them need to happen in parallel. But I think a part we should not forget is that people’s consumer decision-making, which is based on how they feel about themselves, what they understand about their bodies, what they want is going to drive a lot of changes. People will also demand different things from their doctors. If people are more aware of what’s happening right now, to know if you have a metabolic problem, sure you could look at the scale and if you’re overweight or obese, you almost certainly have some element of insulin resistance and probably have some underlying metabolic problem. You’re storing too much fat. That’s a metabolic problem. But for the average person, they’re not thinking that way. They’re waiting to go into the doctor’s office and have them tell them, oh, your fasting glucose is in the normal pre-diabetic or diabetic range. It’s crazy to me that we have tools these days that actually could tell us every day where we stand on that spectrum. And yet we’re still waiting for eight months, a year or two years to walk in and have this unveiling of something that is something we could have an impact on every single day. That to me is absolutely crazy.”

54:30 – How does a GCM feel?

The tracker is a small patch that is stuck on the arm. It sends hair-like filaments that are covered with glucose oxidase, which takes glucose and converts it to byproducts including hydrogen peroxide. That creates an electrical signal which is then tracked. It’s completely painless.

“You basically just forget it’s there. Oftentimes I’ll touch my arm and I’m like, do I have it on right now? But it’s the size of two quarters stacked on top of each other. So it’s very low profile and small, and there’s a four-millimeter, hair-like filament that comes out of it, like a little bit of fishing line, that actually does go under the skin. And so it’s actually put on with an applicator that does have a needle, which for whatever reason is 100% painless. You do not feel it going in. It pushes the little hair-like filament in and it takes like a millisecond or less. And no one feels it basically. It’s kind of incredible. It sits on your arm. There’s an adhesive on the bottom of those little quarters that sticks it to your arm for two weeks. All you see is the white quarter-sized thing on the back of your arm. And then underneath the skin, it’s a four-millimeter hair-like filament that is covered in an enzyme called glucose oxidase that takes glucose and converts it to byproducts that include hydrogen peroxide. And that hydrogen peroxide creates an electrical signal that is transmitted as the data. And then that gets transferred to your smartphone. It’s amazing. You can shower, you can work out, you can lay on it. It just lives there.”

Howard Jacobson: [00:00:00] Hey, Howard Jacobson here. Welcome to today’s Plant Yourself podcast. A quick reminder, this podcast is free for everyone and supported by patrons. So if you would like to find out about becoming a patron of the show and helping us out, helping defray the cost, helping to spread the message, you can do so at plantyourself.com/gift. Thanks so much and enjoy today’s episode.

I confess, when I was pitched this interview, as a medical doctor working for a medical device company that does continuous glucose monitoring, I thought, I can’t imagine anything more boring. And all I will say, is that not only was I pleasantly surprised, I was actually totally jolted out of my natural cynicism, about continuous glucose monitoring, about quantified life, about using high tech instead of simply eating a healthy whole foods plant based diet, that we know can be good for us and reverse most disease. But Dr. Casey Means got me so excited about this idea of continuous glucose monitor, even for me, who is not diabetic or pre-diabetic or worried about my blood glucose levels at all. She convinced me that maybe I should be, and maybe there’s something to be learned from a month of noticing what foods affect me in different ways. So I’ve been highly critical of this idea of bio-individuality because it’s been wielded as a weapon by people say, “Well, everybody eats differently therefore I should be carnivore, and you should be keto, and they should be Mediterranean. And the other person should be vegan.” And there’s all these different dietary patterns for human beings and they’re all equally valid, which is, of course, ridiculous. And it’s also true that we are different and that the way I process a potato or a banana might be different from the way you process a potato or a banana. And so I was throwing out a lot of baby with some bath water there. So in this conversation, Dr. Casey Means and I discuss why glucose monitoring could be important, why it could be an incredibly important predictor of a whole host of health outcomes. And also the implications, and this is kind of where I want to geek out, the implications of really fast objective feedback for changing behaviors. So I hope you enjoy this conversation as much as I do. And at the end, you can hear about if you want to try this for yourself. There’s a 60,000 person waiting list, but Dr. Means graciously gave me a link which will be in the show notes for today’s episode, which is plantyourself.com/fourfourthree, where you can skip that line if you are interested in trying this out for yourself. All right, without further ado, Dr. Casey Means, welcome to the Plant Yourself podcast.

Dr. Casey Means: [00:03:02] Thank you so much for having me, thrilled to be here.

Howard Jacobson: [00:03:05] Yeah, let’s get right into it. You’re, I don’t know if you’re the founder or co-founder or chief medical officer or all three.

Dr. Casey Means: [00:03:14] Two of those three. I am co-founder and chief medical officer of Levels.

Howard Jacobson: [00:03:18] So tell us about Levels.

Dr. Casey Means: [00:03:20] Yeah, absolutely. So, simply put, Levels is a program that breaks the mystery of trying to guess what the perfect diet is. And we do this by empowering people with real time, continuous metabolic data, to understand how food is affecting their individual bodies. So our company, sorry, our members receive a continuous glucose monitor. So this is a tiny wearable sensor that goes on the back of the arm and it tracks our blood sugar in real time. And it actually takes a reading of your blood sugar every 15 minutes and sends that information to your smartphone. And then we built a software that makes that data stream really interpretable. So you can really learn exactly what foods and what lifestyle activities are right for your body. So you can kind of think of it like a Fitbit for glucose. But there are a lot of loud voices in the nutrition space these days. There’s people saying, you’ve gotta be carnivore, you’ve gotta be vegan, you’ve gotta be keto. But the reality is that there’s probably no one size fits all diet for everyone. And what we do know is that people are healthier when their glucose is low and stable, and we are less happy, healthy when glucose is spiking all over the place. We know that that spikiness and high values after meals over time can lead people to have problems with regulating their blood sugar. And this is foundationally at the root of many, many, many chronic diseases that are associated with metabolic disease. So yeah, this is our product and we really are excited, because it’s actually the first time that anyone’s ever had closed loop data on nutrition. This is notoriously an open loop system where you can’t define –

Howard Jacobson: [00:05:02] Define what you mean by open and closed loops.

Dr. Casey Means: [00:05:05] Yeah. So open loop systems are where you make a choice and then it is very unclear what the outcome is. It’s very hard to attribute a one-to-one relationship between a choice and an action.

Howard Jacobson: [00:05:15] So that’s like life.

Dr. Casey Means: [00:05:18] It is in many cases like life, but if you look at behavior change research, there’s a suggestion that the closer you can link an action with a reaction, like a very small action with a temporal reaction, that actually is very useful for us in terms of categorizing and helping understand the implications of what we’re doing. So for instance, you get on the treadmill and you have a heart rate monitor on, and you see that your heart rate goes up to 170, that is a clear indication that you’re at, probably more of the strenuous end of your workout. You’re pushing almost as hard as you can, so it takes away the subjectivity of, well, am I going hard? Is this enough? And while we should definitely listen to our bodies and what our bodies are saying, sometimes that little extra push of knowing where we are objectively can be very helpful in understanding. We’ve never really had something like that for nutrition. We’ve had it for sleep as well, we’ve had sleep monitors that tell us when we wake up, you had this much deep sleep, this much REM, this is the time that you were in bed, this is the time that you were actually asleep. And that is helpful closed loop feedback. People could say, “Oh, but you just can know whether you’re tired or not.” and why not just focus on that? But the reality is, if we get a bad night’s sleep we might be fine, the next day we compensate, we have an extra cup of coffee, we push through. But if that happens night after night after night, you will end up having health problems. And so having that tracking and closing that loop early in each day can help you just make slightly different decisions the next day, before maybe your body catches up and realizes, subjectively, that you’re actually having a problem.

Howard Jacobson: [00:07:08] Yeah. It’s like logging on to your bank account and seeing a really low balance before the moving truck comes up to repossess your furniture.

Dr. Casey Means: [00:07:19] Right. Exactly, so it’s nice to have that for nutrition. You can imagine, an example, for instance, in a lot of people who have used continuous glucose monitoring, is breakfast. A lot of people have high carb, high refined carb, high refined sugar breakfast cause those are often marketed as normal, things like cereal and a pastry or even instant oatmeal. And so you’ll see people who have their instant oatmeal, with a continuous glucose monitor on, and they see their glucose skyrocket, up to potentially pre-diabetic or diabetic levels. And then, when that happens, it usually comes crashing down afterwards, cause your body compensates to get all that glucose out of the bloodstream and it can crash. And that’s a process called a hyperglycemic spike and a reactive hypoglycemia episode. And a lot of people will have been eating this breakfast for years cause the box says it’s heart-healthy and the box says it’s got a good source of fiber, so they think it’s healthy. But for their particular body, it’s actually not, those types of spikes are never healthy. And then they realize, Oh, every morning around 11:00 AM I feel like I need a second cup of coffee and I feel tired. And I’ve always just thought that’s because it’s my mid-morning slump and that’s just what happens. And my coffee is not strong enough and I’m not getting enough sleep. So when you can actually attribute an action to a reaction, the reaction being that you had a spike and you subjectively felt crappy, and realize and not misattribute it, to actually say, “This was related to the food I ate.” and then change that, that’s really empowering. And that closed loop feedback between an action, objective data, and a subjective experience, I think is really at the core of sustainable behavior change.

Howard Jacobson: [00:08:56] Gotcha. Cause in my community, the healthy whole food plant-based community, there’ve been lots of books about how to eat and there’s been a movement to try to simplify it. To say like, cause people think, oh, well eating plant-based is so complicated and there’s a lot of media about you gotta have this, so many grams of this, and complimentary proteins” and stuff that we know is really outdated. So like, people say, well, the most important thing – where do you get your fiber, get 30 grams of fiber a day? Or whatever, but it’s still all talking about inputs. And it sounds like what you’re talking about is, here’s an output measure that actually correlates with long-term health. As opposed to, we’re simplifying it by saying that this 1 measurement is a, it may not be the only thing we care about, but it’s a really good marker for lots of bad stuff that could happen down the line. Is that roughly right?

Dr. Casey Means: [00:09:54] That’s exactly right. And I think that the whole foods plant-based, I’m whole foods plant-based as well, and I practice nutritional medicine and some of the things I’ve discovered, from using this product and building this product, is that even things that we think are healthy, even within whole foods plant-based, which arguably, from my perspective, is as healthy as it gets. It’s unrefined, you’re not getting the refined carbs and sugar, you’re getting whole foods. There’s actually still ways that you can optimize that, I think, with this type of feedback. For instance, so eating what I would call a naked carb, which is just a carbohydrate source all by itself, so like a big plate of sweet potato, or a bunch of fruit altogether. Those are healthy foods, unquestionably, they have many compounds in them that are going to be very useful for our health. But when eaten alone they can actually, or at the wrong time of the day, or in the context of being very sedentary that day, you could have a completely different response. And if you pair them differently, for instance, if you pair the carbohydrate with a protein, fat, or fiber source, or if you make sure that when you’re eating your higher carb foods, you’re doing it on a day when you are very active, when you’re moving around, when you’re stimulating muscle stimulated glucose uptake, it’s going to be a totally different response to an apple when you’ve been sitting on the couch all day, versus when you’ve been walking around and moving during the day. So having that feedback with a glucose monitor can help you tweak even a very, very generally healthy diet to make sure you’re not getting the collateral damage. So I found, that for me, in particular a handful of grapes, or even a pint of blueberries, by themselves would put me up to a glucose of 180, which is far too high. I never want to be really above 140, ever, but now I’ll take the blueberries and I will put them in a unsweetened non-dairy yogurt, like a high-fat cashew yogurt, and I’ll put a ton of chia seeds on it, maybe I’ll swirl in some almond butter, and that’s fat, protein, and fiber, and I barely get any glucose spikes. So it’s that type of refining that I think is really, really helpful. Even for a very, very healthy baseline diet.

Howard Jacobson: [00:12:07] I love that, because there’s a part of me, to be completely honest, that doesn’t like technology.  Like, technology is the problem and being more mechanized and civilized and apart from nature is causing the problems in the first place. But that said, as you’re talking about it, I’m like, Of course, sitting at your desk and eating a beautiful sweet potato, one of the healthiest foods you can eat, is completely different from being a human forager walking eight miles, digging up the roots, walking back, collecting firewood, starting a fire waiting 3 hours for the fire to heat up sufficiently. so you can cook your sweet potatoes, and then eating it. It’s like, we talk about whole foods but we’re not talking about the whole experience.

Dr. Casey Means: [00:13:00] I think you just described that perfectly. I think of this as really metabolic context. It is not just food that leads to our glucose changing in the body. Glucose is actually the centralizing metric, that around it is food pairing, food timing, but also our stress management. When we’re stressed our liver actually produces glucose to help feed us in a time of stress. But because most of our stresses these days are psychological in nature we actually don’t need that glucose in the bloodstream. It’s not like we’re being chased by a lion, so that’s very maladaptive Similarly, sleep deprivation causes increase in cortisol levels in the blood and actually can cause us to, again, get our glucose high. And lack of exercise, of course is going to change our insulin sensitivity. And even one workout can improve our insulin sensitivity that day and the next day. And so, you think about – okay, we’ve got sleep, stress management, exercise, food, food pairing, food timing, all these things make a difference. And in the face of, and then those are just the behavioral choices. There’s also some of the other factors that go into it like micronutrient status and our microbiome and our environmental toxins. So just to quickly go into those, micronutrients, things like, we think a lot about macros but actually micronutrients, so like zinc, manganese, magnesium, B vitamins, vitamin C. These are actually critical co-factors in our cells ability to process glucose and for the mitochondria in the cells to function. Microbiome has been strongly correlated, our microbiome composition, with how we process glucose, our propensity to get diabetes or obesity. These different strains, like firmicutes and bacteroides, they have been implicated, like the ratios of these, in how our metabolism works. They actually, the microbiome, produce short chain fatty acids and other chemicals that our body uses as metabolic information. And then environmental toxins is another really interesting one that we don’t talk about enough. Which is basically pesticides and other persistent organic pollutants in our air, water, and on our food can actually be really metabolic disruptors in the body and live in the fat and cause problems for a long time. So you’ve got all these behavioral things, you’ve got all these more longer-term things like micronutrients, microbiome, environmental stuff, and the reality is our country, there’s 128 million Americans with diabetes or pre-diabetes. 74% of the country is overweight or obese and a recent UNC study showed that 88% of adult Americans have at least one sign of metabolic dysfunction. So we have, literally almost universal metabolic dysfunction in our country. And most of this stems from our Western culture where we’re eating 100 times more refined sugar than we were 200 years ago, about 150 pounds per person these days. And we are exceedingly sedentary. Less than 5% of Americans get the amount of exercise they need to get per day. And muscle is our key glucose sink in the body. It’s the key organ, so to speak, in the body that sucks up glucose and does it, actually, in an insulin independent way. Just contracting your muscles can cause glucose to be taken up. So given all of this, it’s complex and the food culture, the lifestyle culture, the food marketing, what is put in stores and is marketed as healthy. We’re kind of up a Creek here. And I think having, I’m with you that technology is not, I don’t love technology either, to be honest. I’d like to be in the garden with my hands deep in the dirt and just taking hikes and camping. But the reality is we are in a really bad position given our culture and our marketing and having a little bit of recourse in that when 88% of the country is metabolically dysfunctional is what I am passionate about. And I actually think we’re going to see a boomerang effect where technology is going to actually help bring us back to body awareness, to getting close to the earth. Because when you actually wear one of these things, and I’ve been wearing it for 18 months while building this company, you realize, “Oh it’s all the basics.” It’s really kind of getting back to ancestral living that is what is going to be healthy for my body. It’s walking, it’s being in the forest, it’s managing my stress. It’s getting good sleep. It’s moving all throughout the day. And the longer-term thing it’s getting my microbiome on point which means being close to the earth, eating food near to its original source, getting the bacteria in your body. It’s micronutrients, which means whole foods. It means plants. So I think you’re going to see this, my hope is that we will see this boomerang effect where this data wakes people up and then gets back to a lot of the traditional things that are so important for us.

Howard Jacobson: [00:17:49] Hmm, yeah, and I don’t want to be holier than thou because I know, for myself, I am an environmentalist. I believe in saving the environment. As soon as I got a car that told me instantaneously what my miles per gallon were, all of a sudden driving from point A to point B became secondary to the game of highest miles per gallon possible. I’d be like, okay, that light just turned yellow, it’s approximately a quarter of a mile ahead. When should I ease off so I never have to hit the brake. I know there’s some really interesting studies, I think out of Holland, around energy consumption and what happens when people are told to conserve energy or encouraged or even financially rewarded, when the monitor, when the meter is in the basement versus in the front hallway. So I know, for myself, and we know from lots of studies that when you have feedback right in front of you it’s much easier to do the good thing. And of course that’s, I’m a health coach. So the big challenge of a health coach is that Snickers bar or cheeseburger or pepperoni pizza makes you happy now and there’s a theoretical harm, a deficit at some point in the future. Whether it’s in 10 minutes when your stomach hurts or tomorrow when you’re 2 pounds heavier or 10 years when you’ve got a virtually incurable chronic disease. But we know from behavioral economics that we bias the present, whatever’s in front of us is more important than anything else. So I kinda, I really came into this thinking we were going to be talking about like, type 1 diabetics and a kind of niche thing. And now, I kind of want one, I kind of want one of these monitors.

Dr. Casey Means: [00:19:36] Well, I think you just described a lot of why I shifted gears out of, I was a surgeon for 4 and a half years and I switched to digital health to create this product. Because I was realizing that, in terms of things that could benefit the most people, actually attacking metabolic disease was the best way to, I think, spend my time. And the healthcare system is not doing a good job of fixing this. We’re very medication and reactive focused and not proactive focused. And so empowering people with information really became my passion. And it all comes down to the, and why I took this leap to do this is because I really believe what you’re saying, which is that we as humans, cognitively bias the present. If we think that something is bringing us pleasure now, you know that dopaminergic reward system in the brain is very, very powerful and very, very primal. And these foods that are marketed as potentially healthy and these processed foods that are filling our grocery stores, they are designed to take people to their bliss point, in terms of their reward circuitry, to literally hijack these primal evolutionary drives in our body to make people purchase and consume more of these foods. And think they’re making them happy, when in fact, blood sugar spikes and ultimately insulin resistant and metabolic disease actually are significantly associated with anxiety and depression. And these foods don’t make us happy long-term and we get decreasing reward when we eat them frequently because our receptors in our brain change and we actually need more of them to get the same amount of pleasure. So, yeah, the thought is with this type of technology, in the face of these realities, how do you actually change that pleasure equation where people gain pleasure, just like you did with your car and that game of the meter, with actually achieving something in this immediate term? Like you eat something and 5 minutes later you see that it’s causing harm.

Howard Jacobson: [00:21:34] What if my life is a video game? Like I’m getting that kind of dings and bells and whistles and rewards and challenges. Like when I’m happy in life, essentially, that’s what’s going on. I’m writing a book now, there are days when it’s a terrible slog, there are days when it’s… but I wake up every morning going, “I have a goal.”, and the rules are clear and the feedback is clear. And when I pay attention I can, like I’m optimizing my life in some way. And what you’re saying is you can bring that gift to these really, formerly opaque, incredibly complex interactions. Like, there’s one thing I’m thinking, like there’s, sorry you got something to say so I’m going to…

Dr. Casey Means: [00:22:21] No, no, no. I think that’s exactly right. And I think the video game thing is interesting, I think it’s, we are living in a video game right now, I mean, we have a digital world that is all consuming and we have a food culture that actually is designed to hijack our awards circuitry. So the question is which video game do you want to live in? Do you want to live in one where you’re being controlled or where you’re actually making the choices? And that’s sort of how I how I see it. And I think when you couple coaching, especially, or more deep internal work with technology, so the average person who’s using a product like Levels, I think they are going to get some satisfaction from keeping their spikes down and getting rewarded for that, having a higher score etc…  they’re going to learn. But imagine then when you couple that with someone like a coach or more mental health professional, really getting people to the root of why they want to be healthy and why they want to live a better life. And who they’re doing that for and what the purpose is. So you can really start coupling your bigger picture goals in your life, the value system that you have, with why you’re doing what you’re doing. And I think that’s really, really powerful. So I think you’re going to get benefit even just by keeping the glucose spikes down and getting that, but I think also tying it to – what is the purpose here? Why? And that’s where education and how people understand, these glucose spikes are going to lead to this type of life for you, probably more incapacitated, more dependent, less happy, less healthy, etc…

Howard Jacobson: [00:23:50] Well from my perspective as a coach, I’ve become less and less and less interested in motivation. Like, you can teach someone that in an hour and give it to them on an index card. What I find incredibly interesting about this is the big issue that coaches deal with is blind spots. So whether I’m coaching for nutrition, or someone’s behavior in the workplace, it’s that they aren’t getting feedback on, “Every time you say that Sally gets upset. And Sally’s trying to be a stoic woman in the workplace to not…” so you know, like, “Oh, but I can see it and my job is to help you see it.” And what you’re doing is holding up a mirror to, again, these incredibly complex interactions. I co-wrote a book 7 years ago called Whole with T. Colin Campbell which was all about the incredible complexity and how we were never going to figure out nutrition just with guidelines or pills. And that a complexity, in a way, is a little bit discouraging, like, we can never know. But what you’re doing with monitoring is, we don’t have to argue. Like the debates I’ve been involved in with the keto, the carnivore, the paleo, the Mediterranean, these debates are so incredibly unsatisfying. It’s like you’re watching the Olympics 100 meter dash and like the 10 fastest people in the world are arguing about who should win.

Dr. Casey Means: [00:25:23] I love that metaphor, that’s really perfect.

Howard Jacobson: [00:25:26] Right. You’re saying the strap the thing on and you can decide for yourself. That’s the thing I hear, but with people who are unsophisticated about nutrition are like, “I’m so confused. First red wine is good, then it’s bad. Oatmeal is good, coffee is good, chocolate is good, fats and olive oil I shouldn’t. Oh well.” and they give up because they don’t have a reliable source that they can trust. And all of a sudden you’re giving people something on their arm that gives them the end of one, that’s the only end that matters.

Dr. Casey Means: [00:26:00] Yeah exactly. I think it’s almost like poor information and lack of transparency breeds tribalism in a lot of ways. It’s almost like what we saw with the election, fake news and sensationalist media and shuttling certain types of information to certain people through our digital algorithms led to what was a remarkable level of polarization. And I think we’re kind of seeing that with nutrition as well. I mean, t’s incredible how heated things are getting in terms of nutrition space, heated and personal. And so, to me, it is very intoxicating that we actually could potentially rise above that by giving people real information about their own bodies. If someone’s telling you, “This is the right thing to eat, this is what the studies say. You have to eat this.”, and then you eat it and it sends your blood glucose to 200 there is no longer a debate. There is actually no debate. You cannot fight about that. That person should not be eating that food in that way.

And I think as a physician too, I’ve had so many conversations with patients, just like you said, where it’s just like, “I’m so confused. I don’t know why things aren’t working.” Like for instance, with weight loss or something like that, well, with weight loss we know that to burn fat you have to keep your insulin down. Insulin blocks fat burning. And in our culture insulin is, essentially, always high because insulin is released after the blood glucose rises to help take glucose into the cells. And we’ve been told we should eat 6 small meals a day and the majority of calories that people are getting in the US come from refined sugar and carbohydrates. So we never have really a moment during the day, except maybe at the end of sleep, where our insulin actually comes down enough to burn fat. So imagine then putting, and then someone’s eating a pretty healthy diet but they’re not losing weight and they’re very confused and it’s very frustrating. And it creates a tension between the doctor and the patient because the doctor’s recommendations aren’t working and all of this stuff happens. Well then imagine putting a glucose monitor on that person and they see that all this stuff they’re eating that they thought was healthy actually is causing these glucose spikes throughout the day and they just need to make some tweaks to get that lower. And then you’re talking about the data then in the visit, not necessarily just the struggle, and the confusion, and this and that. And I think another thing is you said blind spots and actually that reminded me there are also just a lot of blind spots in nutrition. So not only just food that may work for one person’s body but doesn’t work for yours. Like you and I could both eat a banana and it might cause a huge glucose response in me and no glucose response in you. And that has been well-studied, that people have very different responses to the same carbohydrate source, and a lot of that has to do with our microbiome composition and how we process the food.

The second thing is hidden ingredients, like there’s over 50 names for sugar and they’re hidden in these foods. They’re now in peanut butter, it’s in ketchup, it’s in salad dressings, it’s in whole grain bread. You can find 4 grams of sugar in a single slice of bread sometimes. It’s crazy to me because it actually doesn’t taste better but we are wired to expect it now. And so that type of blind spot as well, where a patient might really be doing everything they can but they put a little bit of ketchup on their sweet potato and then they get this huge glucose response that they were not aware of because they thought they were eating something healthy. That’s something that can really be helpful I think as well. So yeah, I want to see technology used in the right way, help bring us out of this polarized tribalism, this dependence on looking at marketing or people’s claims for understanding our bodies. And to actually shift people towards what I consider just radical personal empowerment where it’s like, “I know what’s right for me and I’m going to make a choice, or I’m not going to make a choice, but I know and I’m making the choice.” It’s less paternalistic, it’s less being told, it’s less reactive. It’s proactive and it’s empowered. And when people feel empowered about things that have been notoriously very difficult in their life, which nutrition for the majority of Americans is difficult, I think that actually can bleed into other parts of life. I think that when you have agency in something like that, it can actually have wide reaching effects. And so that’s why I, even though I am someone who would like to be outside in the garden and camping and this and that, I think there’s a role for technology when used in a thoughtful way for this type of thing.

Howard Jacobson: [00:30:28] I love what you’re saying and there’s a little part of my brain that wants to nitpick a little bit or object.

Dr. Casey Means: [00:30:34] Let’s do it.

Howard Jacobson: [00:30:35] Which is the idea, like you’re talking about individual empowerment and I’m concerned about the focus on the individual. So I would kinda like to see your glucose monitor also have a carbon footprint monitor so that I could see what I’m eating is, “Okay, so maybe it’s good for me but it’s destroying a wider ecosystem.” Like, I’m a little nervous about just optimizing for me. In a world in which you say where there’s so much tribalism, so much fragmentation, and the more scarcity there is, the more fight or flight we go into, the more we are fighting with each other for scarce resources as opposed to being communitarian.

Dr. Casey Means: [00:31:19] Well big picture, the awesome thing is that when people’s metabolic health is optimal it’s associated with making choices that are good for the environment. And so what I mean by that is, pesticides, for instance, hurt our microbiome and they actually are metabolic disruptors. So if we really were able to take this and get people to really think holistically about their diet they’d be eating foods with no pesticides, chemicals on them. Additionally antibiotics kill our microbiome, hurt our microbial diversity and that is going to affect our metabolic health So If people are eating meat that takes antibiotic injected animals and milk off the table, so now we’re getting to better  animal raising practices. And we also know that micronutrients are made in large part by the bacteria in the soil and right now we’re having a huge crisis, environmentally, with our soil depletion. And it’s basically our soil is turning into this sterile dirt that is, and our food is becoming less nutrient dense because of that. And that’s because of our terrible monocropping, pesticide riddled farming practices and the way our farm bill in the US actually promotes this type of unsustainable farming. Well, if we think through the lens of metabolic health we need those nutrients, we need the bacteria and, so let’s say, and this is going to be on the individual day-to-day level, this is not what our app is telling people, but if you think bigger picture, to actually get to the end goal that you want with metabolic health you actually have to make the choices that are better for the environment. You need to be eating whole foods that aren’t covered in crap that come from soil that had a really good microbial diversity in it. You need to be moving which means not on your scooter or in your car or stuck to your TV. And so I actually think it’s very aligned and that’s difficult to build into a digital product but it is very much, as the chief medical officer of the company and someone who is very environmentally focused and who is whole foods plant-based, it’s very much in in my sphere of what I’m thinking about. I do think if everyone achieved metabolic health it would require that we’re actually making decisions that are good for the environment.

Howard Jacobson: [00:33:37] So you’re saying that health is holographic. That actually it’s impossible to be truly selfish, if you’re seeking real health you have to be in, to shift your environment to be supportive of all life.

Dr. Casey Means: [00:33:54] That is absolutely true and I love the way you said that. And I think it also comes down to personal actions, because when we are stressed or in conflict or tired, we’re gonna have poor metabolic health. Like food is not sufficient to generate metabolic health you also have to have the psychological, the cortisol, the stress, all this stuff managed, the sleep. And so if you’re having to stress manage and sleep to get this glucose reading to be optimal and to achieve optimal metabolic health, that’s also gonna impact people around you in a positive way. We know that when we’re stressed or sleep deprived we are not going to be able to be as emotionally regulated, we’re going to be more emotionally mobile. We’re going to make poor decisions poor judgment. And so from that standpoint not just the environment but how we’re treating other people that’s also something that goes part and parcel with achieving this thing this individual metabolic health which actually will result in you probably being a better person.

Howard Jacobson: [00:34:54] So you were so happy to receive my last objection I want to give you my next one which is, right now I’m writing an article on recycling so it’s in my head – like recycling is basically a scam to put the onus on individuals to fix what is really a systemic problem. And I’m wondering if that’s partly true here as well. So when you talk about things like soil health, like eating things without pesticides, like how can most people, you can’t choose that, some people can, but do you see this as maybe sparking some sort of social awareness or revolution? Or like Kaiser Health saying, “Hey we’re going to save money if we get 30% of the farmers in the Sonoma Valley to go organic. Do you see this as having a political arm as well as just individuals optimizing for themselves?

Dr. Casey Means: [00:35:54] Yeah, I mean, I see it as part and parcel with politics. And when I left surgery and I was deciding how am I going to end metabolic dysfunction in the US, which I know it was a lofty goal, but we have one life and that’s kinda what I’m trying to do. And it’s like I had a huge whiteboard and it’s like, I could become a politician, I could lobby for different farm bills, I could lobby for regulations on Monsanto, I could lobby for changing our school lunches, I could lobby for changing the way that we spend snap and WIC funding.

Howard Jacobson: [00:36:30] You’d be really really good at that.

Dr. Casey Means: [00:36:33] Thank you. But those are all ways that you could have the downstream effect of improving people’s health. Or you could have more regulations on food marketing, and I literally was like, “There are so many ways to do this.” You could also change the hospital system. You could change hospital reimbursement, push for the value-based care system as opposed to a fee-for-service system value. In healthcare it’s outcomes-over-cost and nutrition is one of the highest value interventions as we move towards a value-based care system. We might move towards prevention more than reactive stuff like medication and that might shift things. And then I was like, but that’s all top-down. There also is the bottom-up side of this. And as, sort of someone who’s a little bit libertarian leaning and doesn’t want to just create more control mechanisms that have unforeseen consequences, what happens when you actually just allow people to make better decisions? Well, there’s a lot of examples throughout history where that changes, consumer decision making and this free market economy means that when people want something and demand it, the market will shift to accommodate that. And so if people are saying “I’m not going to drink Coke anymore cause it’s hurting me.”, Coke will create a new product. And they are, that is actually happening right now. Coke, the sales of these, are down because people are becoming more aware of this and they’re shifting. I don’t think they’re necessarily gonna make something that’s healthier but you see what I’m saying, and this is kind of what’s happened with the vegan movement. There was literally no non-dairy milks in the market. And it’s not that anyone from up high told the companies to make more vegan milks, people demanded more vegan products, they were buying more vegan products, and so the companies changed.

So I think there’s so many different ways to approach the issue and all of them need to happen in parallel. But I think a part we should not forget is that people’s consumer decision-making, which is based on how they feel about themselves, what they understand about their bodies, what they want, is going to drive, I think, a lot of changes. People will also demand different things from their doctors. If people are more aware of what’s happening, right now to know if you have a metabolic problem, sure, you could look at the scale and if you’re overweight or obese you almost certainly have some element of insulin resistance, and probably have or have some underlying metabolic problem. You’re storing too much fat, that’s a metabolic problem. But for the average person they’re not thinking that way, they’re waiting to go into the doctor’s office and have them tell them, “Oh your fasting glucose is in the normal pre-diabetic or diabetic range.” It’s crazy to me that we have tools these days that actually could tell us, every day, where we stand on that spectrum and yet we’re still waiting for 8 months, a year or 2 years to walk in and have this unveiling of something that we could have an impact on every single day. That, to me, is absolutely crazy. And in that 15 minute visit the doctor might say, “Oh you should eat healthy and exercise more, which is not useful.

Howard Jacobson: [00:39:29] It’s like the pipes under your house are gonna crack and freeze because your air conditioning, your heater system is broken but the plumber isn’t gonna fix your heating system, they’re going to wait until your pipe cracks. Doctors don’t know how to intervene behaviorally, they’re really good at prescribing, so for them it makes sense to wait until you have a clinically significant diagnosis that they can then do something about.

Dr. Casey Means: [00:39:58] Right, but imagine if we change the economics a little bit of healthcare, where doctors were being reimbursed more for outcomes than just for doing. So moving towards this value-based from fee-based system, fee-for-service versus value-based, what I think we would see very rapidly is that because outcomes are tied to our compensation I think medical school curriculums would change overnight. And I think we’d go from having 10 hours of nutrition in 4 years to having 200 hours of nutrition, because that would be a lever that people can pull to actually become reimbursed. So I do think that there’s a lot of dependencies in this and one of them is people’s awareness and knowledge and what they’re asking for and what they’re willing to pay for. So that’s the starting point where we’re kind of coming from but also working in parallel as a company to help educate and spread awareness about some of these other more systems issues that we should absolutely be thinking about.

Howard Jacobson: [00:41:06] Gotcha, all right, well I feel like I’m 0 for 4 in objections, you have defeated all of them. So I’m gonna give you one more, in this I’m channeling some of my listeners who have been hanging on to this point. Because you’re so articulate and you make so much sense and you have so much good energy, but you said something that bothered them right at the beginning, which was, “Well, we don’t know that everyone should be on a vegan or vegetarian or keto diet.” And there are people who are thinking what if people put this thing on and they start eating meat and they find out the meat’s better for them. And this is a plant-based podcast, I don’t preach anything in particular but there is that concern and I heard it in my own head as well.

Dr. Casey Means: [00:41:54] And actually, it’s funny, I hear it in my own head as well too. And I think this is actually a question that in some sense keeps me up at night because I am plant-based. I understand the power of plants. I’m at the plant-based nutrition and health care conference every year, I live and breathe this stuff. And I think the challenge is actually, is education, is helping people understand the complexity and the nuances of nutrition in a way that’s accessible. So I’ve got a number of posts on my social media and whatnot about this, but basically the way I see it is, yes, if you eat meat, you might put your continuous glucose monitor on and eat your vegan diet and see all these crazy spikes. Beans, you go up, sweet potatoes, you go up, and it’s like, “Holy moly! This is not working for my body.” And then, let’s say the next day, you’re like, “I’m going to eat all carnivore, I’m going to be all meat.”, and your glucose is flat, It’s like nothing’s happening. The way I like to put that is that, that is not actually winning the game, cause that’s not playing the game. When you don’t put glucose into the body you’re not going to have a glucose spike. That is true. And meat doesn’t have glucose in it but that means you didn’t even show up. Like you didn’t even play.

What I’m trying to do is help people build a body that processes glucose and carbohydrates properly. That means improving insulin sensitivity, which means improving our micronutrient status, improving our microbiome, making sure we’re physically active, making sure we’re managing our stress, making sure we’re sleeping well, and making sure we’re choosing to pair and time foods properly so that we’re not getting as much of a glycaemic impact. That is playing the game. That means that if you eat a sweet potato properly you still have a flattened glucose spike, you still have a flat glucose curve. That’s showing up and actually having a body that’s processing it properly. So, certainly all refined sugar and carbohydrates should, I think for every person, throw them out. Nobody needs refined sugar and carbohydrates. But our body does thrive on some carbohydrates and for me, who eats a lot of carbohydrates my glucose is still flat and stable cause I’ve learned how to do this. So I like to sort of position the carnivore and the keto like, there’s useful principles we can actually take from those diets, in the sense that yes, having low glucose does keep your glucose down. But there are ways to think more nuanced about it, building a context, building a body that actually processes carbohydrates. That’s the long game. So there’s risk though, with a product like this that everyone would just say, “Well, I’m just going to drink red wine and beef cause both of those things don’t spike glucose.” That’s not, I think over the long-term, going to generate a body that is metabolically healthy. It’s going to make you think that you have low glucose. But that’s not necessarily the end game. The end game is metabolic health and insulin sensitivity.

Howard Jacobson: [00:44:52] Yeah I don’t know if you’ve seen the show Silicon Valley.

Dr. Casey Means: [00:44:55] Yes.

Host : [00:44:57] When they try to get the AI to create the code that eliminates the bugs and it does so by erasing all the code. So that’s kind of what it reminded me of.

Dr. Casey Means: [00:45:07] I haven’t seen that episode, that’s so good.

Howard Jacobson: [00:45:08] That’s kind of what it reminds me of. Like okay, I can manage my glucose really, really well. The other metaphor I like to use here because it’s so disgusting, is like I have a guest bathroom and the toilet’s blocked and I keep the water in the tank in bowl pure by not letting people use it as opposed to fixing the pipes. Getting you know, people, reducing insulin resistance through reducing intramyocellular lipid fats and stuff like that.

Dr. Casey Means: [00:45:42] But one other thing I would just say is like, while I am plant-based and I am very much a part of the movement, I think that something that has, and this will probably sound a little controversial, but I do think this has opened me up a little bit more to thinking, “Okay well I think this is the right diet for me and for my patients.”, there is probably room for different diets for some different people. And imagine if we had continuous monitors for every important biomarker, for inflammation, for cholesterol, for insulin, for glucose, for oxidative stress markers. And let’s say someone’s on a carnivore diet and for whatever biochemical reason everything is identical to, and microbiome, we’re testing microbiome daily, let’s say they do that and for whatever reason because of biochemistry, I don’t think this would happen, that all the markers are exactly the same. And let’s say they are eating only nose to tail meat that was raised sustainably, humanely in a way that’s carbon neutral, whatever, all this stuff. It wouldn’t make me step back and say like, “Okay.” If everything, their antioxidants, microbiome, everything is thriving and healthy, like, that’s good information to know.

One thing that’s a problem with nutrition is that we don’t test people in this way. We don’t actually know long-term how these diets are affecting people. But all I’m trying to say is that I do think increased data and monitoring will maybe help us, I don’t want it to further polarize me, but I’m trying to keep an open mind about nutrition. Because nutrition data and science is very flawed in a lot of ways. I think plant-based has such strong evidence for it, both mechanistically and epidemiologically but I don’t want to further entrench the polarization and say I am going to continue to follow some of the data. None of that changed anything about the animal harm aspect of things which I think is very important. But there are a lot of people in the sustainable meat world, people like Mark Hyman who do feel like actually raising animals in a sustainable way it can be actually healthy for our soil and our environment. So all of that is just to say I am personally trying to stay somewhat open-minded as we learn more, while still very much adhering to what I think is the most sustainable, ethical and healthy diet.

Howard Jacobson: [00:48:12] Right. Well your carnivore with perfect biometrics is like someone who goes to Las Vegas, puts a bet on the worst odds in craps and wins because of a lucky dice throw. It doesn’t mean that on the aggregate that’s the bet to make. So I think if we have a large number of people with glucose monitoring I think you can say regardless of what it tells an individual to do, it will certainly reduce the societal consumption of meat and certainly of low quality factory farms, pesticide and antibiotic laden meat.

Dr. Casey Means: [00:48:54] I think over the long term, if everyone used this over the long term, I think we would see people moving towards more whole foods, much healthier types of quality of food. Cause you’d see that that over time has a positive impact. But yeah, to predict really how things will turn out I think is very challenging. But I think it’s just very important, every day as you’re building a product, to have all of these things in mind. Because the quick win of I ate meat and my glucose is low is not, obviously having people orient around that could have some unforeseen issues. And so making sure that the education and the holistic understanding of what goes into this is super engaging for people so they really understand the multi-variate model of this glucose readout. I think that’s the challenge and that’s certainly something as we’re thinking about very, very deeply as a company.

Howard Jacobson: [00:49:52] Well and what I really love about this and the way this information interacts with the tribalism and with the debates is that it kind of undermines my confirmation bias. If I want to consider myself a person based in reality, so like when I hear debates, public debates about vegan versus non-vegan, they’re of terrible quality. In terms like they’re each bringing their own studies, they’re not talking to each other and I learned nothing. As opposed to saying, let’s look at the data themselves and see what’s actually happening and build our theories upon data rather than going out and finding data, selecting data, and funding what we think will be data that supports what we already believe.

Dr. Casey Means: [00:50:47] Yeah, absolutely. I think having conversations based on real information is always the best. It just takes a lot of the emotionality out of it and the subjectivity.

Howard Jacobson: [00:51:02] So, as a behavioral coach I’m real curious about how you could pair this output data with input data? Which is like, I find people are very foggy about what did I eat today or did I exercise or did I get a bad night’s sleep 2 nights ago and it’s still complex. How do you help people find patterns?

Dr. Casey Means: [00:51:25] That’s a great question. So our app right now takes in, obviously the glucose data stream, but also takes in heart rate and sleep data. So people log their food manually and logging is really easy and we try and make it as fun as possible. And people are very incentivized to log actually, because if you don’t log, you get a very nice package at the end of 2 hours if you logged your food. You have your photo, you say what you ate, and then you have a score, you see your curve, you see all these metrics. So it actually is very, people enjoy logging because you actually get this benefit from it. You get this great image of what happened over the 2 hours after your meal and a score and all this stuff. So food logging is manual. Heart rate data and sleep data allows us to see relationships between activity and glucose but also sleeping glucose. And then over time you can tell, when you get less sleep each night we see this higher percentage, your average glucose is X percent higher. When you walk this much time per day, we happened to find that your average glucose is this much lower. So having those other input variables I think is really, really important and the sky is kind of the limit. I’d love to bring in heart rate variability monitoring as well, as an objective measure of stress, and really start to parse out for people like, “Hey, this is your glucose today. X percent was because of your sleep, Y percent was due to your stress, Z percent was due to your lack of physical activity, and these are the meals that had the most impact on you and ingredients you should probably be avoiding” Like that’s kind of the where we’re moving.

Howard Jacobson: [00:53:09] So are there privacy concerns? Because I’ve seen apps that will report to people your heart rate. People have been caught cheating on their spouse because their heart rate suddenly elevates at 3:00 AM for 25 minutes. Do you think about that or build with that in mind as we’re approaching such a big data world?

Dr. Casey Means: [00:53:35] Yeah. We certainly think about that as a data company and we work with a number of academic universities doing research as well. And so data privacy is of utmost concern. So these days, from the backend, security of data is of paramount importance for a company like ours. If people leave their app out and their spouse sees it on the table that’s not something we can actually control. But certainly from the data security and keeping it secure on the backend, that is critically important.

Howard Jacobson: [00:54:14] Gotcha. So let’s just describe the thing itself. Does it penetrate the skin? Does it sit on top? What is it like? Do you keep it on all the time, do you take it off to show? What is living with it like?

Dr. Casey Means: [00:54:30] Yeah. So you basically just forget it’s there. Oftentimes I’ll touch my arm to even like, do I have it on right now? But basically, it’s the size of two quarters stacked on top of each other, so it’s very low profile and small. And there’s a 4 millimeter hair-like filament that comes out of it, like a little bit of fishing line, that actually does go under the skin. And so it’s actually put on with an applicator that does have a needle which, for whatever reason, is 100% painless, you do not feel it going in. It pushes the little hair like filment in and it takes it’s like a millisecond or less. And no one feels it basically, it’s kind of incredible, and then it sits on your arm. There’s an adhesive on the bottom of those little quarters that sticks it to your arm for 2 weeks. And so, yeah, all you see is the white quarter sized thing on the back of your arm. And then underneath the skin is a 4 millimeter hair-like filament that is covered in an enzyme called glucose oxidase, that takes glucose and converts it to byproducts that include hydrogen peroxide. And that hydrogen peroxide creates an electrical signal that is transmitted, that’s the data. And then that gets transferred to your smartphone So it’s amazing, I mean you can shower, you can work out, you can lay on it, it just lives there.

Howard Jacobson: [00:55:52] Gotcha. So my final question is how do I get one? More generally, is this an FDA approved prescription product? Is it comes to consumer? Are you thinking of partnering, like, what’s available now and what’s your roadmap?

Dr. Casey Means: [00:56:08] Yeah so it is an FDA approved device and it is prescription only. So right now in the US they’re FDA approved for type 1 and type 2 diabetes management. So what our company is doing is bringing this to the mainstream for people just looking for more of the wellness purpose of this as a biofeedback tool. So anyone without diabetes can basically become a customer. And what happens is they, adults I should mention too, above 18 years of age, when you become a customer you basically sign up for a 1 month metabolic awareness journey. And what that involves is a telemedicine consultation, so you actually will fill out a form, a doctor will review it. If you’re approved for a continuous glucose monitor our partner pharmacy will ship those to you and they’ll ship you a month’s worth of sensors, which is 2 sensors because they each last for 2 weeks. And then in there you get awesome covers for the sensors that keep them really stuck on and then access to the app, the Levels app. So that’s really what our core competency is, is building the software overlay to this. But it’s this three-part program of physician consultation, sensors, and the software. So right now, if people wanted to do that, they’d go to Levelshealth.com and then sign up for early access. We’re actually in a closed beta program right now and so we’re taking, there is a wait list right now. But we’re moving through that rapidly so definitely sign up. And if you do sign up for the waitlist you’ll be on our newsletter and we’re putting out lots of really high quality content about these topics so we’d love to hear from people and get connected.

Howard Jacobson: [00:57:51] So in another irony of the system, the people for whom it could be preventive have to pay out of pocket and the people who are already sick can get it covered by insurance?

Dr. Casey Means: [00:58:01] That is correct. Hopefully not for long, but yes.

Howard Jacobson: [00:58:05] Okay. Now my first foray into biometric monitor, self-monitoring, was a heart rate monitor. When I, for when I ran, it was a chest strap attached to a watch and it was really, really cool for about a month and after that I didn’t need it. Like, cause I knew. Is this similar? Like after you’ve been doing this for 6 months or a year or 18 months or 2 years you’re like, “Okay, I got. It I’m dialed in.” Or would you encourage people to wear it their whole lives?

Dr. Casey Means: [00:58:34] Our core program is focused around 1 month because I think you can really derive a ton of insights in 1 month. About how to pair foods properly, time foods properly, how to use other things in your metabolic toolbox to keep glucose stable, so exercise, sleep, stress management, etc. So in 1 month I think you get a lot of gains but there are certainly a lot of people who like to do it for longer. Like I said, I’ve been wearing one for 18 months and I’m still learning and so I think it’s great wearing long-term. But I think because of cost, right now, it’s unsustainable for a lot of people to do this month after month after month. But I think costs will come down as these hardware companies see more of a demand for this, I do think costs will come down rapidly and I think it will be more amenable to a subscription type product. But we do have a number of members who do this month after month. The cost after the first month is half the price of the first month. But I do think there’s kind of 2 phases to using something like this, and all wearables really, the first is the rapid awareness and learning phase, where you’re gaining all these insights and experimenting and sort of figuring things out with your data. Then you move into, that kind of starts I think declining a little bit as you really learn what works for you, and then the value comes in accountability, so staying on track. So for me, now I know that it’s less about figuring out what to eat and more about just wanting to keep in range all the time. And there’s sometimes a few days in between sensors where I don’t put one on and just don’t have it on for whatever reason. And I know, even for myself, I make different choices when I don’t have my sensor on. Cause I’m not going to have any of that negative feedback. And for instance, rice crackers, I love them, they send my glucose way up. I put avocado on them and tahini to help buffer it. They still raise my glucose. The only time I eat rice cakes is when I don’t have my sensor on. And so it’s just funny. How the brain works And so I think awareness, really is the front end, and then accountability is the long, one of the long-term benefits of it.

Howard Jacobson: [01:00:39] Gotcha. Beautiful. So tell us the website again slowly and clearly so people who are not going to look at the show notes can find it.

Dr. Casey Means: [01:00:46] It’s Levelshealth.com. So L E V E L S health.com And our blog is just Levelshealth.com/blog and we’re on Instagram and Twitter at Levels. And we put, it’s really fun to actually follow, I think, our social because so many people are doing experiments with their glucose monitors and you can really start to see all these different members, like what they’re learning. And it’s very fascinating to see people comparing “This was an apple with a walk, this was an apple without a walk. This is what happened.” And then I’m at Dr. Casey’s Kitchen on Instagram and I talk a lot about plant-based metabolic health. So we’d love to hear from anyone.

Howard Jacobson: [01:01:25] Awesome, okay, I’ll include links to all that in the show notes which will be plantyourself.com/fourfourthree. Um Dr. Casey Means, thank you so much, this has been so much more interesting than I thought it was going to be. I kind of thought we were going to be having discussions about, well, I didn’t think it was going to be so exciting and politically aware and socially and behaviorally.

Dr. Casey Means: [01:01:57] Thank you, I loved our conversation and I really appreciate that. And I so appreciate you having me on. Wonderful to be connected.

Howard Jacobson: [01:02:04] Yeah, let’s stay in touch. Let me know when there’s a podcaster’s beta, to strap it. You had me at “It doesn’t hurt.”

Dr. Casey Means: [01:02:14] Yeah. The first time it’s a little scary to put on but then after that, everyone usually starts laughing after they put it on cause they were nervous, and it’s nothing. So yeah, we can jump on Zoom if you’re nervous and put it on together. Yeah, we’ll definitely get you in the beta program.

Howard Jacobson: [01:02:31] Awesome. Thank you so much. Best of luck and thank you for all you’re doing for the world and for taking the time today.

Dr. Casey Means: [01:02:39] Thank you so much.

Howard Jacobson: [01:02:40] All right, I’m convinced, hope you are too. Hey, if you want to watch our conversation we YouTubed it so you can find that  at plantyourself.com/fourfourthree. Where you can also find links to the Levels blog and that link I told you about, where if you want to jump across 60,000 people and go to the front of the line, you can do that as well.