Dr. Taylor Sittler: Levels of Metabolic Resiliency

The medical field is a challenging world to navigate. There are endless variables and possibilities, and clinicians and patients are always looking for more options, better treatments, and, ultimately, more answers. But those answers are not always easy to come by. In this episode of The Lab Report, Dr. Taylor Sittler of Levels talked about the metabolic health crisis, the impacts covid-19 has had on some people’s long-term health, and how we can better address the root causes of disease.

0:21 – Metabolic dysregulation

When your metabolism becomes dysregulated, you are more vulnerable to disease and can have a more difficult time mounting an effective immune response.

It’s really interesting to see that when the body gets deregulated in this way, when you start to see signs that the signaling cascades related to metabolism are off, that there’s a bunch of other underlying pathology that’s already there as well. And I think that’s really what it comes down to is that folks who, whether it’s because of the increased glycation that we see in the body, or it’s because of the shift in the immune system, that folks with prediabetes and diabetes have a harder time mounting an effective immune response. And that leads to problems.

14:40 – Components of the metabolic health crisis

There are two things that have led to the metabolic health crisis we see today: there has been a decrease in exercise and an increase in chronic stress.

I think the other two things that have really led to the metabolic health crisis are we’ve engineered exercise and movement out of our daily life for efficiency and comfort. And we’ve also managed to ratchet up the chronic stress that everybody feels. Some of that is loneliness, but some of that I think is just the way that we’ve designed modern life and the speed of it makes it very stressful. And when those things come together, over time, you overwhelm the body’s systems and these really amazing signaling cascades that enable you to eat and sleep and work effectively.

18:55 – Reading the body’s information

Your body is trying to tell you things constantly, but you have to be able to read what your metabolism is saying in order to provide an effective response.

Your body is this incredible prediction machine. And we can tell a lot by how well your body prepares for food, as well as how well it recovers after a big say, glucose load, as in an oral glucose tolerance test, which is so something that the medical industry uses to measure your ability to handle it. So I think when you’re thinking about both preparation and recovery, you can tell a lot about how healthy someone is by how well the body supply chain management system is functioning. The metabolism involves this complex signaling and cascade. And as we were talking about before, if your sugar is spiking up high, or your insulin is off the chart, you’re probably pre-diabetic and the signaling cascade is off. There’s a lot of information there that’s related to disease.

19:45 – The definition of resilience

Resilience measures your body’s ability to respond to changes in demand and shows how you handle changes in your body.

A person’s resilience, as we define it, is their ability to handle changes in demand. It’s their body’s ability to handle all the things that you throw at yourself. And better resilience enables you to essentially have lower glucose variability, lower insulin variability, better sensitivity in your muscles, et cetera. And I think that’s really the idea behind resilience is that by measuring how your body responds to changes in demand, we’re going to be able to tell you a lot about how to avoid disease. And in the Levels context, I think coupling that testing, which is you’re going to receive via these, what I call feedback metrics, glucose, cortisol, other things that respond pretty quickly. It helps you understand how your behaviors are impacting your health. And that’s really what’s so important. It gives you this mirror that tells you, “Hey I’m actually not that resilient in this particular way. Maybe I need to focus a little bit more on improving my resilience.”

22:41 – The rise of unwearables

Wearable technology is a popular commodity in today’s health market, but unwearable technology can also help you live a healthier life day today.

There are a number of different apps that are coming out now that use a camera plus machine learning to tell whether someone has fallen, whether they’re at risk of falling. This is particularly useful in older adults. And there’s this concept of frailty index, which is basically a measurement of your movement and your functional ability that you can start to measure with these external cameras. And actually, I just heard about something the other day. There’s a new type of device that I think it uses infrared so it can see through walls. And you just stick it in your house and it passively monitors your movement and gives you a sense for whether there’s a problem, that right now it’s really mostly used for fall detection. But I could see that manifesting later. And so I think in addition to the wearables, that I think we’re very interested in because of the ability to benchmark these things, they’re what I call the unwearables. And I think there’s a whole movement around that. So devices that you can have in your home.

30:44 – How exercise is helpful

Regulating your cardiovascular system through exercise can help you regulate your glucose levels so you can live a healthier life.

In terms of exercise, I think to your point, large muscle group exercise seems to be really helpful, high intensity exercise a couple times a week. You also want to get the cardiovascular system going. And the traditional way to do that is 30 minutes every day. What’s been interesting is you’re seeing a rise in things like breath work, that’s where you do these fast ins and outs. And that also seems to push the cardiovascular system. So I think it’s too early for us to know what the output is there, but that can be really helpful, I think, for regulating your cardiovascular system in general, which is really important. And may also impact blood flow in the finer tissues.

31:51 – The impacts of chronic stress

High-intensity stress or chronic stress can both have an impact on your glucose levels, on inflammation, and on your overall metabolic health.

What we find is high stress or chronic stress both increases your average glucose. It tends to have an impact on your metabolism pretty early. It also tends to impact inflammation in ways that we talked about. And the explanation that I think resonates with a lot of folks is that if you go into fight or flight mode, again, thinking about this, your body is a supply chain management system. You’re expecting to get some bumps and bruises. You’re expecting to get a potential puncture wound or something like that. So revving up that arm of the immune system can be really helpful for having the right response and making sure that if you do get bumps, bruises, or something worse that your body can handle it. But if you’re pushing the immune system in that direction all the time, you’re doing so at the expense of something, and that’s the ability to fight certain viral infections, to monitor for cancer, as well as some of the other typical chronic diseases that we see develop, things like arthritis, et cetera, et cetera. So those are my three basic ones.

38:33 – The importance of community

People who are surrounded by and who are active in their community tend to live longer and healthier lives.

Interestingly, there’s a lot of research around community and one’s feeling of social connectedness and longevity. So people that go to church, for instance, in their later years are more likely to live a longer life, which is hard to understand. People with partners are likely to live a bit longer. And there are ways that you can start to measure that. So oxytocin, for instance, we know is released when people feel like they’re part of a group or when they’re volunteering and giving back or things like that. So there are some interesting ways that we can start to provide feedback, extending that mirror beyond metabolism to how is your community life? What are your social connections like? Is that something that you might want to think about improving? So those are things that I don’t think will necessarily be happening tomorrow, but there are things that are on the radar and that there are lots of ways to get feedback on that.

39:51 – Understand the impact of your behaviors

Levels can help you understand the impact of your glucose levels and other behaviors on your overall health.

I think what Levels is interested in is really helping you understand how your behaviors are impact your health, and this is where resilience is so key and core to that. We’re really looking at how your body prepares for and recovers from different demands on the system. And so preparing for social interactions might be releasing oxytocin as an example. And so the type of oxytocin spike, the length of that spike might be able to tell you a lot. So those are the types of things that I think Levels will be interested in. And I think a big part of the reason that I’m talking about resilience and trying to get out there with this concept right now is that we feel that it’s a great way to think about your health and that I think everybody wants to be healthy. But there’s no great definition for what that is. Most of the metrics and markers that we’ve come up with are correlated with disease or correlated with diabetes or heart disease or Alzheimer’s or things like that.

Michael Chapman (00:00):

The contents of The Lab Report are meant for educational purposes only. They’re not meant to be misconstrued as medical diagnosis or treatment advice. Today on The Lab Report, Dr. Taylor Sittler.

Patti Devers (00:12):

Head of research at Levels.

Michael Chapman (00:14):

And on all around cool guy, like most of those Levels people.

Patti Devers (00:18):

They are. The world of medicine can be challenging. Clinicians and patients are always looking for more options, more effective treatments, and in the end, more answers, functional and integrative medicine focuses on addressing root causes of disease. Here at Genova Diagnostics, we’ve watched this field evolve and grow for over 35 years. We’ve not only adapted, we’ve led. Join us as we talk about functional medicine, laboratory testing and optimizing health. Welcome to The Lab Report. I was just talking to Stuby and she saw three black snakes in her yard.

Michael Chapman (00:55):

I saw one, there was one on my house.

Patti Devers (00:57):

What?

Michael Chapman (00:57):

I literally was in the garage. I turned around, there was a face with a tongue sticking out.

Patti Devers (01:00):

Oh my God.

Michael Chapman (01:01):

Hello.

Patti Devers (01:02):

Hi, Michael Chapman. How are you today?

Michael Chapman (01:05):

I’m great, Patti Devers. How are you, ma’am?

Patti Devers (01:07):

I’m good. I’m a little confused, like the snake was on your house, like on the roof or just like slapped against the side of your house?.

Michael Chapman (01:13):

It was in between the gap between the bricks. There was a black snake was trying to get through there. I think it was after, there’s a little bird and I think maybe there’s a nest with some eggs in there. I think he was after that. But he was went across the top of the garage. Well, anyway, this is a podcast. It’s called The Lab Report. It’s brought to you by Genova Diagnostics. And thank you to Geneva for all the support. It’s a little show. We talk about things like functional medicine, specialty lab testing, integrative therapeutics. And today we’re going to talk about glucose monitoring, CGMs.

Patti Devers (01:49):

That’s fascinating. And if you listen to this podcast and you are also into CGM.

Michael Chapman (01:55):

Well you currently are listening to it.

Patti Devers (01:56):

And you happen to love today’s episode, maybe you could go to iTunes or Spotify, perhaps subscribe, rate, review, leave us a star, some feedback. We like that.

Michael Chapman (02:05):

Speaking of feedback, if you have additional feedback, like all that feedback you just gave is not enough and you need to give more feedback, you could send the feedback to [email protected]. Now I know why I always say feedback at GDX. It’s not that it’s [email protected]. That’s our email address.

Patti Devers (02:21):

And you can also follow us on social media @GenovaDiagnostics, Instagram, Facebook, stuff like that.

Michael Chapman (02:27):

Do the following, become a follower.

Oliver (02:30):

What are you on about?

Michael Chapman (02:32):

Good question, Oliver. What are we on about?

Patti Devers (02:34):

Speaking of following, we follow pretty closely all the happenings over at Levels, Continuous Glucose Monitoring company.

Michael Chapman (02:40):

I would say we follow them intensely closely.

Patti Devers (02:43):

We do. And many of us here at Geneva wear CGMs. And so it’s always exciting to get to talk to anyone on their team.

Michael Chapman (02:49):

Yes. And today’s no exception. It is Dr. Taylor Sittler, and he is in charge of research and development over at Levels. And so we’re going to have a pretty fun conversation. He’s got an interesting background, interesting tale, and man, just a tremendous way to look at some of these root causes and what they’re trying to do at Levels to really address these root causes in a real time biofeedback way. So super cool conversation, super cool guy. I can’t wait to talk to him.

Patti Devers (03:19):

Michael.

Michael Chapman (03:19):

Yes, Patti.

Patti Devers (03:20):

I’m kind of fan girling out a little bit. We love Levels.

Michael Chapman (03:24):

We love them so much.

Patti Devers (03:24):

And you know I love pathologists.

Michael Chapman (03:25):

I did not know that, but I know that now.

Patti Devers (03:27):

We have this Dr. Taylor Sittler. And for those of you who don’t know Dr. Sittler, Dr. Taylor Sittler is the Head of Research at Levels, a Continuous Glucose Monitoring company, a physician and entrepreneur. His career has focused on personalizing medicine, starting companies in genetics and women’s health, including co-founding Color Health, where he was the chief science officer. Prior to that, he completed his residency in clinical pathology at UCSF and started a genetics research group in the computer science department at UC Berkeley with David Patterson. Taylor received a Howard Hughes medical training grant and scholarship during medical school at the University of Massachusetts and UCSD. He has published papers on pathogen detection and characterization, genetic sequence analysis and algorithms, and several other topics related to systems biology. He is an avid skier and hiker and enjoys all things outdoors, including coming on The Lab Reports. And with that, welcome Dr. Sittler.

Michael Chapman (04:21):

Thank you. Thank you for being here.

Dr. Taylor Sittler (04:27):

Thank you for having me. It’s great to be here.

Michael Chapman (04:27):

Absolutely.

Dr. Taylor Sittler (04:27):

I’m excited to talk with you all today.

Michael Chapman (04:28):

Yeah. Yeah, yeah. There might be a couple people out there at this point who don’t know Levels. I’m sure everyone else does.

Patti Devers (04:36):

Of course.

Michael Chapman (04:37):

But I’m wondering about your origin story a little bit and how you got involved with Levels and just tell us about your role over there and the work that Levels is doing.

Dr. Taylor Sittler (04:46):

Sure. As I like to say, I bumped into Levels early on as they were raising money going through their first round of financing, and was really taken with Josh and Sam’s approach. And Sam immediately connected me to Casey. At the time, I was actually running a separate company in women’s health, looking at hormones and trying to help, essentially provide a missing medical service to women who are going through menopause, because it’s a time that is really important for setting women up for the second half of life. OBs don’t like to deal with it, primary care docs don’t like to deal with it. It’s like this hot potato that gets passed between different doctors. And so we were trying to start some of these medical services and make them available virtually.

Dr. Taylor Sittler (05:40):

Casey’s work and our work collaborate. I thought we had the opportunity to do a really great collaboration because there’s a lot of evidence that these hormonal shifts that women go through have a big impact on glucose. And so we had thought about doing some studies together. We looked at a few different avenues and ultimately, that startup didn’t end up working out. But I kept being interested in hormones, hormone monitoring, things like that. And so I kept talking with Casey and with Josh and with Sam. And as last summer, it became clear that the company wanted to move in a direction of measuring more than just glucose at the time. And it’s not yet clear how we’re going to do that, who we would partner with to enable those things.

Dr. Taylor Sittler (06:32):

But I thought this is something it’s definitely an ongoing interest of mine that I’ve been pursuing. And if it’s something that they want to do, let’s do this together rather than doing this individually. And so, basically, late in the fall or early this year is when I came on as the head of research to help them expand into a broader service, think about how to enable research and to really supercharge that effort in the company because they’re already doing so many things so well. It’s been really fun to see how the team continues to expand and continues to improve how they’re offering the current service. And it’s exciting to think about where we’re going to be able to go in the future.

Patti Devers (07:27):

Love it. Love it. Yeah. Dr. Casey Means, friend of the show and friend of ours.

Michael Chapman (07:31):

Yeah, for sure.

Patti Devers (07:32):

And everything that happens over at Levels, we love. This glucose variability is becoming such a hot topic. But as relates during the pandemic, we know that the patients whose outcomes were not great were those with metabolic dysfunction. So can you talk a little bit about the scope of this metabolic crisis and why we should care?

Dr. Taylor Sittler (07:50):

Yeah. Maybe I’ll start with the pandemic as a micro and then we can zoom out to this crisis that’s been building for 30 years now. There were two interesting data points around COVID. One is that folks with glucose impairments, some form of diabetes, seemed to be at higher risk for lethal COVID. And it’s the mechanisms there still aren’t 100% clear, but the correlation is definitely there. The easiest way to explain it, maybe the easiest correlation to make, is between modified glucose Levels and inflammation. And what we’re seeing is that having… Usually by the time you get to altered glucose tolerance and you have glucose spikes into the 150s and the 200s, you’ve been pounding on your metabolism for years.

Dr. Taylor Sittler (09:04):

And typically, that increase in sugar that you see, and the tissue’s insulin resistance is linked to inflammation that happens in the body. And in particular, what we’re seeing is there’s a shift toward… One traditional way that we’ve broken these two arms down is Th1 and Th2 responses. Broadly speaking there, responses to external pathogens and puncture wounds and things like that, which you might typically sustain in a fight versus the internal monitoring, like natural killer cells that are making sure that you don’t get cancer and things like that. And I think the altered glucose metabolism for a couple of reasons that aren’t completely clear end up of being linked to a move away from this self-monitoring. And so effectively, you’re reducing the body’s ability to mount a good response when you get COVID, and I may have to get back to you with some materials afterwards, because there were a few mechanisms that were proposed.

Dr. Taylor Sittler (10:21):

But it’s really interesting to see that when the body gets deregulated in this way, when you start to see signs that the signaling cascades related to metabolism are off, that there’s a bunch of other underlying pathology that’s already there as well. And I think that’s really what it comes down to is that folks who, whether it’s because of the increased glycation that we see in the body, or it’s because of the shift in the immune system, that folks with prediabetes and diabetes have a harder time mounting an effective immune response. And that leads to problems.

Dr. Taylor Sittler (10:57):

Another interesting tidbit here is that in a bunch of different emergency rooms, you’re seeing folks start to use cortisol as a marker of the severity of disease. And what you find is if folks come to the ER with an elevated cortisol, their chance of dying of COVID is up by 50 to 100%. And so there are these clear signs in the body that someone is or is not able to mount an effective immune response and that they’re at risk. And I think that’s something that will come back to later in the program, but I think that’s a nugget to take away.

Michael Chapman (11:41):

Right.

Dr. Taylor Sittler (11:41):

And then if we zoom out more broadly, with the number of people with diabetes and pre-diabetes, you’re talking about one in three Americans, half of them are going to have diabetes within 10 years and two thirds of them actually don’t know if there’s a problem. So there’s this huge issue that people are unaware of that puts them at risk for a number of different diseases, and that risk has been building for a long time.

Dr. Taylor Sittler (12:13):

I first encountered this issue back in medical school when it was called the obesity epidemic, and I think the CDC called it that because that would allow them to step in and help rather than leaving it up to the states, which is where medicine is normally regulated. And Michael Pollan actually had a great way of describing this in Omnivore’s Dilemma, which was already back in 2006, where he talks about the alcohol epidemic in the US, in the 19th century and compares it to the obesity epidemic. Now, this is a time when employers were actually expected to provide spirits for their employees.

Patti Devers (12:53):

What?

Dr. Taylor Sittler (12:54):

Yeah. You were expected-

Michael Chapman (12:57):

Born in the wrong century, Patti.

Patti Devers (12:58):

Took the words out of my mouth, Michael Chapman.

Dr. Taylor Sittler (13:03):

Right. Instead of the artisanal yogurt and the five different types of flavored water, it was hard alcohol. People were drinking at breakfast, lunch and dinner with predictably, horrible results on communities and family life and things like that. And it makes you understand prohibition in a different light when you think about that. And I think his point is that the obesity epidemic is just as lethal. It’s just as disruptive and lethal an epidemic as the alcohol epidemic, it’s just much more silent. And it’s important to think about it that way. And I think people have been talking about this for a long time, but for some reason, it just has not been able to hit the public radar.

Dr. Taylor Sittler (13:55):

The other interesting tidbit that he brings up that I like to mention is that it has some of the same origins. So the metabolic health crisis has some of the same origins as the alcohol epidemic, and that is over production. In the 19th century, it was over production of corn, which led to tons and tons of whiskey, corn whiskey, basically. And that’s what gave rise to all of this. In the 20th century, it’s the fractionation of corn and overproduction of some of the other processed foods that lead to these calorically intense foods that almost all of us eat. Escaping high fructose corns syrup these days is almost impossible. Right? So it’s that oversupply.

Dr. Taylor Sittler (14:40):

I think the other two things that have really led to the metabolic health crisis are we’ve engineered exercise and movement out of our daily life for efficiency and comfort. And we’ve also managed to ratchet up the chronic stress that everybody feels. Some of that is loneliness, but some of that I think is just the way that we’ve designed modern life and the speed of it makes it very stressful. And when those things come together, over time, you overwhelm the body’s systems and these really amazing signaling cascades that enable you to eat and sleep and work effectively.

Michael Chapman (15:21):

How’s that for unpacking an etiology Patti. That was pretty amazing.

Patti Devers (15:24):

Well said.

Michael Chapman (15:25):

And it brings up a couple questions. And I really like how you talked a little bit about, the molecular aspects related to inflammation and the cascades there. But you rolled it up into this idea of metabolic dysfunction causing just general inflammation. And so it made me think about what you said about cortisol, because I think of cortisone being produced by adipocytes and how that could tell you a little bit about general inflammation in the body. So that connection between cortisol, what they’re finding as it related to outcomes in COVID, do you think that was more with respect to inflammation and obesity or with respect to stress, or both?

Dr. Taylor Sittler (16:09):

Yeah, that’s a good question. I think the cortisol level specifically is, at the moment that you walk into the emergency department, it’s giving you a sense of the body’s overall stress level. That elevated stress could be related to difficulty breathing, it can be related to a number of different things. But it basically is telling you that the body is having a really hard time dealing with this particular disease. And that translates into ability to recover from COVID. Effectively, what COVID does in the subset of people that it kills is it overwhelms the immune response. What it’s doing is triggering an immune response in the body that really causes the body to attack itself. Right?

Michael Chapman (17:06):

Yeah. Got it.

Dr. Taylor Sittler (17:08):

And so I think the cortisol in this case is really a measure of that.

Michael Chapman (17:10):

I see. I was thinking there was a baseline cortisol prior or two getting COVID that they were doing it that way that, that was the structure of the design rather than upon entry to the hospital.

Dr. Taylor Sittler (17:20):

It’s at the time they show up.

Michael Chapman (17:21):

Got it. Yep. Okay, that makes sense. That makes sense. Yeah. The other thing is the concept of this metabolic resiliency, it is getting more attention these days. You start to hear terms like metabolic flexibility and all these aspects coming out a little bit more with the help of people like yourself and Dr. Casey Means, Dom D`Agostino, all those people who are contributing so much to this. But how do you define, at the end of the day, metabolic resiliency in this term?

Dr. Taylor Sittler (17:48):

Yeah. Resilience to me is actually a concept that includes metabolism, but isn’t limited to it. It’s more of a global phenomenon. And it has some of its roots in allostasis. If you’ve looked into allostasis at all, basically the body has this incredibly sophisticated and complex supply chain management system that it uses. And what we see in metabolism is just the tip of that iceberg, where as soon as you smell or taste food, your body is preparing to move that glucose into the cells, right? It’s getting the digestive system revved up, it’s planning for the liver to be able to process it, the adipocytes and the muscle to be able to handle the incoming energy. And this incredibly complex signaling cascade is working for you to handle all of the things that you’re about to take in. Your body is this incredible prediction machine.

Dr. Taylor Sittler (18:58):

And we can tell a lot by how well your body prepares for food, as well as how well it recovers after a big say, glucose load, as in an oral glucose tolerance test, which is so something that the medical industry uses to measure your ability to handle it. So I think when you’re thinking about both preparation and recovery, you can tell a lot about how healthy someone is by how well the body supply chain management system is functioning. The metabolism involves this complex signaling and cascade. And as we were talking about before, if your sugar is spiking up high, or your insulin is off the chart, you’re probably pre-diabetic and the signaling cascade is off. There’s a lot of information there that’s related to disease.

Dr. Taylor Sittler (19:45):

And so a person’s resilience, as we define it, is their ability to handle changes in demand. It’s their body’s ability to handle all the things that you throw at yourself. And better resilience enables you to essentially have lower glucose variability, lower insulin variability, better sensitivity in your muscles, et cetera. And I think that’s really the idea behind resilience is that by measuring how your body responds to changes in demand, we’re going to be able to tell you a lot about how to avoid disease. And in the Levels context, I think coupling that testing, which is you’re going to receive via these, what I call feedback metrics, glucose, cortisol, other things that respond pretty quickly. It helps you understand how your behaviors are impacting your health. And that’s really what’s so important. It gives you this mirror that tells you, “Hey I’m actually not that resilient in this particular way. Maybe I need to focus a little bit more on improving my resilience.”

Dr. Taylor Sittler (21:00):

And I think that’s the goal here, is to try to identify this concept, that by looking at your body’s signaling cascade in both the lead up, as well as the recovery from different events, you can tell a lot about health. And the best example that we have of this so far is heart rate variability, which is already convincingly linked to a number of different physical activities. We know that the more your heart rate responds to activities that you begin to undertake, or that you’re recovering from, the healthier that you are.

Michael Chapman (21:36):

Yeah. Yeah. It’s so fascinating too, that at its core, these concepts of variability are so important to the body, right? Because with heart rate variability, it’s the ability to handle sympathetic and parasympathetic and bounce between them. And so here, it’s the ability to handle insulin and glucagon and really expose the variability between those two things. It’s fascinating how that’s set up.

Patti Devers (21:56):

Well, I was struck by, so we know that metabolic resilience is important. And then how do you measure it? And it’s coming back to all these wearables, all of these new biohacker tools, right? Things like Continuous Glucose Monitoring and heart rate variability. Are there other ways that we could measure this, Taylor, besides some of these biohacker wearables?

Dr. Taylor Sittler (22:15):

Yeah. By other than putting something on your arm?

Patti Devers (22:20):

Yeah.

Dr. Taylor Sittler (22:20):

I think honestly, because we know so little about it now, that’s probably the standard way that we’re going to do it for the next five to 10 years, because there’s a lot that we have to learn. But once we start to make those basic correlations, I think you can start looking at other things. One great example of that, so there are a number of different apps that are coming out now that use a camera plus machine learning to tell whether someone has fallen, whether they’re at risk of falling. This is particularly useful in older adults. And there’s this concept of frailty index, which is basically a measurement of your movement and your functional ability that you can start to measure with these external cameras.

Dr. Taylor Sittler (23:08):

And actually, I just heard about something the other day. There’s a new type of device that I think it uses infrared so it can see through walls. And you just stick it in your house and it passively monitors your movement and gives you a sense for whether there’s a problem, that right now it’s really mostly used for fall detection. But I could see that manifesting later. And so I think in addition to the wearables, that I think we’re very interested in because of the ability to benchmark these things, they’re what I call the unwearables. And I think there’s a whole movement around that. So devices that you can have in your home.

Dr. Taylor Sittler (23:50):

Another example of this is, so my partner for a long time worked with a company that’s developing a new type of Alzheimer’s therapy based on a discovery at MIT. It was probably eight or 10 years ago now. And what they found is that if you could trigger the brain, the neurons in the brain, to fire at a certain frequency, that it would trigger an immune response that would help clean up Alzheimer’s plaques. And so they developed this device that uses light and sound to be able to trigger that response. You’re essentially just firing those neurons at a certain frequency. And for early Alzheimer’s, it seems to be very effective. So you could imagine having lights that work at a certain frequency or that maybe you, for an hour a day, you listen to music, that’s maybe a bit choppy, but it gets your brain firing at a certain frequency. So I think as we understand these things better, we’re going to have to baseline them with wearables first, but I think unwearables will become a bigger and bigger category over time.

Michael Chapman (24:50):

Cool.

Patti Devers (24:50):

Amazing.

Michael Chapman (24:50):

That is amazing.

Patti Devers (24:51):

And it’s life changing because data is compelling to patients. So once they see something, even if it’s unwearable, it really is compelling for a lifestyle change.

Michael Chapman (24:58):

Yeah. One question too. So we’ve had conversations with people around metabolic flexibility and we get this back and forth between a muscle centric approach to insulin resistance versus a fat centric approach to insulin resistance. And so I’m wondering when you think about the early triggering events, how do you think about those two camps and how they interact, I guess? Does that make sense?

Dr. Taylor Sittler (25:25):

Yeah. And I think in some sense, I’m… Where would I put myself here? So I think I’m sort of in the middle of this. My background is more with genetics, hormones, things like that, so I’m still fairly new to the different camps and I tend to start in the middle. So I like to think of them more as signaling problems than as, oh, it started in the muscle or it started in the fat. My genetics background tells me that I’ll bet that both things are happening in different segments of the population.

Dr. Taylor Sittler (26:11):

If you take it that over 50% of human variation, if you look at molecular variation and enzymes and things like that, occurs at less than 1% frequency. We have an incredibly outbred population. And when you look at causes for disease, I think there was a dominant philosophy in the early 2000s, once they had sequenced the human genome, that there would be these, for common diseases, we would find common genes. And what we found was exactly the opposite, that there were these common diseases that we had identified that actually had different molecular causes. And so usually when I get a question like this, I’m like, well, it’s probably both.

Michael Chapman (26:56):

Sure. Yeah, right. Well, even a binary question is like alluding to what you’re saying, is like, “Oh, I guess what? It turned out to be more complicated.” We should have known yeah that. Probably right.

Dr. Taylor Sittler (27:14):

I think about the signaling cascades as providing information. So what I’m really interested in is measuring the right thing to give you the information content, to tell you how to either modify your behavior or take a particular medication. We can unpack those two camps a little more if you want, but that’s sort of the framework that I-

Michael Chapman (27:38):

Yeah, it’s interesting. I tend to think the one thing that I’ve come to grab is the muscle really seems to be a big sink, a big glucose sink. So I think when it comes to people trying to reduce weight and improve their overall metabolic flexibility, reduce their insulin resistance, gaining muscle, I think is probably really effective of just like lowering everything quickly. As far as etiology, I agree. I think it’s probably knowing the complexity of the body, both things happening at the same time. So I don’t know. Yeah, I don’t know much more than that, honestly.

Patti Devers (28:11):

But based on what you just said, Michael, it leads into the next question. Okay, so we know that there’s this metabolic crisis out there. We know we can assess it. We know it’s important. Now, what do we do? Let’s be part of the solution here. So is it just gaining muscle? Where do we start with this?

Dr. Taylor Sittler (28:28):

Yeah. So I like to have a couple of really basic things to recommend to folks. The basic things tend to be the easiest to implement. And so you can expect a step change. They’re not necessarily the most effective for everyone because that to more work, to figure out. I think Casey and the team has done a really great job of dissecting what foods to eat, what foods not to eat, how to eat them in combination. So for instance, what we’re seeing is that if you want to minimize your glucose spikes, if you eat chia seeds, let’s say before you eat some carbs or you go for a walk right after you eat, to stimulate your muscle to your point. But you’re going to minimize that glucose spike over time because you’re helping your body deal with the metabolism. And I think the reason for the chia seeds as an example is that you’re stimulating multiple arms of metabolism at the same time. So you’re not just pushing in carbs.

Dr. Taylor Sittler (29:28):

And that enables your body to either potentially take in less of that sugar or to metabolize it at a rate that’s not as high. So figuring out the right foods is really helpful and thinking about timing in terms of what foods you eat when, and potentially when you do your exercise is really helpful. Another one on the timing front that I really like is fasting. The way that I think about it is when you fast for a period of time, you’re essentially giving that complex signaling cascade a break, and you’re giving your body a chance to reset. And what we found from programs like AMADA and Virta. I think the Virta folks were particularly focused on using fasting as a part of this, that you can see reversal of type two diabetes in certain situations simply by resetting those cascades.

Dr. Taylor Sittler (30:21):

And part of it is that even with the same amount of muscle, if you’re building muscle, I think is certainly helpful, but even with the same amount of muscle, if you can change the insulin sensitivity of that muscle yeah by giving it a break from having to process all glucose, then you can see improved response over time. And so that’s another thing to think about. In terms of exercise, I think to your point, large muscle group exercise seems to be really helpful, high intensity exercise a couple times a week. You also want to get the cardiovascular system going. And the traditional way to do that is 30 minutes every day. What’s been interesting is you’re seeing a rise in things like breath work, that where you do these fast ins and outs. And that also seems to push the cardiovascular system.

Dr. Taylor Sittler (31:11):

So I think it’s too early for us to know what the output is there, but that can be really helpful, I think, for regulating your cardiovascular system in general, which is really important. And may also impact blood flow in the finer tissues. And then I’m forgetting what my third one is here. I tend to do things in threes because it’s easy for people to remember them, and I just forgot my third one. Fasting and then exercise. And then stress management. And actually, breath work is pretty good for that as well. Meditation, breath work. I think what we find is high stress or chronic stress both increases your average glucose. It tends to have an impact on your metabolism pretty early. It also tends to impact inflammation in ways that we talked about.

Dr. Taylor Sittler (32:10):

And the explanation that I think resonates with a lot of folks is that if you go into fight or flight mode, again, thinking about this, your body is a supply chain management system. You’re expecting to get some bumps and bruises. You’re expecting to get a potential puncture wound or something like that. So revving up that arm of the immune system can be really helpful for having the right response and making sure that if you do get bumps, bruises, or something worse that your body can handle it. But if you’re pushing the immune system in that direction all the time, you’re doing so at the expense of something, and that’s the ability to fight certain viral infections, to monitor for cancer, as well as some of the other typical chronic diseases that we see develop, things like arthritis, et cetera, et cetera. So those are my three basic ones.

Michael Chapman (33:04):

Yeah. That breath work part is super interesting as it relates to the cardiovascular component. I’m really excited to hear that. I had not heard that before. Especially since having used to run, now I’ve got broke knees.

Patti Devers (33:16):

Now you can do the breath work.

Michael Chapman (33:17):

Exactly. So I don’t to work on that.

Patti Devers (33:20):

I will also say that the Levels CGM really helped me to know how my blood sugar related to various foods.

Michael Chapman (33:26):

That was my other point.

Patti Devers (33:27):

Yeah. So if you’re looking to see, like, because something spikes my blood sugar doesn’t mean it’s going to necessarily spike Michael’s blood sugar. So we would encourage you just to get a CGM from Levels and do those experiments yourself, which is super cool.

Michael Chapman (33:38):

Yeah. That part of the self discovery, the personalized, and even I would call it biofeedback, I guess, around what you’re eating and adjusting thereof is so powerful. So that’s part of the great work of Levels. And so we already know that you guys are on the cutting edge as it relates to the metabolic health part of it and behavior change, but what’s on the horizon? What can we expect in the future? Anything new, exciting, that you’d be willing to drop on the show and share with us?

Dr. Taylor Sittler (34:09):

I think maybe spending a few minutes to expand on the point that you just made would be a great start because I think there’s still a lot of rich and fertile territory there. Helping people just unpack how their responses are affecting… How their glucose response to food, for instance, how their body is handling the particular behaviors that they’re taking on or the ice cream that they’re eating or whatever is in impacting their health. I think there’s still a lot to learn there and there are going to be a lot of ways that we can help people get what I call a better mirror of that.

Dr. Taylor Sittler (34:51):

So it’s really being able to, right now, use your glucose to see, oh, that thing that I just ate is actually having a big impact on me, or for me, it was I didn’t eat too many cereals, but there was one I used to eat these Barbara’s whole oat things, which were supposed to be heart healthy. And I had looked at the ingredients on the back and for me, that spiked my sugar into like the 170s. And I was just like, “Whoa, how is this possible?”

Patti Devers (35:26):

Might as well just have Cinnamon Toast Crunch.

Michael Chapman (35:29):

Yeah, yeah. You’re missing out all these years.

Patti Devers (35:30):

You missed out.

Dr. Taylor Sittler (35:32):

Yeah. Might as well-

Michael Chapman (35:33):

Barbara.

Dr. Taylor Sittler (35:40):

Whereas for me, ice cream doesn’t really do that or a bowl of rice most of the time, I’m fine with. But that’s not true for everybody. And there are a whole like the Southeast Asian genetics and in particular, I think there’s been a lot of work recently on South Indian diets and how there’s a set there that really impacts diabetes. Getting back to that, 50% of human variation occurs at less than 1% frequency. It’s really important to get feedback on what you’re doing. If you’re going to improve your health over time and understand how the behavior that you undergo impacts you, I think having that personalized feedback is critical. And I would encourage everybody to try out Levels and at least see it for yourself.

Dr. Taylor Sittler (36:31):

I think within the first two weeks, I’d be surprised if you don’t find something, if you don’t uncover something that’s surprising to you. So that’s the first thing. And I think right now, we’re really doubling down on helping people understand that and tease that apart. One of the things that we’re seeing is that for instance, alcohol has a pretty big impact on sugar and particularly sugar spikes, post eating. It’s pretty common for somebody to drink a beer with dinner or have a glass of wine or something like that. And we’ve had a few people write in and say, “I just had this super greasy, super sugary meal and drank like three bottles of beer and my sugar was totally stable. This thing doesn’t work at all.” And what’s important is for us to understand when, currently, if you’re just looking at sugar, you’re really only even looking at half of metabolism. You need to at least be looking at glucose and triglycerides in some form, whether it’s glycerol or free fatty acids or something like that.

Dr. Taylor Sittler (37:43):

And so it’s possible to confound the metabolic score and our general measures by just combining a couple of bad things, so to speak. Over time, we really hope to help people understand that and to be able to provide better measurements of metabolism. I think there are a couple of ways to do that. One is to involve more markers, like looking at the triglyceride pathways, looking at… We’d love to do lactate or insulin or uric acid is actually another really interesting one. And then for things like stress and exercise and stuff like that, looking beyond that to cortisol. Interestingly, there’s a lot of research around community and one’s feeling of social connectedness and longevity.

Dr. Taylor Sittler (38:43):

So people that go to church, for instance, in their later years are more likely to live a longer life, which is hard to understand. People with partners are likely to live a bit longer. And there are ways that you can start to measure that. So oxytocin, for instance, we know is released when people feel like they’re part of a group or when they’re volunteering and giving back or things like that. So there are some interesting ways that we can start to provide feedback, extending that mirror beyond metabolism to how is your community life? What are your social connections like? Is that something that you might want to think about improving?

Dr. Taylor Sittler (39:22):

So those are things that I don’t think will necessarily be happening tomorrow, but there are things that are on the radar and that there are lots of ways to get feedback on that, right? If you think back to unwearables and cameras or text message analysis, there are a lot of different ways that you can get at things like community and social connection. So I think you can look to that as an area that we might be interested in the future as well.

Dr. Taylor Sittler (39:50):

Fundamentally, I think what Levels is interested in is really helping you understand how your behaviors are impact your health, and this is where resilience is so key and core to that. We’re really looking at how your body prepares for and recovers from different demands on the system. And so preparing for social interactions might be releasing oxytocin as an example. And so the type of oxytocin spike, the length of that spike might be able to tell you a lot. So those are the types of things that I think Levels will be interested in. And I think a big part of the reason that I’m talking about resilience and trying to get out there with this concept right now is that we feel that it’s a great way to think about your health and that I think everybody wants to be healthy.

Dr. Taylor Sittler (40:44):

But there’s no great definition for what that is. Most of the metrics and markers that we’ve come up with are correlated with disease or correlated with diabetes or heart disease or Alzheimer’s or things like that. Actually, Alzheimer’s, we don’t have too many great markers for, but we’re going to continue to try to find them. Whereas, we are just really starting to think about markers that are correlated with overall health. And the fact that actually, if you promote health, you can actually prevent disease. And so I think this concept of resilience and maybe being able to recover or from disease faster or better, being able to recover from an all nighter that you might have pulled, having more energy to spend with your kids, these are things that people really value. And that’s where I think this concept of resilience is going and what we’re trying to help people with, is to live the life that they want, to have the health that they want.

Patti Devers (41:38):

I love it.

Michael Chapman (41:38):

That was perfect.

Patti Devers (41:39):

A fascinating conversation.

Michael Chapman (41:40):

Yeah, absolutely.

Patti Devers (41:40):

And Dr. Taylor Sittler, we can’t thank you enough for spending time with us. But before we let you go, we do have one last random question that I’m going to kick to Michael Chapman.

Michael Chapman (41:49):

Yeah. We have a silly question at the end of interviews that relates to nothing. And so my question for you is, do you have a favorite wild animal?

Dr. Taylor Sittler (42:02):

What would be my favorite wild animal? I think it’s got to be the pangolin. My daughter got this book called Tails, and it’s got all these unusual animals in it and she’s been going around saying, “Pangolin, pangolin.”

Michael Chapman (42:17):

Yeah. Yeah, yeah.

Dr. Taylor Sittler (42:19):

So that’s currently my favorite wild animal.

Michael Chapman (42:21):

I know that book.

Patti Devers (42:21):

I was just going to say that, Michael, I’m sure you have this book at home.

Michael Chapman (42:24):

Yeah, the daddy tail, or the monkeys pulled the daddy tail. I know this book, for sure.

Dr. Taylor Sittler (42:26):

Totally. That’s it.

Patti Devers (42:28):

Amazing. Great answer. Well Taylor, it was awesome to meet you. We can’t thank you enough for spending time and hopefully you’ll agree to come on again soon.

Dr. Taylor Sittler (42:36):

That sounds great. Thanks for having me. It was really fun talking with you all.

Michael Chapman (42:40):

Man, that was so fun. I could talk to him probably all day long. I feel like he does such a great job at not just understanding some of the more subtle biochemical nuances within the pathways, but he keeps an eye on the big picture, which is the general causes of disease, whether it’s inflammation, oxidative, stress, insulin resistance, these sort of things. So it’s just really, really great conversation, I think.

Patti Devers (43:06):

Yeah. We’re going to have to have him on again.

Michael Chapman (43:07):

Yeah, no doubt.

Patti Devers (43:08):

And I will say the pangolin answer was surprising. Pangolin are-

Michael Chapman (43:11):

That was surprising.

Patti Devers (43:12):

They’re kind of creepy looking. They’re scaly, like anteater looking things, right?

Michael Chapman (43:16):

They’re interesting. They’re not an animal that I think I would naturally, like it was a surprising answer when someone’s like not a lot of normal pangolin conversation happening on a daily basis, I don’t think.

Patti Devers (43:26):

I will say it’s a not surprising answer when you’re speaking to someone who’s like a visionary and just thinks differently than everyone else. So that makes sense to me now.

Michael Chapman (43:34):

Look, honestly, anything that is responsible for the death of ants, including eating them, is okay in my book.

Patti Devers (43:43):

Why do you hate ants so viscerally?

Michael Chapman (43:45):

What’s not to hate? Next time on The Lab Report, the world’s most premiere pangolin expert.

Patti Devers (43:52):

How’d you get him so fast?

Michael Chapman (43:53):

Turns out he didn’t have a lot going on.

Patti Devers (44:01):

You’ve been listening to The Lab Report. If you like what you hear, please subscribe to our podcast, rate us and leave us a review. To learn more about Genova Diagnostics, visit our website at gdx.net. There, you’ll find information on specific testing, educational resources and how to connect with our show. Call us at 1-800-522-5762, or email us at [email protected].

Michael Chapman (44:27):

So you said that you love pathologists. Is that true?

Patti Devers (44:30):

Yeah.

Michael Chapman (44:31):

What’s the deal there? You love a whole group of professions?

Patti Devers (44:34):

Well you know I love ER docs the best, right? I’ve mentioned that several times in the show. But I also have this special place in my heart for pathologists and radiologists.

Michael Chapman (44:44):

That’s a lot of people that you’re just loving right away. That’s three categories. This is anti-personalized approach to love.

Patti Devers (44:51):

I’m just saying, because working in the hospital, pathologists and radiologists are these nebulous entities that you never see, but we wait with baited breath on their report because it’s life changing. So they always just felt this like very nebulous important thing.

Michael Chapman (45:07):

Kind of like a judge.

Patti Devers (45:08):

Yeah. Only a judge you don’t see.

Michael Chapman (45:11):

They should wear a big long black robe.

Patti Devers (45:23):

So ridiculous.