Get Off The Blood Sugar Rollercoaster with Dr. Casey Means

In this episode of the Doctor Mom Podcast, hosts Elana Roumell and Stephanie Greunke speak with Levels co-founder Dr. Casey Means. She explains the role of blood sugar in modern day life, including why we need to carefully control it and what happens when we don’t. The bottom line is that metabolic fitness is possible, especially when you have a guide such as the Levels continuous glucose monitoring system.

Keeping patients out of the operating room

Dr. Means was determined to go beyond surgery and attempt to help her ENT patients treat the root cause of their disease.

You see a lot of people in healthcare practice coming back for recurrent issues and recurrences of disease even after surgery, and so that was another little thing to me that said, okay, people are coming back with the same types of conditions, even after you treated them a year before. You think about like a sinusitis patient who might be on antibiotics and steroids every single winter. And it’s like, well, is that potentially because we’re not addressing the root cause?… In that journey, I really sort of came to the conclusion that I wanted to spend my clinical energy helping people on that side of health care, really focus on that front-end. How can we keep people out of the operating room? One of the takeaways from that exploration was how much metabolic health and blood sugar are big triggers of inflammation.

Diabetes is preventable

Diabetes is a leading cause of death in the United States, but it doesn’t have to be.

In 1950, less than 1% of people in the United States had type two diabetes, and now nearly 14% of the population has type two diabetes. This is an almost entirely preventable condition. Right now we have 128 million Americans, so almost 40% of the country, with prediabetes or type two diabetes. Again, almost totally preventable. These blood sugar conditions, the inflammation they generate and the other downstream physiology that dysregulated blood sugar promotes actually impacts dozens of other diseases. It’s really a driver for so many of the chronic conditions we’re seeing in our country. Actually, nine of the 10 leading causes of death in United States are in some way contributed to by dysregulated blood sugar. I learned that, 100 years ago, the average person ate about two pounds of refined sugar per year. Now we eat on average 152 pounds of refined sugar per year, and that’s not even talking about refined carbohydrates.

A health coach right on your arm

Susing CGM technology, Levels helps cuts through the mystery of everyday diet and lifestyle decisions.

That’s where Levels really came from, was how do we use a wearable tool at home, and in this case, it’s a continuous glucose monitor to coach people day in and day out about how to be aware of their blood sugar and how to optimize their blood sugar, and do it in a way that’s engaging and fun, and help people cut through the mystery and the controversy of both nutrition, but also food marketing so that they can really be the owners of their own information and understand their bodies better.

How we become insulin resistant

When glucose levels in the body are too high, the body overcompensates and becomes resistant to it.

Glucose will rise after a meal, as you break down those carbohydrates, and the body wants to get that blood back to the normal level of glucose, and so it releases insulin from the pancreas, a hormone which travels into the bloodstream and then help cells take the glucose out of the bloodstream into the cells so that they can actually be used converted for energy. And if there’s access, it’s either stored as chains of glucose or fat. Insulin is the shuttle that helps the glucose get into the cell so that they can actually use. When these glucose elevations are very high, very frequent, are happening over and over, that’s a lot of insulin the body has to keep releasing and the body actually becomes numb to that signal, which is called insulin resistance. And the body’s amazing and overcompensates to basically make up for this resistance.

What is a continuous glucose monitor?

It short, it’s a wearable device that measures the glucose present in your interstitial fluid.

A continuous glucose monitor is – you can think of it like just a wearable, like another wearable that we might have, like our Fitbits, or an Apple Watch or a WHOOP. It’s telling us about something that’s happening in our body all the time, which is how our glucose levels are changing. What’s cool about it is that it’s the first wearable that’s actually testing an internal biomarker. It’s this little sensor that’s the size of two quarters stacked on top of each other, but there’s a little teeny four-millimeter hair-like filament that goes under the skin, that’s actually testing the glucose, the sugar between cells, which is called the interstitial fluid. The glucose leaks out of the bloodstream into the interstitial fluid, and this measures it there. And then it sends that information to the smartphone so you can actually see this in real-time.

Why annual glucose tests don’t cut it

If only measured annual at the doctor, you could get a misleading glucose reading. And if high glucose is present, you won’t know what’s causing it.

We eat pounds of food a day and probably dozens of different components of food. Maybe the next day your weight is 0.5 pounds higher or lower, or six months from now, you get a fasting glucose test that is three points higher than last year, or your triglycerides are five points less than last year. It’s like, well, what caused that? What was it about what I ate over the past few months that did that? And the doctor might say, “You need to eat healthier. Here’s a pamphlet.” It’s open loop, and that makes it really hard to change behavior and to know what’s actually right for you and what’s working for you. That’s why closed-loop biofeedback between nutrition choices and then exactly what’s happening five minutes later in your body is really, I think, a game-changer.

Healthy eating doesn’t mean deprivation

It’s possible to eat keto or plant-based and still be healthy and happy.

I’m actually a whole foods plant-based person, so I eat a ton of carbs and my glucose is largely like very flat and stable, and that’s because there’s so many other variables that are going into it that you can learn about and gain awareness and intuition about, and that’s what our app is trying to help people understand. It’s not just about deprivation or everyone needs to be on a keto diet to have good metabolic health. I don’t think that’s the answer, and I actually think different bodies are different, and different bodies are different at different times in the life cycle, like where you’re at.

Factors that influence insulin sensitivity

In addition to factors like what you eat and when, things like exercise, stress, and sleep also play a role in metabolic fitness.

Eating a handful of crackers, if you’ve proceeded that with a salad and some protein, they are going to have a different effect than if you just eat them on their own. That’s just food. Then you get into exercise, type, quantity, frequency, stress, how we’re managing our stress. If we’re eating in a sort of high activated state, I think these have the power to get people to do more mindful eating, like really taking deep diaphragmatic breaths before their meals so that your cortisol and your stress hormones are lower before you eat, which means that our body is going to have less of a glycemic response to the food. Then sleep. Sleep is just this like gigantic one that, when we lose sleep, our glucose responses going to be higher the next day. When we chronically lose sleep, it’s associated with worse insulin sensitivity.

It’s time to get back to normal

Modern life isn’t representative of a natural state for human beings.

Ultimately, we wanna hear our bodies, we wanna listen to our bodies. I think, in our modern world, we are overtaxed, we are just running all the time. We’re in a digital world that’s hyperstimulating, and we’re also in a food world that’s hyperstimulating. These companies are actually creating foods that are intended to take us to our bliss point. None of this is normal cues. I find that sometimes it’s very hard to hear like, wait, how am I actually feeling? Because if I’m not feeling well, I can get on Instagram. You can blunt those signals, and then over time, we, background, kind of break down.

Dr. Casey Means:

The continuous glucose monitor is just a movie of what’s going on inside your body. It’s just an amazingly powerful tool because we’ve never, ever had a tool to understand the immediate impact of a nutrition choice on our health. What we really want for optimal long-term health is to not have hyper frequent big spikes and big dips in our glucose. We want things to be more like rolling hills. We want gentle elevations that aren’t causing a gigantic insulin surge.

Dr. Elana Roumell:

Hi, Doctor Mom. Welcome back to another episode of the Doctor Mom Podcast. As functional medicine providers and best friends, we take our clinical experience and combine it with our experience as mamas to bring you practical tips so you could be a proactive parent.

Stephanie Greunke:

Join our conversations every Tuesday, where we interview experts and have hashtag mom life conversations about the challenges and concerns we’re all experiencing on this journey to motherhood.

Dr. Elana Roumell:

We are here to support you, wherever you are on your journey, so you can feel calm, competent and confident as doctor mom.

Stephanie Greunke:

I am Stephanie Greunke, Whole30’s registered dietician and postpartum nutrition and mental health expert.

Dr. Elana Roumell:

And I’m Dr. Elana Roumell, pediatric naturopathic doctor and creator of Med School For Moms, an online program where we teach moms how to safely be a doctor mom.

Stephanie Greunke:

And we want to know more about you, doctor mom, so send us a direct message and introduce yourself. We love getting to know our community and we can’t wait to meet you.

Dr. Elana Roumell:

As a quick reminder, this information is not intended to diagnose, manage, or treat disease. Doctor moms always consult with their doctor before making any changes.

Stephanie Greunke:

Today, we are so excited to share interview with Dr. Casey Means, a Stanford trained physician, chief medical officer, and co-founder of the metabolic health company, Levels. If you’ve been hanging out with me over on my Instagram channel, @stephgreunke, you probably see me share my results from using a continuous glucose monitor and the Levels app. I am a huge fan and wish it was something I could give to everybody on the planet. Continuous glucose monitors help you understand how your blood sugar responds to certain meals, stress, sleep, and exercise, which then allows you to objectively decide which foods and behaviors work best for your body.

Stephanie Greunke:

Dr. Casey is on a mission to empower individuals with tech enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. Today, we invite you to nerd out with us as we chat about the impact of nutrition and lifestyle habits on our blood sugar, which plays a role in our digestion, mood, energy, hormones, body composition, and risk for preventable chronic diseases. We’ll share how you can balance your blood sugar through proven effective strategies so you can feel more resilient as a mama, or set yourself up for a better hormonal position while trying to conceive.

Stephanie Greunke:

We’ll learn how and why we respond differently to even the same foods, proving that there is no one size fits all diet. I can’t wait to dive in. Before we share the interview, I want to give a huge thanks to our podcast partners. BUBS Naturals, Paleovalley, and Active Skin Repair. Sometimes plain water gets boring. There, I said it. And if I’m out of lemons and I don’t want the extra carbonation of a sparkling water, BUBS Fountain of Youth is a fun nourishing option to keep me hydrated.

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Stephanie Greunke:

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Stephanie Greunke:

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Stephanie Greunke:

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Stephanie Greunke:

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Stephanie Greunke:

Welcome to the show, Dr. Casey Means I have been so excited to connect with you on this podcast for what? Months now, and I’m glad we finally have the opportunity to chat.

Dr. Casey Means:

So am I. It’s been so wonderful to get to connect with you online a little bit, and now do this in real life, so I’m so excited.

Stephanie Greunke:

I am too. I’ve been wearing a continuous glucose monitor for a couple of months now, and I’ve been sharing about it on my Instagram feed, and you are the person to talk to when it comes to metabolic health and really understanding how we can realistically navigate blood sugar. This is so important for mamas that are trying to conceive and pregnant moms and postpartum moms, because it impacts our mood and energy and our hormones and our resiliency, and a million other things which we’ll get into today.

Stephanie Greunke:

So, super excited to chat with you about that. Metabolic health is a passion of mine. I think it’s something that we’re not talking about nearly enough as a country. I’m so, so happy to have you here. But before we begin, we always like to talk about one thing that we’re doing or we’ve already done today to nourish ourselves as an icebreaker. What’s something that you’re doing or you’ve done?

Dr. Casey Means:

Ooh, I feel like I have an unfair advantage today because today was a morning very much focused on nourishing myself. My company, Levels, we are doing a remote offsite this week, and because we’re a very health conscious company, pretty much everything in our offsite has been around wellness. This morning we actually had a incredible breathwork session for an hour, which was incredibly powerful. It was like a Wim Hof heliotropic rapid breathing type of experience, and it was very powerful and I think even emotional for many people on the team. So, that was wonderful.

Dr. Casey Means:

Then for lunch, I’ve been using it, a meal kit delivery service called Purple Carrot, which is a plant-based sort of blue apron, and I made myself a beautiful lunch of plants and whole foods and fiber and healthy fats. It’s just got my afternoon going well. Yeah. So, breath work and lots of plants is how I’ve been nourishing myself today.

Stephanie Greunke:

Oh, that sounds lovely. Okay, you win. I feel like we get really spoiled too at my company. I worked for the Whole30, and our off-sites, we always have our Whole30 approved companies and products so we can try them. When we do our off-sites, which we haven’t had in over a year now, and I deeply miss because we’re like family. We like walk into the room and there’s just tons of meat sticks and coffees and like these healthy plant-based foods too, that we get to try and sample. So, it’s making this sad-

Dr. Casey Means:

Oh, that sounds amazing. Yeah. It was fun to … I mean, our company’s only been around for about 18 months, and it was just five of us for the first several months. Because COVID started last March, and the lockdown, a lot of us have never met in-person. So, we are just itching for the time we can be in the same room, but the remote activities were really fun as well. Some cooking classes and breathing work and things like that.

Stephanie Greunke:

Very cool. That sounds so nurturing. For me, I want to share something yesterday that happened. I had a kind of stressful day at work. I had one more hour until I had to go pick up my little kids. I needed like a transition, but my body was telling me like, get a little bit more done, like you have an hour to get more done, but I really just needed to switch off from that masculine work mode and transition nicely before picking up my two children that would really need the best of me, and I saw a friend calling at 3:00 PM, and I’m like, this is my cue.

Stephanie Greunke:

That I need to just talk to my friend. She always makes me laugh. I took the call instead of taking the extra hour for work, sat outside with the fizzy water, had a great conversation with her, and I found that I could go and pick up my kids just with a lot more vitality and not feeling so stressed, and I let go of so much of the tension that I was holding and it was a much better evening that way. That was really nourishing to me and I wanted to share it. Because it’s not always like the best opportunity to be productive. It’s good to slow down sometimes too.

Dr. Casey Means:

Absolutely. It’s such a good reminder. Yeah. I mean, sometimes more is not more, and taking that extra half hour to just get yourself and your mind feeling good. The benefits it can have to those around you too, is incredible, like what you’re saying with picking up your kids, so I love that.

Stephanie Greunke:

Yeah. It was funny. Because she tried to call me the night before and she’s like, I’m at Starbucks just relaxing, and I thought of you and I wanted to talk. I was telling her, I’m like, I was so jealous because I would’ve loved to do that. And I was like, you know what? I can. I can take that time away for myself, so it was kind of full circle. Let’s get into metabolic health because there’s so much to chat and you and I could nerd out about this for the longest time. What got you passionate about metabolic health to the point where you created a company that focuses on helping hundreds of thousands of people optimize their metabolic health?

Dr. Casey Means:

Yeah, so it was a kind of a circuitous route. I have always been interested in nutrition my whole life since high school. In college, I studied personalized genetics and my passion and research in college was about Nutrigenomix, which is how food compounds impact gene expression. I thought that was so empowering because we think we have this sort of blueprint that’s fixed. But in reality, every choice we make every day about what we’re eating and how we’re living, how we move, how we sleep, how we stress, all of these things can actually translate into our molecular reality in our body and change the expression of this blueprint.

Dr. Casey Means:

And that’s really empowering. So, I’ve always really been passionate about food. Flash forward, I went to medical school and then I trained as an ear nose and throat surgeon, had a neck surgeon, and it was there that I was just so deeply embedded in the American healthcare system. What I was observing was that so many of the conditions I was treating day in and day out were fundamentally inflammatory in nature.

Dr. Casey Means:

They were things like sinusitis, laryngitis, thyroiditis, all these itises. That suffix in medicine, itis, is inflammation, and so, kind of had me step back and say like, wow, I’m prescribing a lot of steroids in my practice. These are medications that tamp down on the immune system. When steroids and antibiotics don’t work, you take people up to the operating room and you actually just like bust a hole and stuff. For the sinuses, you bust a hole in the sinus and you suck the pus out.

Dr. Casey Means:

But it was just sort of, it made me step back and say, why aren’t we addressing what’s actually causing inflammation, what’s triggering inflammation? What’s behind all this? Why are we just reacting with medication? And then when that doesn’t work, doing sort of an anatomic intervention, which doesn’t make sense to me because you can’t actually operate on the immune system. It’s in the blood. It didn’t make a ton of sense, and it really felt like a lot of symptom management, but not actually fixing the core physiology that was leading to disease.

Dr. Casey Means:

You see a lot of people in healthcare practice coming back for recurrent issues and recurrences of disease even after surgery, and so that was another little thing to me that said, okay, people are coming back with the same types of conditions, even after you treated them a year before. You think about like a sinusitis patient who might be on antibiotics and steroids every single winter. And it’s like, well, is that potentially because we’re not addressing the root because?

Dr. Casey Means:

This really led me on a journey towards trying to understand really more root cause approach to medicine. Got really interested in reading all the functional medicine and sort of longevity medicine, nutrition focused doctors, people like Dean Ornish and Mark Hyman and Sara Gottfried and Michael Greger, and Neal Bernard, and all these people who were writing about how food and lifestyle impact our health, and in particular, our inflammatory pathways.

Dr. Casey Means:

In that journey, I really sort of came to the conclusion that I wanted to spend my clinical energy helping people on that side of health care, really focus on that front-end. How can we keep people out of the operating room? One of the takeaways from that exploration was how much metabolic health and blood sugar are big triggers of inflammation. Blood sugar issues in the United States are just absolutely monumental and epidemic.

Dr. Casey Means:

They’re so normal and so epidemic that I feel like we almost think it’s just, this is the way it is. But the reality is, in 1950, less than 1% of people in the United States had type two diabetes, and now nearly 14% of the population has type two diabetes. This is an almost entirely preventable condition. Right now we have 128 million Americans, so almost 40% of the country, with prediabetes or type two diabetes. Again, almost totally preventable.

Dr. Casey Means:

These blood sugar conditions, the inflammation they generate and the other downstream physiology that dysregulated blood sugar promotes actually impacts dozens of other diseases. It’s really a driver for so many of the chronic conditions we’re seeing in our country. Actually, nine of the 10 leading causes of death in United States are in some way contributed to by dysregulated blood sugar. I learned that, 100 years ago, the average person ate about two pounds of refined sugar per year.

Dr. Casey Means:

Now we eat on average 152 pounds of refined sugar per year, and that’s not even talking about refined carbohydrates, which basically translate directly into sugar in the blood. So, our poor bodies are just completely overloaded. There’s nothing normal about it. When we’re aware to it, it’s fairly easy to prevent and even reverse and it’s contributing to so much unnecessary mortality. I was just like, this was a huge wake up call for me in my surgical life, and I really shifted gears. I opened my own private practice that was really focused on more holistic root causes approaches to health.

Dr. Casey Means:

I spent two hours with every patient, like versus the 15 minutes I was spending in ENT, and we talked about all aspects of their diet and lifestyle, really what was the core physiology that was probably linking a lot of their symptoms. Some people would come in with 35 symptoms, but it was very clear that many of them were related to inflammation, the gut, oxidative stress. So, we really focused on those links and then how to mitigate them.

Dr. Casey Means:

People got better rapidly, and it was incredible. It was like never felt better being a doctor during that time. Then the next question for me was like, well, this is great, this is awesome, but it doesn’t really fit well into the way we practice medicine in the US. I was charging like out of pocket. This is not the type of care that is covered by insurance. How do we actually figure out how to take some of these principles about promoting metabolic health, sustainable, personalized dietary and lifestyle changes and scale that?

Dr. Casey Means:

That’s where Levels really came from, was how do we use a wearable tool at home, and in this case, it’s a continuous glucose monitor to coach people day in and day out about how to be aware of their blood sugar and how to optimize their blood sugar, and do it in a way that’s engaging and fun, and help people cut through the mystery and the controversy of both nutrition, but also food marketing so that they can really be the owners of their own information and understand their bodies better.

Dr. Casey Means:

That’s been my journey, and yeah, it’s just, now I just focus with clinical practice business work. I edit for the International Journal of Disease Reversal and prevention. So, everything’s really centered around the same ethos of let’s understand our bodies better so we can make these choices day in and day out that helps us express our highest version of ourselves.

Stephanie Greunke:

Well, I commend you for all of that because I know it’s really a choose your heart too. It’s like you stay in one form of medicine that you were trained for and you work through some of these kinks in the system or you step away from that and you create your own thing and set on this new journey. I know it wasn’t easy to make that choice, but at the same time, it probably felt a little bit easy because you knew there was a better option to help more people. Just want to say like, thank you for the work that you did and for being brave to step into that role.

Dr. Casey Means:

Thank you.

Stephanie Greunke:

Yeah. One thing when I was reading too, and I’ve heard you in other podcasts, is just how few people, like how many people are actually undiagnosed with metabolic concerns, so type two diabetes or pre-diabetes. Can kind of speak to that? Because I think there is definitely a range when it comes to metabolic health. What’s the current status of people who may not even know that they have something going on, but they actually do?

Dr. Casey Means:

Yeah. When we think about the … Like I mentioned before, there’s 128 million people with type two or pre-diabetes, and of that grouping, 90 million are pre-diabetic. Of that 90 million, 90% don’t know they have pre-diabetes. So, it’s like huge numbers. So, you’re just marching down this path towards full ball and fulminant insulin resistance and blood sugar problems and just not aware of it. A lot of that is rooted in how we measure and we diagnose these conditions. Right now, to understand your metabolic health, you go to the doctor’s office, maybe once a year, get a fasting glucose check.

Dr. Casey Means:

If it’s under a hundred, they’re like, oh, you’re fine. That’s pretty much it. You might get your cholesterol checked as well, and there’s actually some interesting ratios you can do with the triglycerides and the total cholesterol to get a sense of insulin resistance. But the average doctor is not, I think, aware of the fact that you can do those calculations. We’re really just looking at LDL, triglycerides, HDL, but you can actually learn a bit about metabolic health and insulin sensitivity from taking ratios there.

Dr. Casey Means:

The average person is really just fasting glucose. If it’s under a hundred, you’re kind of given this bill of health. I think that’s where things kind of break down, because there’s so much more to it. First of all, metabolic dysfunction is probably starting 10, 15 years before that fasting glucose actually flips in to the range that is problematic, pre-diabetes, above 100. 100, 125 on the fasting glucose. Just the very quick primer for anyone listening who sort of might not know the relationship between the glucose and the insulin, but basically, when we eat carbohydrates, it converts to glucose in the bloodstream.

Dr. Casey Means:

Glucose will rise after a meal, as you break down those carbohydrates, and the body wants to get that blood back to the normal level of glucose, and so it releases insulin from the pancreas, a hormone which travels into the bloodstream and then help cells take the glucose out of the bloodstream into the cells so that they can actually be used converted for energy. And if there’s access, it’s either stored as chains of glucose or fat.

Dr. Casey Means:

Insulin is the shuttle that helps the glucose get into the cell so that they can actually use. When these glucose elevations are very high, very frequent, are happening over and over, that’s a lot of insulin the body has to keep releasing and the body actually becomes numb to that signal, which is called insulin resistance. And the body’s amazing and overcompensates to basically make up for this resistance. So, it just keeps producing more and more insulin to drive that glucose out of the bloodstream and into the cells.

Dr. Casey Means:

But over time, that process just breaks down. Then what you find is that you can’t overcompensate enough, and then you start to see that glucose instability in the blood and maybe your baseline glucose levels, even in the morning when you’re fasting, rising over time. But that first sign of insulin starting to be elevated in the blood at baseline and after meals, that signal of insulin resistance, you can actually pick that up with a fasting insulin test, but that is not part of standard of care in the United States. We don’t order insulin.

Dr. Casey Means:

I don’t really have any friends in conventional medicine who order insulin, and yet we know that insulin resistance on our lab tests can show up 13 years before glucose ever flips into a problematic range. We also know that, within the fasting, normal fasting glucose levels, so right now it’s anything under a hundred, and really the average person in the normal range is going to be between 70 to a hundred, because your blood to glucose, you don’t want it to go too low, but 70 to a hundred is kind of that range of “normal” fasting glucose.

Dr. Casey Means:

What we actually know though, is that as your fasting, glucose rises from 70 towards 100, you basically exponentially increase your risk of developing type two diabetes or developing heart disease or having a stroke, a cardiovascular outcome down the road. Someone with a fasting glucose of 99 is not the same as someone with a fasting glucose of 72. If you really dig into the research, probably a fasting glucose between 72 and 85 is where you’re going to have the healthiest long-term outcomes.

Dr. Casey Means:

And yet, the way we diagnose things right now, that’s not going to show up in the doctor’s office unless the doctor is very aware of this stuff. If you’re a hundred or a hundred, you’re “normal.” I think a lot of it comes down to the way we bucket things and the way we diagnose things into categories, as opposed to thinking of it as it really is, which is a spectrum and physiologic changes over time that are happening that we really need to, I think, dig into more deeply.

Stephanie Greunke:

Yeah, that’s so well said, because I think, when you’re explaining this, I think about, even just things like thyroid health, which we talked about on the podcast a lot, it’s like your TSH, it may not notice changes 10, 15 years before thyroid antibodies are elevated, but doctors aren’t testing thyroid antibodies, or thinking about hormone testing. Like you can go in for a one day of your cycle of measurement for progesterone or estrogen, but you’re missing the other picture. I think our audience is familiar with that, but I’ve asked clients to put that on the requisition for their doctors to get fasting insulin.

Stephanie Greunke:

And they are, either have their doctor rolls their eyes at them or says, “No, because your blood sugar numbers are okay.” And it’s almost like are concerns that are very valid and based on scientific research are invalidated. And we’re just like, okay, well, I guess we’re all right. One other thing with the blood sugar readings is it’s, unless you’re actually testing after your meals and seeing what that’s doing, we don’t know, okay, how did your body actually respond to that meal? Were you able to take that glucose and put it into your cells efficiently? Or is it hanging out really high after a meal for a long time?

Stephanie Greunke:

The only way you would know is if you tested with a finger prick or a device, like a continuous glucose monitor that can give you an idea of area under the curve, as we call it, or how your body is responding to the carbohydrates in your meal. So, it’s not just about fasting glucose. It’s really, okay, let’s check your fasting insulin, let’s get your hemoglobin A1C. And if possible, let’s see if we can get more readings after your meals through fingerstick testing and/or a continuous glucose monitor.

Stephanie Greunke:

I would just love to have you share what a continuous glucose monitor device is, if possible, because I’ve been getting a lot of questions about it, and I’m sure people have been seeing it on their social media feeds because Levels is everywhere now. So, what is this thing on people’s arms that they’re using?

Dr. Casey Means:

Yeah. A continuous glucose monitor is … You can think of it like just a wearable, like another wearable that we might have, like our Fitbits, or an Apple Watch or a WHOOP. It’s telling us about something that’s happening in our body all the time, which is how our glucose levels are changing. What’s cool about it is that it’s the first wearable that’s actually testing an internal biomarker. It’s this little sensor that’s the size of two quarters stacked on top of each other, but there’s a little teeny four millimeter hair-like filament that goes under the skin, that’s actually testing the glucose, the sugar between cells, which is called the interstitial fluid. The glucose leaks out of the bloodstream into the interstitial fluid, and this measures it there.

Dr. Casey Means:

And then it sends that information to the smartphone so you can actually see this in real time. These sensors typically take measurements every 15 minutes automatically, 24 hours a day. There are some sensors that take them every five minutes, and then you can always just override that and scan as much as you want to get more frequent values, but it’s totally painless. It’s just a really neat technology. It’s technology that was originally developed for the type one and type two diabetes communities as a treatment management, I’m sorry, as a management tool for their conditions.

Dr. Casey Means:

Formerly, you’d have to prick your finger and get a single time point measurement to understand what’s happening after meals and how to dose your medications. That’s like a snapshot of what’s happening with glucose, whereas a continuous glucose monitor is just a movie. It’s a continuous movie of what’s going on inside your body. It’s just an amazingly powerful tool because we’ve never, ever had a tool to understand the immediate impact of a nutrition choice on our health.

Dr. Casey Means:

There’s never been a closed loop system around nutrition. It’s always open loop feedback from nutrition, which can be very frustrating when we’re trying to make specific decisions for ourselves. What I mean by that is like, you could have … We eat pounds of food a day and probably dozens of different components of food. Maybe the next day your weight is 0.5 pounds higher or lower, or six months from now, you get a fasting glucose test that is three points higher than last year, or your triglycerides are five points less than last year.

Dr. Casey Means:

It’s like, well, what caused that? What was it about what I ate over the past few months that did that? And the doctor might say, “You need to eat healthier. Here’s a pamphlet.” It’s open loop, and that makes it really hard to change behavior and to know what’s actually right for you and what’s working for you. That’s why closed loop biofeedback between nutrition choices and then exactly what’s happening five minutes later in your body is really, I think, a game changer. That’s what happens with the continuous glucose monitor.

Dr. Casey Means:

When we digest carbohydrates, glucose can change in 15, 20 minutes, and we’ll typically have our peak elevation around one hour after a meal. So, it’s really rapid. We were talking before the episode, you could try things like a sweet potato and a white potato and do those on two different days and see what type of response you have. How are those converting to glucose in your body differently? How high are they taking you? What we really want for optimal long-term health is to not have hyper frequent big spikes and big dips in our glucose.

Dr. Casey Means:

We want things to be more like rolling hills. We want gentle elevations that aren’t causing a gigantic insulin surge. We just want sort of gentle with our responses. I think some people might think, well, why don’t we just pick low-glycemic foods or things that have low sugar? And that’s certainly something you can do, but what’s interesting that we’re learning over the last few years is that actually, each carbohydrate affects people differently in terms of how it affects their glucose. So, you and I could both eat one cup of cooked sweet potato.

Dr. Casey Means:

I might go up to a glucose level of 175, which I have done with sweet potato before, it’s in one of my highest spikes, and you might go to 95. For you, it’s actually probably a really good metabolic choice. You’re probably not going to have to release a lot of insulin to soak up that glucose on me. Me, on the other hand, I’m just like on a rollercoaster. I’m surging out insulin, and then probably I’m going to have a crash after that meal, totally different response. That’s going to be the way it is for every different type of food between two people. It’s also interesting, even within the same person, that food can have a different response under different conditions.

Dr. Casey Means:

If I eat that carbohydrate source after a high intensity interval training workout, I might have a much lower response than if I did it on a day when I’m sedentary. If I eat that big carb load when I’m stressed, it could actually have a much higher glucose response than if I do it on a day that I meditated. So, there’s both intra and interpersonal variability in terms of how food affects our glucose levels. In our quest to keep insulin more stable, glucose more stable, having that personal information is really helpful.

Dr. Casey Means:

I think you touched on something really interesting earlier, Stephanie, which was about diagnostics. Right now, glucose monitors are not used as a diagnostic tool for early metabolic dysfunction right now, it’s fasting glucose, oral glucose tolerance tests, and A1C, as you mentioned, but we have not yet used glucose monitoring as a diagnostic tool. I think we’re going to see that in the future potentially happening, certainly if I have anything to do with it, because I do think that if, let’s say everyone, when they’re young and seemingly healthy, wears these for a week or three days, and then their doctor reviews that data, you can pick up on early problems that you might not see on other tests.

Dr. Casey Means:

An example of this would be, let’s go back to just the sweet potato example. Let’s say we both eat a sweet potato, and let’s say I’m much more insulin resistant. So, I’m more on that pathway. I probably have higher insulin at baseline. My body’s having to overcompensate to produce insulin to keep us, me, at the same glucose level. We both eat the same sweet potato, and I might go up, and because I’m a little bit insulin resistant, I might stay up for an extra hour because that insulin’s not working on my cells properly.

Dr. Casey Means:

So, I stay up, I maybe go higher in my glucose spike, I stay elevated for longer, slower to turn back to baseline. That could be a sign that I’ve got an early problem. Whereas you, let’s say you’re very, very insulin sensitive, go up, your insulin works, your cells are sensitive of it, you come right back down, you’ve gone up and come down within an hour and a half. I might be elevated for three hours. So, there’s just interesting nuances, but that’s a whole field of research that needs to happen to really map what’s happening with your glucose curve with what it means for where you are on that metabolic spectrum.

Dr. Casey Means:

But yeah, for personalized nutrition, I think it’s just a game changer and it’s certainly changed my life.

Stephanie Greunke:

It really is, and that’s one thing, I mean, carbs like, do I go low carb? Do I go high carb? How do I figure that out? It really has just been like a guessing game, right? It’s like, well, what do you feel better on? And what’s your context and what symptoms do you have after meals? And how are you feeling? How is your body responding? We have to really think through all of these things. Having a continuous glucose monitor doesn’t take all that away, because it is really, you want to put all these variables together, but it has been shocking for some people who you would look at them and you’re like, oh, they’re lean, they’re pretty athletic. They must have fantastic metabolic health.

Stephanie Greunke:

They could be really struggling with keeping metabolic control. Similar to with PCOS, which I’d love to touch on, it’s like, you can’t just look at somebody and be like, oh, you probably have PCOS. We really need to examine what that could be through various variables and weight isn’t always the indicator. For the moms that are listening, PCOS is the most common or one of the most common hormonal conditions in women. We know that for some, there is this insulin component to it, for most cases of, PCOS. Not all.

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Stephanie Greunke:

Can we speak to metabolic health for the women that are listening that have PCOS that are wondering, well, okay, what does this mean and how can I navigate my blood sugar, and how would it help?

Dr. Casey Means:

Yeah, absolutely. PCOS and metabolic health are basically intimately tied for most women, both from a epidemiologic standpoint, so just what we see in terms of rates of concordance of metabolic conditions with PCOS in the population, but also, we know from a cellular mechanistic level that it’s really related. Just looking at the epidemiology, having PCOS puts people at much higher risk for developing type two diabetes, and actually more than half of the women with PCOS will develop type two diabetes by the time they’re in their mid to late 40s.

Dr. Casey Means:

So, it’s like much earlier onset of diabetes. There’s clearly something going on with this relationship. And it seems to be bidirectional in the terms of the relationship like PCOS both makes you more likely to be insulin resistance and then insulin resistance makes you more likely to have worse PCOS symptoms. There’s a lot that we don’t know about PCOS. There’s genetic underlying factors. There’s environmental factors. There’s a lot that goes into it, but we certainly know that being insulin resistant makes the symptoms worse and having it is going to make you more insulin resistant.

Dr. Casey Means:

What’s interesting is that there are cells in the ovary called the theca cells, which they are insulin sensitive cells, and when they are stimulated by insulin, they tend to produce testosterone or androgen male type hormones. When insulin is elevated in the bloodstream, it’s pushing the theca cells to make more male hormones. And that is where a lot of those symptoms arise related to PCOS, so menstrual irregularity and infertility, hirsutism, excess hair growth on the body, acne, visceral adiposity. These things are all related to having too much of that male hormone in the body, which is directly stimulated by insulin of the theca cells.

Dr. Casey Means:

You can imagine, well, I wonder if strategies that can lower our insulin, like keeping our personal diets lower glycemic impact, which we just talked about is actually a very individual thing, maybe that could improve PCOS. The research on that is incredibly strong. There’s been numerous studies showing that just generally, low glycemic diet, so not even personalized with CGM, but just focusing a general low glycemic plan can really improve both symptoms, fertility outcomes, blood lipids, insulin sensitivity in women with PCOS.

Dr. Casey Means:

Then, more recently last year, there was a study that showed that a ketogenic diet, so a very low carb diet, essentially reversed PCOS in most women who did it. They looked at all sorts of blood parameters, lipids, insulin, cholesterol, etc, and all the sex hormones, androgens, estradiol progesterone, and basically, everything kind of turned around on this very low carb ketogenic diet. That’s really promising. I’ve talked to many of my OB/GYN friends who treat PCOS day in and day out and do understand the relationship between insulin resistance and PCOS.

Dr. Casey Means:

But a lot of what we reach for is sort of pharmacologic management. So, Metformin, which is an insulin sensitizing medication and is used for diabetes, is given to a lot of women with PCOS to help with that side of things. But that dietary lens isn’t, I think, a huge part of mainstream OB/GYN care right now, like pushing people to consider a lower insulin stimulating type of diet. I think there’s promise for continuous glucose monitoring in this patient population. The device is not right now approved for that as … There’s not been research showing that using a CGM can improve PCOS outcomes. But I think in the next five years, I think we’ll see that type of research, at least being explored.

Stephanie Greunke:

Oh yeah. I think that’s so needed too, because when we talk about how much time a doctor has with a patient in the waiting room, I mean how much time do you have to discuss nutrition, very little, if any, and the provider may not feel comfortable talking about it within their scope too. To be able to say like, hey, diet can help, wear this tool. Also, the person can really feel empowered by playing around with things and seeing objectively what happens at their blood sugar. You can’t deny the evidence when it’s on your arm.

Stephanie Greunke:

To be able to say like, okay, I can, even within foods that you may want to include that aren’t low glycemic, like I can get away with one piece of toast instead of two, or figuring out how to individualize your diet so that it works for you and it’s still fun and it doesn’t require as much time with your practitioner if you can’t afford a dietician or nutritionist. I think it’s so easy, and your app makes it very user friendly too. I know, with CGMs that are out there, you have to interpret it yourself. There’s definitely like an art that goes into figuring it out and that’s what your app does so well, it helps put that information into a form that anybody can understand what that data means to make more empowered choices.

Dr. Casey Means:

Yeah. That is really the hope of our cell software, which is our company is focused on building software that helps interpret this data stream into something that’s usable. I like what you were saying about, it’s sort of hard to just come to conclusions just looking at the data stream because … The reason for that is because there’s so much that goes into that glucose readout. It is not just about the amount of carbohydrates we’re eating in our diet. That’s the biggest misconception, I think, there is about glucose monitoring.

Dr. Casey Means:

I’m actually a whole foods plant-based person, so I eat a ton of carbs and my glucose is largely like very flat and stable, and that’s because there’s so many other variables that are going into it that you can learn about and gain awareness and intuition about, and that’s what our app is trying to help people understand. It’s not just about deprivation or everyone needs to be on a keto diet to have good metabolic health. I don’t think that’s the answer, and I actually think different bodies are different, and different bodies are different at different times in the life cycle, like where you’re at.

Dr. Casey Means:

The main pillars that we try and light in the app and these features will only continue to grow that are directly related to glucose, or of course food, so food composition, food logging, understanding which types of foods are stimulating the most. Also food timing, when are you eating? Food will have different impact in the morning versus the night. Food sequencing is important to think about. When you eat carbs first in your meal versus protein or fat first in the meal, can have a very different glycemic impact. Additions of things like fat, protein and fiber to carbohydrates.

Dr. Casey Means:

So, how you’re mixing and pairing foods, like food sequencing, food pairing, and food timing, food composition. There’s so much to it. Eating a handful of crackers, if you’ve proceeded that with a salad and some protein, they are going to have a different effect than if you just eat them on their own. That’s just food. Then you get into exercise, type, quantity, frequency, stress, how we’re managing our stress. If we’re eating in a sort of high activated state, I think these have the power to get people to do more mindful eating, like really taking deep diaphragmatic breaths before their meals so that your cortisol and your stress hormones are lower before you eat, which means that our body is going to have less of a glycemic response to the food.

Dr. Casey Means:

Then sleep. Sleep is just this like gigantic one that, when we lose sleep, our glucose responses going to be higher the next day. When we chronically lose sleep, it’s associated with worse insulin sensitivity, higher cortisol, and even our satiety and our hunger hormones are totally thrown off, our ghrelin and our leptin levels. So, sleep, exercise, stress, food. There’s so much to it. There’s also things that are involved in what we do that have longer term. You’re not going to see them affect your glucose that day, but over the long term, they really matter.

Dr. Casey Means:

Three that I would highlight there are micronutrients. So, the quality of our diet, there are dozens of micronutrients that actually serves as cellular co-factors for the enzymes and the cellular machinery that process glucose, and this is things like B vitamins and alpha-lipoic acid, and zinc and manganates, and magnesium, selenium, chromium. These things are literally like structurally necessary for us to process glucose effectively. And they’re not the types of things that change overnight.

Dr. Casey Means:

It’s more like adherence to a quality diet over time. That also goes through microbiome. When our microbiome becomes more diverse, which can take months of eating, sort of like a healthier, cleaner diet, we see metabolic health improve as well, and poor microbiome is associated with poor metabolic health. Then pollutants, exposure to pollutants is a big one. Not going to have an immediate effect if your outside on a heavy pollution day in LA, for instance, like you going to see your glucose levels change that day, but over time, those chemicals in the bloodstream can actually hurt our mitochondrial function.

Dr. Casey Means:

That’s like seven or eight components that we just talked about that are all related to our glucose control. It’s complex. And even as a physician, I felt unable to look at this whole picture of a patient’s life and pick out little pearls. I do think software actually does it better than a brain can do it. I just think it’s exciting because when you focus on metabolic health, you’re actually focusing on just living a comprehensively holistic lifestyle, and having that feedback can just help you kind of pull those levers in a lot of those different health behavior areas that I know we’re all thinking about.

Stephanie Greunke:

Oh, thank you for all that feedback. That’s so good. I’m like, just keep going. Just keep going. One factor that I found particularly interesting, now that I have my cycle back after babies, is just the changes that I see in my luteal phase versus my follicular phase. After ovulation, because of the change in estrogen to progesterone, that ratio, you actually tend to be more insulin resistant in that second half of your cycle. I usually hang out at around like 80s, the first two weeks of my cycle, and then after ovulation, I can get up to like the 90s.

Stephanie Greunke:

And after some meals, over like 100, which is high for me. Just seeing the difference of all of these factors really, it’s an art to be able to navigate your blood sugar. So, I’m glad you touched on the composition and the sleep. Same thing with sleep. If I have a poor night of sleep, my numbers are much higher throughout the day, not just in the morning. Let’s get a lead into then pregnancy with these hormonal changes. I’m curious, our audience is … They may not love the idea of doing the Glucola drink.

Stephanie Greunke:

Some are fine with it. Others are like, do I really have to drink that? Or they’re not used to drinking 50 grams of sugar at one meal. So, the readings might not be accurate and all of these things. One thing that I did when I was pregnant and my midwife was fine with that was taking my blood sugar readings after meals and using that fingerstick. When I talked about this continuous glucose monitor, I had so many moms that were like, could I do that instead of a Glucola? I know, maybe I don’t know what you’re able to say, but I think, I mean, I know my midwife would’ve been totally fine with that, because it’s actually a more accurate reading, in my opinion.

Stephanie Greunke:

You’re seeing how you’re actually eating through those two weeks and how your blood sugar is responding versus stimulating a pattern that may not be your norm.

Dr. Casey Means:

Yeah. I mean, right now, continuous go glucose monitors aren’t FDA approved for the diagnosis of gestational diabetes. I believe that for people who are diagnosed with gestational diabetes, they are being used … I’m not 100% sure though if that’s an FDA indication for it, but I mean, I think that absolutely this would be a great use. It’s so strange to me that we’re having people drink these unhealthy amounts of glucose, 75 grams, 50 grams. Sometimes there’s orange synthetic food coloring in the drink. I don’t know if … Not for everyone, but sometimes it’s really got yucky stuff in it.

Dr. Casey Means:

It’s just not a great thing to be exposed to. I think, obviously a one time exposure like that is not going to do any long term harm to the mom or the baby, but it’s not ideal. It’s like, can we think of a better way maybe? I know there’s a lot of, some women do other things like they’ll eat like uncolored gummy bears or something like natural organic gummy bears because they don’t wanna drink the Glucola drink. But I am hoping in 10 years we see that basically, instead of doing that, we give people a continuous glucose monitor for like three days, five days, see what’s going on with blood sugar patterns under free living.

Dr. Casey Means:

I make an assessment of whether there’s a metabolic problem. It’s very, very simple. Certainly, if I’m ever pregnant, I’m going to push for that in my own life, but it does take doctors who are aware and understand how to interpret the data effectively. Right now, we don’t have standard criteria to say, okay, if you have this CGM, continuous glucose monitoring pattern, this means you have a problem. It kind of is more like reading the tea leaves. Until we have standardized criteria like, okay, women who are free living, not using standardized Glucola drinks, if they hit 150 or 200 on their glucose, or they stay elevated after a meal for more than two hours, this means that we’ve got to think deeper about gestational diabetes. We unfortunately just don’t have that criteria right now.

Stephanie Greunke:

Yeah. I think it depends on your provider too, like what they’re comfortable with. It’s a conversation. And also, you have the ability as a pregnant person to say like, I want to opt out. I had to sign waivers and say like, this is how I’m going to do it and get your provider on board. But yeah, I just wanted to kind of bring that up. Then, so now moving into the postpartum period, I had really debilitating postpartum anxiety. I know there’s a connection between blood sugar and mood.

Stephanie Greunke:

I’m thinking about the moms that are out there that are feeling depleted and they are maybe snacking more than usual versus sitting down having a meal, because they’re navigating virtual schooling and all these other things. We’re just navigating a mental health crisis in this country as a whole, or in the world as a whole. Can we talk about the connection between blood sugar and mood? I know I would’ve loved to have something like this to kind of keep me on track, so I wasn’t just like snacking all day and I could really nourish myself well, but can you kind of share what the science says and how we could use something like a continuous glucose monitor to optimize our blood sugar to potentially help with those mood disorders?

Dr. Casey Means:

Yeah. There’s two pieces to this. One is more the long term effects of metabolic dysfunction on mood. And then the second is how just day to day glucose variability affects our mood, which are kind of two different types of physiology. We know that in people with diabetes, for instance, there is almost a two times higher rate of depression and anxiety in these populations. You could ask like, okay, well, is that because people are depressed because they have a chronic illness and that is causing financial strain, emotional strain, etc? It’s very possible that’s part of it. But there also seems to be very biologic mechanistic reasons for why insulin resistance could lead to mood issues.

Dr. Casey Means:

For instance, the fact that insulin resistance in the brain … Insulin resistance doesn’t happen in one specific part of the body. It happens everywhere. This is a unified entity, right? So, it can happen in the brain as well. When the brain becomes less efficient at processing energy, which is essentially the root of metabolic disease and insulin resistance, we can see symptoms emerge related to dysfunction of the brain.

Dr. Casey Means:

It’s not just mood actually, when it comes to the brain and metabolic health, we’re talking about mood issues like depression and anxiety. We’re talking about neurogeneration, like Alzheimer’s dementia, we’re talking about chronic pain and chronic fatigue. All of those things are related to dysfunctional metabolism, and it makes sense when you think about what metabolism is. It’s our way of converting food energy to cellular energy. When that process is co-opted or goes awry, symptoms emerge, our cells need energy to function, and lack of production or lack of efficient energy production is going to lead to symptoms, and one of those can be mood.

Dr. Casey Means:

That’s sort of the longer term effects. The shorter term effects are also really interesting, and this really comes down more to anxiety. When we have a blood glucose spike after a meal, even if we’re otherwise healthy, have good insulin sensitivity, if we have a really big spike, let’s say we eat 10 sweet potatoes and glucose goes up over 200, our body responds to that by producing a huge amount of insulin. It’s gonna go up in a sort of comparable magnitude to what that glucose spike is.

Dr. Casey Means:

The body, in effort to clear the glucose out of the bloodstream, can frequently overshoot when it’s been a big glucose spike. And that’s where it goes big up and then a huge crash. That’s kind of that postal meal crash. The technical term is reactive hypoglycemia, like reactive to a choice that’s been made or a spike, and that dip to below baseline levels in that time, it’s been associated with feelings of anxiety. There’s been studies looking at, if you take people who have frequent episodes of big up-downs and put them on a low glycemic diet, generalized anxiety, disorder, improves significantly.

Dr. Casey Means:

That’s really not the only cause of anxiety, of course, but it’s something we can control, which is exciting. I tend to think that extreme glucose variability for me often leads to extreme subjective variability of my day. If it’s up and down, up and down, my mood’s up and down, up and down, my energy’s up and down, up and down, my brain fog is up and down. It’s like, the more stable that curve is, the more stable my life to ends to be, which I appreciate, because I can actually learn and improve.

Dr. Casey Means:

And it’s not hard. It’s not about deprivation, like we’ve talked about, it’s just about modulating and being thoughtful about all of it. That’s what I would sort of … The short term takeaway is like, the more we can kind of smooth out those big spikes, it may have an impact on how we feel during the day.

Stephanie Greunke:

Yeah. I can look at my readings and tell you if I had a good day or if I had like a really hard day, just based on like how many ups and downs I have and just … Yeah, absolutely. And it’s fun because I’ll notice if I’m feeling hungry or if I’m feeling cranky, I’ll check, and I’m either going down or I’m like have been down for a while. I really do think it plays a role. I’m thinking, I say this because I know in the postpartum period, it can be hard to sit down to have a meal. So, we may not be having balanced meals.

Stephanie Greunke:

We’re grabbing something, we’re eating off of our kids’ plate. We’re having usually more like refined carbohydrates and starches. That just really brings on those up and downs up and downs and up and downs all day. It’s okay to go up and down, like you said, but when it’s fluctuating so much, we might get a dip below what our body wants, and that does not feel comfortable. When we joke about the term hungry, there’s actually a physiological reason you’re feeling that, and it’s often linked to that reactive hypoglycemia.

Stephanie Greunke:

The more that we can really understand and know that it’s not us, like we’re not doing something wrong, we’re not cranky, we’re not experiencing rage because we’re bad people. It’s a red flag or a warning that like, hey, there’s things that we need to fix. And it’s not, like you said, not always blood sugar. There’s really different reasons, but there is one common theme that I see, and it is this like snacking and not really nourishing ourselves with those balanced meals. If we can really understand the power of that, it might help us to make better choices when we can.

Dr. Casey Means:

Totally. Yeah. I think it’s just like knowing what we do have some control over and then seeing that changing, modifying a choice just slightly has both a positive objective, like database sort of improve it, but also subjectively, I think that link between choices, objective data, and then subjectively how you’re feeling, that’s really the core of being able to, I think, improve our lives. Just linking objective data and choices, that’s helpful. That’s closed loop biofeedback. But adding in like, how do you feel? That’s really where like the hour comes from.

Dr. Casey Means:

Because ultimately, we wanna hear our bodies, we wanna listen to our bodies. I think, in our modern world, we are overtaxed, we are just running all the time. We’re in a digital world that’s hyperstimulating, and we’re also in a food world that’s hyperstimulating. These companies are actually creating foods that are intended to take us to our bliss point. None of this is normal cues. I find that sometimes it’s very hard to hear like, wait, how am I actually feeling? Because if I’m not feeling well, I can get on Instagram. You can blunt those signals, and then over time, we, background, kind of break down.

Dr. Casey Means:

I think, just like you’re saying, you look at your data, you see what happened, you then think about how you felt, and then it’s just … I can be really a cool experience. I don’t think we should be tied to technology, just shackled to it forever to help us make decisions. But I think the key to not having that kind of the outcome is linking it to how we’re actually feeling, so then we can start to make that association between the choice and the feeling, not just … Yeah. Just sort of learn body awareness and somatic awareness by harnessing data to help us pick up on those signals inside of us.

Stephanie Greunke:

Yeah. It’s almost like a spiritual practice too. It’s like really tapping in, and like, what am I feeling? What am I needing right now? And making a choice, often food is an easiest choice, but it may not be what we need in the moment. There are so many other things. I would love to just round this conversation out with, if you could give, maybe one action step, some somebody’s listening, and they’re like, oh, I’m really interested. I’m craving sugar all the time. Maybe share one of your favorite snacks or something that you grab when you’re having like a sweet tooth that doesn’t spike your blood sugar. What are like a few things that you found that the people that are like, oh, I need something sweet, could go to?

Dr. Casey Means:

One of my absolute favorites is chocolate chia pudding with some fruit in it. This to me is like, it is a, on the level score, it’s a 10, so it’s like a perfect score. It doesn’t raise my glucose at all, but it feels like a super decadent dessert. How I make that is I just take a Mason jar and I put six tablespoons of chia seed, two cups of an unsweetened non-dairy milk. I usually use like almond milk or cashew milk or something like that. Or sometimes I’ll use just like full fat coconut milk, which is super luscious, but two cups of that, six tablespoons of chia seeds, three tablespoons of cocoa, organic cocoa powder.

Dr. Casey Means:

Then I’ll put usually like a few teaspoons on fruit, which is a type of natural sweetener that doesn’t raise blood sugar. I shake up the jar and put it in the fridge for three or four hours, and it’s just like this thick, delicious pudding. What’s amazing about it, and then I’ll cut up usually oranges and maybe some blueberries, put maybe a little bit of ginger on top, maybe some coconut flakes. It’s absolutely delicious. It’s like such a good glucose meal and good for cravings and blood sugar because of the components of the chia seeds.

Dr. Casey Means:

They have omega three fats, which are healthy anti-inflammatory fats. One of the highest plant-based sources of omega three fats. There are some of the highest density fiber you can possibly eat. Just two table spoons has 10 grams of fiber, which is crazy. The average American’s only getting about 12 grams a fiber a day. We’re supposed to be getting like 50 to 75, really good for our hormones, for our digestion, for satiety. It also has lots of protein, and then quite a bit of fat, whole food fat. It makes you feel full, not hungry, stabilizes blood sugar, and feels like a treat, so that’s one of my favorites.

Stephanie Greunke:

Oh, I love that. I love following your account too, because you talked about … You’re vegan, correct?

Dr. Casey Means:

I am.

Stephanie Greunke:

Or plant-based.

Dr. Casey Means:

I should say I do take fish oil every single day, so I’m mostly vegan. Yeah.

Stephanie Greunke:

Okay. But I think there’s this, when we think about a vegan diet or a vegetarian diet, a lot of people are like, well the grains and the beans, her blood sugar just must be all over the place. What I do is you’re really proving that like, no, that’s not the case for everybody. And you’re showing how to pair these things. I know you use tahini a lot and nuts and seeds, and kind of looking at your portions of some of the higher carbohydrate, like grains and being thoughtful about it. So, it really is like, there is no one size fits all diet.

Stephanie Greunke:

This isn’t a, everybody go low carb, keto carnivore podcast. It’s like, there’s food is powerful and you can combine things like we were talking about, thinking about the time of day, and make it work and really still enjoy the food, and that’s really what Levels is about too. You guys don’t push one certain diet. You’re just trying to help people optimize their metabolic health. I will definitely put your Instagram account in these show notes. What is it for people that are listening though?

Dr. Casey Means:

drcaseyskitchen. So, D-Rcaseyskitchen.

Stephanie Greunke:

And you have highlights of all your foods, so I’ve been loving seeing that, because I’m on a plant-based journey myself too.

Dr. Casey Means:

Oh wow.

Stephanie Greunke:

Yeah, and I’ve been really surprised by just how well I’m able to keep my metabolic control, having beans and even a little bit of quinoa. It’s been great and I’ve never felt better. Yeah, I would definitely encourage you to go check out a drcaseyskitchen. And then, where can they find more about Levels, and can you tell us, like how do you actually get one of these meters?

Dr. Casey Means:

Yeah. People can go to levelshealth.com, that’s our website, and there’s a lot of more information about the program on there, the one month metabolic awareness journey. We are currently in a beta phase, so we haven’t launched publicly yet. We’re iterating on our product rapidly with our beta customers, and so you can sign up for the wait list on the website there. There’s also, I highly recommend levelshealth.com/blog. We’ve invested just massively in our editorial operation because we think that people aren’t talking about metabolic health enough. We want to put out great information about why this is relevant to all of us.

Dr. Casey Means:

It not just relevant once you have a metabolic condition. It’s actually so relevant before that. So, we’ve got just really wonderful content out there. I believe you contributed to something on our blog as well, if I’m not mistaken, which is awesome. Yeah. So, check that out and reach out to us on social as well @levels on Instagram and Twitter. Lots of people, beta customers are posting really interesting things they’re learning about their glucose. I certainly enjoy seeing what people are … How they’re using the product. I love the things you’re posting.

Stephanie Greunke:

Oh thank you. Yeah, and @levels too. I watch the highlights and I see what everybody’s doing, and everybody is so different, and it’s really cool to see what they’re noticing with their lifestyle and their readings. I have a skip the wait list link. It’s levels.link/stephg, and that will get you to the front of the line, because that is amazing that, that many people are interested in it, and I can’t wait for them to get their hands on it.

Stephanie Greunke:

Yeah, the blog I wrote was about metabolic health for moms, and I share a little bit more about how to control it for mood and energy and resilience as moms. I don’t think we touched on this, but it’s important. With the continuous glucose monitor, right now in the US, it’s different in other countries, but in the US, you need a prescription to get one of these things, but Levels, you don’t, correct?

Dr. Casey Means:

You do, actually.

Stephanie Greunke:

Well, you do, but you don’t have to get it from your provider.

Dr. Casey Means:

Right. Our system is physician consultation, so it’s very simple. You fill out a health questionnaire and then a physician in your state reviews that, and if it’s deemed safe and appropriate to prescribe a CGM, then we have a partner pharmacy that actually ships them directly to your house. So, it takes away that step of having to go to your doctor and talk to them about this, and then we provide the Levels software that you pair with your prescription, continuous glucose monitors. So, it just kind of makes it a lot easier to get access to these.

Stephanie Greunke:

Yeah, absolutely. Yeah. It’s nice because otherwise, without your service, you’d either have to really convince your provider that it’s a good idea, which I don’t know how that will turn out, but then you also wouldn’t get the app that gives you all the information, and you’re constantly adding things to, and I’m finding new features all the time. Yeah, I cannot recommend this enough if it’s accessible to you. I know your company’s really working hard to create research and to bring down the cost. If it’s not accessible to you right now, just hang on and stick with us, and keep checking to see, and you can still do the things that we talked about on the podcast with working on sleep and stress, and pairing meals together, and looking at time of day, focusing on earlier in the day for some of those higher carb meals.

Stephanie Greunke:

Thank you so much for being with us today, Dr. Casey, this was amazing. Just so many knowledge bombs were dropped on this episode, so I appreciate you.

Dr. Casey Means:

Thank you so much. It was so wonderful to spend this time chatting, and thank you so much for having me on.

Dr. Elana Roumell:

Thanks for joining us today, and we look forward to bringing you more episodes so you can feel calm, competent, and confident as a doctor mom. If you enjoy this episode, please share with two of your mama friends who you think can really benefit from this information. Send them a quick text message or share on social media and tag us, Stephanie Greunke and Dr. Elana Roumell.

Stephanie Greunke:

You can also visit our website, doctormompodcast.com to review show notes, find past episodes, and find other resources to help you be a doctor mom. Please remember that the views and ideas presented on this podcast are for informational purposes only. It is not intended to serve as a substitute for the consultation, diagnosis and/or medical treatment of a healthcare provider. Consult with your provider before starting any diet, supplement regimen, or to determine the appropriateness of the information shared on this podcast. Now, go on, have a great day, and nourish nurture yourself and your family.