Glucose: Your Continuous Marker of Health with Dr. Casey Means

Dr. Casey Means is a Stanford-trained doctor, an ear, nose and throat surgeon, an award-winning biomedical researcher and now the co-founder and Chief Medical Officer of Levels Health, a metabolic fitness company that uses continuous blood glucose monitoring to guide users to making better decisions for their health. On this episode of the WhealthCo Podcast, host Dasha Maximov talks to Dr. Means about how glucose impacts our health long term, the effects of high glucose on women’s health in particular, and how digital tools and wearables could help us to become more in tune with our bodies.

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out the WhealthCo Podcast
• Connect with Dasha Maximov on LinkedIn

15:25 – A first of its kind wearable

We’ve had heart rate monitors, sleep monitors, and step counters, but never a wearable lifestyle monitor for food.

“We’ve never been able to just like sit down at the dinner table and be able to answer the question, what exactly should I eat for dinner that is going to be good for my body? We’ve never been able to answer that question to date. Really what we’ve had is, you can kind of sense how you feel after a meal. You might weigh more te next day or the next week after some meals. You might go to the doctor in six months and have a glucose test that tells you your glucose is going up or down by some amount. But none of that really actually helps you change behavior or change actually your dietary pattern because you can’t create a one-to-one relationship between something specific you ate and what it actually did to you. And with a continuous glucose monitor, you have access to this biomarker glucose, which is our core metabolic substrate. It is a core molecule that we use to make energy that powers every single cell in the body and we have access to that. And so you can eat a cookie and say, ‘Oh, you know, this cookie up-spiked my glucose a very large amount. This is probably not, this is actually doing some harm to me.’ You can see that for the first time.”

21:25 – Gamification of health

Levels is trying to make tracking and experimenting with your health data informative and fun.

“So I think the four key things that I think about in terms of things that modulate glucose is food, exercise, sleep, and stress. Low sleep increases glucose. High stress increases glucose. Exercise tends to decrease glucose and then food of course is a complex one. Things you have to think of within that food pillar is what you’re eating, how you’re pairing it with other foods and what time you’re eating it at food eaten later at night tends to spike because more than food didn’t earlier in the day. Food eaten with protein and fat tends to spike glucose less than just a carbohydrate alone. And then there’s all these interesting foods that are kind of modulators of insulin sensitivity. Like vinegar is an insulin sensitizer, cinnamon is an insulin sensitizer. So within just those four main pillars, and then some of the nuances of the food stuff, there’s this whole world of opportunity to sort of experiment and trial and figure out what can you mix together to just essentially create the most metabolically-friendly space for food to be consumed.”

27:35 – Eating carbs earlier in the day is best

Melatonin, which is secreted in our bodies at night to make us sleepy, makes us less sensitive to insulin so our blood sugar will spike more later in the day.

“If you can keep glucose low, you can keep insulin low, and then you have to start tapping into fat burning for energy because your body doesn’t have this other source of energy as readily available. So, this is kind of this idea of the spectrum from insulin sensitivity to insulin resistance. We want to be as insulin sensitive as possible. We want to keep our insulin levels low. We want small amounts of insulin in the bloodstream to be enough to get those cells, to get glucose in. We don’t want to have to secrete a ton of it to force the glucose into the cells. So what’s interesting is that, you know, we actually kind of can fluctuate day by day, a little bit on our insulin sensitivity, even within a day. So there is some evidence that maybe this melatonin and late at night stuff makes us just transiently a little bit more insulin resistant at night. And that’s why eating the carbs earlier in the day is likely better for us. And so, you know, you hear a lot of people saying, eat your biggest meal for breakfast, eat a smaller lunch and then eat a tiny dinner. And I think a lot of that conventional wisdom is rooted in some of this molecular biology that we’re learning about.”

29:30 – Insulin sensitivity should be tested as often as glucose levels

Doctors test glucose levels yearly at physicals, but an insulin test is a better indicator of whether a person is becoming insulin resistant.

“The thing we should probably be measuring early is insulin, because insulin levels are actually going to rise chronically in the blood a lot quicker or a lot earlier than you’re going to start seeing glucose go up in the blood. And the reason for that is because the body is trying to overcompensate with insulin to keep glucose levels stable. And that can go on for a long time. You can imagine you can just keep rising your insulin levels to force that glucose into the cells, keep the blood range in a steady range over time. And only until that process really goes off the rails, you can’t produce enough insulin to kind of keep those levels of glucose in the blood stable. That’s when you start seeing yearly fasting insulin rise. Some doctors say that insulin probably is rising, like baseline insulin is probably rising about 10 years before we start to see glucose levels rise. So insulin levels are something that I actually check in all my patients as sort of just a baseline of like where you’re at in terms of insulin sensitivity.”

35:22 – Metabolic flexibility is achievable

Metabolic flexibility means that your body can switch easily between using glucose or fat for energy. But people with high glucose levels and insulin resistance are in a state where they never reach the fat burning part of that spectrum.

“We have like weeks worth of fat energy in our bodies. Even if you’re lean, you have just orders of magnitude, more fat that you could use for energy. But for most people it’s not accessible if insulin is always high, so what do you do? Well, you can start burning through your glucose, kind of intentionally to sort of get to a state where you need to use fat and then kind of force your body to use that. That’s what people are doing with ketogenic diets. They’re doing this with intermittent fasting, where they’ll burn through that 2,000 calories of stored glucose and kind of make their body start doing some fat burning. But you can also do it by using the biofeedback from the CGM. Because if you get your glucose levels, if you choose a diet, that’s not spiking you all the time and you’re keeping yourself more flat and stable by using this data to shape your diet, what happens is you are then by default, not spiking your insulin as much. And as you minimize those spikes hour after hour, day after day, your body perks up again and says, ‘Oh, I have to be more sensitive to insulin because I’m not seeing as much of it around.’ So the more you go day after day after day with lower spikes, the more your body is becoming insulin sensitive again.”

45:40 – Glucose and infertility

PCOS is the leading cause of infertility for women and there is a strong link between the disorder and metabolic dysfunction. 70% of women with PCOS have insulin resistance and 50% will develop type 2 diabetes.

“What’s interesting is that the ovaries actually have insulin receptors. And as insulin levels in the blood go up, it stimulates the ovaries to make more male hormones, so testosterone and androgens. You can imagine if you are of a predisposition for this disease and you are in the context of a standard American diet — really high refined carbohydrates and sugars — you are stimulating your insulin more. It’s very possible that your insulin levels are high at baseline. This is directly stimulating your ovaries to make male hormones, testosterone, androgens. And that is often what drives some of the other symptoms of PCOS. So like excessive hair growth on the face, on the nipples, acne, hirsutism, things like that, which often go along with the infertility. But those androgen, sort of male hormones also affect the menstrual cycle and affect our ability to ovulate properly and affect the whole balance of hormones and can relate to the infertility side of things as well. So there’s been quite a bit of research showing that low-glycemic and ketogenic diets can be extremely effective for women with PCOS to get the glucose levels down, get the insulin levels down, get the hormones, the ovaries to create less testosterone, get things back into a normal cycle.”

50:53 – Weight gain in women

Women tend to gain weight after menopause, and there are links between estrogen and insulin sensitivity.

“As we ovulate and our estrogen and progesterone both start creeping up. Progesterone is high relative to estrogen, and progesterone seems to be sort of anti-metabolic health in some capacity. It seems to be associated with less insulin sensitivity, higher glucose levels. So we’ll have higher glucose close to our menstrual cycles, post-ovulation. That’s just some background to say estrogen seems to be favorable in regards to metabolic health. So when you lose that, postmenopausally, it kind of takes a hit. So again, coming back to just tools to help people understand this, if you can give people a tool like this, women who aren’t necessarily like, have diabetes or prediabetes, but are just post-menopausal and are now more at risk for these issues. If you can start really dialing in your diet then, making sure you’re keeping your diet and lifestyle in a way that your glucose is fairly flat and stable, that’s just so empowering to me.”

57:42 – Glucose and aging

High glucose can have a negative effect on collagen, the protein that keeps our skin looking young and plump.

“High glucose can stick to things in the body. It can literally get stuck to proteins and that’s called glycation. And when sugar sticks to things in the body, because the concentration is high in the blood, you form what’s called an advanced glycation end product, AGE is the acronym for that. And this can happen with collagen. You can get glucose sticking all over the collagen and what happens is you cross-link the collagen. When it’s got all that glucose, it becomes cross-linked. This happens with other skin proteins too, like keratin, vimentin, but collagen is really the big one. And as you cross-link, the skin wrinkles. So there has been some basic science research showing that in low glucose, if you take cross-linked collagen and reduce the glucose concentration, you can reduce the amount of cross-linking by I think like 25% or something like that. That is not saying that you can reduce wrinkles by 25%, but like, you can actually impact this process by changing the glucose concentration. So I just think there’s a huge opportunity here to think about our diet and how much glucose we’re exposing our skin to. And how can we, instead of reaching for Botox, reaching for serums, reaching for creams, like why not start with this fundamental pathway of glycation?”

1:08:53 – There’s a sleep sweet spot

A lack of sleep can cause cortisol levels to rise, which then leads to higher blood glucose levels and the effects can happen quickly. But oversleeping can hurt you, too.

“There was an interesting study where they took a bunch of super like healthy young men and they deprived them of sleep. I think for six days they could only get four hours of sleep per night. So six days in a row, four hours of sleep per night, so maybe something you’d see college when people are studying for exams or something, they might be depriving themselves. And just with that amount of sleep deprivation, they basically went from being healthy to being pre-diabetic…as a culture, we’re maybe not sleeping four hours a night, but we’re sleeping less than we should be sleeping. And we’re doing this for years on end and you can imagine how that can take a toll. So it looks like the optimal amount of sleep for metabolic health is between seven and eight hours, although that’s going to be variable for everyone. But what’s interesting is that as people sleep a lot more, outcomes get worse. And as people sleep less outcomes get worse. So you kind of want to be in this sweet spot of like seven, eight hours.”

1:15:25 – Stress works a bit differently

The spike of blood glucose from stress can last longer than it does from food. It’s important to track your stress and try management techniques.

“We’ve seen people anecdotally on our own team who have had a really intense phone call and glucose has gone up like 40 points. And it’s been up for basically the duration of the phone call and then comes down. I think the first podcast I was ever on my glucose actually went up quite a bit and stayed elevated during the entire podcast. And I didn’t necessarily feel stressed, but my body thought I was stressed, which was so interesting to me. Because I was like, that’s funny that consciously, I felt okay, but my body knew something different was happening, like, and it mobilized resources accordingly. So I think the stress thing is fascinating. And I’m really hoping that if glucose tracking becomes as mainstream as like wearing a Fitbit or wearing an Oura or Whoop, or something like that, that we end up using it in a similar way as like a stress biofeedback tool. If you know that certain things, certain stressful events are objectively creating a problem in your body, that gets a very motivating way to start incorporating changes in your life to mitigate that stress.”

1:20:07 – Insulin sensitizers

There are ingredients that you can add to blunt the glucose spikes from meals, like vinegar, cinnamon, and probiotics.

“Getting sleep, managing stress, exercising, those just sort of are obvious, but then the more interesting nuanced stuff. So I would say that the other tools you can use are vinegar. So there’ve been studies showing that if you have a shot of like one ounce of vinegar about just before a meal and then eat a very high carbohydrate load, like two or three pieces of bread, it will significantly lower the glucose response to that bread. And similar is true with taking cinnamon before a meal. These seem to sensitize us to insulin. There’s certainly a lot of supplements out there that can also help, things like berberine has been studied quite a bit as something that can lower glucose. And then there’s actually now probiotics on the market that have been shown to lower glucose levels.”

1:27:20 – Americans are metabolically unhealthy as a whole

Studies show the majority of Americans have metabolic dysfunction, but it’s possible to change that.

“There have been studies showing that 88% of the American population is metabolically unhealthy and that’s monumental. Essentially it is super unlikely for you to be totally metabolically healthy living in this country. And that is really amazing to me because it’s essentially, this is a preventable situation. There are certain metabolic conditions, like type one diabetes that are much more rooted in genetics and sort of in many ways more unavoidable, but that makes up 5% of the diabetes we’re seeing in our country. 95% is more, this what we call adult onset diabetes that is much more related to diet and lifestyle and much of which is preventable.”

1:35:39 – Tech tools can motivate us to stick to new habits

50% of people don’t fill their prescriptions, so how do we persuade people to make better choices? Digital tools can help motivate them.

“We live in a culture where right now the threats that we’re facing as a country, we are facing threats that are based in diet and lifestyle. Our chronic diseases that are robbing the country of our health and our vitality and our biggest economic costs to our $3.4 trillion yearly healthcare costs. These are chronic conditions rooted very much in, or at least propagated by diet and lifestyle choices, which means that as healthcare professionals, the onus is on us to create interventions for people and plans for people that make it so that sustainable behavior change is possible. So we have to think more creatively, like if we can’t even prescribe a medication and people won’t necessarily fulfill it and take it, how are people going to change their whole diet, sleep, stress exercise. It has to be more effective. And this is where I do think digital tools, really tapping into: what do people actually use and love using day in and day out? People always have their phones on them. People like games, people want to be social about things. People want to compete with other people about things.”

1:38:14 – Wearables can put us more in touch with our bodies

The instant feedback lets us connect the dots between how we’re feeling and what is happening in our bodies.

“The way I see it is, how do you create something that makes people like using a digital tool to actually get people more in touch with their bodies? How do we create a tool that makes people listen to their internal cues right now? It might be mid-afternoon and you’re like, ‘oh, I’m feeling frustrated. I’m feeling tired. I want to take an afternoon nap. I have no idea why.’ And it’s just sort of this, you just think it’s like part of your mood or your personality, but then how can you know? You can then use a tool like a continuous glucose monitor to show people data that might correlate with that. And then all of a sudden there’s this trifecta of I had an action, which is I ate this cookie. There was an objective change in my physiology, and this is the subjective experience of the world that I had. So as opposed to just a subjective experience, that we’re very likely to misattribute to other causes ,things like our identity. We now have a very clear answer. It cuts through all the noise and the story. It’s just much more clear.”

Dasha Maximov: [00:00:14] Hello there. And welcome to episode 10 of the WhealthCo Podcast. Today, we have with us Dr. Casey Means.

Dr. Casey is a Stanford-trained doctor, an ear, nose, throat surgeon, and nutritional therapist. And now the co-founder of Levels, a new company in this personalized medicine, health space. I love that Dr. Casey has been playing in so many parts of the health field. She’s seen the invasive surgery route. She’s seen the natural healing through food route, and now she’s into bio wearables.

You’ll see how her expertise in all three fields comes out in this combo. During this episode, we talk about a continuous glucose monitor, also known as a CGM, and how tracking our glucose levels can help us get a better understanding of our overall levels of inflammation and metabolic flexibility. A CGM has historically been used for diabetic patients, people who need to be keeping a close eye on their glucose levels. So companies like Levels and others are now, just now, foraying into the space of viewing and teaching people about their glucose levels before they get sick and are diagnosed with pre-diabetes or other health issues. The CGM is something that you wear for two weeks at a time, and it gives you immediate readings of your glucose levels.

I’ve been using mine for about a week now, and I’ve already implemented some changes to my daily habits. If you’re interested in getting one, you can go to Levels Health and use the code whealthco to purchase one. At the time of this recording, they’re still in beta mode. They’re only available in the US and they have a pretty long wait list.

But if you use the code, you’ll likely be able to jump ahead of some of those folks in the wait list. Enjoy.

Dr. Casey, welcome to the podcast.

Dr. Casey Means: [00:02:11] Thank you so much for having me. It’s great to be here.

Dasha Maximov: [00:02:14] I learned about you through Levels and we’ll talk a lot about that during this conversation, but your background isn’t just within this new wearable, within this new technology, it spans the gamut. So we did a little bit of intro beforehand, but I’d love to hear from your own words, for the listeners, what is your story in a nutshell and how did you get into this house?

Dr. Casey Means: [00:02:39] I am a medical doctor, so I trained in the conventional medical system. I started out my career actually as a surgeon. So I trained as an ear, nose and throat doctor, head and neck surgeon before transitioning my career more to metabolic optimization, digital health and preventative health care. You know, kind of backing up a little bit, I was really fortunate to train at Stanford and Silicon Valley, sort of at the height of the personalized genomics revolution. It was in the early 2000s, the human genome project had just wrapped up and so everyone really talking about personalized medicine and how we could use direct to consumer tools, like something like 23andMe to understand more about our bodies and more about our genetic blueprint and these sort of small differences between ourselves and others that make a real difference in health and disease.

And what was so fascinating to me about the personalized, genetic sort of revolution was not only how we were understanding our genetic blueprint and that the individual nature of that, but also how our environment interacts with our genome to create the expression of our characteristics of whether we’re healthy, of whether we express disease, it’s not just the blueprint itself that is deterministic. It’s really that relationship between the blueprint and the environment. And we think about an environment you’re thinking about all the different things that can modulate expression of the genome and some of the big players there are: food, what we eat, what actual molecular compounds we put into our mouth that actually changed genetic expression, change the structure of the genome.

We think about even things like, you know, the toxins we’re exposed to in the water and the air, stress is an environmental input. How we process information around us and how that translates into our hormones that can affect our genome. How genes are expressed, how our genes are folded, our epigenetics, how much sleep we get and how much we move and exercise, they all translate in the body. These behaviors are environmental inputs that translate in the body through molecular pathways, through hormones, through our nervous system, into actual information for our genes of how they get expressed. So it’s not only interesting to find out sort of what our blueprint is, but also how we can modulate our choices and our behaviors and our environmental inputs to change the expression of that genome.

So that was sort of the ethos in the air when I came to medicine really as like an undergrad. And then I was also at Stanford as a medical student. So that was kind of like the milieu I was in when I was coming to medicine, which was really empowering because I was thinking a lot about how we could get modulate behavior to achieve the best expression of health. Flash forward, I did go into surgery. I trained as an ear, nose and throat, head and neck surgeon. And that was a really interesting phase of my career because in that part of healthcare, it’s a little bit less personalized in the sense that, you know, you’re going in there kind of as like a artisan technician. And you are like, really like changing the structure of someone’s body. They have a lump, you take it out. If they have a clog sinus, you bust it open and you suck out the pus. If they have pus in their ears, you bust open the eardrum, you put a tube in, you suck the pus out. So it’s a beautiful art and there’s a huge role for it. But it’s less of that really nuanced sort of relationship between environment and genes and how we can kind of nudge the body towards this like optimal expression of health.

It’s a little bit more like heavy hammer, you know, like here’s a problem, right? We’re just going to go in and fix it. And it is a lot less based in that sort of nuanced behavior change. You have this incredible skill as a surgeon and people have an advanced disease and problems, and you go in there at the most advanced stage of disease and you fix it with this very invasive tool.

So that was kind of interesting to me because it actually sort of became a conflict for me, between, and to be able to perform this great service to people as a physician, but also really wanting to help inspire people in that much more nuanced way, to understand their bodies on this deep molecular level, understand how these behaviors and environmental inputs do change the expression of health and really proactively create lifestyles that are going to ultimately lead to long-term health, as opposed to, as in surgery where you’re really on the back end of things, you don’t really see people until things have really advanced down the road of pathology and you’re there to kind of clean up the mess, kind of simply put, I wanted to sort of be more a part of, if poor health is water pouring out of a faucet, I wanted to go turn off the faucet as opposed to mopping up the floor, like after it had already poured out of the sink.

And so that was kind of a journey about 10 years into my medical career of saying, “You know what, I love what I’m doing with surgery, but I want to help people take more ownership in control of their health.” So yeah. I went and I actually got additional training in sort of advanced nutrition, functional medicine. And functional medicine is this part, I’m sure a lot of your listeners know about it, but really an approach to health care that is very proactive. It’s really focused on molecular biology and how do we nudge these cellular pathways in the body through behavior and through lifestyle to help people express the best health?

After being in surgery for four years, I went back and got additional training in that, back to studying genetics like Nutrigenomics, how food compounds affects gene expression and all these interesting things and tried to sort of blend that into my surgical practice. And ultimately, I just honestly became so inspired by this proactive root-cause approach to healthcare through functional medicine that I actually split away from surgery.

And I opened a functional medicine, private practice, and was still seeing people for some similar conditions like your nose and throat conditions, chronic sinusitis, Hashimoto’s thyroiditis, chronic ear diseases, chronic cough, hoarseness, a lot of the same things I was seeing, but I was approaching it from a different perspective, instead of saying, you know, surgery steroids, antibiotics, antireflux medication, I was looking super deeply at their diet lifestyle, stress exercise, and really trying to zero in on how we could modulate those things to express the best health. Fundamentally, a lot of those conditions come down to chronic inflammation, you know, sinusitis, Hashimoto’s, chronic ear disease, these are all diseases of chronic inflammation in the head and neck.

And we know that so many of those lifestyle behaviors can serve to mitigate chronic inflammation. What we expose ourselves to day in and day out is what generates inflammation in the body. If we’re putting a bunch of processed food, high stress, lots of toxins in our body, our immune system has to go on high alert and that is going to create inflammation in the body that can arise anywhere.

And so it was really to try and help people sort that stuff out. So that was kind of my movement from, you know, more personalized genetics out into surgery, and then really back into that personalized approach to medicine. And so that’s what I’m doing now. I practice functional medicine. I support companies that are working to create products and digital products that help people make those decisions, those behaviors, those lifestyle choices, day in and day out to improve their health in as personalized way as possible.

So that’s really my passion in health care.

Dasha Maximov:Dasha Maximov: [00:09:45] And I like that you have gone full circle that it’s, you went completely deep and narrow and focused and then said, wait, there’s better ways than the blunt tools of surgery. That being said, I think it’s the right place, right time, right now, as well with personalized medicine and wearables and people really starting to realize that they can do something.

And yet it’s still quite niche. Right. We’re still in this space, like the biohackers, yeah, fine. But then people saying, it’s a lot easier for people to just go ahead and do the surgery rather than saying, okay, I know that chronic inflammation can take 20, 30 years for it to really manifest in something that’s horrendous, but that means that I have to put in the work every single day to manage that chronic inflammation. Are you finding that as well? That people want the quick fix or that the industry is shifting a little bit more towards the, “Yeah. You know what? The quick fix is not so quick actually, because there’s follow up surgeries and there’s other things that end up happening after that first surgery?”

Dr. Casey Means: [00:10:52] I think fundamentally people want to live a good life and they want to feel good.

And people are obviously striving for that answer. I think more than half of the country going on a diet each year, you know, people are trying to move in the right direction, but the reality is that it’s difficult. It’s challenging. And I don’t think it’s necessarily that people want a quick fix, but it’s that they don’t necessarily know what the effective route is to get from A to B.

And we live in a difficult culture for knowing really, how to efficiently achieve our health goals. There are a lot of loud voices in the industry from healthcare to the food industry and the nutrition industry, and it can be very difficult to know what’s the right option. And so sometimes, you know, going with like a pill or a surgery may seem like the only route when you’ve got people yelling at the rooftops, like you’ve got to be carnivore, you’ve go to be vegan, you got to be paleo, you got to be, you know, keto. It’s like, I have no idea what to do. You’re going to choose what it seems like, you know, I think the path of least resistance in a lot of ways. And so that’s really, what’s so interesting to me is how can we use personalized tools and give people information that’s really relevant to their own life and help them understand their bodies better, such that they can make decisions that will actually work for them, and help make that process of sort of trial and error in health, a lot more efficient and rewarding. And I think a second piece to that, again, in our culture, it is difficult to feel really in touch with our bodies I think sometimes. We are on the go. We are moving really, really fast. We live in a very digital forward world where we’re often, you know, engaged with screens.

We’re eating a lot of processed foods that are hyper palatable and that tap into reward circuitry that’s, you know, not quite natural. So in so many ways, we, it’s hard to listen to the cues of our body to tell us like this action is making you feel good. This action is making you feel bad. There’s a lot of confounders out there.

And so, anything we can do, I think, to give people tools to help them understand their own personal body better, through data, through biofeedback, can help cut through a lot of that noise and help us sort of get in touch with our own unique signals. And I think that is really key to sustainable healthy movement, is to be able to hear our body’s signals and respond to those.

Dasha Maximov: [00:13:15] So I will now shift over into kind of talking about this latest project that you have and what you mentioned just now about, you have to be keto or you have to be carnivore, or you have to be paleo or you have to be vegan, you know, that’s the old mentality, I think. And it’s just following influencers or following the kind of the loudest noise, loudest voice.

But for me, I’ve not done keto and this month I’m starting to do that. And play around with it in part, because I feel really empowered by using this Levels, CGM that you guys have created and seeing that data every single time, I kind of look into it or scan it, which is every 15 minutes basically. But yeah, it’s been really nice because that personalized medicine, it’s that wearable, it’s that tool that can actually tell me what my body is doing, because I think that I’m really in tune with it.

But what I’ve noticed over the past week that I’ve been using it is that, I mindlessly do things I completely forget about, this snack or this movement or this, you know, and finding the patterns that I’m noticing is already been incredible. So can you tell us about this latest product of yours?

Dr. Casey Means: [00:14:26] So Levels is the company that I’m a co-founder of, I’m also the chief medical officer. And essentially you can kind of think of it most simply as like Fitbit for blood glucose. So this is a wearable sensor. It’s a program that involves a wearable sensor that you wear on the back of your arm that is testing your glucose levels, Dasha is modeling it here, test your glucose levels in the background every 15 minutes. So it’s giving you a internal biomarker of your body every 15 minutes and transmitting that information to your smartphone, and then it’s paired with software that helps you interpret what that data actually means.

So this is for the first time a bio wearable that tells you how nutrition is affecting your health in real time, you know, we’ve had bio wearables to understand our sleep pretty much in real time, you wake up, you know, how you slept. We have heart rate monitors that tell us about some feedback about our exercise, but we’ve never been able to just like sit down at the dinner table and be able to answer the question, like, what exactly should I eat for dinner that is going to be good for my body?

We’ve never been able to answer that question to date. Really what we’ve had is like, you can kind of sense how you feel after a meal. You might weigh more the next day or the next week. After some meals, you might go to the doctor in six months and have a glucose test that tells you your glucose is going up or down by some amount.

But none of that really actually helps you change behavior or change actually your dietary pattern because you can’t create a wonder on relationship between something specific you ate and what it actually did to you. And with a continuous glucose monitor, you have access to this bio-marker glucose, which is our core metabolic substrate.

It is a core molecule that we use to make energy that powers every single cell in the body. And we have access to that. And so you can eat a cookie and say, Oh, you know, this cookie cup spiked my glucose, a very large amount. This is probably not, this is actually doing some harm to me. You can see that for the first time.

It’s not subjective, it’s not nebulous. It’s just very, very clear. And so by having that information about your own body, it makes it a lot easier to make choices and to sort of triage nutrition. And what’s really interesting about using a tool like this is that. Everyone responds differently in terms of how their glucose rises to a specific food, just sort of to back up, you can think of glucose as a breakdown product of carbohydrates.

And when carbohydrates in the diet breakdown, they can turn into glucose in the bloodstream. And when glucose gets high, it can cause problems. When this happens frequently over time, this is kind of what leads us down the path of having metabolic dysfunction, weight gain. And ultimately if it happens over the very, very long-term can lead to problems like diabetes.

And so it’s something that we really want to track and keep very stable in our bloodstream as best as possible. And what’s so interesting, you know, people have heard about keto diets, which is like keeping carbohydrates very low to keep glucose low or low-glycemic diet. So it’s just kind of similar where you follow a chart that says eat these things that shouldn’t spike glucose in the blood much.

But what we’ve learned more recently is that actually, because of the different variability between the different bodies, people are actually going to, can eat the exact same carbohydrate, you and I can both eat the exact same banana and have a totally different glucose response in our blood. And that’s because a carbohydrate in the mouth has to go through a huge process before it actually becomes glucose in the blood that involves the microbiome.

It involves digestion. It involves our baseline insulin sensitivity. It involves how much sleep we got the night before, all these things actually change the way we confer that carbohydrates into glucose. And so it is actually important for us to know how food is specifically affecting our levels so that we can really tailor a personalized diet.

And what’s amazing is that this wearable, this monitor that we wear, that checks glucose, called a continuous glucose monitor can tell us that information. And it’s really, really neat. The reason this is kind of novel is because traditionally, this technology, this advanced tech has been around as a medical device.

This was a tool used by the diabetic population as a treatment tool. It allowed people with diagnosed disorders of blood sugar, like type one, and type two diabetes to see their glucose all throughout the day and prevented them from having to prick their fingers like multiple times a day to see glucose.

So this was a game changing tool in the diabetic space. But since we know that glucose is something that all of us, you know, it’s important for all of us to care about, for all of us to keep stable, because this has a wide impact on current and future health, what we’re trying to do with Levels is bring this tool to a much greater population of health seeking individuals who want to optimize their health, their diet, their lifestyles, personalize their nutrition and just really uplevel their current lives and really ward off some of these chronic diseases associated with blood sugar.

So kind of circling back to what I was talking about with my own healthcare journey, this is about inspiring, personalized behavior change to create those conditions in the body that express our  best health, and make it fun for people and really interesting.

Dasha Maximov: [00:19:55] That last bit that you just said is critical health has always been petrifying, right?

You go to the doctor and you don’t want to go to the doctor because you’re scared of what he or she is going to tell you, because like, Oh, you have this, you have this, you have, it’s usually a negative thing. And if your test comes back negative or, you know, it’s okay, good. Move on. Right.

Versus now that fun element and that reward element is coming to fruition. It’s coming into the market of being able to say, yeah, check me out. I actually have a really good metabolic flexibility. Look at that. I can have that pizza and be fine in a day. Right? I’m not that bad. I think that element is what I’ve been finding really fun with the app as well, because it’s the game of vacation of health.

And it’s being able to say, Oh wait, today, I’m better than yesterday. I know my habits and therefore I can do something about it. And that empowerment for me has been tremendous. Absolutely tremendous. And it’s kind of what Oura did for sleep, which was fantastic of. Okay. Well, I know if I drank alcohol before I go to sleep, my sleep is going to be worse.

All right. Well, I can do something about that. Not drink alcohol, right? Same thing here. It’s I can see what a chocolate bar is going to do and see that the banana that I eat is going to spike as much as the chocolate bar. Oh wow. Interesting. Maybe a banana is not exactly as healthy as I thought it was, for me.

Dr. Casey Means: [00:21:22] Yeah. And that’s so interesting to hear, like, and you know, one thing that we really are building into the product experience too, to help empower people and make it fun, is this realization that it’s not necessarily about eliminating things from the diet, like it’s not necessarily that you have to never eat a banana again, if it spikes you, because glucose is again, there’s a lot of complexity to what causes a glucose spike.

And so there’s actually ways that you can pair food with other foods, you know, to make that glucose spike maybe less pronounced, or you can pair a food that tends to spike glucose with a behavior that tends to minimize a glucose spike. So it’s all about, you know, from my perspective, building this toolbox and this really holistic awareness of all the things that modulate glucose elevation so that you can create this context for essentially as flat and stable glucose as possible, which is what we know is healthy. So I think the four key things that I think about in terms of things that modulate glucose is food, exercise, sleep, and stress. Low sleep increases glucose, high stress increases glucose, exercise tends to decrease glucose and then food of course is a complex one. Food, things you have to think of within that food pillar is what you’re eating, how you’re pairing it with other foods and what time you’re eating it at. Food eaten later at night tends to spike glucose more than food eaten earlier in the day.

Food eaten with protein and fat tends to spike glucose less than just a carbohydrate alone. And then there’s all these interesting foods that are kind of modulators of insulin sensitivity. Like vinegar is an insulin sensitizer, cinnamon is an insulin sensitizer. So, you know, within just those four main pillars and then some of the nuances of the food stuff, there’s this whole world of opportunity to sort of experiment and trial and figure out what can you mix together to just essentially create the most metabolically friendly space for food to be consumed.

And so I’d be so curious to hear in your experience using a CGM, a continuous glucose monitor, like have you noticed any of those things with like those other levers?

Dasha Maximov: [00:23:38] So one thing that I loved actually was I had clams with like a fatty broth, a massive baguette of bread and a glass of wine, and it was flat. Absolutely flat.

So for me, something about the fattiness and that heavy protein with clams, with the fatty broth actually was able to offset that big piece of bread and that wine. So now granted also I ate earlier in the day, so I’d be curious and not, it was, I think, around six o’clock. So, you know, good enough for dinner. I try and eat dinner earlier. So I wonder, if I did push it and, from the circadian biology standpoint, if I pushed it, how that would have spiked it even more, or would it have spiked it more, which it sounds like you’re saying that it’s when it’s later on in the day, we see that spikes more.

Dr. Casey Means: [00:24:33] Yes. So that’s a super interesting example. So yeah, we, there is research to suggest that as you eat later in the evening, your glucose will spike more. So they’ve done research, basically giving people the exact same meal for breakfast versus dinner and the glucose and insulin rise at dinner time is much higher than it is in the morning.

Part of this may be because of our circadian rhythm and actually the way melatonin impacts our insulin. So as the day goes on and the sun starts going down, our pineal gland secretes melatonin, which is that hormone that helps us fall asleep and feel sleepy. But melatonin also seems to have an effect on the pancreas and on insulin sensitivity and basically makes us less insulin sensitive.

So to back up a little bit, cause we haven’t really talked about insulin yet, just a brief primer on that. So when glucose comes into the bloodstream from digestion, glucose has to actually get into our individual cells from the bloodstream to be converted into energy. That’s the whole purpose of the glucose is to, you know, be used as an energy source for the body.

We can’t use glucose alone. We have to convert it to a currency that we can use in the body, which is called ATP. And that’s done inside the cell and the mitochondria. So first you have to get glucose into the cell. So glucose stimulates an organ in the body of the pancreas to steam, to release insulin, which is a hormone that travels in the bloodstream as well, binds to cells and lets the cell take up glucose cells.

You know, we want cells to be super responsive to insulin. So when there’s glucose around, insulin binds and it soaks up all this glucose, but what happens is if you’re constantly spiking your glucose over and over again, because you’re eating, you know, a standard American diet, lots of carbohydrates, lots of refined grains and sugars, all of which turn to glucose in the blood.

Your pancreas is constantly secreting this insulin and our cells actually become resistant to it. They’re like there is so much of this stuff around. We can’t do all this work. We can’t get all this glucose into the cells. We’re going to just like block it a little bit. And that’s called insulin resistance.

And that’s a problem because then what happens is the glucose levels start rising in the blood. And the body, it still needs that glucose in the cell. So the pancreas starts creating more insulin to try and overcome that resistance, to force the glucose into the cells. So that all becomes a problem and that’s essentially the spectrum towards moving towards type two diabetes. The secondary issue of this is that insulin is a signal to the body that there’s a lot of glucose around. So you can use glucose or fat for energy in the body. Both of those things could be converted into energy that we can use glucose and fat. But when insulin is high, it tells the body there’s plenty of glucose.

We don’t need to burn fat for energy. Don’t use it. We’ve got glucose. Glucose is easy to use. So what happens is insulin blocks, fat burning. So when your insulin is high, you are not burning fat. So you can see how that could be a real, really for weight loss efforts, if your insulin is always high. So this is really kind of a foundation of like the keto diet.

If you can keep glucose low, you can keep insulin low, and then you have to start tapping into fat burning for energy because your body doesn’t have this other source of energy as readily available. So this is kind of this idea of the spectrum of, from insulin sensitivity to insulin resistance, we want to be as insulin sensitive as possible.

We want to keep our insulin levels low. We want small amounts of insulin in the bloodstream to be enough to get those cells, to get glucose in. We don’t want to have to secrete a ton of it to force the glucose into the cells. So what’s interesting is that, you know, we actually kind of can fluctuate day by day, a little bit on our insulin sensitivity, even within a day.

So there is some evidence that maybe this melatonin and late at night stuff makes us just transiently a little bit more insulin resistant at night. And that’s why eating the carbs earlier in the day is likely better for us. And so, you know, you hear a lot of people saying, eat your biggest meal for breakfast, eat a smaller lunch and then eat a tiny dinner.

And I think a lot of that conventional wisdom is rooted in some of this, you know, molecular biology that we’re learning about. So that’s really interesting about, you know, what you were saying and just the second piece which we can touch on maybe later is the alcohol one, which we should come back to, but alcohol actually tends to lower glucose levels not rise them.

So it actually could have been that glucose, that wine actually really offset your bread. And we can definitely talk more about that.

Dasha Maximov: [00:29:05] I like what you, that primer about insulin, that was helpful as well, because I don’t know how many people know that. Is there any way for us to measure insulin sensitivity or insulin resistance?

Dr. Casey Means: [00:29:13] Yeah, absolutely. So you can measure insulin in the blood, which is a test that is not readily done by doctors, because we are very focused on glucose itself. You, you know, frequently, even at a young age, you’ll get a glucose test at least like once a year, when you go to the doctor, the thing we should probably be measuring early is insulin because insulin levels are actually going to rise chronically in the blood a lot quick or a lot earlier than you’re going to start seeing glucose go up in the blood.

And the reason for that is because the body is trying to overcompensate with insulin to keep glucose levels stable. And that can go on for a long time. You can imagine you can just keep rising your insulin levels to force that glucose into the cells, keep the blood range in a steady range over time.

And only until that process really goes off the rails, you can’t produce enough insulin to kind of keep those levels of glucose in the blood stable. That’s when you start seeing like yearly fasting insulin rise. So, some doctors say that insulin probably is rising, like baseline insulin is probably rising about 10 years before we start to see glucose levels rise.

So insulin levels are something that I actually check in all my patients as sort of just a baseline of like where you’re at in terms of insulin sensitivity. And I’d say, you can get a sense of it by looking at just what fasting insulin levels are. If they’re between like two and five, you’re like secreting very little insulin.

You’re likely quite insulin sensitive. But if they’re creeping up to like first thing in the morning, your insulin levels are like 15, 20, that means your body’s producing a lot to keep glucose levels in some normal appearing range. But there’s also other tests that you can do. Something called a HOMA-IR, which is a test of insulin sensitivity.

I’d say the easiest one that a doctor can order is fasting insulin. Another thing I’ll say, and this is still to be discovered in the research, but if you look at the data from a continuous glucose monitor, you’re basically, as I said, you’re seeing every 15 minutes glucose levels and you’re seeing what happens after a meal.

And you can kind of get a sense of insulin sensitivity by seeing what your curve looks like after a meal. So you can imagine, let’s say you eat a cookie and 20 minutes later, your glucose starts going up. And then it reached some peak, like 140, and then it’s going to come down to baseline. If you’re quite insulin sensitive, that means that every little molecule of glucose that’s getting released into the bloodstream, your body is pretty quickly soaking that up into the cells because you’re quite insulin sensitive. So your spike is probably going to look like really quick up, really quick down, and probably not super as high potentially.

But as you become more insulin resistant, it’s going to be harder to get all those little molecules of glucose being released from digestion into the cell. So your curve might look wider. It might be a longer time that your peak is elevated and that whole curve, essentially that bell curve of your glucose spike is going to just look like a wider curve.

And so there’s not a lot of research yet to suggest how our continuous glucose monitor curve looks like, how that correlates to insulin sensitivity, but I have a hunch that some aspects of that curve do actually correlate to how insulin sensitive someone is, based on kind of what it looks like.

Dasha Maximov: [00:32:47] Logically, that makes sense. Yeah. Now, you touched a little bit on metabolic flexibility, can you explain what that is? And you had an article on your blog as well about the fact that Americans have, like 80% of Americans, have one biomarker or more of metabolic inflexibility. Can you talk about what it is and what those biomarkers are to show that we aren’t as healthy as we think we might be?

Dr. Casey Means: [00:33:12] Metabolic flexibility is this term that we’re starting to hear more and more, which basically says that we have the capacity. If you’re metabolically flexible, you have the capacity to use different sources of fuel for energy based on different resource availability. So what this means is, like I mentioned, we have the ability to use glucose or fat for energy in the body. We can run ourselves sort of on either of those things, but because of our standard American diet, which is very carb forward, very highly ultra refined and very much spiking our glucose and insulin levels all the time, what happens is we don’t ever really get the opportunity to burn fat for energy because insulin is high and it’s blocking that molecular process. So that’s not a flexible state. And if your insulin levels have gotten to a point where they’re kind of always chronically high, because you’ve moved down this spectrum of insulin resistance, you can imagine that let’s say you don’t have much glucose around like it’s first thing in the morning and you haven’t eaten eight hours, but your insulin is kind of chronically elevated so you don’t have glucose available and your insulin is a little bit high, so you can’t really burn fat well. What does that look like? Being super hungry, being hangry, being super lethargic, needing to eat first thing in the morning, because your body’s like, I need glucose. I need it. I can’t use this fat.

It’s not flexible. So what you want to do is you want to train the body to be able to use fat when glucose is unavailable, be able to use glucose when glucose is available. And what that means is we have to keep our insulin levels stable and low, and so that we can bounce back and forth between these two different pathways when different resources are available.

One way to train ourselves to become more metabolically flexible is to get ourselves into a lower insulin state and make our body burn fat for fuel. Almost think about it like lifting. We have to lift weights and do reps to be able to be strong, but we have to do reps of fat burning to be able to be good fat burners and to be able to use that source of energy in the body.

So the interesting thing is that we have about 2000 calories of glucose stored in the body. And that’s stored as chains of glucose that are like rapidly accessible for energy called glycogen. And that’s sort of the liver and it’s stored in the muscle. So that’s just available when we need it, like overnight, when we’re sleeping and we’re not eating, we can use that for energy, but we have like weeks worth of fat energy in our bodies.

Even if you’re lean, you have just orders of magnitude more of fat that you could use for energy. But for most people it’s not accessible. If insulin is always high, well, you can start, yeah, burning through your glucose, kind of intentionally to sort of get to a state where you, you know, need to use fat and then kind of force your body to use that.

So that’s what people are doing with ketogenic diets. They’re doing this with intermittent fasting, where they’ll like burn through that 2000 calories of stored glucose and kind of make their body start doing some fat burning. But you can also do it by using the biofeedback from the CGM. Because if you get your glucose levels, if you choose a diet that’s not spiking you all the time and you’re keeping yourself more flat and stable by using this data to shape your diet, what happens is you are then by default, not spiking your insulin as much. And as you minimize those spikes hour after hour, day after day, your body perks up again and says, Oh, I have to be more sensitive to insulin because I’m not seeing as much of it around. So the more you go day after day after day with lower spikes, the more your body is becoming insulin sensitive again.

And you’re going to lower those sort of baseline elevated insulin levels. So as you do that, you free up that break on fat oxidation and you allow yourself to do that. So, you know, there are people who can fast for two, three days without getting hungry because they are so able to burn fat that it’s just easy for them.

And so that’s kind of the state we want to get ourselves into. And what’s really cool is that we can move in that direction very quickly by just tailoring our diet to not spike us all the time. We regain our insulin sensitivity fairly quickly. So again, it’s like doing reps each day that you don’t spike your glucose all the time and kind of keep it flatter and stable.

You can be confident that you’re moving in the direction of becoming more insulin sensitive. And in doing that, you are releasing the break from blocking fat oxidation and allowing your body to be able to sort of jump back and forth between using fat when glucose is around and using glucose, when it’s available.

Dasha Maximov:Dasha Maximov: [00:37:59] What you just said is exactly what I’m doing right now, just anecdote, just as an N of 1 experiment. So I’ve noticed that my CGM is showing spikes, right? So in average, I’m around between 70 and 110 or so. And then every once in a while, when I had pizza, it spikes up to 115, 120, right? So it’s those types of things that, I mean, the data that you guys are presenting at Levels of saying that’s a fine level, right, that kind of, that’s a spine ribbon of variance that I’m in, in between. But that being said, how can I just as an N of 1 experiment and having fun with it, how do I reduce that even more? And how do I kind of push that down? And so today, I’m starting a multi-day fast, just to say, you know what, I’m going to kick this off.

Let’s see how this plays out. So I’m curious to see again what the data is going to show to see. Also one, when I think of fasting, I think of that as a stressor. So I’m curious to see also how that stress and the cortisol response is going to impact my glucose levels. Have you seen anything with

that?

Dr. Casey Means: [00:39:07] Yeah, it is definitely, we see a lot of different things with people who are fasting and it really depends on the person, but also like the duration of their fast. For people who start more time restricted feeding fast, which is like stopping at 6:00 PM at night and not eating till like 10:00 AM the next morning, so more of like an 18, six hour type of fast, that’s not really going to generate a stress response, you know, because it’s just, it’s a pretty short fast. And so you’re not usually going to see an elevation from that. You’re usually just going to see, as the night goes on, the levels go from sort of an oscillating wave to just like really flat.

But as people sometimes do a longer day fast, like 24 or 48 hours, 72 hours, the body is a little confused sometimes, especially if you’re new to fasting and that can be seen like a threat. Like I don’t have access to resources, you know? And like, this is a problem and I need to kind of mobilize my, so what the body will do is it will release stress hormones, like cortisol.

And that cortisol is going to tell the body to sort of mobilize whatever stored glucose is left, put it in the blood as like a quick energy for like this time of threat that’s going on. So sometimes people will see a little elevation later in their fast. I wouldn’t consider that like in any way, a negative, like it’s, you know, like the fastest failing, it’s more that the body is clearing out its stored glucose, and working through it. It’s obviously not exogenous glucose that you’re eating, so you’re using it. And as you empty the tank, you know, and you see that glucose going into the bloodstream and you’re using it because you’re not getting it from food sources, you can be confident that you are, you know, moving towards that state when you are going to need to be tapping into fat for fuel.

And so something that can be sometimes interesting is to be fasting with the CGM, a continuous glucose monitor, but also checking your ketones during a fast to sort of see what’s happening with your fat oxidation as the fat goes on and see if you know, 24 hours, it might go up a little bit, at 48 hours, it might go up quite a bit.

And by three days it’s likely that you’re, you know, you’re really running on fat at that point. So it’s a pretty fascinating experiment, but it’s definitely variable between people.

Dasha Maximov:Dasha Maximov: [00:41:28] Yeah, absolutely. And I think, and it’s also from a women’s standpoint, what time of the cycle, what time of your life, and also in general, where are your stress levels, Right? In 2020, all of our stress levels are probably elevated. So, you know, just seeing how that all plays out. I’d like to switch a little bit into specifically, because this is WhealthCo and we focus on women’s health, and I find that a lot of our guests, they’ve been on other podcasts or they’ve been on, they’ve talked a lot about the topic, but not necessarily always the topic with respect to women.

And so I’d love to, and I kind of, we talked a little bit offline of, you know, how do these things impact women, right? So if we can just focus these questions that some folks have sent in is, you know, glucose and women. How have you seen a link between glucose and some of the bigger health issues that we’re seeing within women, for example, PCOS?

Dr. Casey Means: [00:42:24] I think there is such a cool opportunity for more awareness about glucose to really uniquely impact women. And one of the big ones is PCOS. So I would say, I would separate into a few categories. I would separate it into fertility and really, hormonal parts, talk about weight and how glucose uniquely affects women and weight, especially post-menopausally, and the way estrogen dropping during menopause affects metabolic health in the later half of life.

And then neurodegeneration, women are a much higher risk for Alzheimer’s disease than men, and that may have to do with glucose as well. And then I put a separate category and just sort of more like beauty. So we are, women are spending a lot of money and a lot of time and energy on beauty regimens, products, invasive interventions. And what’s interesting is, a lot of this is actually rooted in metabolic health things like wrinkles, psoriasis, acne, a lot of the root causes of acceleration of some of these problems actually can be related to high glucose levels and poor metabolic health. And so it’s the question of like, are we spending our resources and our energy and the right things with more like external fixes or can we do something from within that helps us really like fix these issues in a more holistic way?

So those are kind of the buckets that I would think about, like beauty, brain health, neurodegeneration, weight and post-menopausal patterns of metabolic health and then fertility in general. So, happy to go into to any of those more, but there’s a lot that I think women can benefit from in being really on top of their glucose levels.

Dasha Maximov: [00:44:03] Yeah. So let’s do that. Let’s go into each one of those. Cause I think that’d be fascinating. So from, so fertility, for example, and hormone balancing glucose, how does that play in?

Dr. Casey Means: [00:44:14] It’s amazing. It’s huge. So PCOS is polycystic ovarian syndrome, and I don’t know if most people are familiar with this, but it’s actually the most common cause of infertility in women in America.

And it has, polycystic ovarian syndrome is like this notoriously nebulous name. It’s like cysts and, you know, multiple cysts, it’s kind of confusing. It actually was at one point going to be renamed a multi-system reproductive metabolic disorder, but that was like essentially vetoed. And I actually think that name would have been much better – multisystem reproductive metabolic disorder.

Because that would have actually been more actually aligned with the root cause of what the condition is. So there’s a huge overlap between this infertility and metabolic disease with up to 70% of women with PCOS having insulin resistance. And I believe that more than half of women with PCOS will develop type two diabetes by the time they reach 40 years of age, that’s crazy. So there’s this huge co-morbidity between metabolic disease and its infertility. And then it comes down to like why it seems that it’s a very multifactorial condition that probably has a lot to do with, you know, underlying genetics and family history, but there’s also probably a component of lifestyle diet, and sort of just this Western culture that we’re in with this very refined food culture, because this disease is increasing in prevalence over time. What’s interesting is that the ovaries actually have insulin receptors and as insulin levels in the blood go up, it stimulates the ovaries to make more male hormones.

So testosterone and androgens. So. You can imagine if you are of a predisposition for this disease and you are in the context of a standard American diet, really high, refined carbohydrates and sugars, you are stimulating your insulin more. It’s very possible that your insulin levels are high at baseline.

This is directly stimulating your ovaries to make male hormones, testosterone, androgens, often what drives some of the other symptoms of PCOS. So like excessive hair growth on the face, on the nipples, acne, hirsutism, things like that, which  often go along with the infertility but those androgen male, sort of male hormones also affect the menstrual cycle and affect our ability to ovulate properly and affect the whole balance of hormones and can relate to the infertility side of things as well So there’s been quite a bit of research showing that low-glycemic and ketogenic diets can be extremely effective For women with PCOS, to get the glucose levels down get the insulin levels down get the hormones the ovaries, to creating less testosterone get things back into a normal cycle So I think there’s a really cool opportunity for adding this biofeedback tool of a continuous glucose monitor to the mix because well sure someone could just adopt A super low carb, ketogenic diet, how cool would it be if we can use this also as really, accountability and a motivational tool to keep people on track If you can see in like this really engaging fun way that you’re keeping your glucose levels low and stable through your diet and your lifestyle I think really amps up the ability to kind of make these changes sustainably Also it’s probably not necessary for every woman with PCOS to be on a ketogenic diet It’s likely that a lot more women can actually tolerate carbohydrates but it’s about which carbohydrates you’re choosing how you’re pairing them how you’re exercising and stressing and sleeping and really creating this holistic environment to keep glucose low and stable That doesn’t necessarily mean you’re eating no carbs It just means that you’re being really thoughtful and wise about how you’re doing it So I think there’s an opportunity to really like liberate women to have flexibility in their diet but still keep on track with low glucose levels and keep their insulin levels stable So that’s kind of the 10,000 foot view with PCOS but I think there’s huge amount of hope there because of this research showing that dietary interventions actually are very effective and now we have a tool to sort of really promote these dietary changes in a personalized way

Dasha Maximov: [00:48:21] Yeah Yeah And it’s, just to double back on that, is that tool to me is again I haven’t been using it very long but I can already see what a game changer it is because when you have that it’s like having a coach in your pocket And I know this is this podcast is not you know meant to kind of you know be a sales pitch or anything like that but I’m just finding it so fascinating by even tracking and seeing and I find I think of myself as fairly healthy but there’s so many things that we don’t understand And when you have that Present with you that coach to say Hey listen Yeah if you have nut butter and an Apple and you eat the nut butter first before you have an Apple then that pairing together is going to be fine for you But if you just have the Apple that you’re going to get spiked right And that’s such a small little nuance that you wouldn’t really think twice about because both an apple and nut butter is healthy Right You’re being healthy eating an Apple Yeah Actually though your body needs that fat It needs that protein to keep that glycemic index lower Right But it’s I think what you’re saying of That positive reinforcement especially right now when everything is so confusing and it is everybody does have different thoughts about nutrition and what everybody needs It’s okay Well when I have it and I look at myself then I know what works for me versus my you know my friends Can we move then to and I really like those four things that you spoke about so weight and weight gain as one of the four things that is impacted by glucose

Dr. Casey Means: [00:50:00] Yeah absolutely So we talked a little bit about how Insulin levels affect fat burning and like fat oxidation And so really it’s virtually impossible to burn through your fat without the insulin levels being controlled and stable So in that regard we for women who want to lose weight we’ve got to get our glucose and our insulin under control And what we see is that after menopause as estrogen levels drop women tend to start increasing their rates very significantly of metabolic disease So type two diabetes and like obesity and overweight women take it seem to take a hit on their metabolic health as in as estrogen levels drop during menopause So that’s very interesting And there is the way that our sex hormones impact metabolic health is quite interesting We note that in the first phase of the menstrual cycle so the follicular phase pre-observation we tend to have higher estrogen in relation to progesterone And that ratio is higher in favor of estrogen And estrogen seems to be sort of like pro metabolic health It keeps glucose It seems to be associated with lower glucose levels And our glucose levels are significantly lower during that first half of our cycle And we’re more insulin sensitive then as we oblate and our estrogen and progesterone both start creeping up progesterone is high relative to estrogen and progesterone seems to be sort of anti metabolic health in some capacity It seems to be associated with less insulin sensitivity higher glucose levels So we’ll have higher glucose you know close to our menstrual cycles post oscillation And so That’s just some background to say estrogen seems to be favorable in regards to metabolic health So when you lose that postmenopausally it kind of takes a hit So again coming back to just tools to help people understand this you know if you can give people a tool like this women who aren’t necessarily like have diabetes or prediabetes but are just post-menopausal and are now more at risk for these issues If you can start really dialing in your diet then making sure you’re keeping your diet and lifestyle in a way that your glucose is fairly flat and stable That’s just so empowering to me You’re not going to walk into the doctor’s office one day a few years after menopause and have them say Hey sorry you’re now have pre-diabetes or start seeing weight creep up and not necessarily have any idea why it’s happening You have this little biofeedback angle to give you at least some insight into why that might be happening and you can make some adjustments and modulations accordingly I will just caveat this by saying there’s no research yet to suggest that using a tool like this can ward off some of the metabolic sequelae of post-menopausal weight gain and metabolic dysfunction But this is where I’m really excited to see the research go because this is a population I really care about and want to empower And then you know we talked about that third bucket of neurogeneration you know women have two times the rate of Alzheimer’s than men And Alzheimer’s has been shown increasingly to be linked to high glucose levels And What we call insulin resistance of the brain So Alzheimer’s is starting to become called type three diabetes It’s so linked to blood sugar and thinking about how women as they get older become more metabolically dysfunctional more insulin resistance We also see higher levels of Alzheimer’s I think this is all wrapped up together And so anything we can do to give people tools to have a little bit more agency in that regard I think would be huge So my company we are pushing very we have an amazing team of medical advisors and deep in the research community and we’re really hoping to push some research forward to see like does a tool like continuous glucose monitors help people ward off some of this stuff like later in life and stay as healthy and well as possible Yeah there’s a really cool company actually run by Dr Taylor Sittler called the cusp which is a company helping women It’s a telemedicine digital health product helping women through menopause in this really holistic personalized way They’re totally in touch with this metabolic health aspect And I’ve actually seen a really interesting relationship in the research between glucose levels and hot flashes And there may be like a very close relationship between glucose spikes and a hot flash So that’s another thing that could potentially help women If we can control our glucose spikes can we potentially control our hot flashes which are one of the most troubling symptoms of menopause So there’s a lot there in that phase of life that I’m excited about Yeah

Dasha Maximov: [00:54:46] Yeah I’ve heard a lot of so women who are on a ketogenic diet into perimenopause and menopause Dr Anna Cabeca is a fantastic voice about this in talking about keto and menopause And what she says is that if you are on a ketogenic diet maybe those hot flashes end up being lower and not as intense So perhaps it follows then exactly what you’re saying of a ketogenic diet requires has less glucose or you’re eating less glucose and so therefore that, exactly what you were saying, that link is there.

Dr. Casey Means: [00:55:20] The thing is that like we’ve had virtually no treatments for it. Like this is something that we just are like it’s going to be a few years suffer through it . So sorry like have a hot you know nice towel Like it’s just, it’s we have nothing you know And so yeah It’s so I think it’s important that we We focus on some of this stuff and just yeah, empower women to be able to make personalized choices that can help all aspects of health

Dasha Maximov: [00:55:48] Yeah And one thing you mentioned before about weight gain and kind of the progesterone for the for that second part of the phase I’m curious also with so birth control kind of sits us there right It puts us into that second It makes our body feel like we’re in that second phase So could it be that if women are on birth control for a long period of time they end up having more insulin resistance and having kind of could that be even propagating some of the problems we have with inflammation

Dr. Casey Means: [00:56:18] I don’t know the answer to that It’s such a good question It’s such a good question I don’t yeah Needs to be studied

Dasha Maximov: [00:56:25] And lastly just to touch on the beauty and the collagen side of things because I think there are so many people using a vast a variety of different tools and beauty tips and things like that Now glucose and collagen What is that link there

Dr. Casey Means: [00:56:42] This is so fascinating to me So as someone who has spent way too much money at Sephora in the course of my life you know and I also actually did my honors thesis as an undergraduate in a dermatology lab And I didn’t really know any of this at the time So it’s been fascinating to me but so collagen is the most abundant protein in the body It’s what gives our skin its structural integrity And as we age, collagen becomes dysfunctional it doesn’t turn over as rapidly It becomes sticky And this is basically part of the pathogenesis of wrinkling, of the skin, of aging, is the way that collagen just doesn’t work properly in these like really like lovely sheets that it’s normally in So what’s interesting is that glucose, So some of the reasons that glucose being high in the body are problematic, there’s three main things One, high glucose generates inflammation. Two, high glucose can generate oxidative stress so free radicals in the body that can be damaging to proteins and the body change function But the third reason is that high glucose can stick to things in the body It can literally get stuck to proteins and that’s called glycation And when sugar sticks to things in the body because the concentration is high in the blood, you form what’s called an advanced glycation end product. AGE is the acronym for that And this can happen with collagen You can get glucose sticking all over the collagen And what happens is you cross-link the collagen When it’s got all that glucose it becomes cross-linked And this happens with other skin proteins too like keratin, vimentin but collagen is really the big one And as you cross-link, the skin wrinkles So there has been some basic science research showing that in low glucose if you take cross-linked collagen and reduce the glucose concentration you can reduce the amount of cross-linking by I think like 25% or something like that That is not saying that you can reduce wrinkles by 25% but like you can actually you know impact this process by changing the glucose concentration So I just think there’s a huge opportunity here to think about our diet and how much glucose we’re exposing our skin to And how can we instead of you know reaching for Botox reaching for serums reaching for creams like why not start with this fundamental pathway of glycation There’s so many other aspects to the skin as well industry in terms of aging and youthfulness One of the ways our skin looks healthy looks vibrant is through all the little capillaries in our skin that bring blood to the face and to the skin and help with clearing out waste You need all this really healthy blood flow to the skin for it to look healthy And one of the things that sugar can do, high blood sugar, is cause inflammation, cause glycation And this can have a huge impact on small vessels When you got inflammation in the lining of blood vessels they get more narrow When you have glucose sticking to the lining of blood vessels they get more narrow You get what’s called endothelial dysfunction which is endothelium as the lining of the blood vessels It gets dysfunctional it gets tight You’re not getting as much blood flow to the skin and it doesn’t look as good And so that’s really important too You just want to like keep that glucose super like low and steady and it’s going to have multifarious positive benefits for the aging process in the skin Yeah that’s one that’s just I think, an under-recognized link and I know people care about it, because I’ve seen people spend a lot of money on neuromodulators and Botox And so I would just say like start with the refined sugars, the refined grains And if you want to amp it up like wear a CGM for a little while and see how much  sugar is actually in your blood

Dasha Maximov: [01:00:25] The example that comes to mind about somebody who has really good skin is somebody who’s like a monk, who’s sitting and fasting all day and not really having much sugars at all And yet their skin is fantastic and they’re not putting Botox and they’re not you know granted they’re not living necessarily a modern lifestyle which we have all these stressors but it is something just to think about that Maybe it is that fasting or maybe it is that which obviously is helping against glucose or just a diet where you aren’t constantly carb loading

Dr. Casey Means: [01:00:58] Absolutely Yeah The other huge one is I don’t know if this is one that’s as interesting to your listeners but like is acne like such a strong relationship between glucose and acne and multiple studies showing that low glycemic diets over 12 weeks can significantly reduce acne lesions and The mechanism of that is a very interesting genetic one high glucose stimulates this genetic pathway mTOR An mTOR is like a genetic pathway that’s going to promote like cell division and proteins and it’s a pro growth signal And when this happens in the oil glands of the face the sebaceous glands it can tell the body to basically like make more oil And that can result in particularly like that jawline cystic acne Yeah So low-glycemic diets like have been studied I you know yet still to this day I learned in medical school that diet doesn’t really have an impact on acne but when you actually go to the research literature there are many papers with statistical significance showing that lower glucose diets do affect it So that to me is actually personally relevant because I did have acne as an ER in my early twenties and my you know in my teenage years And I was on every one of the medications under the sun And you know it was Antibiotics hormones you know tretinoin the harsh benzyl peroxide based topical scrubs like the redness I just thinking about what I did to my microbiome what I did to everything you know with the doxycycline and just like all of the side effects of these medications that they put people on When I personally think we should be putting everyone on a low-glycemic diet before any pharmaceutical intervention for acne just from an ethics standpoint

Dasha Maximov: [01:02:45] Yeah And if we think about young girls as well who are going through hormonal changes the first thing that people do or maybe not the first but one of the first is birth control pill Right And I’m not I bring it up I’m not against it It’s just is that necessarily the first thing we should be doing versus okay You’re going through hormonal changes What does your diet look like Are you having Pop-Tarts and are you having like these things that are the quick grab and goes that you can have because you’re busy or you know can you change that diet And then all of a sudden your acne is going away and you don’t then need to be on birth control pill because it’s at that’s not the actual root cause

Dr. Casey Means: [01:03:22] Yeah Knowing what I know now I’m like if I could just have everyone do 12 weeks of low sugar maybe with a CGM and no dairy like those two things have been pretty well studied with acne And I think could probably clean up a lot of the cases that we end up going first to extreme topical therapies or pills But that’s just that’s my opinion

Dasha Maximov: [01:03:45] No that’s fantastic And do you find that to be the same with things like eczema and psoriasis You mentioned that in the beginning as well

Dr. Casey Means: [01:03:53] Yeah I mean the different physiology for sure The you know psoriasis is more of an autoimmune skin condition, and so it’s very different physiology There is, people with high glucose and with metabolic disease, tend to have much worse psoriasis And so there is some relationship there And I think that one is probably more mediated by the inflammatory component of metabolic disease high blood sugar metabolic dysfunction obesity all of these things promote a pro-inflammatory state in the body And that may be contributing to these types of skin conditions So a little bit different on I think, the mechanisms but there is definitely a relationship between glucose and the severity of those

Dasha Maximov: [01:04:36] Because I mentioned it to Mike. I kind of texted him I was like are you guys doing anything with that,  of like menstruation and the CGM? Because I track all of my, like everything on clue and he’s like Yeah. He directed me to the blog and I was like that’s fantastic But is it daily, you know, is it? But not yet.

Dr. Casey Means: [01:04:54] No it’s going to be great though like for sure .

Dasha Maximov: [01:04:58] Okay. What about the tie between the kind of lack of sleep and impact to insulin resistance? Because I’m noticing some big spikes just because I haven’t been sleeping very well.

Dr. Casey Means: [01:05:10] Yeah. That’s interesting that you’ve seen that already. Do you notice it just one night or is it more over the course of multiple nights, you start seeing?

Dasha Maximov: [01:05:19] Multiple nights. Unfortunately, multiple nights. And I think it’s also, what I’m noticing is, I am a good sleeper usually, and I am, and I still continue to be. But it’s kind of like a chronic reduction in sleep, right, or chronic slight reduction. So it’s not, my deep sleep isn’t as long, my REM sleep isn’t as long. I’m having a little bit more wake-ups now. Could that be again just 2020 as it is and the stress that we’re all having and a little bit of that chronic stress? I’m not sure. But I am noticing that, I think it’s an element of my monthly cycle where I’m at right now and as well the lack of sleep and it’s a couple of days that has not been that great.

Dr. Casey Means: [01:06:06] Yeah. It is profound how much sleep impacts our metabolic health on such a rapid timeframe, like it is so, sleep is intricately related to our metabolic health and the mechanisms have actually been pretty well studied. There are a number of essentially pathways through which sleep deprivation can increase our glucose levels, decrease our insulin sensitivity. The first is cortisol. So lack of sleep basically causes cortisol to be elevated, and cortisol is sort of our prototypical stress hormone and cortisol is typically lower during the evening so that we can like be less stressed and go to sleep And then as sleep goes on cortisol raises right before we wake up, and that actually helps us get up from bed. Like the cortisol rises right before we wake up and it tells the body like get up, time time to go. But if we are sleep deprived, in some studies, for as little as just six days it can cause this chronic increase in our cortisol levels. We just throw off that whole normal balance of how it kind of goes down at night and then up before the morning. If you can imagine, you’re staying up really late, your body’s like more vigilant. You’re doing stuff, you’re on your computer, that cortisol is going to stay high to keep you awake. We want that more like natural what we call a diurnal pattern of cortisol. So that can increase glucose levels, just from cortisol being high. The second thing is that sleep restriction increases our growth hormone levels in some studies, and that growth hormone actually tends to decrease glucose uptake by the muscles, and this can cause glucose to rise in the bloodstream. Additionally, sleep deprivation can make us hungrier and more prone to eat higher carbohydrate foods. So it’s been shown that when you deprive adults of sleep for as little as two days you get an increase in your hunger hormone ghrelin and a decrease in the satiety hormone called leptin. And when these things happen, these changes in these hormones, you get a increase in hunger and appetite. And typically, when people have that increase in hunger and appetite it’s for those like calorie dense foods. And then the last thing is that sleep deprivation increases inflammation. So when you are sleep deprived your body’s going to release, that clearly to the body, sends a sign of threat like why aren’t you sleeping? Maybe there’s a threat, you know, you’re having to protect yourself or something. So your body says okay there’s a threat I’m going to mount an immune response. So you get increases in cytokines like interleukin-6, TNF alpha, c-reactive protein. These are some major inflammatory markers, and these are also immune markers that we find increased in diabetes, in obesity. So it’s like you’re promoting these inflammatory mediators that are associated with metabolic disease. So many bad things are happening metabolically, when we don’t sleep. Then from a more like clinical research perspective, there was an interesting study where they took a bunch of super like healthy young men and they deprived them of sleep I think for six days they could only get four hours of sleep per night. So six days in a row, four hours of sleep per night, so maybe something you’d see in like college when people are studying for exams or something they might be depriving themselves. And just with that amount of sleep deprivation they basically went from being healthy to being pre-diabetic, like they went to impaired glucose tolerance levels in that short amount of time when they then flipped it and let them all sleep as much as they wanted like up to 12 hours per night for about a week, things came back to normal. But I think you can just take a person, sleep deprive them, not change anything about their diet and put them into pre-diabetes essentially. Like that’s because we’re doing that to ourselves. Like as a culture, we’re maybe not sleeping four hours a night but we’re sleeping less than we should be sleeping. And we’re doing this for years on end and you can imagine how that can take a toll. So it looks like the optimal amount of sleep for metabolic health is between seven and eight hours. Although that’s going to be variable for everyone but what’s interesting is that as people sleep a lot more, outcomes get worse. And as people sleep less, outcomes get worse. So you kind of want to be in this like sweet spot of like seven, eight hours probably because of the impact on circadian rhythms, cortisol and melatonin and all that.

Dasha Maximov: [01:10:17] Yep. So oversleep, so not sleeping for the entire week and then sleeping for 12 hours on the weekend, is that something that actually, based on the study, it seems like that could be fine, right? Because if they had six days of four hours of sleep and then they were able to sleep however long they wanted and get rebalanced, though that’s not optimal, is I feel like many people do that right now. Where it’s, I got to work. Go go go Monday through Friday, and then they just sleep until 1:00 PM on Saturday or Sunday. Do you think that that is a, obviously not optimal, but that balance, does that work or not really?

Dr. Casey Means: [01:11:00] I would say even though the study does suggest that you can bounce back from that insult, you know, not sleeping for quite a few nights and then you can kind of recover, I think that that is going to have diminishing returns if people did that over the long-term. I think the impact of our normal sleep-wake, light-dark cycles each day on metabolism and our metabolic hormones is so profound that it’s going to be significantly better for us to have a regular sleep pattern throughout the week, a consistent sleep pattern then to try and overcompensate on the weekends. Because while that might, you know, sort of get you back to the edge of normal, like you are probably slowly moving down. I mean think about all, you’re doing inflammatory harm during the week, you’ve got your hormones out of whack, cortisol growth, hormone, ghrelin and leptin, it’s going to catch up with you if that’s happening week after week, year after year. So I’d say the things you really want to optimize for is consistency of sleep. So going to bed at a consistent time and getting up at a consistent time and then really trying to get between that seven and eight hours of sleep per night.

Dasha Maximov:Dasha Maximov:Dasha Maximov: [01:12:13] Yeah. That’s cause that’s a good point as well. As even if you, from a sleep perspective, you’re able to get back to normal, back to that baseline, then there’s still the effects that you had during the week of likely if you didn’t sleep well on Monday and on Tuesday then on Wednesday, you’re, the hormones of leptin and ghrelin, you’re going to eat poorly likely unless you have insane willpower but likely you’re going to wake up and you’re going to say I need that bagel or I need something that’s savory or really filling or extra caffeine which, what are the effects that that’s going to have.

Dr. Casey Means: [01:12:44] And it’s kind of like how people can say like Oh well I spiked my glucose but I came back to normal. I spiked my glucose then but I came back to normal, but even though you’re coming back to normal after a big glucose spike, that’s not going to be the way it is forever because your body has been exposed to that glucose. There has been a hormonal cascade that resulted from that spike. It’s not like it didn’t happen just because you are back down to normal. There was a whole sequence of events that your body was exposed to molecularly that will eventually stack up. And eventually, it won’t be coming back to normal. You will eventually start to have a rise in baseline glucose over time as you become more insulin resistant et cetera et cetera. So I think it’s sort of like, what it looks like is not necessarily what it appears like. We are so resilient especially as young people. Consistency I think, is what it’s all about.

Dasha Maximov: [01:13:35] How long do you see blood glucose levels typically elevated after a very stressful episode? Obviously, it depends on the individual, it depends on the time, like that makes sense, , but is it something that you see?I suppose again, maybe I’m answering my own question which is, you know, you, based on the metabolic flexibility of somebody, if they are very flexible they can see that spike. They can see that fall and it’s not a very long curve but it happens fairly quickly and they can bounce back. Is that accurate to say?

Dr. Casey Means: [01:14:08] It’s a little bit of a different mechanism with stress. Because stress, what’s happening with stress is that you know the cortisol is rising, the catecholamine hormones from some psychological or physical trigger. It could be psychological like a stressful email, a stressful meeting, when you’re giving a presentation or it could be physical, you do a high intensity interval training workout and you have a physical stressor. It doesn’t really matter if it’s a psychological or physical stressor, your body still thinks you need to mobilize energy to fight some sort of threat. And so the mobilization of energy is dumping glucose from the liver that you have stored into the bloodstream to feed your muscles. That is what the body wants to do. It says, you need to fight something cause I’m sensing some threat stress. And so here, have some quick energy into your bloodstream so that your muscles can either run or act or do something. It’s a little bit different than the more like eating and then secreting insulin and then soaking it up. So I haven’t personally seen, you know, a difference in a stress-related glucose spike between someone who’s like super metabolically fit versus not as metabolically fit. But that would be so interesting to look at over time because ultimately your body does have to take up that glucose again. And there’s probably something there. I haven’t seen a difference yet but I would also say the magnitude of the stressor has a big impact on how big that glucose spike is. We’ve seen people anecdotally, on our own team who, you know, have given, had like a really intense phone call and glucose has gone up like 40 points And it’s been up for basically the duration of the phone call and then comes down. I think the first podcast I was ever on, my glucose actually went up quite a bit and stayed elevated during the entire podcast. And I didn’t necessarily feel stressed but my body thought I was stressed which was so interesting to me because I was like, That’s funny that consciously, I felt okay but my body knew something different was happening, like and it mobilized resources accordingly. So I think the stress thing is fascinating. And I’m really hoping that if glucose tracking, you know, becomes as mainstream as like wearing a Fitbit or wearing an Oura, WHOOP or something like that, that we ended up using it in a similar way as like a stress biofeedback tool, if you know that certain things are objectively, certain stressful events, are objectively creating a problem in your body, I think it’s a very motivating way to start incorporating changes in your life to mitigate that stress. Whether that means really intentional deep breathing or changing the situation. If having a conversation with a specific person always raises your glucose, maybe you need to like really work on that relationship in a new way. So it’s kinda like this, like you know, very objective, almost like BS meter on our body of like Nope you’re stressed. I know you don’t think you’re stressed but you’re stressed and you need to do something about it and it’s hurting you. And so I love that. I think that a similar tool that does that is heart rate variability monitoring. You know, it actually tells you like, you are stressed physically right now whether you like it or not, your body’s exhibiting signs of objective stress. And that helps us really feel motivated to make changes in our lives whether it’s mind, body practice or whatever. And the overlap of HRV and glucose I think is going to be such an exciting future and something that we’re working on. There’s a lot of awesome companies that are doing cool stuff in this like WHOOP, Oura, Leaf Therapeutics, HeartMath, and so I really am excited about a future when glucose data streams and HRV data streams are integrated.

Dasha Maximov: [01:17:46] I also wonder, one friend of mine who is a ER nurse, she actually called that out and said, I’d be curious, Dash, if you measured not only just what the meter is showing, right, in terms of glucose spikes but also emotions. So if eating a pizza and then you see the glucose spike 30 minutes later then also what is the reverberating emotion later on down the line? So do some people, you know, do they, if they feel not only lethargic and not only on an energetic level but also positive or negative emotions. And I wonder, have you guys seen anything like that? I mean, yeah, it’s very qualitative and it’s something that perhaps there’s a lot of conflicting variables as well but maybe something, I don’t know. Have you seen anything with that?

Dr. Casey Means: [01:18:35] You know, not precisely. But that would be very interesting. And I think that the more that we can do to capture subjective experiences, better, you know, in a more like high fidelity way and use that as a piece of data to correlate, that is going to be increasingly, you know, give us data that we’ve never been able to have access to before, you know, in scientific literature And I think a lot of companies are doing a great job with soliciting subjective sort of input. So I know like with WHOOP, it’ll ask you questions about how you’re feeling and what you’re doing. There’s a really cool app called Youper that’s a mental health app that finds ways to ask you subjective questions in a really engaging way. And so in terms of using subjective stuff like that as a data stream it’s like very very exciting, and that’s something that’s really on our radar. And yeah, I think we’ll open up a whole new world and we can compare that with glucose data for like the first time.

Dasha Maximov: [01:19:33] Lots to come. Because again,  first time that we’re really tracking things in healthy individuals not just for the medical side of things. Okay. What have you found can help blunt glucose spikes? Apple cider vinegar, I think you mentioned cinnamon. Anything else?

Dr. Casey Means: [01:19:49] The best blunters are going to be like those big things that we talked about, getting sleep, exercising regularly any exercise works, yoga, resistance training, high intensity interval training, walking, cardio, doesn’t matter. Basically it’s all been studied and it lowers glucose levels over time. So getting sleep, managing stress, exercising, those just sort of are obvious. But then the more interesting nuanced stuff. So I would say that the other tools you can use is vinegar. So there’ve been studies showing that if you have a shot of like one ounce of vinegar about just before a meal and then either very high carbohydrate load like two or three pieces of bread it will significantly lower the glucose response to that bread. And similar is true with taking cinnamon before a meal. These seem to sensitize us to insulin There’s certainly a lot of supplements out there that can also help things, like berberine has been studied quite a bit as something that can lower glucose. And then there’s actually now probiotics on the market that have been shown to lower glucose levels. There’s a company called Pendulum Therapeutics that has clinically validated probiotics that can help people with pre-diabetes and diabetes, lower their glucose levels. Hasn’t been studied in non-diabetics yet but probiotics seem to be, this is the first product that is, as far as I know, that’s clinically validated to lower glucose levels, with a probiotic intervention. Because microbiome has a huge impact on our metabolic health. So those are some things. Eating fiber with a meal seems to also kind of lower the glucose response. Fiber is definitely a friend of metabolic health. Fiber tends to be carbohydrates that our microbiome digest but we don’t actually turn into glucose, so you can almost think of it like as like a freebie carbohydrates. For me, high fiber is key to keeping glucose levels stable. It also helps us thrive and develop our microbiome. And then the microbiome are going to produce mediators. They’re going to produce actual byproducts of the breakdown of fiber that are helpful for our immune system and our metabolic health, things like short chain fatty acids, like butyrate and others. So yes, cinnamon, berberine, vinegar, fiber, improving them over our microbiome. Maybe probiotics needs to still be studied in non-diabetic individuals. Those would be the main ones. Kind of a fun one that’s counterintuitive is that they’ve actually studied water intake on glucose spikes and actually seems that drinking more water with your meals increases your glucose spike. And so they did some studies looking at taking like 300 milliliters of water, right, when you eat carbohydrates and people had a bigger spike than if they did not drink that water with the meal. And I think the reason is because it’s like flushing it all onto your system more quickly and you’re not digesting it as slowly. So one thing to consider is to actually just like space your fluids out from the meal itself, especially if you’re eating carbohydrates. So that’s kind of a fun one as well.

Dasha Maximov [01:22:47] How funny, because in IRA, they do say don’t drink water with your meals. So yeah it’s one of the things. And so you’re drinking water throughout, you know, throughout the course of the day, fine. Perfect. But then when you’re actually having a meal don’t do so, or if you’re going to do so then do it after you’ve eaten. So you’ve taken the foods and then afterwards have water if you’re just craving it. But it’s interesting that the science is coming to corroborate what IRA has been saying for millennia.

Dr. Casey Means: [01:23:16] That is so interesting. I did not know that. Yeah. And then another thing that tends to blunt glucose spikes is alcohol. Although I would not recommend that as a tool to blunt glucose spikes, people will often find that having a, like a spirit, unsweetened alcohol. So like straight, wine and hard spirits essentially can seem to lower glucose levels. And that’s because of a much more mechanistic reason. So alcohol is going to block the process of what’s called gluconeogenesis in the liver and that’s where the body takes, the body basically will do anything to keep some bare minimum level of glucose in the bloodstream because if you have no glucose in the bloodstream, if it gets too low that’s a big problem. You want it in this normal healthy range but you don’t want it to get too low. So the body has all these redundancy mechanisms to make sure there’s at least some glucose in the blood. One of those is gluconeogenesis, meaning making glucose of other things in the body. You can actually take like amino acids like alanine. You can take lactate. You can take other things and you can build glucose out of them in the liver. It’s a very inefficient process and it’s not the main way we get glucose but in times of starvation you can do that. Alcohol blocks that. And so basically what happens is you may be taking in glucose from like a meal or externally, you’re generating less new stuff from the liver. That basically will like kind of stop the influx of glucose into the bloodstream during a meal. You’re blocking one of the faucets of glucose which is kind of interesting. So one thing that you really want to be aware of is for people who are on like a keto diet or are fasting meaning that like they already have very low stored glucose, they have low glucose levels because they’re not taking any from the diet, really you do not want to drink because your glucose, you’re relying more on gluconeogenesis in those states because you’re not taking in glucose. And so drinking during an extended fast or on a intense ketogenic diet has been like, people have like had comas or death, because you’re essentially stopping the faucet that is the redundancy mechanism for making glucose. So it can be super dangerous but anecdotally, for people eating like a pretty diverse normal diet wearing CGM, we’ve seen a lot of people report, they eat a big bowl of pasta with a glass of wine and they see a much lower spike. So that might’ve been what happened with

your bread.

Dasha Maximov: [01:25:39] That’s exactly what happened to me. Now the next night, when I had wine with pizza, did not happen. The pizza definitely overloaded the wine. Hey it’s all for science. It’s all for science. I’m glad you touched on the alcohol element because I was going to ask you about that. Fair. So yeah. So there’s a lot more still to come. So with kind of overarching broad strokes, men versus women with glucose, have you seen any large patterns? Or is it so individual that we can’t talk about it on the macro?

Dr. Casey Means: [01:26:12] Yeah. So in our personal data set we have not seen large differences between men and women in terms of glucose levels, but this is, at this point, a small population size. What we do know is that after menopause, women seem to sort of exceed men in terms of their development of metabolic disease and obesity. Our curve moves past them after menopause and becomes worse. So it does seem like this protective benefit of estrogen, when that wears off, we start getting into trouble. And so that’s that’s a pretty interesting finding.

Dasha Maximov: [01:26:50] Damn. Damn it.

So yeah. So again it’s one of those things where early habits starting now before menopause could probably help us out either not only with hot flashes but also degenerative diseases. Anything else that really comes to mind that you want to touch on or that, you know, either from the macros that we’re eating or just in general you’re noticing with glucose and how it is a major component of health?

Dr. Casey Means: [01:27:15] Yeah. Well, I think you touched on this earlier but it’s worth kind of going into more which is that there has been studies showing that 88% of the American population is metabolically unhealthy and that’s monumental, you know, essentially it is super unlikely for you to be totally metabolically healthy living in this country. And that is really amazing to me because it’s essentially, this is a preventable situation, you know, there are certain metabolic conditions like type one diabetes that are much more rooted in genetics and sort of in many ways more unavoidable but that makes up 5% of the diabetes we’re seeing in our country. 95% is more this what we call adult onset diabetes that is much more related to diet and lifestyle and much of which is preventable. And so, you know, this is a number that we’ve got to move in the other direction, this 88% of Americans. In the study that looked at, that came up with that number, it was done out of UNC, it was about two years ago, and they were looking at cholesterol levels, waist circumference and blood sugar levels as markers of metabolic health. And if you basically met, they looked at five criteria of cholesterol blood sugar and waist circumference, and if you met all five of the healthy criteria for those things you were considered that part of that 12%. But if even one of them were off you were considered what they called, you know, not metabolically optimal. So basically that’s saying that 88% of people have one or more of those markers that’s off. And we really want all five to be on point. And a lot of that starts with keeping our glucose levels healthy and which we all have the power to do. What I think, I would just wrap up by saying is that, what I don’t think you will realize is how much that’s related to so many aspects of health other than just development of diabetes. We’ve talked already about how it’s related to weight through this sort of glucose insulin fat burning pathway. It’s related to PCOS and infertility. It’s related to acne. It’s related to wrinkles. It’s related to Alzheimer’s disease, but it’s also related to so many other things- mental health issues, depression, anxiety, chronic. Fatigue, chronic pain, auto-immune disease. It’s related to erectile dysfunction. It’s related to liver disease and kidney disease, you know, non-alcoholic fatty liver disease. The rates are skyrocketing. This is a metabolic condition related to the clue, the liver storing too much fat because of excess glucose being converted to fat and being started in the liver, you know, chronic kidney disease, the leading cause of chronic disease kidney disease in our country are because of metabolic conditions. So it’s just like every organ system you look at whether it’s the brain, the ovaries, the liver, the kidneys, the skin, you know, the eyes, each one is affected by high glucose and high insulin levels. And the symptoms that are arising, whatever these like diagnoses are, is a different manifestation of the same route, the same tree. And so in terms of having widespread benefits on our current and future health, I think one of the lowest hanging fruits is to just clean up the glucose picture by doing all the things we’ve talked about, personalizing your diet, personalizing your lifestyle, in terms of bang for your buck and, you know, pulling out the weeds from the root, like that is I think the place to start. There’s always going to be a role for, you know, medication and surgery, for like really uncontrolled downstream cases. But to just kind of get the lowest hanging fruit here of stuff we can work on, like this is something everyone can do, you know, work on their glucose and with or without a CGM I would  like to just, you know, restate how  much it’s an easy way to kind of uplevel so many aspects of our lives and kind of take control back.

Dasha Maximov: [01:31:05] Yeah And I think, to double down on that, I would say what I’m finding is, when I talked to some of my girlfriends it’s, Alright, well, I’m not going to do that because it’s difficult right. These lifestyle changes are so difficult. I’ve grown up eating this way for the past 30 years and I’m going to continue doing it because you only live once, and that’s that, right. And I think for me that mentality it makes sense until you all of a sudden have a pain of some sort, until all of a sudden that brain fog becomes too intense. I mean, I’m coming from brain injuries right. So for me, after my concussions, I completely cut out glucose for a year and I know how much that helped me. I wasn’t ketogenic but I was, you know, I was just very very particular about it because I knew how inflammatory it was, but I think that’s it. My wish is that not everybody has to get to that pain point of diabetes or pre-diabetic or PCOS or infertility or really intense weight gain or brain, all the things that you’ve said in order for people to finally get and start saying your health is important. And I think what I’m noticing again with the CGM is that, the fact that I have that tool now, I’m having the ability to realize how easy it actually is to be healthy. It is a lot easier to stay within that range. If I just make a couple of little tweaks, you know, not eating, instead of eating at eight I can eat at seven, start bringing that in once a week. I can start doing a 24 hour fast or trying a 16 hour fast, you know, and it’s almost like crowding the bad habits out and bringing in some of these little things that’s backed in data. And then that way you can say, yeah, see, actually, the 16 hour fast is really going to help me out in the long-term so that I don’t have to deal with hot flashes, you know, in the future potentially or things like that, or I’m not going to be predisposed to Alzheimer’s which is affecting women three times as likely as men. So I think just double down on what you just said of one, it’s a lot easier than we make it out to be. Lifestyle changes suck. Yes, they do. Full stop right. Because it is a change. But the question then becomes, is the change better or easier or worth it much more so than the pain of staying? And I think that’s that question of is the pain of not being able to have a child worth starting to map out your glucose and starting to, you know, to take control of that? I would say Yeah. And I don’t mean to be, you know, so stark about it but it is right. Your health is something that you can take control of. And it’s not this, it’s not us back 30 years ago, 50 years ago when we didn’t have this data available to us.

Dr. Casey Means: [01:34:06] Yeah, absolutely. I think, you know, and certainly glucose is such an important metric to track. It is, I don’t want to paint the picture that it is the panacea for health, you know, it’s not certainly, having stable glucose levels is not going to ensure that someone has perfect skin forever, that’s, definitely don’t want to paint that picture but in terms of nudging the body into the best shape possible, to have the best outcomes like we can only do what we know has been shown to be sort of positive. And we were pretty certain at this point in healthcare that chronic hyperglycemia, high insulin levels, not good for all aspects of health. So something that we can do in a world where a lot seems very much out of our control and I think you get at a great point which is that we have to make this fun, compelling and interesting, if we’re going to make hard choices in our day-to-day lives. And that is so important to me as a physician and feels like a big missing link to me in healthcare. There’s research that shows that, you know, a doctor can prescribe a medication to a patient and still, less than 50% of those prescriptions are filled or taken as prescribed. So even something as simple as taking a medication a lot of people don’t even do it. So it doesn’t even matter how simple you make it. If it’s not something that you understand, buy into and it’s fun and fits into your workflow, it’s not going to happen. So the onus is on given that we live in a culture where, right now, the threats that we’re facing as a country, we are facing threats that are based in diet and lifestyle are chronic diseases that are, you know, robbing the country of, you know, our health and our vitality and our biggest economic costs to our $3.4 trillion yearly healthcare costs. These are chronic conditions rooted very much in or at least propagated by diet and lifestyle choices which means that as healthcare professionals the onus is on us to create interventions for people and, you know, plans for people that make it so that sustainable behavior change is possible. So we have to think more creatively, like if we can’t even prescribe a medication and people will necessarily fulfill it and take it, how are people going to change their whole diet, sleep, stress, exercise? It has to be more effective. And this is where I do think digital tools, really tapping into what do people actually like use and love using, day in and day out. People always have their phones on them. People like games. People, you know, want to be social about things. People want to compete with other people about things. So how do you bring all those elements into, you know, tools that help people move in the right direction? Like we can’t just say, like well if people want to do it they’ll do it. We have to think deeper than that because we are in a big hole of chronic disease. We went into a healthcare profession, we’ve got to adapt to the realities of what we’re dealing with right now, which are behavioral, chronic, dietary and lifestyle conditions, and think creatively about how to help people do better. And I just think that you’re seeing this huge boom in doctors working in digital health because I do think a lot of people are feeling this like, how do we make it more effective? And so I think it’s super, it’s an exciting time in medicine, as people bridge those different disciplines to create tools that are going to really make a difference. So.

Dasha Maximov: [01:37:34] Yeah. How do we use the addictive properties of social media, Facebook, like all the tools that, from a psychological standpoint, make health addictive, right? How do we make health a good thing that we want to keep on paying ourselves or competing or all of the gamification elements that you were mentioning as well?

Dr. Casey Means: [01:37:55] Yeah. I think the gamification aspects are important, but I would push back a little bit on the addictive side because I certainly don’t want to be a part of making anything that people are addicted to, cars that I, you know, I do have concerns about social media and the way it’s tapping into people’s reward circuitry in such a hyper palatable way. But the way I see it is that how do you create something that makes people like using a digital tool to actually get people more in touch with their bodies? So how do we create a tool that makes people listen to their internal cues? Right now, it might be mid-afternoon and you’re like Oh I’m feeling frustrated, I’m feeling tired, you know, I want to take an afternoon nap, I have no idea why. And it’s just sort of this like, you just think it’s like part of your mood or your personality but then how can you, you know? You can then use a tool like a continuous glucose monitor to like show people data that might correlate with that. And then all of a sudden there’s this like trifecta of, I had an action which is I ate this cookie, there was an objective change in my physiology and this is the subjective experience of the world that I had. So as opposed to just a subjective experience that we’re very likely to miss-attribute to other causes, things like our identity, we now have a very clear answer. It cuts through all the noise. And the story, it’s just much more clear. And then we start learning what is this link between behavior, data, subjective experience and the more I think you can do that, the same exact thing is true of like HRV. I’m feeling stressed. This thing happened. I had an objective change in my HRV. When you can start making those links, you can then start moving away from doing it with technology and just understand it yourself. So I’d love to see a world when we don’t need all these tools to do this. But I think in the meantime, helping guide people thought awareness through tools is important but at the end of the day, if people learn what works for them, learn their toolbox and can just essentially face this world eyes open with a big understanding about the world and their body and how those things are interacting, that is my ultimate goal.

Dasha Maximov: [01:40:12] Yeah. And just kudos to you for saying that and pushing back because you’re completely right. It’s not, and I misspoke, it’s not about addictiveness. It’s about, because there is, I mean the Social Dilemma movie was petrifying. Petrifying.

Dr. Casey Means: [01:40:28] I’m seeing it this week actually. I’m so excited to see it. Yeah.

Dasha Maximov: [01:40:33] Well, careful. But you’re right, it isn’t necessarily the addictiveness. It’s the behavioral change and that’s the key. That’s the thing. That’s key, and I love that you, as somebody who is the forefront, you know, runner of pushing a company that is a bio wearable, you’re, right now, saying I would love a time when we don’t have to have this technology. And I think that that is such a beautiful thing that you’re saying because so often it’s what’s the latest gadget? What’s the latest tech? What’s the latest this? And in reality, the truth is that we need this tech because we’re so unplugged from what our bodies are telling us. We’re not hearing the signals. And yet once we start learning those signals then we probably don’t need this technology quite as much, right? I know that I was noticing that I, after having the pizza, I keep on bringing this example, but after having the pizza, and I had some chocolates too, I, you know, I’m noticing heart palpitations. I’m noticing that it’s just too much for my body, it’s overloaded. Now what I have noticed that as acutely had I not had a CGM? Maybe not. And so having that CGM, having that data, having that wearable at this point in time, it’s fantastic. Will I need it for the next 20 years? Probably not. Because at some point it’s just data, just to have data for no reason, unless you’re really trying to test something. And I find that with some of the other wearables that I’ve had in the past where I was like, Ahh, I’m good. I don’t need that anymore. And I think that what you’re pointing to, which is beautiful, is how do we get back to that intuition about health? How do we make the behavioral change? To change from the past 30 plus years that you’ve been living and doing these things that you, unbeknownst to yourself, haven’t realized, are hurting you, right, the food choices, the lifestyle choices, and then showing this wearable which is going to tell you what that is and then changing your behavior such that you don’t need the wearable in the future.

Dr. Casey Means: [01:42:42] Yeah. I think that’s exactly how I see it. And I think you do have to think about, if you really believe that you have to create a business model around that too, you know. And I see a time I think where people, I could see people are, our core journey with my company is around a one month metabolic awareness journey. So really try and glean as much as you can out of this one month to set yourself up for success moving forward. I think there’s going to be people who need six months or a year to dial this stuff in. And then I think that there’s going to be people who want to do this one or two times a year like for a month to just kind of like re-dial-in, you know, re-entrench the habits, and there might be people on a longer weight loss journey who want to wear it for like two years. It’s just there’s going to be different people. But I think the key is what you’re saying, it’s like we’re building this metabolic intuition, this holistic body intuition through a tool with the ultimate goal of not needing it. But the world is also a complex and constantly changing thing with new threats, whether it’s from the food industry or something coming up here and there. And so children tap back into it, you know, down the road and use it again as a tool but not as a dependency, just a tool. That’s where I think it’s excellent. But yeah, it’s that fine line between wanting to get people obsessed with it in a somewhat maybe unhealthy way versus using it as a tool to really liberate our lives, and that has to be built into all aspects of a product and a business model. And yeah, but I think, you know, like you brought up Social Dilemma, I think it’s really interesting how you can go in a lot of different directions with these things. So. Yeah.

Dasha Maximov: [01:44:21] Yeah. So not only a doctor, a surgeon, but also somebody who has good morals and good ethics. Fantastic. Just to end off, because I know we just covered so much and I’m sure that we can continue talking but I always like to end with just rapid fire questions. So three questions for you, one, what would you tell your 15 year old self?

Dr. Casey Means: [01:44:45] I would tell my 15 year old self to, since we’re focusing on health and wellness here, I would say eat more plants. Stop eating dairy, because I was eating a lot of cheese and dairy and I think it was affecting my gut and my skin and everything and my mood. And I would say learn how to use breath as a tool to regulate your emotions and your autonomic nervous system now because the payoff will compound over the years. I think I didn’t even understand the concept of meditation or breath work or how to manage our own nervous system at all at that age. And I think it would have been so valuable at that time in my life. So yeah. Eat plants, learn to breathe, probably avoid dairy.

Dasha Maximov: [01:45:30] Fab. Three good ones. If you could wave a magic wand and change one thing about women’s health what would it be?

Dr. Casey Means: [01:45:38] Hmm I think there’s a many things, you know, the way we do research in our country, like there’s a lot of meta macro things but I think something that comes to mind just right off the bat is I would want our healthcare system to more obviously educate about the fact that we have so much more control over our hormones than we think we do. I think a lot of people are walking around thinking that like our hormones are what they are and if they’re wrong or if they’re off we need to probably be taking other hormone to fix it. So, you know, if you have a hormone issue in this country and you’re having irregular periods or your PCOS or infertility of some other kind or something you end up often getting more hormones to like sort of quote unquote fix that problem, but I think something that has been so powerful to me about really learning about functional medicine is really understanding the full life cycle of hormones and how many parts in that life cycle we have the opportunity to intervene. So let’s just take a hormone like estrogen and estrogen is processed and basically detoxified in the liver through what’s called phase one and phase two metabolism and then it’s excreted in the stool. So right there we can think about liver health and liver optimization and also our GI health as a way to sort of clear estrogen and move estrogen through these pathways more effectively, you know. Part of this process involves methylation which is like adding a methyl group to different byproducts to basically be able to excrete estrogen. So methylation that’s another process where we can intervene with diet. So, we can take care of our livers. We can give ourself foods that are methyl donors. We, you know, with our B vitamins and we can make sure we’re eating tons of fiber and hydrating so that we actually are passing stool regularly and not doing a bunch of things to screw up our GI system and our microbiome. I mean those three things alone help us process estrogen in an effective way. And a lot of us right now are not doing a lot of good stuff for our livers. We’re not eating foods that have good methyl donors and we’re not taking care of our GI system. So I think very few OB-GYNs in this country are talking to their clients about their stool but it’s critical. We can’t just always be putting more hormones on top of hormonal issues. I think we have to start with some of the very very basic stuff about just thinking about the life cycle of a hormone. So anyone dealing with maybe estrogen dominance, high estrogen levels, I would say I would talk to them about eating 50 to 75 grams of fiber per day. Get the stools regular, you know, making sure our microbiomes are safe but are healthy by, you know, reducing pesticides, reducing NSAID use, stop taking unnecessary antibiotics, you know. Doing just like very basic low-hanging fruit stuff. So that’s just kind of, you know, just thinking more holistically about hormones and how we actually do have the power to make small changes in our life that can balance our hormones, and it doesn’t always just need to be reaching for more hormones. Of course, there’s a place for exogenous hormones in healthcare but I just think we reach for that prescription pad too fast.

Dasha Maximov:: [01:48:54] Yeah. Yeah. I would agree with that based on what I’ve seen so far, is the same thing it’s, figure out the lifestyle changes first and then reach for the exogenous. But oftentimes right now, for so many different reasons we just say either we don’t have time, we don’t have interest, we don’t, it’s too much effort, et cetera. Would you say okay, just give us the exogenous.

Dr. Casey Means: [01:49:16] Yeah. And the other big thing is like, that I think we forget often is that, you know, our fat tissue, our adipose in the body, is a hormone producer in its own right. You know, our fat has an enzyme called aromatase on it that converts testosterone to estrogen. So if we have excess adiposity in fat, we are basically making more estrogen. And like with all things, a certain amount of something is good. Too much of it is often bad. We don’t want excess estrogen in the body. And so, you know, weight loss for instance should be a first line for so many hormonal issues both in men and women, especially if we’re dealing with issues of estrogen. And again, not something that’s talked about that widely, there are validated tools to help with weight loss out there. We’re not aggressively pushing those before we reach for that prescription pad. If I’m one voice saying, you know like, ask deeper questions about this or find a functional medicine doctor or, you know, someone who can help you with some of this lifestyle stuff related to hormones. Like hopefully, that is helpful.

Dasha Maximov: [01:50:21] Yeah. That’s very helpful. Especially hearing it from a doctor who is saying that it’s again, these lifestyle changes are something that of adipose tissue, of being, you know, overweight. It’s not about body shaming. It’s about health.

Dr. Casey Means: [01:50:37] And 74% of Americans are overweight or obese right now. And so that that excess fat tissue that the majority of us are carrying, that is an endocrine organ. That fat is converting hormones to other hormones, and so we’d need to, anything we’re doing pharmaceutically is in some way not dealing with the root cause. It may be helpful. It may help with symptoms. We got to start with some of that stuff that we know is going to have a positive impact on the foundational part of hormone.

Dasha Maximov:: [01:51:09] Yep. Okay. Last question. What has been one teacher or one book that has changed your way of thinking?

Dr. Casey Means: [01:51:17] Oh man, there have been many. I would say one thing that has been very empowering for me in my career is Ayn Rand’s book, so like Atlas Shrugged, The Fountainhead, she really talks about purpose and how important it is to identify the areas of our life that we’re most passionate about and try and really find professional and personal alignment, and that if we focus on what we’re most passionate about personally, we are going to do the most good in society overall. So sometimes this message gets a little bit confounded and people talk about that as being called like selfishness, like if you’re focusing on your own loves and your own passions at the expense of other things that you could be doing. But I really have found that as I tap more into my purpose and what in my life just truly gets me excited intellectually and just lights me up, I am going to work harder. I’m going to do more. I can talk about it nonstop. And that ultimately is going to be better for people and my patients and, you know, whatever companies I’m working with, because I’m so into it. And so I do think there, you know, it’s certainly good to do things for the sake of just being helpful and doing good things, but I think it’s also very important to focus on what your core passion is, go hard at it. And I do think the re-trickle down effect of how that benefits other people has, you know, quite a bit of magnitude because you are bringing the fire to it. So that’s what I took from that book.

Dasha Maximov: [01:52:58] Beautifully. Beautifully said. And you can sense the fire coming from you. Because you’re pushing forward. I mean, again, you’ve changed your career multiple times and all within the health space and now you’re bringing all that knowledge to these companies that you’re founding and you’re advising. So thank you for finding your own passion first, because that’s also a part that takes a lot of time usually, for people. So where can people find you? Where can people learn more about what you’re doing?

Dr. Casey Means: [01:53:28] Yeah, so people can find out about Levels and continuous glucose monitoring and metabolic health on Instagram and Twitter at levels. And then our website is www.levelshealth.com. And I write a ton of blog posts for our blog which is a lot of the stuff that we’ve talked about here, and that’s levelshealth.com/blog. And it’s really certainly not a sales pitch for the company. It’s really just trying to help people understand how metabolic health relates to them even if they’re not diabetic. So encourage people to check that out. And then for me personally, I’m on Twitter and Instagram at Dr Casey’s kitchen, so Dr Casey’s kitchen and I write a lot about, I’m vegan, plant-based, and I talk a lot about plant based nutrition and how that relates to metabolic health. So yeah, feel free to reach out there.

Dasha Maximov: [01:54:15] Fantastic. And again, just to, the Level’s blog is wonderful. I’ve been looking at it for the past couple of weeks and it’s chock-full of information about glucose, about metabolic health and something that I, it’s just, it’s great to read. So thank you for that.

Dr. Casey Means: [01:54:31] Thank you so much.

Dasha Maximov: [01:54:32] Thank you again, for your time. This has been fantastic. If people do want to get one of these Levels, we will have a code later on, so just check us out on Instagram and then the code will be there. So thank you again, Dr Casey. This has been fantastic. Can’t wait to have a Q&A with you later.

Dr. Casey Means: [01:54:50] Awesome. Have a great day.

Dasha Maximov: [01:54:52] Lots of information in that episode, right? Who knew that something as simple as tracking our glucose levels would help you get a better understanding and a better handle on your brain fog, your weight gain, your fertility and even your skin health. For me, the past week of use has really caused me to really understand how I’m combining foods together and at what time should I be eating. From the vast variety of tech that I’ve played with so far, I’d say that the CGM has been the best thing for habitat. Just, if you got one, do me a favor and message us on Instagram. We’d love to hear your thoughts on what you’re finding out about your own health. If you learn something during this episode please leave us a five star review and tag us on social media. It’s the best way for other women like yourself to learn about your health. If you enjoy content like this then chances are you’ll also love our online global private community, a women’s health explorers. You can join us at www. whealth.community. Catch you there. Until our next house exploration, stay awesome.