How to track your way to being superhuman

What does your morning oatmeal and a jump into a cold pool have in common? As data is showing us – they’re both impacting your glucose levels and long-term metabolic health. Dr. Casey Means is the co-founder of Levels, the company behind a biowearable device that tracks glucose levels along with your daily nutrition and activities. With real-time data and insights, Dr. Means believes Levels can give us a better understanding of what to do – and not to do – to optimize our health for the long term. On this episode of The Motivational Podcast, Dr. Means and Carli Williams talk about metabolic dysfunction, the major levers of holistic health, and why healthy choices are the best gift you can give to yourself and your community.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out The Motivational Podcast
• Connect with Carli Williams on LinkedIn or Instagram

2:53 – The ‘Fitbit’ for glucose

Levels Health brings biowearable tech, data tracking, and behavior-changing info to the fourth pillar of health: nutrition.

“Traditionally we have had wearables for three of the four main pillars of health. So that’s sleep and activity and stress. So we’ve got heart rate variability monitors for stress, like HeartMath and Lief Therapeutics and Oura and WHOOP all measure these things. We’ve got our sleep trackers, amazing products –  even beds –  that track our sleep now, like Eight Sleep, Oura and Fitbit. And then of course our activity trackers, Apple Watch, all these things. But we have never, ever had a wearable for nutrition. We have had no way of knowing what’s happening to our bodies in real-time, based on our decisions. And that time is now – we have that. And so it’s really, really exciting because ultimately, to generate optimal health we have to be making decisions every single day, day in and day out that create the physiologic conditions in our bodies that generate health. And those are decisions on food, sleep, exercise, stress amongst other things, and to be able to actually make sustainable behavior changes. It’s not just about knowing what to do. That’s often not enough. We all know we’re not supposed to eat junk food. We all know we’re not supposed to eat potato chips. So really it’s about how can we leverage tools that tap into behavior change and let us really understand our bodies and our unique personal physiology, and then figure out how to pull the levers to move it in the right direction. We’re really all about closing the loop between actions and reactions to drive sustainable behavior change.”

6:25 – Generating stability from the inside out

Without real-time data about what we eat, we’re likely to make poor choices that send our glucose levels on a roller coaster ride straight to metabolic dysfunction.

“High variability in our glucose leads to high variability in our subjective experience of our days, whether that’s energy, mood, cognitive function, memory. When our glucose is up and down, up and down, up and down, we often see that same roller coaster in our lived experience of our life. And the more we can stabilize our glucose, the more I think we can stabilize our life and really be as high-performing and control as possible. One of the reasons for this is because when we spike our glucose by what we eat over and over again and also just how we’re living – if we’re sedentary and we’re stressed and we’re not getting good sleep and we’re eating a lot of refined carbohydrates and sugars, and we’re getting these big excursions in glucose where that stuff is essentially turning into glucose in the body – what happens is our body has to release all this insulin to help the body soak up that glucose into cells. And the cells are taking up this glucose because they want energy. And they convert that glucose into a usable form of energy. And our cells need energy to function. They will not function properly if they’re not getting energy properly. But when we put the body on this rollercoaster day in and day out, year in and year out decade after decade, which, quite frankly is what the average American is doing, because the vast majority of the food wheat that is widely accessible to people is refined carbohydrates and sugars. That rollercoaster that we’re putting our bodies on changes our metabolic health completely and turns it into a really dysfunctional system.”

13:53 – Your glucose ‘fingerprint’

Your glucose process is as unique as you are, and only monitoring can help you understand what’s best for your body.

“What’s so interesting is that two people are going to process carbohydrates very differently in terms of how it elevates their glucose. So you and I could both eat one cup of sweet potatoes and I could go up to a glucose level of 170 – really, really high – and you might go up to 90. And there has been amazing research about this. We used to think that a certain type of carb will spike everyone the same way. That was the whole concept behind the glycemic index but that theory is really evolving to actually people have very individualized responses to carbohydrates. The main study that looked into this was five years ago, it was published in this huge journal, Cell. And it was out of the Weizmann Institute in Israel. It was called Personalized Nutrition by Prediction of Glycaemic Responses. They put continuous glucose monitors on a bunch of healthy non-diabetic individuals – people without a diagnosis of metabolic dysfunction, healthy people – and gave them standardized meals like bananas or a cookie. And they found just a totally diverse range of glucose responses. And it’s like, wait, how is this possible? It’s the same amount of carbohydrates, but there’s a lot of different steps between a carb in the mouth and glucose in the blood.”

18:20 – You are more than what you eat

Aside from diet, Levels’ data shows that timing, exercise, and other factors can impact glucose stability and spikes.

“Aside from just like food pairing, I learned that for me, eating earlier in the day has much less of a glycemic impact. And if I eat late at night, we naturally actually become more insulin resistant as the day goes on. And part of that, this is kind of crazy, but when we were getting closer to sleep, our body releases melatonin, which is a hormone from the pineal gland and near the brain and that melatonin helps us get sleepy, but it also tells the pancreas to get sleepy and it stops us from producing as much insulin. So you could eat the exact same meal in the morning and the exact same meals after dark, and for many people they’re going to have a higher glucose response in the evening. So food timing matters. And then of course, exercise – huge impact. Stress management – big impact. And sleep. I’ve just realized that for me to maintain healthy metabolic health on my vegan diet, I’ve got to be getting seven hours, eight hours of sleep a night. I’ve got to be doing my consistent exercise, walking after meals, making sure I’m getting some high-intensity interval training, and then doing my stress management. Even if you eat the perfect diet, if you don’t have your sleep stress and exercise dialed in, it’s never going to be 100 on your metabolic health. And so the beauty of that is there’s all these levers we can pull to create the context in the body to process carbohydrates effectively.”

22:45 – The data-based path to living your best life

When we tune-in to our body and understand the impact of our choices, we can live happier, more energetic, and healthier lives backed by data.

“My firm belief as a physician is that symptoms are the body screaming at us that there’s underlying dysfunction. And we have to listen to that and think of that as a guide, and then search for what that underlying dysfunction is, which can be a journey. There’s many different things that can lead to the same symptom, but that is the body telling us something. So many of the things we think are normal in our life, like feeling up and down and anxiety and feeling lethargic, we just think it’s really, really normal. But a lot of it is that our current culture – it’s very difficult to hear the internal signals of our body. We are living in a hyper palatable food culture. We are digitally stimulated constantly. We are very, very busy. We’re getting less sleep. And so it can really drown out our ability to hear the signals inside the body. And one of my big hopes for Levels and future biowearables is not that they just give us a data stream that sort of tells us what to do and this and that, but that they actually draw us inward and help us create connections between actions we took and the objective reality inside our body. And then also the really key point is to circle it back to how we actually feel. So if we feel lethargic after a meal and have that post-meal slump, how can we help people 1) actually hear that signal and identify it, and then actually attribute it.”

35:25 – The power of nutrition

After decades of dismissing the importance of diet, science is starting to realize how nutrition can control our health and day-to-day outcomes.

“In our current healthcare system, we don’t think a ton about food and doctors are getting less than 10 hours of nutrition training in all of medical school. And yet the vast majority of the conditions that we are dealing with in our country and that promote our healthcare costs are related to diet and lifestyle. I think there’s just a huge opportunity for people to use these tools, to really understand it for themselves. And certainly hope that the medical field is going to move in the direction of understanding how much we need to be talking to patients about food and really thinking about precision nutrition. I think there’s good forces at play moving in that direction because, at the end of the day, food is molecular information. And food is not only the instruction manual for how ourselves function, but it’s also the building blocks of how our cells function. And so it has a dual purpose to control the outcome of our health and our day-to-day experience of the world. And on top of being this molecular information, but also the building block, it’s also having this other benefit of telling our microbiome – a totally separate sort of part of our body – exactly what to do and what to make.”

38:45 – The best form of self-care

The healthier you are, the happier you can be – and the better you can show up for the people and activities you love.

“I think that the way we choose to eat and then of course, the way we choose to practice, our mind body practices and how we choose to shape our sleep hygiene, and then of course how we move, these things are all the greatest form of self-love and self-respect that we can do. And I think we also have to remember that, us taking the time and energy to do those things for ourselves and really understand our bodies and what makes it thrive and optimize – that is the greatest gift we could give to those around us and also to the world at large. Because when we’re biologically not functioning properly, and not thriving physically or mentally, we’re not able to show up and be the people we want to be to those around us. I can speak from personal experience. At times in my life when life has been extremely stressful and I’ve not been able to practice these types of self-care behaviors or, do my best in terms of metabolic health – it shows up everywhere, and especially in the mind and my ability to be kind and patient and creative.”

43:30 – The glucose-spiking stress secret

Tracking changes  in your glucose processing will also give you insights into the negative impact of stress – and show you why mindfulness matters.

“I’ve really found glucose monitoring to actually be not only a nutritional biofeedback tool, but a mindfulness biofeedback tool. Because if I’m giving a talk or something like that, and I’ve seen my glucose, even when I’m totally fasted – so no glucose in my mouth, but just glucose from my liver – I’ve seen it go up 50 points when I’m stressed before. That’s a crazy amount. If I know that’s going to happen, and now I understand that damage that I’m doing, you better believe that before any potentially stressful events, I am doing Wim Hof breathing. I am doing guided meditations on my Calm or Headspace app. I am getting in the zone, telling myself a new story about the stress, remembering that giving a talk is an opportunity to share, not an opportunity to be judged. All of these different things, all of that before and after, totally changed my body’s physiologic response to that stressor. So I think it can be just this wonderful mindfulness biofeedback tool to show us how these stories and these beliefs are impacting our health in real time. And before that, we all know we don’t like the feeling of stress, but I don’t think we quite understand what it’s doing to our health instantly. We know that like heart disease and cancer and a lot of these conditions are worse when people have underlying stress. So in an amorphous way, we’ve always known we should be on top of this because it’s better for health and longevity, but to see it immediately and know you can do something about it, I think is powerful.”

46:20 – Support for the polar bear club

Can cold exposure reroute your glucose processing? Dr. Means – and science – say yes.

“I certainly have been reading a lot about the benefits of cold thermogenesis. And what’s interesting about the cold that also is fascinating for metabolic health is that there has been evidence, mostly in animal studies, that exposure to cold has this really interesting molecular process going on. It’s a hormetic stressor is what they call it, meaning that you put your body under this stress to make it more adaptive. And one of the things it does is increase this part of our body called brown fat. Brown fat is a type of fat that we actually have a ton of when we’re babies, but we don’t have it a lot more as adults – it diminishes over time and it keeps babies warm. The reason it does that is because this fat is actually brown in color because the cells have so much more mitochondria in them, which are the part of the cell that converts glucose and fat to energy. And so when you expose yourself to cold over and over again, it upregulates pathways that increase my mitochondrial biogenesis. So more mitochondria and more brown fat. And it’s one of the only ways we know in animals that you can increase brown fat. And this is a very, very metabolically active tissue that’s going to be processing glucose really efficiently.”

48:43 – Spike isn’t always a bad word

When food spikes your glucose, that’s a bad sign – but exercise, cold exposure, and other external glucose elevators aren’t a problem

“Your glucose will actually probably go up while you’re doing the cold. And that is because it is a stressor and it is going to cause your body to be like, ‘Oh my gosh, what’s going on?’ That is something that you might see – like this little up and down peak. But over time we believe that that is going to be building adaptive metabolic pathways. And you actually also see this same thing with high intensity interval training workouts. HIIT training is inherently stressful for the body. When you get on the pellets and, and go like 10 out of 10 you’re just like your body’s like ‘what’s going on?’ You’re being chased by a lion. It is going to release cortisol to feed the muscles. And you’ll often see a glucose spike in a high intensity workout. These do not seem to be disadvantageous in the same way a food-related spike is because that food-related spike is going to generate the whole metabolic insulin pathway. And a lot of that could be stored as fat and this and that. Whereas these other responses, like with high intensity interval training, your body actually needs that glucose. And it’s going to be using that glucose and it’s going to make our body, our muscles are going to be hungry for that glucose. And actually glucose can be taken up during exercise without insulin.”

55:51 – Inspiring a health revolution

At Levels, data shows us that diagnoses aren’t life sentences when smart choices can reverse or reduce many metabolic-based illnesses.

“I think the biggest truth is that health is a two-way street. It’s not a one-way street. So we often think that we’re marching down this trajectory of health or disease. And that it’s linear in one direction. We’re fine and then we’re not fine. And once we’re not fine, we’re going to be that way for the rest of our lives. And we were going to potentially take medication for the rest of our lives, or we’re going to be diabetic for the rest of our lives. It’s very rare that you hear people saying something like, ‘Oh yeah, I have a diagnosis of diabetes and I’m actively working on reversing that.’ You hear people say ‘I’m diabetic.’ And that becomes an adopted part of their persona and their who they are. What I would rather the language be around it is ‘I’m currently in a diabetic state and I’m working on my metabolic fitness so I can get out of that diabetic state.’ That’s a real shift in thinking because of what I’ve studied with physiology and biochemistry, but we live in a dynamic body, it’s a dynamic system. And when we change the conditions of the body and when we change the types of molecular information that the body is actually receiving, you can absolutely move in the right direction on the continuum of health and that can really happen at any stage of disease.”

1:01:26 – Data moves us forward

Want to make the most of your Levels device use? Track and test how your lifestyle impacts your glucose levels to gain more insights and share outcomes with your network.

“Test out your diet, test out foods, take this first week or two to just really try the foods you love and the foods you normally eat and see how they’re affecting you. Post about it, show your experience and your screenshots. I think it’s really fun to see other people experimenting and sort of biohacking in real-time. And then try out some of these levers, like what happens when you do Wim Hof? What happens with the cold plunge? What happens when you get less sleep or more sleep? If you’re up in the middle of the night with a baby, when you’re up with your twins, what happens to your glucose at that time? You know, really learning about those levers: sleep, stress, exercise, food, food timing, food combinations, and then learn a little bit there. And then in the last part of the program, really try and optimize and be like, ‘okay, how can I keep things as flat and stable with what you’ve learned from the prior three weeks?’”

Carli Williams [00:00]                         Welcome to the Motivational Podcast where we talk about ideas to elevate, transform, and heal your life. I’m Carli Williams and I’m honored to have you here. Let’s go. Casey, welcome to my podcast. I’m so honestly so stoked to talk to you. I’ve been kind of nervous because I feel like I’m talking to somebody who’s just like the master of everything that you do and a doctor and obviously crushing it in her life. And so I’m just so grateful to be able to ask your brain questions and get some knowledge for my following. So thank you so much for being here. Seriously.

Casey Means [00:56]     Thank you so much for having me and right back at you on all of that.

Carli Williams [00:59]                         I’m so happy. So, first question is. Well it’s for everybody. I actually reached out to this company. I don’t know if you knew that Casey, but I actually reached out to your company. I was like, “I have to get this product.” So it’s called Levels and it measures blood glucose, right? And I have been working with Ben Bikman. If you guys have been following my podcast, then you know that I’m-  Ben Bikman is my guru and now Casey is, too.

Casey Means [01:37]     Bow down. Ben Bikman, though. He’s my guru, too. Everyone should go get his book, Why We Get Sick. It’s the best.

Carli Williams [01:33]                         Like, I love you. I’m so grateful that you’re sharing all of this. It made my life so much better, truly. And that’s not even like paid. This is just like, I feel an obligation to spread the good news. So I saw Ben using your, the Level’s patch and I texted him and I’m like, “How do I freaking get that?” You know, now granted, I’m excited to show people the products, but I was like, “How do I get that?” And it’s like a huge wait list. It was totally hard to get. You guys are crushing it. So tell them like, what, like a little about you and I don’t know, just like who you are and about Levels a little bit. And, well, introduction.

Casey Means [02:13]     Awesome. So I’m Casey Means. I’m a medical doctor and I am the co-founder and chief medical officer of Levels. And what Levels is, we help health seeking individuals understand and improve their metabolic health. And so practically speaking, what that means is that we offer a product that’s really kind of like Fitbit for glucose. So it’s a system that involves a wearable sensor called a continuous glucose monitor and paired with- Yes, you’ve got it right there, about to be put on. And we pair it with a software that we’ve created that takes that continuous glucose data stream and makes it highly understandable and actionable. So, you know, traditionally we have had wearables for three of, I think the four main pillars of health. So that’s sleep and activity and stress. So we’ve got heart rate variability monitors for stress, you know. Things like Heartmath and Leaf Therapeutics and Oura and Whoop all measure these things. We’ve got our sleep trackers, you know, amazing products, like even beds that track our sleep now, like Eight Sleep and an Oura and Fitbit. And then of course our activity trackers- Apple watch, you know, all these things. But we have never, ever had a wearable for nutrition. Like we have had no way of knowing what’s happening to our bodies in real time, based on our decisions. And that time is now that we have that. And so it’s really, really exciting because ultimately to generate optimal health, we have to be making decisions every single day, day in and day out that, you know, create the physiologic conditions in our bodies that generate health. And those are decisions on food, sleep, exercise, stress amongst other things. And to be able to actually make sustainable behavior changes, it’s not just about knowing what to do. Like that’s often not enough, just, we all know we’re not supposed to eat junk food. You know, we all know we’re not supposed to eat potato chips. So really it’s about, how can we leverage tools that tap into behavior change and let us really understand our bodies and our unique personal physiology, and then figure out how to pull the levers to move it in the right direction. So we’re really all about closing the loop between actions and reactions to drive sustainable behavior change.

Carli Williams [04:23]                         Oh, that’s so cool. So the reason, so I just was like, “Okay.” Using my own brain, I’m like, “I want to use this.” And I want- I was like talking to my assistant, who I actually also got one for her because she’s dealing with chronic pain. She has headaches; no doctor can figure out what’s going on. And, you know, there’s all this information about healing foods, but they all spike your insulin, always. And so when I was talking to, I think that glucose is the most important thing. I think it’s just a theory, but I think that glucose has to be monitored and in check before any other kind of healing stuff can happen because it’s so powerful that- And I would love to get your take on that. But I was just like- Casey, I had a six pack and I was like, crushing it. And I like, could not remember like my brain and my energy levels were all over the place. And I, from an outsider’s perspective, like I had it all, right? But I didn’t feel like I’ve evolved. It’s like I’m so hippy, you know? It’s so weird, but I’m like, once you’re in this new state where you have this beautiful stream of energy from fats and you’re able to sleep better and your mood are stabilized, you feel like you’re the master of your body instead of your body controlling you. It’s a beautiful process. And so I want to track how I feel with this, say, “How do I feel when my glucose rises?” And like, I’m more concerned about how I feel after I eat certain foods. And that’s why I wanted to order this. I don’t know if that’s what the intention is, but I would love to know how can I use this to best optimize my life and to evolve as a human being.

Casey Means [06:15]     Yes. I love that. And I’m so happy for you on your journey. And I, you know, I truly believe that variability, high variability in our glucose leads to high variability in our subjective experience of our days, whether that’s energy, mood, cognitive function, memory. When our glucose is up and down, up and down, up and down, we often see that same roller coaster in our lived experience of our life. And the more we can stabilize our glucose, the more I think we can stabilize our life and you know, really be as high-performing. And in control, like you said, as possible. And you know, one of the reasons for this is because when we spike our glucose by what we eat over and over again, and also just how our living, if we’re sedentary and we’re stressed and we’re not getting good sleep and we’re eating a lot of refined carbohydrates and sugars, and we’re getting these big excursions in glucose where that stuff is essentially turning into glucose in the body, what happens is our body has to release all this insulin to help the body soak up that glucose into cells. And the cells are taking up this glucose because they want energy. And they convert that glucose into a usable form of energy. And our cells need energy to function. They will not function properly if they’re not getting energy properly. But when we put the body on this rollercoaster day in and day out, year in and year out, decade after decade, which quite frankly is what the average American is doing because the food that is, you know the vast majority of the food that is widely accessible to people is refined carbohydrates and sugar. That rollercoaster that we’re putting our bodies on, changes our metabolic health completely, and turns it into a really dysfunctional system. That insulin being spiked over and over and over again does two things: One, it tells our cells that, you know, it’s this overwhelming signal to the cells and they actually get numb to it. They’re like, “There’s too much insulin around. We need to sort of block the signal a little bit.” And so the body actually has to produce, then, more insulin to overcome that numbness to even get the same amount of glucose in. And over time the cells can become so insulin resistant that it’s actually hard to get glucose in. Even though glucose levels are high, it’s hard to drive it into the cells. So then we have an energy deficit in our cells. And when our cells don’t have the energy they need, they don’t work properly. And where that’s happening in the body is where we’re going to see any symptoms. If that’s happening in the brain, that could look like, think of all the things that could be possible if your brain’s not functioning quite properly, in terms of energy. It can look like depression, anxiety, Alzheimer’s, dementia, brain fog, chronic pain, chronic fatigue. All of those conditions have been associated with blood sugar dysregulation, because if we go back to the principles, if the body’s not processing energy properly, a fundamental pathway, then we aren’t, our cells are not functioning properly. If that happens in the liver, it could look like fatty liver disease. If it happened to the blood vessels, it could look like erectile dysfunction or retinopathy or heart disease or hypertension. These are all vascular problems. If it happens in the ovary, it could be polycystic ovarian syndrome. All of these conditions I’m mentioning are fundamentally rooted in blood sugar dysregulation. So that’s one, is the insulin sequelae and sort of what’s happening there. The second thing that happens when insulin is chronically spiked, aside from insulin resistance and that pathway, is that insulin is telling the body, “Don’t burn fat.” And I know you talked about this so much with Ben Bikman, but just to kind of recap, insulin is essentially a signal to the body like, “Oh, we’ve got so much, we’ve got so much energy from glucose. We don’t need to burn fat,” this other substrate of energy, because we’re good on glucose. But we want to be burning fat in the body. We want to have our insulin levels low enough that we can both use glucose when we have it around, but when we don’t have that glucose around, we can just tap into fat burning. But we can’t do that if our insulin is chronically high. And at scale in our country, our insulin is high. So this is why things like fasting and eating sort of a lower carbohydrate diet, both of which minimize our glucose in the blood and minimize our insulin, allow us to get into that fat burning generate ketones, which are very helpful. You know, the brain really thrives on ketones. And so for many, many reasons, we really want to be keeping that glucose day after day in this lower, very moderate ups and downs, none of these big spikes and dips, because it allows us to be what we call metabolically flexible and be able to switch between fat burning and carb burning when different substrates are available, and just keep our energy, our ability to produce energy so much more stable. And you can imagine if you’re producing energy in a stable way, your life is going to be more stable. So that’s kind of just the 10,000 foot view of why it’s important to keep these things stable. And it’s really hard to change or improve something we can’t track. So tracking glucose gives us that edge into starting to optimize this.

Carli Williams [11:09]                         Yes, I totally have felt such a difference. Like I was telling you before we started recording, I literally feel like an evolved human being. I feel like I am, and I say this, I’m sorry. I’m so spiritual and a little hippy about it, but I’m like, it seems like this is the body that God designed. And like, this is how it’s supposed to be working or whatever spiritual source it is. It seems like this is what a human being functioning correctly should feel like. It’s just like this beautiful, sustained- Like it feels like that. Like, ahh, and I got this and I have so much energy and I’m totally fine and I’m not exhausted. And I can think clearly and it’s wild. But okay, so I have so many questions for you. So first is, I want to know what you eat.

Casey Means [12:02]     Ooh, well, this is actually going to veer, this is going to veer so much from what Ben was talking about because I’m actually a hundred percent vegan. So yeah, he was, he was talking about-

Carli Williams [12:16]                         Like, “Eat your cheeseburgers, you’re going to fall asleep.

Casey Means [12:19]     Yeah, exactly. And, you know, he was talking about whey and eggs and animal protein and all these things, but you know what? I’m here to tell you, I’m going to show you my glucose. Like I’m vegan and I’ve eaten multiple things today. And my glucose is 100% flat. It literally hasn’t gone up at all. And so I think, the beauty of that- And it’s flat in like the low eighties. So very, it’s not like it’s elevated and I eat a lot of carbs. And this is very different from what Ben talked about, but I think it actually gets to a very interesting aspect about physiology and actually why glucose monitoring is so important because I have essentially shaped my plant-based diet to not cause glucose spikes. I know how to modulate all the different levers of metabolic health at this point, to eat the diet that I want to eat. And that’s aligned with my passion and my values for plants and not have the collateral metabolic damage of not knowing, you know, what’s spiking me. So when I first started wearing a CGM and developing Levels, I was all over the place. And I thought I was eating so healthy. I wasn’t just eating a vegan diet. I was eating a whole food plant-based diet, like no refined foods, no sugars. And I was just all over the place. It was like grapes, corn, oatmeal, quinoa, sweet potatoes. It was just like up and down, up and down, up and down.

Carli Williams [13:34]                         That’s how I was, exactly like that. I was like, “Carbs are good and they make you feel good.” And so I was exactly like that. All good sources. But keep going.

Casey Means [13:44]     Yeah, no, exactly. And these are healthy foods, you know. But what I found is that they’re not healthy in isolation and the way I was eating them for my body. What’s so interesting is that two people are going to process carbohydrates very differently in terms of how it elevates their glucose. So you and I could both eat one cup of sweet potatoes, and I could go up to a glucose level of 170 really, really high, and you might go up to 90. And there has been amazing research about this. We used to think that a certain type of carb will spike everyone the same way. That was the whole concept behind the glycemic index, but that’s actually, that theory is really evolving to that actually people have very individualized responses to carbohydrates. And the main study that looked into this was five years ago, it was published in this huge journal cell. And it was out of the Weisman Institute in Israel. And it was called Personalized Nutrition by Prediction of Glycemic Responses. And they put in, it was so good, and they put continuous glucose monitors on a bunch of healthy non-diabetic individuals. So people without a diagnosis of metabolic dysfunction, healthy people, gave them standardized meals like bananas or a cookie. And they found just a totally diverse range of glucose responses. And it’s like, “Wait, how is this possible? It’s the same amount of carbohydrates?” But there’s a lot of different steps between a carb in the mouth and glucose in the blood. And one of the big predictive factors they found was that microbiome composition had a huge impact on whether someone would spike or not. But also other things like body type, anthropomorphic features, which can tell us about sort of insulin sensitivity and how much sleep people got. Hmm?

Carli Williams [15:14]                         What is it? What is that feature you said? I’ve never heard that word.

Casey Means [15:18]     So the word that they use in the paper is anthropomorphic features. And what that means is like body type. So you can imagine, you know, they talk about like there’s apples and pears for body shapes. And this has a bearing on telling us a little bit about how much subcutaneous visceral fat people have. We know that visceral fat, which is fat around organs, is much more damaging to our metabolic health than fat under the skin. So like the fat, you know, in your arm, that’s right under the skin, that’s not really going to be a huge hit for you in terms of your insulin sensitivity, but when you are insulin resistant and you’re storing glucose as fat and not burning fat because your insulin is high, it actually preferentially likes to store itself around organs, like the heart and the liver and the digestive tract. And so that’s going to be these people that are more like round in the middle, you know, maybe thin extremities, but round in the middle. And this is why this measurement- You can measure this in a number of different ways. You can do body impedance analysis. You can, but there’s actually a really simple way to look at this is waist to hip ratio. So the measurement around your waist to the measurement around her hips, and you want that to be low. You want your waist to be small and your hips to be wider. You don’t want to be like a square where your waist is wide. And you can imagine if that’s happening, it might signal that you got a lot of this visceral organ based fat. So you don’t want that number to be close to like one or more where the waist is actually bigger than the hip. So this is, that’s what I mean by anthropomorphic features and body type. It’s like a signal of what might be the underlying insulin sensitivity based on how you have stored fat in the past. And that type of thing, you can imagine if people with two different insulin sensitivities or anthropomorphic features eat the exact same banana, the one with sort of the more favorable features are probably going to have a lower and smaller response to that same carb as someone who’s more insulin resistant, and isn’t going to clear that insulin as fast, and it’s going to be a totally different profile in terms of how that glucose hits their bloodstream. So, that was just a fascinating paper to sort of show that we need to really individualize this for ourselves. And what’s right for you may not be right for me. And for me, with my vegan diet, it was really about figuring out which plant foods and which combinations of plant foods were not going to spike my glucose. And so it definitely shifted more towards green leafy vegetables and plants that, some of the less starchy plants. I definitely moved away from grains quite a bit. And so. And definitely upped my fat and protein composition. And these days I would really never eat a fruit without pairing it with some fat or protein, and sometimes eating it in sort of a smaller portion and more frequently, as opposed to a big, as Ben called it, “Sugar bomb,” and just hitting my body with that. So, and then aside from just like food pairing and learning all of that, I learned that for me, eating earlier in the day has much less of a glycemic impact than if I eat late at night, later at night, you know, we naturally actually become more insulin resistant as the day goes on. And part of that, this is kind of crazy, but like when we are getting closer to sleep, our body releases melatonin, which is a hormone from the pineal gland near the brain, and that melatonin helps us get sleepy, but it also tells the pancreas to get sleepy and it stops us from producing as much insulin. So you could eat the exact same meal in the morning and the exact same meal sort of after dark, and for many people that are going to have a higher glucose response in the evening. So food timing matters. And then of course, exercise- huge impact.  Stress management- big impact. And sleep. And I’ve just realized that for me to maintain healthy metabolic health on my vegan diet, I’ve got to be getting seven hours, eight hours of sleep a night. I’ve got to be doing my consistent exercise, walking after meals, making sure I’m getting some high-intensity interval training, doing my, and then doing my stress management, because all those things, even if you eat the perfect diet, if you don’t have your sleep, stress and exercise, I think, dialed in, it’s never going to be a hundred on your metabolic health. And so the beauty of that is there’s all these levers we can pull to create the context in the body to process carbohydrates effectively. And that’s been the journey for me over the last, you know, 18 months, and just taking everything I know from my medical career and really putting it into optimizing a personalized diet, and then what we are building in our product experience for other people to do this for themselves.

Carli Williams [19:53]                         Oh, I love it. It’s so interesting. It’s so fascinating. And that’s, you know, people can eat the- People have all of these different opinions on which is the best diet. And I was talking with my assistant and I was like, “Do you want to know what I think? I think every diet is right. And I think that it’s very personalized to you and what you need and what result you’re looking for.” Right? Like for me, I’m like- Okay, I love having like, it’s like totally stupid, but I love the six pack that’s really like, that’s really fun for me because just from a, I don’t know, from a desire standpoint, like I never thought that I could get a six pack again after kids. And so it’s almost like I wanted to be the example for what’s possible. And so my diet reflects that desire. Right? But if I was on a healing diet, where I’m like, “I want to heal,” which I’m kind of leaning into now that I’m looking at more plant-based, more, right? It’s like, there are certain diets that have this almost like spirituality to them. I know that that sounds a little funny, but it’s like, “What is the desired result that you want?” Right? Like, why are you, why is there something inside of you that wants to be vegan? Whereas me I’m like, “Oh, that’s just not really my vibe,” but other people are like, “Veganism.” I, like something inside of you is like pulling you towards that kind of a diet. And I think that when insulin is so high, you can’t even really go inside and really recognize what your body’s saying, because it is so flooded with something that’s so powerful that it’s almost like we lose a part of the connection to our intuition in our body. And I’m realizing, like I think that the body is so intelligent and I think that it is this magnificent creation that we need to honor and respect. And insulin to me, “I love it!” Heart. Right? Like, I think that it’s like, there is this consciousness and intellect about our body that we get for free and we’re not honoring that. And we’re just searching for pleasure and for our next hit of sugar. And it would be such a shame if that is all that life is, you know? It’s like you come out of the clouds when you’re doing what you’re doing. Do you have any?

Casey Means [22:07]     Oh my gosh, I just love everything you just said. And I think it’s so important to realize that. I think to really live our most thriving life and to really be able to just rock our purpose and all of this. Like we do have to understand our body and hear what our body is saying. You know, we- My firm belief as a physician is that symptoms are the body like screaming at us that there’s underlying dysfunction. And we have to listen to that and think of that as a guide and then search for what that underlying dysfunction is, which can be a journey because there’s many different things that can lead to the same symptom. But that is the body telling us something. And you know, so many of the things we think are normal in our life, like feeling up and down and anxiety and feeling lethargic and all this stuff, we just think it’s really, really normal. But I think a lot of it is that in our current culture it’s very difficult to hear the internal signals of our body. We are living in a hyper palatable food culture. We are digitally stimulated constantly. We are very, very busy. We’re getting less sleep. And so it can really drown out our ability to hear the signals inside the body. And one of my big hopes for Levels and future bio wearables is not that they just give us a data stream that sort of tells us what to do and this and that, but that they actually draw us inward and help us create connections between actions we took, the objective reality inside our body. And then also the really key point is to circle it back to how we actually feel. So if we feel lethargic after a meal and have that post-meal slump, how can we help people, one, actually hear that signal and identify it and then actually attribute it to the right cause. It’s like right now we are like, “Oh, maybe it’s because I didn’t sleep as well. Maybe it’s because I had too much coffee. Maybe it was my breakfast. Maybe it was because of this difficult email I got just now. I don’t know why I don’t feel good right now.” But to be able to say, “Oh, I had oatmeal, my glucose spiked to 200. Then it went down to 50, which is just sort of like, you know, just spike and crash. And now I feel this way.” You can start attributing in a real way subjective experiences, internal body cues to actions you took and to real objective data. And I think that is really fundamental for both feeling empowered, to make choices that are actually going to be efficient. It’s no longer like trial and error, which can be so frustrating, and so much less misattribution. And so I think that’s just really positive. And there’s actually a term that I love for this whole process, which is called interoception. And it’s essentially a fancy word for body awareness, but what it, people who have interoceptive capabilities is that you actually are really in touch with signals inside your body. So sometimes in the research literature, it’s talked about a lot with heart rate. There are people who can sit quietly and have a very good and accurate sense of how fast or slow their heart is beating. And they can just like, you know, tell people, yeah, they can like, you could just tap, you know, “This is how far my heart’s going.” There’s other people who can’t feel it. And interestingly, the people who can feel their heartbeat and track it and, or have a sense of it throughout the day have better health outcomes, better cardiovascular health, and less anxiety and mental health issues. And it just comes back to mindfulness. Like the more we’re in touch with our internal cues, the more we understand. Like when we’re anxious, maybe it’s because our heart rate is going really fast, you know? And I think that we can move into this with metabolic health. And I think you can start to develop what I consider a metabolic interoception, which is that all of a sudden by tracking the data over time, you can say, “Oh, I’m pretty sure my glucose is really high right now. I can feel that. I feel that little shakiness. I feel a little anxious.” You know? Or, “Wow, I’m feeling super stable today. I bet my glucose is rock solid.” And I think for most of the people at my company who have been wearing a glucose monitor for a year are like- I can predict my glucose I think within five points at most times. And I think that’s been good for all aspects of my mental and physical health because I’m no longer living in this world where things are just happening to me. Like I’m making choices and then there’s results. And I understand that feedback loop and can make progress. So, I think it’s just, you know, there’s potential for increased body awareness and increased feeling of empowerment, and ability to actually enact change in your own life.

Carli Williams [26:34]                         And that’s so crazy that you just said that heart rate thing because- Okay, so I’m going to like- Oh my gosh, I can’t believe you just said that because I said to my assistant, who’s kind of like my, like we’re kind of in this together. We’re trying to figure out some chronic pain with her. We’re trying to figure out why. She’s the healthiest person I know, and she doesn’t have the results that she wants and it makes no sense. Like she, you know, it’s all plant-based, it’s all like amazing food, amazing ingredients. And like. Anyways, so I was talking to her and I was like, “I feel like ever since I started to do, to pay attention to insulin, like I feel my heartbeat. I can feel my heartbeat.” And I was like, “Is that like a problem? Like, am I doing something wrong?” I just said that to her. I’m like, “Am I just, like?” But I literally like, I can feel my heartbeat right now, but I just started to notice that. And I was like, I don’t know. Like, is that like, is my heart beating? But I feel like it’s stronger or something. It’s so weird, but I can totally notice that. And I said that to her last week. I’m like, “It’s so weird. I feel like I can feel my heartbeat very clearly.” I, and maybe it’s, you know, when you don’t have a brain fog, it’s almost like you’re, you have so much more attention. And maybe it’s that. I don’t know. But I said that exact thing to her last week.

Casey Means [27:49]     That is so interesting.

Carli Williams [27:51]                         That’s wild, that you just said that. That’s crazy. And I love stuff like this. How do I even go from here, Casey? I’m like- Okay. My next question is, and I think I’m going to be brave and I’m going to put this on with you, even though I am a little [inaudible 00:28:03] about it.

Casey Means [28:05]     Amazing! Let’s do it. You got this.

Carli Williams [28:07]                         I totally got this, all right? We’re virtual COVID, but we’re connecting.

Casey Means [28:13]     Oh my gosh. I’m so excited for you. I have mine on, I just put it on a couple of days ago. I just posted an Instagram video where I was practically dancing when I put it on. So this is going to be great. You’re going to love it.

Carli Williams [28:24]                         Okay. Only because I love looking fear in the face and saying, “FU.” And that’s why.

Casey Means [28:28]     We’re going to do it together. And I can guarantee you it’s not going to hurt.

Carli Williams [28:33]                         Okay. Great. Great. Casey, I just, I’m wearing a swimming suit right now, this is so-

Casey Means [28:39]     Oh my gosh.

Carli Williams [28:40]                         But I was like, I just got into a really amazing conversation and didn’t have time to get ready. And I was like,”You know what? I don’t even care. This is for the good of humanity.” So I’m going to say-

Casey Means [28:48]     Yeah. Cute swimsuit. Okay, so step one. And have you, strange question, but have you showered today?

Carli Williams [29:00]                         I did take a bath, but then I just went in the hot tub. So should I?

Casey Means [29:04]     Okay. No, I think it’s fine. I just tell people they should probably have showered or been in water or whatever within the day that they’re doing it because it’ll get some of the oils off the skin and that’s helpful for the adhesive to stick. But you’re going to take the alcohol swabs inside that box and you’re going to clean off the area that you want to put it on. And so. You want it right behind the bicep, sort of in the more fleshy tissue, like underneath the muscle. Exactly. But not so close to the armpit, down a little bit, because you don’t want it to be right in your armpit. Right there is perfect.

Carli Williams [29:36]                         I’m seriously so freaked out right now and I’m going to do it anyway.

Casey Means [29:39]     You’re amazing.

Carli Williams [29:40]                         Thank you, Casey. You are too. You’re my new best friend. I hope you already know that.

Casey Means [29:44]     So clean it off really well. Yeah, do a couple of swipes.

Carli Williams [29:47]                         This smell gives me anxiety because it just reminds you of getting a shot at the doctor and I’m like, “Oh, not today. Not today, fear.”

Casey Means [29:58]     I’m going to send you some keto sugar-free ice cream if this hurts. I swear, because it won’t, I’m so confident. Yeah. So that’s perfect. So now just let it dry for 10 or 15 seconds. This is such a fun side trip on a podcast.

Carli Williams [30:13]                         Casey, thank you so much for giving me this experience. It’s like sticking a needle in my arm.

Casey Means [3:18]         I wish I had a new sensor to put on, so I could do it with you-

Carli Williams [30:21]                         Would love to. Thank you so much for giving me. I actually am really grateful. Like I feel stoked that I get the master of Levels here. Okay. So tell me.

Casey Means [30:29]     Okay, so now take the, hold up this, the, yeah so the thing in your left hand, so twist. Yeah, twist the, just, you know twist basically, and then pull that out and just set. Yeah, pull it. Yeah. Perfect. Set that down. And then open up the pack and lift the top off. That’s the sensor applicator pack. Rip that off.

Carli Williams [30:50]                         Okay. Does it matter which arm I do it on or not?

Casey Means [30:53]     I would do it on your non-dominant arm because you’re going to be scanning the sensor with your phone, and so it’s easier to do it with your- Yeah, exactly. Okay. So take the thing you just twisted and there’s a little black line, I believe on the pack in your left hand. And you’re going to line up the- In your right hand there’s a ridge and you want to line those two things up. Yeah, exactly. So put those together and then you’re going to press down on the table.

Carli Williams [31:17]                         On the table. Okay.

Casey Means [31:18]     Yep. Perfect. And now lift out the gray thing. Okay. And yeah, don’t look at that.

Carli Williams [31:28]                         Ahh, I can feel it. Like I, pins. Like, they sliced me open.

Casey Means [31:30]     Yeah, this is going to be nothing. It’s literally less than a fraction of a second. So now you’re going to hold it in your other hand and you’re basically going to push it up, put the sensor applicator to that fleshy part, not super close to the armpit. Yeah, that’s perfect.

Carli Williams [31:43]                         Right there?

Casey Means [31:43]     And you are going to just, we’re going to do one, two, three, and you’re going to press down and you’re not going to feel it.

Carli Williams [31:48]                         Okay.

Casey Means [31:48]     Okay. You got this. One, two, three. Yes, you’re done!

Carli Williams [31:54]                         What?! I didn’t feel that at all.

Casey Means [31:56]     I know! You are such, you are such a champ.

Carli Williams [32:00]                         I literally didn’t feel that though. Like, I’m not even saying that. Like my heart is like, was prepared, like I’m in fight or flight. Like, I didn’t even feel a prick.

Casey Means [32:08]     What you just did took me three hours to gear up for.

Carli Williams [32:12]                         [inaudible]          I wasn’t with you. Just kidding. That didn’t, nobody like, I didn’t even, like literally, feel prick at all.

Casey Means [32:17]     You can’t feel it.

Carli Williams [0032:18]                   I literally thought I was going to feel a prick and I didn’t feel it.

Casey Means [32:21]     And now the needle that put that in the arm is hidden in that applicator. It pulled back and you’ll never see it. So, now did you get a little Levels cover in your kit? There should be a black circle.

Carli Williams [32:36]                         Yes.

Casey Means [32:37]     Yeah. So this will keep it on and keep it waterproof. Is it in there?

Carli Williams [32:40]                         I’m like shaking and it’s so stupid because it was for no reason. Like, I’m not even saying that, like I literally, I was like, “Okay, like, I’m going to feel a prick and it’s going to be fine,” but you don’t feel that at all.

Casey Means [32:50]     It’s weird how much you don’t feel it.

Carli Williams [32:52]                         Yeah, like it makes no sense.

Casey Means [32:55]     Yeah.

Carli Williams [32:55]                         You just tricked me and said, “I’m not going to feel it,” and my brain was like, “Oh.” But I didn’t really believe you, but you were right.

Casey Means [33:02]     I’m so excited.

Carli Williams [33:03]                         Okay. So is this my patch?

Casey Means [33:07]     No, there should be two black.

Carli Williams [33:10]                         Wait, did somebody-

Casey Means [33:12]     Were they in the kit when you opened it?

Carli Williams [33:15]                         I feel like- Oh no there it is right here.

Casey Means [33:16]     Oh, perfect. Okay. So what you’re going to do, there should be a middle circle, a white circle on the middle, and you want to leave that part on and then appeal off all the other plastic. And then you’re going to just stick that on. And you can do it after the podcast if you want. But, uh-

Carli Williams [33:33]                         Right now I want to show everybody. Casey, this is so cool.

Casey Means [33:37]     Awesome.

Carli Williams [33:38]                         I’m so stoked about this. Like I-

Casey Means [33:40]     You’ve been so great.

Carli Williams [33:41]                         Oh, thank you.

Casey Means [33:42]     Oh, and the other thing that we should do right after you put your, what you put the sticker on is that you’re going to scan your sensor and it’ll be ready in one hour to get your first reading. So yeah, put the white part over this. Perfect. Beautiful.

Carli Williams [33:56]                         I love that I’m in a swimming suit right now. This is all funny. Actually, I wouldn’t have been able to do it if I was wearing a shirt, I would have had to take my shirt off. I mean, call that fate, I don’t know.

Casey Means [34:08]     So this performance cover is going to make it waterproof and just help it so that you don’t run into- Oh, you look, it looks great. So awesome.

Carli Williams [34:18]                         I just feel so legit.

Casey Means [34:19]     Now, if you have your phone with you, have you downloaded the app?

Carli Williams [34:23]                         No, and I need to do that.

Casey Means [34:24]     Okay.

Carli Williams [34:25]                         And so, and, yeah, I don’t have my phone with me and I had- I don’t know why I don’t have my phone with me. So I’ll get the app and then I scan it and then it’ll start reading my glucose levels, right?

Casey Means [34:36]     In one hour. Yep.

Carli Williams [34:28]                         Casey, this is so cool.

Casey Means [34:41]     I can’t wait to hear what you learn.

Carli Williams [34:42]                         No, I know. And I just want to know, like, I want to know everything. I just feel like this is like giving you a little glimpse into the miracle of your body. And I know that I get so weird about the body, but I’m just like, my body is like the vessel in which I experience the world. Like, if you think that the food that you put in your body doesn’t have an effect on your life, you are very mistaken. And it’s so nice to not have to just guess, you know, and that we get the knowledge of you who is just so professional and has devoted so much of her time. And we get to like have your brain in our arm. Like how cool is that? You know? I love it.

Casey Means [35:21]     Thank you. Thank you. Yeah, I think, you know, you’re exactly right. Like food, you know, for whatever reason in our current healthcare system, we don’t think a ton about food and, you know, doctors are getting less than 10 hours of nutrition training in all of the medical school. And yet the vast majority of the conditions that we are dealing with in our country and that promote our healthcare costs are related to diet and lifestyle. And so I think there’s just a huge opportunity for people to use these tools, to really understand it for themselves. And I certainly hope that the medical field is going to move in the direction of understanding how much we need to be talking to patients about food and really thinking about precision nutrition. But you know, I think there’s good forces at play moving in that direction because- But, you know, at the end of the day, food is molecular information. And food is not only the instruction manual for how our cell’s function, but it’s also the building blocks of how our cells function. And so it has a dual purpose to control the outcome of our health and our day to day experience of the world. And on top of being this molecular information, but also the building block. It’s also having this other benefit of telling our microbiome, a totally separate sort of part of our body, exactly what to do and what to make. And we know now more than ever that the microbiome is producing so many byproducts. They eat our food first, and then they will produce substrates from that and those molecules that they produce after they eat the food we eat, directly tell our brains how to function, our immune system how to function, and our metabolic pathways how to function. They make all sorts of things- short chain fatty acids, lots of different things that have a direct relationship on our brain health, obviously our gut health, our immune system and our metabolism. And so in so many ways, food is just like one of the biggest, biggest levers. And, yeah- So I just, it’s so great that you’re promoting this, and you know, sharing so deeply about your personal experience.

Carli Williams [37:22]                         Yeah, no, I’m like everybody. I mean, I think that my relationship with the body has just been one of such a, like I feel so lucky that I have been able to just kind of been given this understanding that my body is not gross. My body is not against me. My body is literally serving whatever I choose to put, whatever I choose to do. And it’s so fascinating. And it has, like all it does is serve me and I, and it’s like, that sounds so cheesy, but literally my body is the thing that grew my family. It is the thing that I feel love for my husband. It is the, you know, it’s like, I can give somebody a hug and that makes a difference. More like, this is important. It’s so important to honor and respect it. And when you do that, and it’s not about worth and it’s not- That’s I think the trouble is that people attach health with worth and they think like, “I’m not worthy right now. And so I need to eat healthy because I’m not something.” And that’s not what it is, it’s totally separate from worth. It’s, “I have so much worth, and so I’m going to take care and take care of my body because it is so valuable and it’s such a gift.” You know what I mean?

Casey Means [38:44]     Yes, absolutely. I think that the way we choose to eat and then of course, the way we choose to practice, you know, our mind body practices and how we choose to shape our sleep hygiene, and then of course how we move these things, are all the greatest form of self-love and self-respect that we can do. And I think we also have to remember that us taking the time and energy to do those things for ourselves and really understand our bodies and what makes it thrive and optimize, that is the greatest gift we could give to those around us and also to the world at large, because when we’re biologically not functioning properly, and not thriving physically, or mentally, we’re not able to show up and be the people we want to be to those around us. And you know, I can speak from personal experience. When my health hasn’t, at times in my life, when life has been extremely stressful and I’ve not been able to practice these types of self-care behaviors, or you know, do my best in terms of metabolic health, you know, I just, it shows up everywhere. And especially in the mind and my ability to be kind and patient and creative. And I think those are things that are all really important to being a good community member and a good leader. And so for me at this point, you know, when I’m cooking myself a healthy meal or when I’m meditating or when I’m getting on my bike and exercising, I not only feel like I’m doing it to show respect for myself and also just this gratitude for this life that I’ve been given, but I’m also doing it for my mom and my dad. I’m doing it for my partner. I’m doing it for my friends. I’m doing it for my brother because I can show up for them and be there for them if I’m doing that for myself. So.

Carli Williams [40:25]                         I agree 100%. And I was just going to, one of my next questions was, do you meditate? And do you, like I just kind of stumbled upon the meditation thing. I do Wim Hof breathing. You ever heard of Wim Hof?

Casey Means [40:38]     Mhm.

Carli Williams [40:38]                         I love it.

Casey Means [40:39]     I do Wim Hof breathing.

Carli Williams [40:41]                         Casey, when I’m in Wim Hoff breath holds, I could just hold my breath for three minutes in complete peace and ease. And I’m like, “What is happening?” And my mind is like, “Boom!” And it’s like, I love it. And I feel like I emerge a new human and like my body’s like, you know? And so what do you think the importance is of meditation? Because I never- It’s wild. I never did it until recently, until Wim Hoff.

Casey Means [41:06]     Yeah. That’s so fantastic. Yeah. And I think it’s so important for so many reasons. Obviously, just being in the present moment and being super focused on that activity and focusing so much on one thing, it’s so good for the brain to be that focused and that clear, and to engage in that mindfulness. But from a metabolic health perspective, it’s just, it’s really critical. And this kind of gets into some really interesting physiology about stress. So, you know, throughout history for most humans, stress was something that was related to needing to actually- If we were stressed, it was probably because we were in, somehow threatened by something that was going to require us to do something physical. So that the classic example you can think of. Yeah, exactly. The- I bet your glucose went up when you put that sensor on, but you know, the classic example that people always say like, “We’re being chased by a lion,” you know? And so you can imagine, “Okay, I see the lion. My body releases stress hormones, like catacholamines and cortisol, and I’m probably going to have to run or do something. And my muscles need energy.” So the body has this mechanism where those hormones tell the liver to dump glucose into the bloodstream and to feed the muscles. We store some glucose in our liver at all times, and our liver makes glucose. And Ben talked about this in his episode as well. And when the body senses stress hormonally, it dumbs that glucose out and we’ll see a glucose elevation in the blood. And that’s to feed muscles. But now we are not actually dealing with physical stressors. You know, it’s very rare that we’re going to be chased by a lion. And what’s really happening is that we’re getting repeated text message, we’re getting email pings, we’re hearing honking, we’re having stressful conversations, we’re staying up too late, which is a stressor for the body and these hormones are being released, but we don’t actually have a physical need for it. We don’t need our muscles to send that text back. And so it’s maladaptive now because it’s actually causing the glucose rise, but we’re not using it. And so anything that we can do to minimize our perceived stress, because a lot of these stressors, they’re not real. They’re psychological, they’re stories that we’re telling ourselves about this. And the more we can change that story, change our reaction to that perceived stressor, the more we can get control of that whole hormonal process that’s happening that’s leading to worse metabolic health. So, I’ve really found glucose monitoring to actually be, not only a nutritional biofeedback tool, but a mindfulness biofeedback tool, because if I’m giving a talk or something like that, and I’ve seen my glucose, even when I’m totally fasted. So no glucose in my mouth, but just glucose from my liver, I’ve seen it go up 50 points when I’m stressed before. That’s a crazy amount.

Carli Williams [43:52]                         Okay. That’s wild.

Casey Means [43:56]     And I can, if I know that’s going to happen, and now I understand that damage that I’m doing, you better believe that before any potentially stressful events, I am doing Wim Hof breathing. I am doing guided meditations on my Calm or Headspace app. I am getting in the zone, telling myself a new story about the stress, remembering that giving a talk is an opportunity to share, not an opportunity to be judged. You know, all of these different things, all of that before and after totally changed my body’s physiologic response to that stressor. So I think it can be just this wonderful mindfulness biofeedback tool to show us how these stories and these beliefs are impacting our health in real time. And, you know, before that, I don’t think we had much sense of, we all know we don’t like the feeling of stress, but I don’t think we quite could understand what it’s doing to our health instantly. We know that heart disease and cancer and a lot of these conditions are worse when people have underlying stress. So in an amorphous way, we’ve always known we should be on top of this because it’s better for health and longevity. But to see it immediately and know you can do something about it, I think is powerful. And there are actually a number of studies that have given breathing interventions to people. And you can see blood sugar change. So it’s fun to experiment with.

Carli Williams [45:20]                         I did Wim Hoff, I would go in my pool in the winter, started out kind of as like a joke. And then I literally have never felt like a sense of, it really was like not wishful thinking. It was like my brain- I was saying, “This is going to be cold and you’re totally fine.” Right? And I would go in and I would just be like, “I’m totally fine.” And I would use my mind. And it showed me how to control stress. I was in stress and I was totally at ease and it was not a problem. And I trained my brain how to do that. And I would have my, I wasn’t reactionary throughout the day. And like, it was wild, and like all of the physiological stuff. And so, and it really taught me how to manage stress. So do you take cold showers?

Casey Means [46:09]     I’ve been trying. That’s sort of the last frontier for me because it’s, you know, I’m not quite there yet. But I certainly have been reading a lot about the benefits of, you know, cold thermogenesis. And what’s interesting about the cold that also, I think is fascinating for metabolic health, is that there has been evidence, mostly in animal studies, that exposure to cold has this really interesting molecular process going on. So it’s a hormetic stressor is what they call it, meaning that like, it’s this sort of like you put your body under this stress to make it more adaptive. And one of the things it does is increase this part of our body called brown fat. And brown fat is a type of fat that we actually have a ton of when we’re babies, but we don’t have it a lot when we’re adults. It diminishes over time and it keeps babies warm. And so the reason it does that is because this fat is actually brown in color because the cells have so much more mitochondria in them, which are the part of the cell that converts glucose and fat to energy. And so when you expose yourself to cold over and over again, it up-regulates pathways that increase my mitochondrial biogenesis. So more mitochondria and more brown fat. And it’s one of the only ways we know in animals that you can increase brown fat. And this is a very, very metabolically active tissue that’s going to be processing glucose really efficiently. So there’s really interesting stuff about how- This has not been well studied in humans, but there’s a lot of animal evidence that this could be a way to also improve metabolic health by increasing brown fat and mitochondrial efficiency.

Carli Williams [47:46]                         Oh. Well, I’m in. If you’re ever, if you ever come to Texas, you have to do it with me in the winter. Okay?

Casey Means [47:50]     Oh my God. I’ll jump in. Yeah.

Carli Williams [47:52]                         You’ll love it. Like you literally come out and you feel so good. It makes me, I was not wanting to do that. Everyone’s like, “I hate the cold.” I’m like, “I literally sleep with a heating pad, okay?” Like, I hate the cold, but I love what it does to my brain. And honestly, like my anxiety, I’m like, “I will do anything to figure out anxiety.” And that was it. Like, I literally could have gone off my anti-anxiety medication, and I think glucose is a big thing. And it was wild. Like I’m like, I’m totally fine. Like, you know how you feel in that, for after you do Wim Hof breathing? How you’re like-

Casey Means [48:30]     Floaty?

Carli Williams [48:32]                         Like 10.

Casey Means [48:33]     Wow.

Carli Williams [48:33]                         It’s wild. And if I could stay 15 minutes, feeling more of it. I don’t know.

Casey Means [48:37]     Unreal. Well, that’s fantastic. And one thing I should tell you, since you are doing the cold plunges, is that your glucose will actually probably go up while you’re doing the cold. And that is because it is a stressor and it is going to cause your body to be like, “Oh my gosh, what’s going on?” And so that is something that you might see, is like this, you know, this little up and down peak. But over time we believe that that is going to be building adaptive metabolic pathways. And you actually also see this same thing with high intensity interval training workouts. So, because HIIT training is inherently stressful for the body. You know, when you get on the Peloton and go like 10 out of 10, you know, you’re just like, your body’s like, “What’s going on? You’re being chased by a lion.” It is going to release cortisol to feed the muscles. And you’ll often see a glucose spike in a high intensity workout. And so these do not seem to be disadvantageous in the same way a food-related spike is because that food-related spike is going to generate the whole metabolic insulin pathway. And you know, a lot of that could be stored as fat and this and that. And, whereas these other responses, like with high intensity interval training, your body actually needs that glucose. And it’s going to be using that glucose and it’s going to make our body, our muscles are going to be hungry for that glucose. And actually glucose can be taken up during exercise without insulin. So the liver’s releasing it. The muscles can actually take it up just from their contracting. They don’t actually need insulin to get into the cells. So very different pathway, but something people should be aware of when they’re tracking glucose, is that there’s other times that we actually will see spikes that are slightly different physiology than a food-related spike, which we want to, of course, minimize.

Carli Williams [50:17]                         Because we need carbohydrates, right? Like I think that that’s probably the main question that I have for you. Two questions. Oh my gosh. There’s so many questions I want to ask you. Number one question, what should my blood glucose, what should my goal be with Levels?

Casey Means [50:32]     Yeah, so.

Carli Williams [50:33]                         Should it just be my goal be like align, like it should look like that or, like what’s the goal?

Casey Means [50:41]     The goal is really low and flat, I would say. I mean, that’s pretty extreme, and I don’t think that’s something that everyone should be shooting for off on day one. But event- But really flat to very gently rolling hills is what we want to see. We don’t really ever need to see big spikes and big dips. That is, our body doesn’t need that. And so-

Carli Williams [51:03]                         Should I be trying to stick between a number?

Casey Means [51:06]     Yeah. So we recommend in the app, say between a glucose of 70 milligrams per deciliter, and 110 milligrams per deciliter. This is what we call our optimal range. And this is really our opinion based on, you know, deep review of the scientific literature of what is going to be healthiest for a non-diabetic human, who is trying to improve their performance, their energy, their mood stability, all of this stuff. And this is based, like I said, on looking at a lot of big reviews, like that study in Israel that I mentioned, and a few others that have been done, where CGMs have been put on healthy non-diabetic individuals. And you can just see what happens to their glucose over a 24 hour period. And when you do that over big populations, what you see is that people for over 90% of the day stay between about 70 to 120, that’s where the vast majority of healthy people should stay, with very rare excursions up to like 140, 150. But if we look at just that- So this is, we’re shooting for, we’re helping people strive for a really tight, narrow, optimal goal. We also recommend that in the morning when you first wake up and you haven’t eaten for about, you know, seven, eight or more hours. So fasted. Your fasting glucose, so your first scan in the morning should be somewhere between 72 and 85. This we believe is really optimal for health, and has the lowest risk for developing future diseases or conditions down the road. And I would say when you eat a meal, you really want to be sticking to less than, I would say not going above 15 points of glucose. So you eat, and then in the two hours after the meal, you see your glucose maybe go up a tiny bit, but striving for less than 15 point bump is good. You know, that’s going to be, you’re not going to have to surge a ton of insulin to soak that up. It’s going to be probably a lighter insulin response. You’re not going to see this exaggerated dipping glucose after all that insulin is released because you’re just kind of a gentle rise and a gentle low. But what you might find when you first start using your sensor and eat some favorite foods, some people might see spikes of 70, 80, 90, a hundred. We’ve seen spikes of 120, like with things that are generally considered healthy. I mean, we’ve seen spikes of 80 with oatmeal with no sugar on it. And so it’s going to be really fascinating to kind of just try different things out and see what is spiking you and what’s not. But yeah, long story short, you know, really sticking between 70 to 110 for most of the day. Gentle hills after meals, no big mountains and valleys, trying not to really get much above elevating more than 15 points from your baseline after, in the two hours after a meal. And really trying to see a morning glucose between 72 and 85 or so. A caveat, this is all very, very different than just the standard criteria we use in medicine to tell people whether they’re normal or pre-diabetic. And it’s probably worth mentioning those, because again, these are ranges that Levels is pushing for health seeking people to really optimize health, but aren’t, you know, necessarily what the doctor is telling you, or clinically validated. What the system, the healthcare system, would tell people is, you want to shoot, that essentially a normal person who’s not pre-diabetic or diabetic, has a fasting glucose under 100. And within two hours after a meal, at two hours post-meal be below 140. Those are the two pieces of information we have. But if you look at some more detail on some of the research, you know, less than a hundred for fasting glucose, well that’s just the general bucket for normal. We actually know that people in the lower range of normal have fewer worse health outcomes than people in the higher range of normal. So we’re trying to help people strive towards that healthier range.

Carli Williams [54:55]                         We want to optimize the human experience.

Casey Means [54:57]     Yeah.

Carli Williams [54:57]                         I love that. So, okay. I have, ahh, so good. I cannot wait. I’m so glad that you helped me put it on because I was a little bit stressed, like, you know, just like. But it really didn’t. I could have totally done that right. You can’t feel a thing. You really can’t.

Casey Means [55:13]     Awesome.

Carli Williams [55:13]                         So I was so happy about that. Okay, what, this is like a good question, and yeah. Okay. What’s like a truth that you have come to know that you wish that you could like shake the whole world and be like, “This is true. Like you need. Like, this will make you feel better.” Or what is like a truth that you wish that you could, that you have come to know through all of your research or through all of your dieting or not dieting, but just through your healthy practices and your meditation and everything. Like, what’s a truth that you have come to know that you wish that the world would know?

Casey Means [55:50]     I think the biggest truth is that health is a two-way street. It’s not a one-way street. So we often think of- That we’re marching down this trajectory of health or disease. And that it’s sort of, it’s linear in one direction. You know, we’re fine. And then we’re not fine. And once we’re not fine, we’re going to be that way for the rest of our lives. And, you know, we are going to take a, potentially take a medication for the rest of our lives. Or we’re going to be diabetic for the rest of our lives. It’s very rare that you hear people saying something like, “Oh yeah, I have a diagnosis of diabetes and I’m actively working on reversing that.” You hear people say, “I’m diabetic.” And they, that becomes an adopted part of their persona and their, who they are. But what I would rather, the language around it that I would sort of say is that, “I’m currently in a diabetic state and then I’m working on getting, I’m working on my metabolic fitness so I can get out of that diabetic state.” And so I think that’s a real shift in thinking, but because of what I’ve studied with, you know, physiology and biochemistry, like we have, we live in a dynamic body. It’s a dynamic system. And when we change the conditions of the body and when we change the types of molecular information that the body is actually receiving, you can absolutely move in the right direction on the continuum of health. And that can really happen at any stage of disease. And so I just think that’s so important for people to know. Like it’s very, very hopeful. And while there’s many diseases that we may not be able to get full remission or a full, you know, “cure,” we, I think we can always move the needle in the right direction, even if that’s improving our symptoms, or improving our quality of life. And the key is we have to change the conditions. And those conditions are generated by our choices and our choices are: How we eat, when we eat, how we move, how we stress, when we sleep, how much we’re in touch with our purpose and our relationships around us. So.

Carli Williams [57:51]                         Gosh, it really is such a message of hope and that’s kind of what I’ve- I think I’ve never put it into words like that, but I believe that, you know? I think as a mom, it is really disheartening to say, “Well, your body’s just, well it’s just gone now.” And it’s like, not true. It’s just, when you think that, you just don’t, you don’t do anything and you, it’s really sad, you know? And it’s like such a message of hope that you live in this beautiful dynamic body. Thank you. I’m going to, I love that. Okay, so you want to know what I would love?

Casey Means [58:24]     What?

Carli Williams [58:25]                         So I do these, I just had this thought. I do these like challenges. Like how sick would it be if we could eventually be like a Levels challenge where we like, we’re like (? Katie) for eight weeks, like we get a before and after picture. We’re going to do a prize and stuff, and we’re all going to use Levels so that you have a really good breathe of like- That’d be amazing. But how could I ever do that because you have like a 3,500 person waiting list. So like, what are, how do, like do you know how amazing that would be for my challenges?

Casey Means [58:58]     I think we’re totally going to get there. You know, when we, once we’ve launched and we’ve moved out of our beta phase, you know, I think we’d be so excited to partner with you on that. And that’s something we’re really trying to build into our product experiences. “How can people create community around this?” And we’re actually running a challenge like that right now called The Weight Loss Challenge with Justin Mayers, who’s the founder of Perfect Keto. And he is doing, this is the fourth version of this experiment that we’ve done. And it’s pretty cool. So basically this was his idea and he actually tweeted this out for the first challenge we did quite a few months ago. And he said, “If you pay me,” I believe it was $800. “Venma and me and her dollars will get you a CGM at Levels Continuous Glucose Monitor. And every day you keep your glucose under 120, I’ll give you $25 back.” I think those were the numbers. So people could make back all their money if they kept their glucose low. And in that cohort of about 30 people who did that challenge and used Levels to keep their glucose, you know, lower? People lost on average 10 pounds in one month and they made back their money. A lot of them. And we’re now on the fourth challenge. And it’s just so, it’s so, the sky’s the limit, I think, in terms of how can we use this tool to support, you know, people with their own coaching, you know, practices and philosophies to really generate community around their personal philosophy for metabolic health? And so, you know, Ben Bikman could run his program and you could run your program, but yeah. So we’re just working our butts off over at Levels to, you know, keep moving the product forward and be able to support things like this.

Carli Williams [01:00:33]                 I’m in. And like, seriously, I will pay five grand. I’m creating a [inaudible 01:00:38]       right now, or the winner gets five grand. And I’m like, “How amazing if everyone had a Levels?” It would be so much more helpful to actually get your desired result because the weight is really in direct correlation with glucose and I’m like fully converted on that. I’m like, “Oh my gosh, if everybody just really trusted this.” And it makes it actually a lot more simple. Like it’s so much simpler to be like, “Hey, we’re going to fast. And then you’re going to track your levels.” And I love all Levels, that no pun intended. Right?

Casey Means [01:01:12]Yeah.

Carli Williams [01:01:14]                  It would be so fascinating. So please, like anything I can do, how can? So my last question is, how can I help in terms of your mission? Like what can I do?

Casey Means [01:01:22]That’s so.

Carli Williams [01:01:22]                 What do you want me to do? For the greater good, honestly, I’m like that passionate about it.

Casey Means [01:01:28]Yeah. I mean, I think test out the, test out your diet, test out foods, take this first week or two to just really try the foods you love and the foods you normally eat and see how they’re affecting you. You know, I would say post about it, show your experience and your screenshots. And I think it’s really fun to see other people experimenting and sort of biohacking in real time. And then, you know, then try out some of these levers, like what happens when you do Wim Hoff? What happens with the cold plunge? What happens when you do, when you get less sleep or more sleep, you know, if you’re up in the middle of the night with your, you know, is it a baby?

Carli Williams [01:02:04]                 Yeah, I have twins.

Casey Means [01:02:05]Twins. Oh my God. When you’re up with your twins, what happens to your glucose at that time? You know, and really learning about those levers? You know, sleep, stress, exercise, food, food timing, food combinations, and then, you know, learn a little bit there. And then in the last part of the program, really try and optimize and be like, “Okay, how can I keep things as flat and stable,” with what you’ve learned from the prior three weeks? And so that’s how I would recommend, you know, doing the one month journey. And I think it’ll be just, you know, sharing that is great.

Carli Williams [01:02:34]                 Yeah. I’m all in, seriously. I’m like, anything I can help to- I really think this will, I feel like I’m on a mission to improve the mamas’ lives. And I’m like, those, I think would totally, like if every mom had one and understood this like amazing research that you guys have done, I know that their lives would be so much better from an emotional, mental and physical standpoint. So I’m so grateful. Thank you so much for coming on here. I’m in your corner. Anything I can do in my little, you know, segment of Instagram or whatever. Like I’m singing your praises and I’m so grateful. So thank you so much.

Casey Means [01:03:10]Thank you so, so, so much. And you know, it’s just so great to be connected. And yeah, certainly people can reach out to us on Instagram, too. We’re at Levels, and we’re at levelshealth.com. So, you know, come say hi and get on the waitlist and we’ll get you processed as quickly as we can. So.

Carli Williams [01:03:29]                 Oh, I cannot wait. Okay. Thank you so much, Casey. You’re the best. You’re amazing. I’m so honored.

Casey Means [01:03:35]Thank you.

Carli Williams [01:03:36]                 Have a good one. Okay.

Casey Means [01:03:37]You too

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