#HURDLEMOMENT: Understanding Your Metabolism With Levels Co-Founder Dr. Casey Means

It’s not just unhealthy people who need medical help. In fact, you might feel and look perfectly fine – but are you? According to Josh Clemente of Levels, only 12% of Americans are actually in good health. Many of the rest are either diabetic, or on their way there. It’s not entirely our fault – changes in technology and human behavior have moved faster than we can catch up. We’re no longer running from lions – we’re running from scary Zoom presentations. But our body reacts how it always has – by releasing a flood of glucose. On the Hurdle podcast, Josh spoke with host Emily Abbate about how CGM technology can help us gain critical insight about metabolic dysfunction.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out the Hurdle podcast
• Connect with Emily Abbate on LinkedIn

05:53 – The entirely preventable pandemic

90% of pre-diabetics in America don’t know they have a problem. The cause of this silent epidemic? Metabolic dysfunction that is caused by diet, poor sleep, chronic stress, and a lack of physical activity and quality micronutrients.

“We have 128 million Americans with pre-diabetes or diabetes and of those, 30% are diabetic and the rest are pre-diabetic. And of those who are pre-diabetic, 90% don’t know that they have this problem. It’s just really incredible. That’s a huge percentage of our country and these are disorders of metabolism. We can’t control our blood sugar properly. But even more broadly, there’s more recent data from UNC from last year that suggests that 88% of Americans actually have at least one marker of metabolic dysfunction. So expanding just from glucose, it’s also looking at things like waists-to-hip ratio or cholesterol levels, all of which have to do with metabolism in general, metabolism being the core way in our body that we make energy for ourselves. So 88% of Americans are not doing this properly. And only 12% of people are considered optimally metabolically healthy. And this is really rooted. Most of this is entirely preventable. It’s rooted in the way we’re living our lives. Now it’s what we eat, it’s lack of sleep, it’s increased chronic stress, it’s lack of physical activity, lack of quality micronutrients in our diet, all of these things translate into problems with the way we make and process energy in the body. And that is fundamentally metabolism.”

07:15 – Taking control of your health with CGM technology

Levels is using continuous glucose monitoring technology to empower people. With better insight and awareness into key factors of our health, we have a chance to fight the chronic disease we’re seeing in the United States.

“When you think about a tool like a continuous glucose monitor, you can imagine like, Oh, well this would be fantastic for people who have a disorder of glucose like diabetes. And that’s what this technology has been used for the most part. It’s actually an FDA-approved wearable device for people with diabetes. But when you think about the fact that it’s not just diabetic people who would need to think about glucose. This is a core substrate for all of us in terms of how we process and utilize energy in the body. And so all of us can optimize this aspect of our health to improve our current performance and prevent future diseases. What we’re really doing at the company is taking it out of that medical realm, just sequestered to a population who has been diagnosed with an overt metabolic disorder, and bringing it to the masses for people who want to take control of their health and who want to have some insight on these daily behaviors that they’re doing that impact our overall current performance, but also the future risk of disease. We’re trying to help people have insight and awareness into some of these key factors of our health that underlies so much of the chronic disease we’re seeing in our country.”

09:15 – All dysfunction is metabolic dysfunction

Every single cell in our body needs a usable form of energy through the process of metabolism. Wherever this process goes awry, we see symptoms. They look different based on where the symptom is, but they are all caused by metabolic dysfunction.

“Potassium metabolism refers to all these cellular pathways, the chemical reactions that are happening in the body that take the food we eat and convert it into energy. So food is this basic building blocks substrate that can be used for energy, but we have to convert it in ourselves. And every single cell in our body, we have trillions of them, they all need this usable form of energy to function. Every single cell. So we think about metabolism in terms of weight and energy, but really it finally comes down to powering our body with a currency that we can use. We have to convert food to something that is usable, and that is metabolism. And that is every cell. And this is why when metabolism goes off course, we can see almost any type of symptom or disease. We right now know that metabolic dysfunction, these chemical reactions, these pathways in the body of converting food to energy that we can use when those are off course, we can see things ranging from obviously diabetes and obesity, but also heart disease, chronic liver disease, dementia, chronic pain, fatigue, depression, anxiety, wrinkles, premature balding, infertility. The most common causes of infertility have polycystic ovarian syndrome, which is a metabolic condition. We see erectile dysfunction, we see a lack of athletic endurance. We see so many different things in all parts of the body. And when you think about this, metabolism is this core fundamental pathway you can imagine, if that’s going awry, where that’s showing up is where you’re going to get symptoms.”

11:34 – Our biochemical reality is powered by micro-choices

The food we eat, micronutrients, our stress levels, how much we workout, how much we sleep, all of these factors act together to create hormonal pathways that determine our metabolic health.

“I think there’s really a movement in medicine now to think more from a root cause perspective of what’s the physiology that’s linking so much of the chronic conditions and symptoms that we’re seeing, especially in our population now. And one of those key root causes is dysfunctional metabolism. So it’s a complex thing. There’s a lot of things that feed into it because it is fundamental cell biology. The food we’re eating and the micronutrients that we have in our body are key co-factors and a lot of these metabolic reactions, those will have an impact on your metabolism. How much stress you’re under and the hormone cortisol will have a huge impact on metabolism. How much sleep or how little sleep you’re getting translates into tons of downstream hormonal pathways. Growth hormone, insulin, cortisol, ghrelin, and leptin, all of these hormones impact metabolism based on how much or how little you sleep. And then, of course, physical activity. When our muscles move, we actually increase our metabolic processes, we increase our insulin sensitivity. Insulin is the hormone that allows glucose to get into cells. It’s when we say people have different metabolisms, we’re talking about basically how people have different genetics and different behaviors, which translate into a biochemical reality that basically creates different types of metabolisms. I like to frame it that way because so much of what our personal “metabolism” is actually just how our hundreds of micro choices are translating into our biochemical reality of ourselves and our bodies.”

13:52 – Closed-loop biofeedback as a catalyst of behavior change

It’s hard to change what is not measured. Once-a-year glucose and cholesterol tests do not give any information that can help in making better daily decisions on what to eat. Levels GCM is a closed-loop biofeedback device that can help drive positive behavior change.

“One of my core maxims of behavior change in health is that it’s really hard to change what you can’t measure. So you really need to measure things and to be able to know your baseline and the progress that you’re making. This comes from the closed-loop theories and control theory, which is that the quicker that you have feedback on a very specific action, the more you can create a one-to-one relationship between an action and an outcome, the easier it is to actually change that. Nutrition in particular has been notoriously an open-loop feedback system where we might eat 50 different things in a day, 50 different ingredients, and we have really no idea how one of those is directly impacting our health. We may be aware ourselves the next day and are like, okay, well, what I ate yesterday seems to make me weigh more. Is it inflammation? Is it fat? Is it water? What is it? Then we get a cholesterol test once a year, maybe. And then you’re like, okay, well, my cholesterol is high. What of the thousands of things I eat this year actually did that? Or you get a fasting glucose test from the doctor. It’s very hard to create behavior change when there are tons of different nutrition ideologies out there, we’re getting different information from the government, from influencers, from doctors, it’s very confusing and we don’t have any closed loops. I fundamentally believe in closed-loop biofeedback for being a huge catalyst of behavior change. And the nice thing about passive data streams like glucose, where you’re not actually having to track or check anything, it’s just doing it in the background and sending it to your phone.”

18:25 – How blood sugar affects the quality of sleep

Eating carb-rich food in the evening can cause blood sugar to fluctuate, leading to high body temperature. Both of these can affect the quality of sleep and cause insomnia.

“We know that when your blood sugar goes up and down very frequently, it creates spikes and dips throughout the day, which is not what we want. We want our glucose to be as stable and as low and in the healthy range as possible. But when you’ve got lots of different fluctuations happening that can trigger quite a few things like what we call endothelial reactivity. So that means the lining of the blood vessels gets a little bit reactive and it can actually cause you to change the blood flow and the way blood is flowing in the body and make you hotter. So when you have what we call glycemic variability, these ups and downs in blood sugar, it can make your core body temperature actually go up. This is actually really relevant to sleep, because we know that sleep quality is worse when your body temperature is higher. You want to be cool when you’re sleeping. And so eating your higher carb higher glycaemic meals late in the evening, right before bed, and then maybe following it with dessert or a sugary drink, that could cause a very large glucose spike in the evening causing you to then crash down and bounce around with your glucose throughout the night. And so that can be related to insomnia.”

22:51 – We are stressing our way to metabolic dysfunction

When we are stressed, our body releases cortisol which triggers our liver to dump glucose into the bloodstream. Biologically, this process is indented for physical stress. But mental stress results in the same glucose spike – without our muscles working to absorb it.

“When we were feeling stress, meaning we’re releasing cortisol and epinephrine and other catecholamine hormones, our body was preparing to have to do something physical. And so to do that, you need to use your muscles and the muscles needed really quick energy. So these stress hormones actually trigger our liver, which stores a little bit of glucose to dump that glucose into the bloodstream rapidly to feed our muscles. So that was useful then because we needed that energy quickly. Now in this day and age, we have very few actual physical stressors. Most of our stressors are psychological. They’re low grades psychological stressors that for better or worse actually release the exact same hormones when we get a stressful text, when we hear honking, when we’re having a difficult conversation with a coworker or we’re giving a talk or something like that. Our body registers that exact same way as like we’re chased by a lion. But the difference is that we don’t actually need to then go use our muscles. So we ended up having these glucose spikes essentially in our blood when we’re stressed, which don’t actually have a purpose. And so then we just have higher circulating levels of glucose in the bloodstream for essentially no reason.”

24:21 – The three dysfunctions of elevated glucose

Inflammation, oxidative stress, and glycation are the three ways in which elevated glucose causes inflammation. Over a period of time, all three can lead to insulin resistance.

“Glucose being elevated in the bloodstream can cause three main processes. One, it will generate inflammation. The second thing it’ll do is it can generate oxidative stress, which is where the body basically produces more reactive free radical molecules that can be damage free radicals, damage proteins and other structures in the body, and make them dysfunctional. And the third is that high glucose circulating causes glycation, which is where the sugar in the body actually sticks to other things in the body. Glycating is essentially sugar getting stuck to things and that can also cause dysfunction. And so those are the three things that glucose can just do by being elevated, which are problematic. The other thing is, it stimulates insulin in the body. Insulin is the hormone that’s released from the pancreas when glucose is elevated in the bloodstream. Like after we eat that tells the cells, Oh, you can take up glucose now. So insulin actually has to bind to the cell for glucose to go into the cell to be processed for energy. And what happens is when we’re spiking our glucose over and over and over again, whether it’s through stress or it’s through a refined carbohydrate, refined sugar diet, when we’re doing this over and over, our pancreas is having to do all this work. It’s producing all this insulin and the cells actually become numb to insulin. They become what’s called insulin resistant.”

Dr. Casey Means: [00:00:00] We think about metabolism in terms of like weight and energy, but really it finally comes down to power our body with a currency that we can use. We have to convert food to something that is usable. And that is metabolism. And that is every cell

Emily Abbate: [00:00:27] What’s going on, everyone. Emily Abbate, here bringing you another installment of Hurdle Moment from Hurdle. I feel the need as the year is starting, to wind down to revisit what my goal has been with these weekly Hurdle Moment episodes, dropping them more often than not on Wednesdays. These episodes have been

my way to offer you more information, to bring both new experts into the fold, and just give you tips and tricks that you can use to live a happier, healthier, and more motivated life. And that continues today with my guest, Dr. Casey Means. Casey is the co-founder and chief medical officer of Levels Health.

I feel like I’ve been hearing about Levels absolutely everywhere lately. So I’m so amped about this conversation, and to be able to bring you some information about what Levels is, and more importantly, perhaps what we need to know about our metabolism, about metabolic health. So let’s talk about what Levels is. Levels tracks your blood glucose in real time, so that you can maximize your diet and your exercise, simply put. The team at Levels believes that metabolic health is the key to warding off chronic diseases that make us more vulnerable to viral outbreaks.

Seems pretty relevant to what you’re going through right now. I know that this can all seem a little bit complicated, but that’s why I’ve got Casey here at the ready, to help us really understand how we can gauge metabolic health, what metabolic health really means? Let’s talk about things like inflammation and how blood sugar levels affect body temperature.

And really help us understand the science in a way that feels relative to our every day now, just because it is the season. If you are listening today, and you like what you hear and you want to try out Levels for yourself, I worked with a team there to do something pretty awesome. Right now their app actually has a 60,000 person wait list, and they’re running a closed early access program.

But you are welcome. If you’re interested, you can skip that line and purchase Levels today by heading over to a special link, just for Hurdlers. It is a Levels.link/Hurdle. Again, next Levels.link/Hurdle to skip the line today and check it out for yourself. As always, as you’re listening today, make sure to tag me over on social media @ Hurdle Podcast, and I am @ Emily Abbate. I would love to interact with you over there. I always promise to check into my DMS. So if you’ve got questions, comments, concerns, love letters, I’ll take it all. In addition, I know we’re in the home stretch of 2020, but trust me, stick around for the next few weeks in your podcasts app.

Keep checking in on Hurdle because I have some really exciting content and special, special guests to round out an awesome year and kickstart a brand new one. With that, well, let’s get to Hurdling

Today, I am chatting with Casey Means. She is a co-founder of Levels and their chief medical officer. How are you doing today? Casey?

Dr. Casey Means: [00:04:02] I

am doing so well. Great to chat with you today.

Emily Abbate: [00:04:06] Thanks for coming on. So I could give a brief synopsis of Levels, but I feel like it’ll obviously be better if you do it. So give me the brief synopsis.

Dr. Casey Means: [00:04:16] Sure. So Levels is really the first bio wearable company. So what we are is we are a wearable sensor called a continuous glucose monitor that you put on your arm. And it’s actually doing like a little lab test, 24 hours a day on your arm. It’s measuring your glucose, an internal biomarker, the key substrate of metabolism, every 15 minutes, 24 hours a day. And it’s sending that information to your smartphone. And what Levels does is interpret that metabolic data stream and help people understand exactly how the food they’re eating, and the exercise they’re doing, and their different lifestyle choices are all affecting their metabolism in real time.

So it’s the first closed loop biofeedback that we’ve ever really had on nutrition. So you can sort of say, like, I just had lunch. Was that a good meal for me, or was it not? Are those foods I should be eating or are they not? Or you can do the same for a workout. So we’re really bringing bio wearables, meaning wearables that are testing internal biomarkers to the mainstream for a market of people who are trying to improve their health, optimize their diet, optimize their athletic performance, and just really live their best life.

Emily Abbate: [00:05:23] Live their best life. Now I know that the statistic is almost 10% of the U S is diabetic. That’s increasing rapidly. 84 million Americans are pre-diabetic, 70% will be diabetic within 10 years. So that’s kind of, to my understanding, where the idea or the thoughts for the necessity of a product, like Levels really came from, is that right?

Dr. Casey Means: [00:05:48] Yeah. So, this is. You’ve got the stats, you know exactly right. It’s kind of astronomical. We have 128 million Americans with pre-diabetes or diabetes. And of those, 30% are diabetic and the rest are pre-diabetic. And those who were pre-diabetic, 90% don’t know that they have this problem. It’s just really incredible.

Like that’s a huge percentage of our country. And what’s more, and this, you know, these are disorders of metabolism. We can’t control our blood sugar properly. But even more broadly, there’s more recent data from UNC actually from last year that suggests that 88% of Americans actually have at least one marker of metabolic dysfunction.

So expanding just from glucose, it’s also looking at things like waist to hip ratio or cholesterol levels, all of which have to do with metabolism in general, metabolism being the core way in our body that we make energy for our cells. So 88% of Americans are not doing this exactly properly. And only 12% of people are considered optimally metabolically healthy.

And this is really rooted. Most of this is entirely preventable. It’s rooted in the way we’re living our lives now. It’s what we eat. It’s lack of sleep. It’s, you know, increased chronic stress. It’s lack of physical activity, lack of quality micronutrients in our diet. All of these things translate into problems with the way we make and process energy in the body. And that is fundamentally metabolism. So when you think about a tool like a continuous glucose monitor, you can imagine like, Oh, well this would be fantastic for people who have a disorder of glucose like diabetes. And that’s what this technology has been used for, for the most part.

It’s actually an FDA approved wearable device for people with diabetes. But when you think about the fact that, you know, it’s not just diabetic people who would need to think about glucose. This is a core substrate for all of us in terms of how we process and utilize energy in the body. And so all of us can optimize this aspect of our health to improve our current performance and prevent

future disease. So, what we’re really doing at the company is taking it out of really that medical realm, just sequestered to a population who has been diagnosed with an overt metabolic disorder, and making it, you know, bringing it to the masses, for people who want to take control of their health and who want to have some insight on these daily behaviors that they’re doing that impact our overall current performance, but also future risk of disease.

And so, yeah, so that’s exactly right. We’re, you know, we’re trying to you know, help people have insight and awareness into some of these key factors of our health that underlies so much of the chronic disease we’re seeing in our country.

Emily Abbate: [00:08:30] And of course, as you mentioned, many times over that explanation, we’re really talking about metabolism, and better understanding metabolism, which I think for so many is something that just kind of seems like out of their realm. They don’t really understand like what it means to have a fast or a slow metabolism. Or maybe the only thing they think to themselves is like, Oh, my metabolism is so slow because it’s just not helping me, you know, do the things that I want to do.

So what I would love to do with you is kind of talk through probably some of the most popular questions that are asked about metabolism. Firstly, metabolism, it differs from person to person. Is that right?

Dr. Casey Means: [00:09:10] Yeah, I’d say that that’s right. I mean, zooming back a little bit. Yeah. Metabolism really refers to all these cellular pathways, sort of the chemical reactions that are happening in the body that take the food we eat, and convert it into energy. So food is sort of this like basic building blocks, substrate that can be used for energy, but we have to convert it in our cells. And every single cell in our body, we have trillions of them, they all need this usable form of energy to function. Every single cell.

So we think about metabolism in terms of like weight and energy, but really it finally comes down to, to power our body with a currency that we can use. We have to convert food to something that is usable. And that is metabolism. And that is every cell. And this is why when metabolism kind of goes off course, we can see almost any type of symptom or disease.

We, right now, know that metabolic dysfunction, these chemical reactions, these pathways in the body of converting food to energy that we can use, when those are off course, we can see things ranging from obviously diabetes and obesity, but also heart disease, chronic liver disease, dementia, chronic pain, fatigue, depression, anxiety, wrinkles, premature balding, infertility. The most common causes of infertility, of polycystic ovarian syndrome, which is a metabolic condition. We see erectile dysfunction, we see athletic, lack of athletic endurance. We see so many different things in all parts of the body. And when you think about this, you know, metabolism is this core fundamental pathway.

You can imagine if that’s going awry, basically where that’s showing up is where you’re going to get symptoms. It could look like anything depending on what cell type it’s arising in. So if we think of, you know, all these diseases that I just mentioned and symptoms as separate things, that’s kind of a fallacy because really they’re all branches, that the root of the tree is metabolic dysfunction.

And so, you know, in traditional medicine we’ve often looked at things very reactively of like, you know, you have this symptom or this disease. And we think of it like, very specifically as part of its organ system. But the reality is we are a. And we treat it accordingly. We, you know, we give a very specific drug for that type of thing. But we are a unified body, and there are core pathways that dictate so much of our health.

And so I think there’s really a movement in medicine now, to think more from a root cause perspective of what are the actual, what’s the physiology that’s linking so much of the chronic conditions and symptoms that we’re seeing, especially in our population now. And one of those key root causes is dysfunctional metabolism.

So it’s a complex thing. There’s a lot of things that feed into it, because it is fundamental cell biology. So, you know, the food we’re eating and the micronutrients that we have in our body that are key co-factors in a lot of these metabolic reactions. Those will have an impact on your metabolism, how much stress you’re under and the hormone cortisol that will have a huge impact on metabolism.

How much sleep or how little sleep you’re getting translates into tons of downstream hormonal pathways, growth hormone, insulin, cortisol, ghrelin and leptin, all of these hormones impact metabolism based on how much or how little you sleep. And then of course, physical activity. When our muscles move, we actually increase our metabolic processes.

We increase our insulin sensitivity. Insulin is the hormone that allows glucose to get into cells. So, you know, it’s when we say people have different metabolisms, we’re talking about basically people have different genetics and different behaviors, which translate into biochemical reality that basically creates different types of metabolisms.

So, I like to frame it that way, because so much of what our, you know, our “personal metabolism” is actually just how our daily hundreds of micro choices are translating into our biochemical reality of our cells and our bodies.

Emily Abbate: [00:13:09] Right.

Emily Abbate: [00:13:09] And I mean, obviously a lot to take in here. I think that something that’s interesting to me and something that can be difficult for many is, with a tool like Levels,

is so much about keeping track of things, right? Keeping track of the foods that you’re eating, keeping track of the fitness, keeping track of, you know, how long you are sleeping. And then like seeing, you know, how all of this is being monitored, how all this is being put into play for someone who’s curious about their metabolism, but would think like, Oh, this thing isn’t for me. Like, what can they, even, what options do they have to kind of take back control without spending so much time logging every day.

Dr. Casey Means: [00:13:51] Well, yeah, I mean, one of my, sort of like core maxims of behavior change in health is that it’s really hard to change what you can’t measure. So you really need to measure things I think, and to be able to know your baseline and the progress that you’re making. This comes from basically the closed loop theories and control theory, which is that the quicker that you have feedback on a very specific action, the more you can create a one-to-one relationship between an action and an outcome, the easier it is to actually change that. Nutrition in particular, has been notoriously an open loop feedback system where, you know, we might eat 50 different things in a day, 50 different ingredients.

And we have really no idea how one of those is impacting our, directly impacting our health. We maybe weigh ourselves the next day and are like, Okay, well, what I ate yesterday seems to make me weigh more. Is it inflammation? Is it fat? Is it water? What is it? Then we get like a cholesterol test once a year, like maybe, you know. And then you’re like, Okay, well, my cholesterol is high. What of the thousands of things I ate this year actually did that. Or you get a fasting glucose test at the doctor. It’s very hard to create behavior change when one, there’s tons of different nutrition ideologies out there. We’re getting different information from the government, from influencers, from doctors. It’s very confusing and we don’t have any closed loops.

So, I really fundamentally believe in closed loop biofeedback for being a huge catalyst of behavior change. And the nice thing about passive data streams like glucose, where you’re not actually having to track or check anything, it’s just doing it in the background and sending it to your phone. You know, that’s really nice because it’s a very low lift for people.

And I think that a big part of the future of healthcare is going to be the combination of these really easy to use bio wearables or wearables in general, with software that makes the interpretation just like totally easy, on a silver platter. Like basically just like, yes, no, this was good for you, this was bad for you. When you do this activity, you have 20% higher chance of having X, you know, don’t, do that less basically. And just make it really simple for people. Because the trial and error that we’ve had to do so much with, you know, nutrition and exercise and all this stuff, I think it can be very discouraging for people sometimes. Sometimes there’s very obvious results. You know, you have a reaction to a food immediately, but a lot of times that’s much more nebulous. And so it leaves us just with so much trial and error, which I think is actually a bigger cognitive burden than just, you know, tracking, even if it’s for the short term and kind of just figuring out some clear answers, and then moving forward, moving forward with your life.

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We’re talking about, you know, overall metabolic health, obviously kind of going hand in hand with that, and what Levels monitors here, your blood sugar levels. Blood sugar levels, they can affect a ton of stuff in the body, as you said, but something else that I know that they can affect is your body temperature.

So how do your blood sugar levels affect your body temperature?

Dr. Casey Means: [00:18:21] Oh, that’s such a great question and really an interesting one. So yeah, so we know that when your blood sugar goes up and down, like very frequently, so, you know, spikes and dips throughout the day, which is not what we want. We want our glucose to be as stable and as sort of low in the healthy range as possible.

But when you’ve got lots of different fluctuations happening, that can trigger quite a few things that can trigger what we call endothelial reactivity. So that means the lining of the blood vessels get a little bit reactive, and it can actually cause you to, you know, change the blood flow and the way blood is flowing in the body and make you hotter.

So when you have what we call glycemic variability, these ups and downs in blood sugar, it can make your core body temperature actually go up. And so this is actually really relevant to sleep, because we know that sleep quality is worse when your body temperature is higher. You kind of want to be cool when you’re sleeping.

Right. And so eating, you know, your higher carb, higher glycemic meals late in the evening, right before bed and having sort of, and then maybe following it with dessert or a sugary drink, that could cause like a very large glucose spike in the evening, causing you to then sort of like crash down, and sort of bounce around with your glucose, throughout the night.

And so that can be related to insomnia and worse sleep. And we know that in diabetic individuals who are going to have more glycemic variability, because they have less glucose control. we do see higher body temperatures at night and worse sleep patterns. So, even just getting your evening meals more

stable in terms of your glucose response to them, it can be a nice way to kind of get your sleep more on track, which is a wonderful cycle to get into because when your sleep quality is better, it actually also feeds into good metabolic health. So it’s kind of this, like this two-way street.

And what’s kind of interesting is that, we know from more recent research that two people, any two people out there are actually going to have very different responses in terms of how much their glucose changes in response to the same food. So, like you and I could eat the exact same cookie, and I could have a huge glucose response and you could have a very small one.

And so, in terms of how that’s going to affect something like our glycemic variability, it’s going to be different in each of us. So that’s one area where tracking can be really helpful in personalizing and knowing exactly what your responses to a food. So, there’s a lot of different factors that go into that, why you and I would respond differently than the same food, ranging from, you know, our microbiome composition to how much sleep we’ve gotten, to our body types, our insensitivity, our genetics, things like that. But it is interesting.

We’ve thought a lot, you know, in the past, we’ve really oriented around this idea of like a glycemic index chart and like, can tell us like how much or how little something is going to spike your glucose. But it’s actually likely much more personalized than that, where each person’s going to respond a little bit differently, and have their own personal glycemic index to a particular food. So that’s something to keep in mind when you’re kind of choosing like what to eat, especially late at night, choosing something that’s specifically for you that doesn’t have a large glucose response is what’s going to be, you know, most optimal.

Emily Abbate: [00:21:44] Right. And of course, as we, as you mentioned, this can definitely vary from person to person. The last thing that I do want to hit on before I let you go today, we’re talking about, you know, the different things that could impact, increase levels of glucose.

And one of those, as you touched on earlier briefly, is of course stress, something that, God, in 2020, all time high for so many of us and pushing us to do things like overeat, which can raise our glucose levels. And then in turn, I know that can lead to us being fatigued and having low energy. So what is it about stress that has such a major impact on the circulating glucose in the body and the metabolism?

Dr. Casey Means: [00:22:25] Yeah, it’s a fascinating pathway. So it really actually stems from an evolutionarily advantageous response that we had, which was basically that when we were stressed, you know, back in the day, you know, old, old times, it was usually because we had some sort of physical stressor that we were dealing with.

Like the old example would be like we were being chased by a lion, you know? And, so when we were feeling stress, meaning we releasing cortisol and epinephrin and other catecholamine hormones, our body was preparing to have to do something physical. And so to do that, you need to use your muscles. And so the muscles needed really quick energy.

So these stress hormones actually trigger our liver, which stores a little bit of glucose, to dump that glucose into the bloodstream rapidly to feed our muscles. So that was useful then because we needed that energy quickly. Now in this day and age, we have very few actual physical stressors. Most of our stressors are psychological.

They’re low grades psychological stressors that for better or worse, actually release the exact same hormones when we, you know, get a stressful text, we hear honking, we’re having a difficult conversation with a coworker or we’re giving a talk or something like that. Our body registers that exact same way as like we’re chased by a lion.

But the difference is that we don’t actually need to then go use our muscles. So we ended up having these glucose spikes essentially in our blood when we’re stressed, which don’t actually have a purpose. And so then we just have higher circulating levels of glucose in the bloodstream for essentially no reason.

And you can imagine when we’re walking around all day with our digital devices and so many, like little, little stress signals all day, this basically can keep us elevated, you know, artificially just like through for a lot of that time. And that’s bad for our body for so many reasons.

You know, glucose being elevated in the bloodstream can cause three main processes. Like one, it will generate inflammation. The second thing it’ll do is it can generate oxidative stress, which is where the body basically produces more reactive free radical molecules that can be damaging. Free radicals go around and damage, you know, proteins and other structures in the body, and make them dysfunctional.

And the third is that high glucose circulating causes glycation, which is where sugar in the body actually sticks to other things in the body. Like, it, glycating is essentially sugar getting stuck to things and that can also cause dysfunction. And so those are the three things that glucose, you know, can just do by being elevated, which are problematic.

The other thing is, actually it stimulates insulin in the body. Insulin is the hormone that’s released from the pancreas when glucose is elevated in the bloodstream, like after we eat that tells the cells, Oh, you can take up glucose now. So insulin actually has to bind to the cell for glucose to go into the cell to be processed for energy.

And what happens is when we’re spiking our glucose over and over and over again, whether it’s through stress or it’s through a refined carbohydrate, refined sugar diet. When we’re doing this over and over, our pancreas is having to do all this work. It’s producing all this insulin, and the cells actually become numb to insulin.

They become what’s called insulin resistant. They can’t take in all that sugar. And so they block it by becoming insulin resistant. And then you can imagine, you have higher circulating glucose levels and it’s a vicious cycle. And for young and healthy people, the pancreas compensates by just saying, Okay, well, we can’t get the glucose in because you’re insulin resistant, we’re going to produce more insulin to just try and shove it in. And then what happens is you get what’s called hyperinsulinemia, high insulin and you got rising glucose. And that insulin being elevated is sort of a problem in its own right. So now you’ve got too much energy substrate, i.e. glucose in the bloodstream, and you can’t get it into the cells to actually convert it to energy.

So you’re in this sort of energy deficit in the body. So you think about like, okay, someone who’s chronically stressed, they’re fatigued, they start getting sick, you know. They’ve got, you know, other symptoms. They might break out this and that. It’s, so much of it is linked to the fact that that stress is causing metabolic dysfunction.

It’s causing you to not be able to utilize energy effectively in the body, despite having a lot of resources circulating and available, but you’re not using it well. So, you know, if I would just, to sort of sum it up, you know, one, glucose spikes from, generated from anything, whether it’s stress or food, that is going to cause physiology that ultimately makes your body metabolically dysfunctional.

The best thing we can do is keep those spikes down over time, so we kind of perk up ourselves again and become insulin sensitive again. And you do that by just living a life day in and day out that keeps your glucose spikes down. And that can be, you know, if it’s stress we’re working on, mind body practices, you know, deep diaphragmatic breathing, which lowers cortisol has been shown to improve glucose control and metabolic function.

Decreased perceived stress can actually improve our glucose control. And then of course, lots of things with the diet we can do to get our glucose spikes down, and help with that process. So that’s sort of how it’s all related between stress and metabolic health.

Emily Abbate: [00:27:38] This is one of those episodes where it’s just like a drop of knowledge, and probably one of those moments where someone would say, maybe I should listen to all of this at least.

Um, I think it’s all super interesting. I think it’s all super helpful. I also think that when it comes to metabolism and glucose and you know, the things that y’all are focused on over there at Levels. A lot of it is just stuff that if you don’t know, or if you’re not informed, if you’re not equipped with the intel to better understand what is going on in your own body, then you don’t know what could be the cause of so many of your issues.

So here we’re talking about, you know, your metabolism and the things that can impact your metabolism, things that can certainly make an impact in your overall body, your mood. So many things. And it’s, it’s a lot, it’s a lot for us to figure out. It’s a lot for us to learn about, but with time and with great resources and experts like yourself, that is, you know, that’s what we can do here.

Dr. Casey Means: [00:28:35] Yeah, absolutely. You know, and it is, you know, it can feel, I think, complex, you know, on the surface of like, Oh my gosh, there’s a lot to think about. And you know, the physiology is kind of complex, but I think it boils down, it’s like, you know, we are these, you know, awesome biologic machines.

Our bodies are incredible. And you know, we, as Americans are eating like a hundred times more refined sugar and carbohydrates than we were a hundred years ago. And throughout human history, that’s a lot for a poor little body to like process. It’s, you know, and every single molecule of sugar that goes into your body and, you know, refined carbs also turn into sugar, we have to process.

And so the less burden you can kind of put on your body, you know, just. And so to keep making it really simple, you know, eating whole foods and not. You know, trying to avoid some of the refined carbohydrates, the refined sugars, you know, making sure you’re balancing your meals with, if you’re going to eat carbs, eat the protein and fat with it.

There’s just some really simple steps people can take. I think once there’s an awareness about how much this is related to so many aspects of health and how, when we can get that glucose a little bit more stable, get our blood sugar more stabilized. Like we can, yeah, we can uplevel our lives in so, so many different ways.

So it’s really, it’s low-hanging fruit. And, so you know, it’s yeah, tracking is great and it certainly can help, but there’s even certainly small things we can do, to get that blood sugar more stable from the simple food swaps from refined foods to whole foods. And then of course, you know, trying to be more mindful about our stress, you know, really getting our

quality sleep per night, and then making sure we’re physically active. So, yeah, a lot of simple steps we can take to make huge impacts on so many aspects of our health.

Emily Abbate: [00:30:21] We like keeping it simple. We like big impact. So thank you so, so much Casey, for your time for breaking it down for your expertise, how can the hurdlers keep up with you? How can they learn even more about Levels? Give me the details.

Dr. Casey Means: [00:30:36] Sure. So people can visit us at LevelsHealth.com. And there you can sign up for our wait list. And there, you’ll be able to get on our newsletter and we’ve got lots of great information coming out. I would also definitely recommend on the LevelsHealth.com/blog.

There, we write all about this type of content and metabolic health. And we’re just really trying to help people better understand how this is relevant to so many aspects of our lives and performance, specifically nutrition, athletics, and just, you know, simple ways to kind of get our metabolic health back on track. And then you can also follow us @Levels on Instagram and Twitter, where lots of members of our community who are tracking their glucose, put up tons of fun, like experiments and what they’ve learned and how they’re kind of using glucose tracking to improve their lives. And then I personally am at, I’m on Twitter and Instagram @DrCaseysKitchen, and I am vegan. And I actually talk a lot about metabolic health and plant-based food. So, please reach out and get in touch with us. We’d love to hear from any of the Hurdle listeners.

Emily Abbate: [00:31:47] Thank you so much. I am over @EmilyAbbate and at hurdle podcast, another Hurdle conquered. Catch you guys next time.