Is Glucose The Cause Of Chronic Disease? – With Dr. Casey Means

Dr. Casey Means was a successful head and neck surgeon. After seeing the negative results of metabolic dysfunction in surgery patients, she teamed up Josh Clemente to address this issue. The result was Levels Health, which focuses on preventative medicine. Levels is empowering individuals from different health backgrounds to track their glucose through continuous glucose monitoring. The goal is to help people understand how different lifestyle factors such as food, sleep, and stress affect their glucose levels, which can cause other long-term health issues. Dr. Means is the Chief Medical Officer at Levels Health. In this episode of The Resetter Podcast with Dr. Mindy Pelz, they discuss glucose, the negative effects that metabolic dysfunction can have on our health, and ways to better manage our glucose levels.

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out The Resetter Podcast
• Connect with Dr. Mindy Pelz on LinkedIn

2:54 – The downfall of a reactive medical system

A reactive medical system allows important information to fall through the cracks that could help prevent disease before it happens.

“We tend to be a very reactive medical system. We sort of don’t address things until they are fulminantly manifested. And because of the way our healthcare system is structured, we don’t focus as much on prevention as we maybe should. And you know, a lot of this comes into the nuances of how we finance healthcare. We’ve traditionally had a fee for service model where we kind of wait until things manifest and then we treat them and then we get paid for that. But in that model, unfortunately, something that falls through the cracks is thinking about these critical biomarkers before disease emerges.”

19:06 – Metabolic fitness is a journey

We can improve our metabolic health but it doesn’t happen overnight. It requires work and repetition.

“The beauty about metabolic health and improving our metabolic processes in the body is that if you have a good metabolic day because you’ve seen your data, you’ve made these choices, that is going to lay the bricks for basically improving the health over time. I like to think about metabolic health – I like to call it metabolic fitness. Because it’s just like going to the gym to build muscles. You don’t immediately build big muscles overnight. You go, and you do the reps every single day. And over the course of weeks or months, you generate adaptations that are ultimately bigger muscles. The exact same is true with cell biology. As we do something day in and day out consistently over and over, you generate the cellular adaptations to improve the way we process energy in the body. And the reps for metabolism are keeping our glucose low and stable day after day. The more you do that, the more you improve your insulin sensitivity, the way our cells respond to insulin and glucose, and you end up building a body that can process carbohydrates more efficiently for energy and fat more efficiently for energy.”

20:26 – The loss of an internal sense of body awareness

Continuous glucose monitoring can help people regain an internal sense of body awareness that’s been lost due to an overwhelming amount of external stimuli in our society and everyday lives.

“Ultimately, one of my goals with continuous glucose monitoring being more mainstream is that it also generates an internal sense of body awareness that I think we’ve lost in a lot of ways. I think in our modern world with just all the stimulation, we have hyper palatable foods that help us reach our bliss point. We’ve got these crazy digital environments with so much stimulation and buzzing and beeping, and it can be hard to sort of hear the internal cues of our body. And I think something with bio wearables that’s quite interesting is that when you can see your data and you can link it to a subjective feeling like, okay, I had a huge glucose spike and then it came crashing down and now I feel tired and I feel anxious. When you link that choice with a subjective experience, with data, I think that trifecta actually helps us tune more into what we’re doing.”

27:44 – Increased inflammation = reduced immune function

There are many diet and lifestyle triggers that create a higher pro-inflammatory state and a reduced immune function in the body such as lack of sleep and physical activity, or chronic stress.

“It’s not actually the virus that is necessarily killing people. It is the immune response to the virus that causes the terrible lung symptoms and the massive cytokine storm inflammatory response is what ends up killing us. And so one thought about why diabetes and obesity and other metabolic conditions are leading to increased mortality with the virus is not just because these conditions and hyperglycemia reduce immune function, but also because these are pro-inflammatory states in the body.”

33:18 – Focusing on calories for weight loss doesn’t work

The standard American diet includes refined carbohydrates and sugars, which causes glucose spikes. If our bodies don’t have time to burn fat, we won’t won’t be able to lose weight or we’ll put the weight back on after a short time.

“The key thing that these people are talking about is that this calorie in, calorie out model of diet has not worked. Almost all weight loss studies in published literature fail or within two years, people gained back the weight. And this is because it’s often looking at reducing caloric content, reducing fat content. When in reality, we need to be thinking through a hormonal lens about weight loss, just very basic hormonal biochemistry. We know that insulin, the hormone released when we elevate our blood sugar through food choices is the hormone that allows glucose to get taken up into our cells to be processed. But it’s also the hormone that tells our body to stop burning fat. It’s basically a full block on fat oxidation or fat burning. So you could imagine if you’re eating the standard American diet where you are probably eating five or six times a day. Between meals and snacks, the vast majority of our calories are coming from refined carbohydrates and sugars, which generate glucose spikes and therefore insulin spikes. You are virtually never giving your body a time when insulin is low. Therefore you are not giving your body a time when you can burn fat.”

36:54 – Glucose dysregulation in women

There are a lot of insulin receptors in the Theca cells of the ovaries that respond to high insulin levels. The insulin stimulates your ovaries to make more male hormones such as androgens, which can lead to issues such as Polycystic Ovarian Syndrome.

“I think there’s a lot of amazing use cases for women and particularly relating to hormones. And so one interesting thing about insulin is that there are insulin receptors on I believe every single cell type in the entire body, which is pretty incredible. We have so many different cell types and almost every single one has insulin receptors.”

44:03 – Erectile dysfunction and glucose

Erectile dysfunction can be a warning sign for metabolic dysfunction. Anyone experiencing this should figure out how to adjust their diet  to improve their glucose and insulin sensitivity before looking to pharmaceuticals or other treatments.

“There, there are so many sexual health areas where I think glucose monitoring could help men. I think one of the key ones is erectile dysfunction. We know that erectile dysfunction is significantly worse in people with higher glucose levels. I don’t think the average neurologist is talking to their patients about this.”

46:51 – Move your body

Any kind of movement can have a positive impact on our metabolic health.

“If you’re moving your body, you’re improving your metabolic health and your insulin sensitivity. Whether it’s resistance training or power sports, whether it’s stretching and yoga and more gentle type activities like that, high-intensity interval training, or just moderate aerobic activity. All of these things in research has been shown to improve our insulin sensitivity and our blood glucose control.”

50:08 – Physiological stressors and their impact on the body

Uncontrolled stress responses can lead to small glucose spikes throughout the day. Activities like mindfulness and breathing can help control stress and reduce glucose spikes.

“When you stress, you release cortisol and epinephrine, our catecholamine hormones, and these travel the body and they tell our liver to dump our stored glucose to basically fuel our body for other stressful things we have to respond to. And this made sense way back in the day when maybe our stressful events actually were physical in nature. We were being chased by a lion and we got stressed and we had to run and our muscles needed sugar. That’s no longer the case. Now almost all of our stressors are actually psychological in nature. It’s a text. It’s an email. It’s going on a podcast.”

52:25 – The link between sleep and metabolic health

Sleep has a significant impact on our metabolic health and sleep deprivation can have negative effects on our health.

“Basically, if you sleep one hour less per night than you should for your body’s needs, you will see a significantly higher insulin and glucose response the next day and sleep deprivation increases cortisol, growth hormone, insulin. It also changes our ghrelin and leptin levels, which are satiety and hunger hormones, and just creates a profound hormonal cascade that is not good for metabolic health.”

54:10 – Our bodies are like a machine

Our bodies need good inputs to function to the best of their ability and have good outputs.

“I think the key thing here to remember is that for glucose to be processed by the mitochondria or for fat to be processed in the cells, that requires proteins, it requires enzymes, it requires pathways and all of those machinery require micronutrients like locks and keys to let them work. Some of the key ones for metabolism are Vitamin C, Zinc, Magnesium, Manganese, a lot of the B vitamins, lipoic acid. So these are things that come from food. We are eating the most nutrient poor diet we’ve ever basically eaten throughout history. Our soil is depleted. Lots of issues with that. So we’re micronutrient depleted for a lot of these key nutrients. So we have to remember that for our machinery to work, it needs these micronutrient substrates. So it’s way more than just macros, it’s also micro. So that means getting back to that whole foods diet, really getting nutrient rich foods, making sure we’re getting lots of probiotic sources to basically optimize our machinery.”

01:04:21 – No better career than healthcare

Dr. Casey Means is fascinated by the intersection of the different factors that contribute to healthcare, which is why she thinks it’s the best career.

“I think I’m biased, but I think there’s no better career to be in than healthcare. I think it is just the intersection of so many things that are important. It’s the intersection of our personal identity, of the environment, of all of our behaviors, and also with the earth because ultimately health is the intersection between the earth and our body and how those two things interact – food and environment and air and water. These are all things that translate in our bodies to our biochemical reality. And so to me, healthcare is a constant joy. It’s always evolving and it really brings philosophical and very meaningful thoughts and relationships into everyday life. So I can’t recommend it highly enough.”

Dr. Casey Means: [00:00:00] We all have this deep intuition that actually our bodies are very unique and individual and what works for one person may not work for another.

Dr. Mindy Pelz: [00:00:10] I am a woman on a mission that is dedicated to teaching you just how powerful your body was built to be. I like to do that by bringing you the latest science, the greatest thought leaders and applicable steps that help you tap into your own internal healing power.

The purpose of this podcast is to give you the power back and help you believe in yourself again. My name is Dr. Mindy Pelz, and I want to thank you for spending part of your day with me,

Dr. Mindy here, and on this episode of the Resetter Podcast, I am bringing you Dr. Casey Means. Now Dr. Casey is a, or was I should say, a head and neck surgeon who turned to functional medicine to start to answer some of the questions she was seeing in her surgery practice. And I will tell you that we have never unpacked blood sugar to the level that we do in this episode of The Resetter Podcast. Dr. Means now works with Levels. It is a company that has a continuous glucose monitor, and they’re making it available to the everyday person. So I’m excited to share that with you guys. But all of your questions that you’ve ever had about blood trigger, what raises your blood sugar, what breaks a fast, all of these things Dr. Means and I unpack in this episode. So again as always, bringing you guys information that’s going to make your fasting lifestyle so much easier and especially those of you who have engaged in asking us questions on all of our platforms, we want to make sure that you’re getting your questions answered. And in this episode, we are going to unpack every single question you’ve ever had about blood sugar.

Dr. Casey Means, enjoy this one. You’re going to want to take notes. It has so much incredible information to change your life.

I feel like blood sugar is so helpful for people to understand, but why are we not getting a tool like what you’ve got in the hands of the everyday person? Why hasn’t it made it mainstream? And we’ll go into… I want to talk a little bit about how you got to this place in your career, but I really just want to answer this one question right off the bat, because we are ignorant, as a society, when it comes to blood sugar, and it just seems like it would be the most helpful tool. Throw away the scale. Let’s start looking at blood sugar. Why are we not doing this?

Dr. Casey Means: [00:02:42] This is the key question, I think, and I actually think it comes down to really how our medical system fundamentally works. We tend to be a very reactive medical system. We don’t address things until they are fulminantly manifested. And because of the way our healthcare system is structured, we don’t focus as much on prevention as we maybe should. And a lot of this comes into the nuances of how we finance healthcare. We’ve traditionally had a ‘fee for service’ model where we wait until things manifest and then we treat them and then we get paid for that. But in that model, unfortunately, something that falls through the cracks is thinking about these critical biomarkers before disease emerges. So the average person, when they hear the word blood glucose, the immediate thing they think about is diabetes. We’re not thinking about things like depression or fertility or acne or liver disease or chronic pain, all conditions that have to do with dysregulated blood glucose, but we’ve just so much linked glucose to diabetes that we haven’t really zoomed out and thought about metabolism more holistically. And I think a really exciting movement that we’re seeing in healthcare now is there are a lot of doctors who are thinking more about the root causes of issues. And when we actually look at root causes, we start to think about, okay, there are all these diseases, there are all these symptoms out there and sometimes we call conditions and symptoms comorbid, meaning that they arise together in the same patient. What does that really mean? What it means likely is that there’s a core underlying biologic pathway that’s linking a lot of these conditions and what we’re learning more and more is that dysregulated blood glucose links so, so, so many conditions. And I think this really comes down to the fact that metabolism is just how we convert food to energy in the body that we can actually use to help to your cells. Metabolism is this core pathway required for every single cell in the entire body. We have trillions of cells and every single one needs to convert food energy to cellular energy for that cell to function. And that largely means efficiently processing glucose or fat into energy. When that pathway, that core pathway is perturbed, is awry, we can see dysfunction manifesting in so many different ways. If that dysfunction is happening in the ovaries, it could look like polycystic ovarian syndrome. If that is happening in the brain, it could look like depression, Alzheimer’s, chronic pain, chronic fatigue, all things related to metabolic dysfunction. If it’s happening in the vessels, it could look like heart disease or peripheral vascular disease. So this is one of these core fundamental pathways and the way we are living these days, what we’re eating the massive amounts of refined carbohydrates, refined sugar, eating all the time and not having fasting or regularly spacing out meals, getting poor sleep, lots of stress, lack of physical activity – all these things perturb this key process. So as a society, because of the way we’re living these days, metabolism as a core fundamental pathway is going off the rails. And so really helping people, I think, orient around glucose much earlier on in their lives, thinking about their diet and their lifestyle through the lens of glucose could keep us out of so much trouble that we’re seeing these days. But it’s exciting to see people start to talk about it, start to think about it. I think the Keto Movement has helped people start to think about it, intermittent, fasting, things like this, but I think there’s huge room for us to expand the conversation on it.

Dr. Mindy Pelz: [00:06:22] Yeah. I have a friend who’s got a daughter who has Type 1 diabetes and she was upgrading her monitor and asked me, “Oh! Do you want to try her old one out?” And with of course, the new adapter to it and everything. And I was like, “Sure, let me try it.” So I tried it for two weeks and  when I got done, I was like, “Why does not everybody have this?” I learned so much about myself. I purposely did it when I did a five-day water fast so I could understand what was going on there. I was shocked that I could be in a fasted state and I could have an argument, my daughter was a teenager at the time, and I’ll never forget sitting at my kitchen table, I hadn’t eaten anything. She came in, we had a disagreement, I looked down at the monitor and my blood sugar was up. And I was like, “What?” I started to learn what foods brought it down, what foods…  And I wasn’t educated at that point. So why do you think that the medical world… I know you came from that world. How are we not… I know we’re waking up to it, but why hasn’t this tool been accessible or been used much earlier? Is it just because the healthcare system has been focused on symptoms?  Did they not think that the individual would want it? I fell in love with it after that and I threw my scale away. It totally changed my relationship to food.

Dr. Casey Means: [00:07:47] Yeah. It’s so great that you had such a great experience with it, and I think that part of the issue with why we haven’t made this mainstream yet so far, is because we tend to think of these diseases and these symptoms as very isolated silos. It’s like we diagnose it and then we either give a pill or we do a surgery. And we think of these things as very much… All these symptoms we have are like totally separate entities. And a lot of this, again, comes back to systems issues. Even the way we code in healthcare and bill in healthcare feeds back into this. We label things as these individual conditions when in fact it might make more sense to actually code the underlying physiology, like metabolic dysfunction, as opposed to coding the downstream symptom that arises from that, because then we’d think more about… Instead of just treating acne with hormones or antibiotics or topicals or Tretinoin,  what if we actually treat the physiology, which is in many cases, metabolic dysfunction and dysregulated blood sugar, which drives oil production in the skin. So I think  there are these systems level issues. But I think we are moving in this different direction where we’re seeing… I think a big movement in healthcare is what’s called network and systems biology with  proteomics and whole genome sequencing and  advanced technology. We can actually now really understand diseases on these core fundamental levels of how they’re connected from a cell biology and a genetic pathway. And, and what’s emerging out of all of this research and these studies is that…

Oh wait, there are a couple of really big things that are linking a lot, that are like low hanging fruit in healthcare and one of those is glucose dysregulation. The most beautiful part of it is, it’s really easy to modify. This is not like a hopeless path. We can rapidly improve our glucose levels in literally days. And there’s been companies who are even… Like Virta Health, for instance, which is a diabetes reversal program, which is showing that in 10 weeks they can take people from a diabetic state to a non-diabetic state through coaching and nutritional intervention. So the beauty of… I think it’s a really hopeful time because we know a lot is related to metabolic dysfunction and glucose dysregulation, and we know that it’s highly, highly actionable. But the disconnect there is, how do we get the tools to people so they can measure where they’re at and then learn to optimize. And I think that really speaks to what your experience was using a continuous glucose monitor. You know, we have this wearable sensor, it’s the size of a quarter. It’s painless. You stick it on the back of your arm and it’s testing your glucose 24 hours a day, seven days a week, and sending that information to your smartphone so that you can actually get instant feedback on exactly how your stress, like you mentioned, your diet, sleep, exercise is all impacting glucose. And what we want is the flattest, most stable, in the low and healthy range glucose possible. What the average American is seeing is just up and down swings all day from how we’re eating and stressing and living, etc. And so with that tool immediately, you can say, “This is where I’m at. This is where I need to go, and this is how I can tweak little things in my life like the food I’m eating and the exercise and the sleep and the stress and all of this to move there.” So now all the pieces are falling into place. We have the technology, we have increased understanding in the healthcare system, we definitely have a movement, I think, towards people being more interested in prevention, and I think that’s going to all come together with seeing more of an expansion of this technology to more people. Because previously, like you mentioned that you got the CGM from someone who was… Or you had heard about it from someone with Type 1 diabetes, this technology has only been accessible throughout… It’s been around for about 10, 15 years for people with Type 1 or Type 2 diabetes and we’re now realizing, “Wait. What if you took this technology, this continuous glucose monitor and give it to people before they developed the disease so they could actually improve and not get to that end stage, when you never really need to get there. I think some of the most recent research I’ve looked at showed that up to 87% of cases of Type 2 diabetes are completely preventable. So this is where we need technology to be used earlier and not just  sequestering it to when the disease has fully emerged.

Dr. Mindy Pelz: [00:12:05] Yeah. We’re kind of in a really cool time of healthcare because people are using Fitbits and we’re getting used to this more personalized approach. Our whole team has Whoop Bands, and you got to Whoop too. I want to talk about blood sugar and HRV too, but it’s been really fun. Like just with the Whoop alone, we’ve been going to bed earlier, we’ve been making some changes and just to have that in our hands, and then if you combine that with a continuous monitor. Wow! We could really start to make some smart choices. My question, and this is, I think, a difficult one to answer is, if we got a continuous monitor in everybody’s hand and people started managing blood sugar, and if they manage blood sugar better and their health got better, what would that do for Big Pharma?

Dr. Casey Means: [00:12:59] Great question. I think we would see some really big changes in the way we utilize healthcare and I think we’d also see big changes in consumer decisions related to food, because those are, I think, two industries that would be impacted from this type of technology, because it’s pretty incredible. I don’t know if you’ve had this experience, but I’ve been wearing a continuous glucose monitor now for about 18 months and my diet is radically different than it was 18 months ago. And it’s not because of, I had to give things up or I had to eliminate things. It’s just that I learned over time exactly which foods were total culprits and did have to go, but also how to modify meals, and pair foods differently, and sequence foods differently, and do fasts appropriately, and what times of day were better for me to eat, and how to pair exercise with food for good glucose response. It just changed really every everything. And what’s nice about it is that it was not emotional. I think a lot of people associate diets with deprivation and it’s like, someone just tells you from up high whether it’s Instagram or the government or your doctor, this is what you have to do. And we’ve been hearing really loud voices a lot of conflicting nutrition information for our whole lives, which leads us to basically do a ton of trial and error with our diets and our lifestyle plans. And this can be extremely frustrating. And part of that is because there’s a really basically open loop system with nutrition and with exercise and other lifestyle factors as well. You might change your diet, but not really notice any results quickly. You might eat something and the feedback you have is like maybe the next day, you step on the scale and it’s a few ounces different. Maybe six months later, you get a cholesterol test and it’s a little bit different. Maybe you get a fasting glucose in a year and it’s a little bit different. But those are open loop systems. There are very little one-to-one feedback between a choice you’re making, which can sometimes be difficult and be associated with deprivation and then an outcome. So it’s very hard to generate behavior change with nutrition and other lifestyle activities that are heavy lifts that don’t have an immediate response.

And so one of the things that’s so exciting about wearables and now with continuous glucose monitoring, which is really poised to be the first nutrition bio wearable, where you’re actually getting closed looped on nutrition, what’s great about that is you can start to close that loop between what choice you’re making and what the health effect is immediately. So instead of having to wait six months for a cholesterol test or a blood sugar test, you see within 10 minutes, how your glucose is responding to a specific meal. So that’s revolutionary…

Dr. Mindy Pelz: [00:15:38] Totally revolutionary.

Dr. Casey Means: [00:15:39] For behavior change. Yeah. Yeah. And also… Oh! Go, please.

Dr. Mindy Pelz: [00:15:43] Just on that topic, one thing that… Again, I just wore it for two weeks, but one thing that really shocked me was when I get on the scale, what I realized is that I have a whole story about what the numbers on the scale say. If I am a certain weight, I go, “Oh, that’s the weight I was when I was in college.” I have a weight I don’t want to get above. Every number on that scale has a story and it’s a story that isn’t really beneficial to me. It’s based off my past and I just found it to be so hard to get on the scale and ridicule myself, or applaud myself based off of that number. Now with a blood glucose monitor, I could just sit back and almost be an observer to my own health. It was freeing. It was so freeing.

Dr. Casey Means: [00:16:36] It is so funny you mentioned that because both in my personal experience and many customers who are using my company’s products, Levels, we are finding that people are saying that they are no longer basically getting on the scale. They’re totally reorienting around this new metric and I think part of why it’s such an empowering metric is because you have this opportunity every single day, multiple times a day in the choices that you make, to improve that metric. You can see it in real time. If you exercise, your glucose comes down. If you get a poor night of sleep, your glucose is going to be higher in the morning. If you eat a bunch of refined carbs or sugar, it’s probably going to have a higher response. If you eat whole food carbs and pair them with fat and protein, it’s probably going to be a lower response. So each day you have all these opportunities for these micro wins and overall…  There’s no real mystery to it. You learn about how your body reacts and then you make those choices. And so you really get to orient around this really positive,  actionable metric. Whereas, weight can really be sometimes very, very difficult. One, because we’re playing trial and error and kind of going on blind faith what someone recommended to us, whether it’s a book or a doctor, government recommendation, that that’s going to work for you. I think we all have this deep intuition that actually our bodies are very unique and individual and what works for one person may not work for another. And so to see a personalized response also makes it very, very empowering.

And the beauty about metabolic health and improving our metabolic processes in the body is that if you have a good metabolic day, because you’ve seen your data and you’ve made these choices, that is going to lay the bricks for basically improving the health over time. I like to think about metabolic health. I like to call it metabolic fitness because it’s just like going to the gym to build muscles. You don’t immediately build big muscles overnight. You go and you do the reps every single day and over the course of weeks or months, you generate adaptations that are ultimately bigger muscles.

The exact same is true with cell biology. As we do something day in and day out consistently over and over, you generate the cellular adaptations to improve the way we process energy in the body. And the reps for metabolism are keeping our glucose low and stable day after day. The more you do that, the more you improve your insulin sensitivity, the way our cells respond to insulin and glucose, and you end up building a body that can process carbohydrates more efficiently for energy, and fat more efficiently for energy.

So the reps are keeping the glucose lower and stable, and you can do that by measuring and tracking it and being empowered with all those wins throughout the day as you make choices that you know are generating better health. So yeah. So certainly what you’re saying really speaks to me about the scale and ultimately one of my goals with continuous glucose monitoring being more mainstream is that it also generates an internal sense of body awareness that I think we’ve lost in a lot of ways.

I think, in our modern world with just all the stimulation, we have hyper palatable foods that help us reach our bliss point. We’ve got these crazy digital environments with so much stimulation and buzzing and beeping, and it can be hard to hear the internal cues of our body.

And I think something with bio wearables, that’s quite interesting is that when you can see your data and you can link it to a subjective feeling like, “Okay. I had a huge glucose spike and then it came crashing down and now I feel tired and I feel anxious.” When you link that choice with a subjective experience with data, I think that trifecta actually helps us tune more into what we’re doing. And so Whoop, I think, does a phenomenal job of actually helping you subjectively and qualitatively think about how you’re feeling in regards to your data. And for Levels, our product, we’re really trying to help people link their data to how they’re feeling, because that’s like this extra step to make it not just about, I want to hack my data, but I want to feel better. I want to hear the signals of my body and go off of that. So it’s almost like using… It’s like a boomerang of using tech to get back to the basics.

Dr. Mindy Pelz: [00:20:41] Yeah. I got chills as you were talking because I just… This year above all years, I have been blown away at how little faith people have in their own bodies and probably an extension of that thought is how little people understand their bodies. And a lot of that has been because of the metrics we’ve been using, the scale, the traditional blood tests you get at your doctor. Most people don’t even know how to read that. Nobody knows what their A1C is or what their insulin or their glucose should be when their doctor says it’s okay. They don’t even throw out numbers. They’re like, “Okay. It’s okay,” or “It’s bad.” But when this year hit and we had this pandemic and I dove into the science, and I know you already know this, it’s like, “Okay. The root issue of this pandemic spreading across the world is metabolic syndrome.” So what if we slapped one of these monitors on everybody instead of slapping a mask on them and we got everybody to understand their own body, how quickly we would change this experience.

Dr. Casey Means: [00:21:50] Man, I think you said that so beautifully. I could not agree more. I think what we have seen this year with how metabolic dysfunction contributes to increased COVID morbidity, mortality should be on every billboard in America.

Dr. Mindy Pelz: [00:22:06] Yes!

Dr. Casey Means: [00:22:07] And unfortunately, it’s not. I certainly am not going to slam… I think that there’s a place for hand sanitizer. We want to prevent the spread of the virus. But the virus is only one half of the equation.

Dr. Mindy Pelz: [00:22:18] Thank you.

Dr. Casey Means: [00:22:19] The virus interacts with a host and we are the host and we are virtually not talking about the host.

Dr. Mindy Pelz: [00:22:25] At all.

Dr. Casey Means: [00:22:27] I truly think on the New York times front page, it should be a reminder every single day that we have a lot of control over our metabolic health, and metabolic dysfunction is the key predictor of mortality and morbidity from COVID, and then list examples for people of how they can improve it and simple steps they can take.

It is strange to me… Not to go too far on this standard, but we’ve got magazines and news outlets that are constantly talking about increasing death rates and cases going up and in the next page is a recipe for a pie with two cups of granulated sugar when  what’s really interesting is that recent research has come out that blood sugar is not just a problem for COVID in diabetic individuals. It’s actually also a problem for non-diabetic individuals. So research has shown that even in non-diabetic people, if your blood sugar is higher, in a higher range, that will put you at increased risk of in-hospital mortality, if you have COVID.

So every single one of us, one of the best things we can do to empower ourselves, improve our bodies, improve our resilience is to do everything we can to keep that glucose flat and stable, improve our metabolic fitness, improve our biologic resilience. And the same goes for so many other papers that have shown that factors like micronutrients, like vitamin D and selenium and zinc actually have a significant predictive relationship with COVID mortality. These are substances that we get from our food that have key roles in some of our immune functioning. Selenium, for instance, if you look at an immune cell, one of the key proteins they use are called seleno-proteins. They are proteins that actually have selenium in them.

So to think that food doesn’t have a relationship with our biologic resilience is absolutely insane. These are key building blocks of proteins that let our immune cell’s function. So we’re speaking the same language.

Dr. Mindy Pelz: [00:24:20] Yeah.

Dr. Casey Means: [00:24:20] I think it’s premature to say that if we put CGMs on every single person in the US, we’d have better COVID outcomes because that research has not been done, but I would darn sure like to see that happening very soon, because the first step to improving it is understanding where you’re at and tracking it. Yeah.

Dr. Mindy Pelz: [00:24:41] And I’m not picking on the mask either. I’m just frustrated that we’re over here, debating the mask when all that energy could be over here, educating people on what they can do so that they aren’t a good host.

For example, I just found a study and did a video on it, on my YouTube that showed that viruses are like parasites. They don’t have a metabolism of their own, so when they come into a host, they are going to live off the host’s metabolism. So if they come into a sugar burning metabolism, just for simplicity’s sake, they can move into that cell. They can replicate and they can gain energy and they can wreak havoc in that body. If they go into a cell that is living off the ketogenic metabolic pathway, they can’t replicate because there’s no energy for them to gain, to live off of and to be able to gain momentum on. And this was a study on PubMed. I was like, why aren’t we talking about this?

Dr. Casey Means: [00:25:42] Right. It is literally front page news. It is very simple to get into a ketogenic state with mild dietary tweaks that don’t even require deprivation. They just require thinking differently. Another thing that really blows me away, and then I talk about a bit with the patient, is that it’s not actually the virus that is necessarily killing people. It is the immune response to the virus that causes the terrible lung symptoms, and the massive cytokine storm inflammatory response is what ends up killing us. And so one thought about why diabetes and obesity and other metabolic conditions are leading to increased mortality with the virus is not just because these conditions and hyperglycemia reduce immune function, but also because these are pro-inflammatory states in the body. People with diabetes and obesity tend to have higher levels of circulating immune cytokines and mediators like TNF-α and Interleukin-6, CRP, etc.

And so, the way I like to think about it is, anything we can do to decrease the baseline inflammatory state in our body means that when the inflammation that occurs, if you were infected with COVID, we’re starting from a better place. And so one of the big things that can generate inflammation is hyperglycemia, blood sugar spikes, high blood sugar. This can cause immune activation. So too are so many other parts of our diet and lifestyle – refined seed oils, lack of sleep, lack of physical activity, chronic stress. All these things also create a higher pro-inflammatory state in the body. So now is the time to be thinking, how do I just minimize all the possible inflammatory triggers in my body. If I’m going to be infected with the virus, I want to be starting from that place of just a really low cytokine level. And again, these are things that are very, very, very simple. But it’s not a part of Western culture, I think, to think that way about diet and environmental exposures. I see it in the podcast community for sure that there are people talking about this, like you and others and I think there is hope, so…

Dr. Mindy Pelz: [00:27:47] Even on my YouTube, I have to be careful. It’s censored. And this study was so profound, I don’t care if I get censored. This has to get out there because like you said, to tap into these ketogetic pathways are not that difficult. This doesn’t mean, okay, starve yourself. This means manipulate your food in a way so that you’re not a sugar burner. And that is so incredibly important.

Hey guys, Dr. Mindy here and I want to tell you about my book that’s coming out very, very soon. It’s called “The Menopause Reset”. One of the things that we realized from our community that was so desperately needed was a book on how women over 40 should do fasting, how they should do keto, what principles they need to apply to their lifestyle to be able to balance their hormones. So you all asked and so I put it in a book and it’s called “The Menopause Reset” and I poured my heart and soul into this book. I walk you through the five steps that I took when I went into my early forties and found myself down a bad, bad menopause path. And like many of you guys, I found no answers. I didn’t want to take medication. I didn’t want to wake up at night. I didn’t want any more hot flashes. There were so many parts of my menopausal journey that I did not like. So I took matters into my own hands and I researched the heck out of what happens to our body as we move from 40 and beyond. And I found that there are actually five things that you need to implement, five lifestyle changes that you need to look at in order to weather these menopausal years with grace. And so I put it in a book and it’s available for pre-order now. I made it a simple, easy read. You’ll hear about my journey and I give you steps. As much as I love inspiring you, I also love moving you into action. So the book is filled with ideas, followed by action steps you can take, and it’s now available for pre-order, really excited to share it with you, “The Menopause Reset”. You can find all the information that you need on it in the Show Notes. I hope you enjoy it as much as I loved writing it.

Let’s move into a little bit of the weight loss world, and I’m sure a lot of people would come to a product like yours because they want to lose weight.

Where do you think we’ve gone wrong with weight loss as far as looking at it from the wrong angle? Do you think something like a continuous glucose monitor could totally change the weight loss world?

Dr. Casey Means: [00:30:30] Yeah. I think that continuous glucose monitoring is going to be one of the biggest game changers for weight loss that we’re going to see in the next decade. I think it’s going to become part and parcel with any weight loss plan within a couple of years and I think there’s been some amazing thinkers and authors who have been writing about this. I think a lot of the ketogenic authors have been thinking about this for awhile, but some of the key books that I love are Jason Fung, “The Obesity Code”. He talks about a different way of thinking about weight loss. “Why We Get Sick” by Dr. Ben Bikman, which just came out this summer is all about this. And then Mark Hyman, “The Blood Sugar Solution”, which is about weight loss. And the key thing that these people are talking about is that this calorie in calorie out model of diet has not worked. Almost all weight loss studies in published literature fail or within two years, people regained back the weight. And this is because it’s often looking at reducing caloric content, reducing fat content, when in reality, we need to be thinking through a hormonal lens about weight loss, just very basic hormonal biochemistry. We know that insulin, the hormone, and I know I’m totally preaching to the choir here…

Dr. Mindy Pelz: [00:31:42] No. This is great. I love it.

Dr. Casey Means: [00:31:45] But insulin, the hormone released when we elevate our blood sugar  through food choices, is the hormone that allows glucose to get taken up into ourselves to be processed. But it’s also the hormone that tells our body to stop burning fat. It’s basically a full block on fat oxidation or fat burning.

So you could imagine if you’re eating the standard American diet where you are probably eating five or six times a day between meals and snacks, the vast majority of our calories are coming from refined carbohydrates and sugars, which generate glucose spikes and therefore insulin spikes. You are virtually never giving your body a time when insulin is low. Therefore you are not giving your body a time when you can burn fat. So really a new lens that I think we’re looking at weight loss through is, how do we keep insulin down so we can take the break off fat burning? Well, we have to do that by keeping glucose low and there’s a lot, a lot of people who’d be interested in ketogenic diets, which keeps carbohydrate content per day, very, very low.

But I actually think there’s another way to do this, which is by tracking with a continuous glucose monitor. And that’s because each person actually responds to carbohydrates in the diet very differently in terms of how it elevates their glucose. You and I could both eat a banana and I might have my glucose go up 50 points and you might go up five points. So for you, there may not actually be a large insulin response for you, and for me, there might be a huge one. So it’s really CGM, continuous glucose monitoring, can be somewhat empowering and liberalize a really strict keto diet and allow you to find the foods that may have a little bit higher carb content, but actually don’t spike your glucose.

And in the main study that looked at this phenomenon, which was that different people respond differently to different carbohydrates in terms of how their glucose changes, which was a study out of Israel called, ” Personalized Nutrition by Prediction of Glycaemic Responses”. They found that things like microbiome composition…

Dr. Mindy Pelz: [00:33:36] I was just going to ask you that. I’m like, okay, keep going.

Dr. Casey Means: [00:33:39] It all comes back to microbiome. It’s like the bacteria process just does differently and so it’s going to be a different reaction. Other things that were involved were recent physical activity, body type. Body type can  be a predictor of insulin sensitivity. Those are some of the key factors, but microbiome was a big one.

And so, we’ve actually had a number of people on ketogenic diets use continuous glucose monitoring and find that they were actually able to eat more carbs than they thought and still stay very much in a fat burning ketogenic space because for whatever reason, those carbs weren’t actually affecting them quite as much.

So I think we’re going to see… And I also say we’ve had lots of early customers come to us seeking continuous glucose monitoring for weight loss, and we’ve seen some really exciting early results. And people saying that this is the easiest it’s ever been, because as opposed to just guessing and depriving, I’m just figuring out how to eat and live to keep my glucose low and then you basically know that you’re keeping your insulin low, and then you know that you’re going to have more likelihood of getting into fat burning. So we actually just recently… Yeah.

Dr. Mindy Pelz: [00:34:45] Oh my God! Go ahead. I love this. No. I just… I hope all my Resetters are listening to this. This is just beautiful. This is the kind of level of healthcare we need, but continue on.

Dr. Casey Means: [00:34:57] I was just going to say we did a small pilot. It was called “Our Weight Loss Challenge” and basically the only thing we asked people to do is to try and keep their glucose under 120, so 120 milligrams per deciliter, which is pretty liberal. It’s not that hard to stay under 120, but for the average American they’re getting higher than that quite frequently. And we found that in 30 days, for people who were able to keep their glucose under 120, they lost an average of eight pounds in that 30 days. And it actually, if you actually stratified them by BMI, the higher the BMI, the more the weight they lost. We didn’t study this in explicit detail in this particular pilot, but I would expect that the people with the higher BMI’s had slightly more insulin resistance. And so by keeping the glucose low, they really were able to get that break of the insulin off and start to really see some of those quick results. So I think there’s a lot of promise there, but it’s just  more research needs to be done.

Dr. Mindy Pelz: [00:35:52] Yeah. We do a lot of DUTCH Tests on women that are over 40 going through hormonal changes and the one thing that we can see when we start to monitor repetitive DUTCH Tests is that when they get their insulin under control, all of a sudden their sex hormones get under control. So I’m thinking, as you’re talking, I’m like, what about for the menopausal woman who is looking to HRT or bioidenticals, is out of answers, and you put a continuous glucose monitor on her, you get her to stabilize her sugar  and her insulin and now you’re in the ballpark of being able to manage her sex hormones. To me, insulin is the door, blood sugar is the door into all these other hormones because it’s the one that changes so fast and that you can manipulate so easily with lifestyle.

Dr. Casey Means: [00:36:44] Yeah. I think there are so many interesting implications for women’s health with this. And I think this is going to emerge, the technology that can really uniquely impact women. Men too, but I think there are a lot of amazing use cases for women and particularly relating to hormones. And so one interesting thing about insulin is that there are insulin receptors on, I believe, every single cell type in the entire body, which is pretty incredible that every… We have so many different cell types and almost every single one has insulin receptors.

So it has an incredible amount of activity all over the body. So when it’s dysregulated, it can cause problems. And one of the places that there are quite a few insulin receptors are the Theca cells of the ovary. And so they are going to respond to high insulin levels, which you are going to have, if you are eating that refined carbohydrate or refined sugar diets spiking your glucose a lot and going down that trajectory of insulin resistance.

So what happens when the insulin stimulates the Theca cells is they actually… In the ovaries as they increase in number, they also produce more androgens, more male hormones. So basically insulin is stimulating your ovaries to make more male hormones and this is really foundationally one of the pathways that leads to Polycystic Ovarian Syndrome.

Dr. Mindy Pelz: [00:37:55] I was just going to say, PCOS is the number one hormone issue for women. This makes perfect sense.

Dr. Casey Means: [00:38:02] Yeah. So there have been amazing studies that have been done, one a few months ago that was powerful, looking at a ketogenic diet for PCOS, and the data was phenomenal in terms of resolution of FSH and LH and estrogen, progesterone, testosterone, weight, cholesterol. Everything improved by keeping glucose down on the diet. And it makes a ton of sense – and their insulin sensitivity of course went up. And so insulin sensitivity goes up by keeping the glucose down over time. That means less insulin circulating in the body, less stimulating to Theca cells, less androgens. And then it’s just like a waterfall effect of all the goodness that that comes from that.

And then the second thing with the menopausal women is that… Something really interesting about menopause is that as estrogen declines… Estrogen tends to be sort of like a pro metabolic hormone. It helps us and when estrogen declines, we see women start to have really increasing rates. The slope of the line of incidents of obesity and diabetes goes up right after menopause and that’s actually when women start to exceed men in terms of rates of diabetes and obesity. So when that estrogen declines you are in worse shape, basically, worse risk metabolically. So I think there’s a huge opportunity to help women become more metabolically aware during that time so that they can modify their activity, their food, and be aware of whether they’re starting to go off this metabolic cliff at that time because it’s an at-risk time. So I think that would be great for women in their perimenopausal time to be thinking through the lens of metabolism, glucose. And then you also think about how Alzheimer’s rates are double in women compared to men. Alzheimer’s, which is now being called Type 3 diabetes, because we’re realizing that one of the physiologic pathways that leads to it is insulin resistance in the brain. The brain cells can’t get enough energy because they’re resistant to this hormone. And what happens when you can’t get an energy in a cell type, they start not functioning well, and that can lead to dementia. And so I think this metabolic cliff that happens at menopause plus what we’re seeing with Alzheimer’s, I think that’s very related.

So first step, helping people understand where they’re at and how the choices they’re making are impacting that. So that’s what I’m very passionate about. Yeah.

Dr. Mindy Pelz: [00:40:20] So I have a book coming out in the spring called “The Menopause Reset” and it’s all about my journey. I’m 51 and it’s really about my journey with my health as I have moved through menopause. And one of the things I wish somebody had told me… And I have had a really… I mean, my lifestyle in my forties was healthy. I wasn’t eating, going to fast food or anything like that. But what I found is that at 40, as your ovaries stop producing sex hormones and your estrogen is going up and down and you become more insulin resistant, there is a lifestyle that has to match that. And once I figured out that lifestyle, I found I could manage my hormone ups and downs a lot better. But how many women aren’t finding that lifestyle? And then they’re being shamed, or they’re not talking about it, or they’re being given medication. And the damaging part of that is if the lifestyle doesn’t change, like you said, they now move into their 50’s, 60’s and they’re unprotected. As far as their hormone imbalance is so low, they’re getting cancer, they’re getting Alzheimer’s. There is so much that needs to happen for a woman as she shifts into that, and again, this is why you got to get this out to the world.

Dr. Casey Means: [00:41:36] I think that book is going to be so valuable for people and I can’t wait to read it. And actually, I just published an article on our blog, our Levels Health blog, about menopause and glucose, because aside from all the stuff we were just talking about, like risk profiles, there’s actually some evidence that the symptoms of menopause could be quite a bit better if people’s glucose were under control. And a key one is hot flashes. Insulin sensitivity seems to really impact the autonomic nervous system and create basically more vasomotor activity. So like blood vessels, constricting and whatnot. And so people who are insulin resistant or have overt diabetes tend to have significantly higher hot flash frequency than people who don’t.

And so I think there’s going to be maybe some interesting opportunity there to help people actually, almost like a biofeedback tool for hot flashes. How could keeping glucose more stable be actually an adjunct, very natural tool, no hormones or anything like that to help you with that symptom that is so troubling to so many people.

And there was a company, a digital health company called The Cusp, that’s really interesting that’s basically holistic telemedicine, menopause care and they’re all over this. They’re thinking like, we’ve got to be thinking about metabolic health and glucose when we’re talking about symptoms and I don’t think it’s something we’re thinking about in the mainstream OB GYN community, but certainly I’m talking to my OB GYN colleagues about it, and everyone’s very receptive to learning about it. So yeah, I think…

Dr. Mindy Pelz: [00:43:06] Yeah. I actually tell a story in the book about how, when my symptoms started to appear, I went to a friend of mine who is an OB GYN that’s very well-respected. And I was hoping she was going to have the cure for my menopausal symptoms. She stopped everything she was doing and she looked at me and said, “Mindy, I have a practice full of women like this and my medical textbooks have failed me.” That’s literally what she said. And I was like, “Whoa! You mean there’s no solution?” And that was almost 10 years ago and I’ve since uncovered so many solutions, but blood sugar being a major, major one. And it’s just not talked about, and women are suffering in menopause. And this is a time when wisdom is at its highest and the kids have left the nest. And this is a time we should be thriving, not a time that we should be now struggling with our health.

Dr. Casey Means: [00:44:00] Yeah, absolutely, and the same goes for men. There are so many sexual health areas where I think glucose monitoring could help men so, so much. I think one of the key ones, erectile dysfunction. We know that erectile dysfunction is significantly worse in people with higher glucose levels and this… I don’t think the average urologist is talking to their patients about this, but for anyone out there listening who may have a friend or a partner who has this issue, if you’re not thinking about glucose, you’re doing yourself a total disservice, because it’s actually such a strong link. There is research published suggesting that people who present with erectile dysfunction should be considering that basically a warning sign that they need to get checked for metabolic dysfunction because it’s so, so, so related. So before reaching for a pharmaceutical or other things, truly the easiest thing you could do is figuring out how to clean up your diet to keep your glucose stable and improve your insulin sensitivity. So I just think it’s fascinating and I’m really hoping we see more of this trend over the next five to 10 years, to thinking about these root causes, because when you… Let’s say the motivator for a 40 year old man, who’s having this issue is to improve their erectile dysfunction, what they’re going to get from that as a side benefit is so much in terms of improved health. They’re going to have better workouts. Their brain is going to function more properly. Mood is probably going to improve, less risk of heart disease, diabetes, and obesity. So whatever the motivator is, that’s great. But the beauty is that this has such pleiotropic impact on health that it’s going to have wide reaching effects.

Dr. Mindy Pelz: [00:45:39] I love that. It’s like you clean up one thing and all these conditions, the comorbidities, they all clear up. It’s quite incredible.

Talk to me a little bit about what else raises blood sugar. So we know that we have food as a big thing. My community knows quite well that how often you’re eating… So if you’re eating all day, that messes it up. But there are other things that are messing up our blood sugar. Can you talk a little bit about that?

Dr. Casey Means: [00:46:05] Yes. Absolutely! So I would say there’s really like five others that are, I think, important to recognize. So food – that’ a whole category that I think… Your listeners are probably very familiar with. Food timing is a big one, food sequencing, and then food combinations. So that’s huge.

The others would be exercise, physical activity, stress, sleep, micronutrient status, and microbiome. So those are the key things that I focus on. And I will actually add one more, which is environmental pollutants.

Dr. Mindy Pelz: [00:46:33] I was just going to say obesogens and toxicity. Okay.

Dr. Casey Means: [00:46:36] Yeah. That one is becoming more and more recognized, but very, much early on with that aspect of things, but I think it’s key for us to start thinking about. So exercise – just briefly touching on these, so exercise. We pretty much know that every single type of activity you could possibly… If you’re moving your body, you’re improving your metabolic health and your insulin sensitivity, whether it’s resistance training or power sports, whether it’s stretching and yoga and more gentle type activities like that, high-intensity interval training, or just moderate aerobic activity. All of these things in research has been shown to improve our insulin sensitivity and our blood glucose control.

Two things that are worth mentioning here. One is that high-intensity interval training, people actually often see their glucose rise during high-intensity training. So if your heart rate or your VO2 is above about 80% of your max, you’re actually going to see your glucose rise during the workout. And that’s not necessarily a bad thing because it’s not from the food you’re eating. It’s actually your body releasing its stored glucose to feed the muscles. So actually you’re working through your stored glucose to feed those muscles and clearing out that liver storage, which is a good thing because it means that once you move through that, you’re going to start burning fat and you’re going to flip that switch from glucose burning to fat burning. So not a bad thing if you see your glucose rise during high-intensity training, even if you’re fasted, you don’t have glucose on board. So that’s one thing to note.

The second fun sort of thing to think about with exercise is, there’s some studies showing that… They’re basically taking three different groups and saying, if people work out once a day for like an hour versus take that amount of time and split it up into really small chunks all throughout the day, which is better for glucose? It turns out that the small chunks throughout the day is better for glucose control than one workout. So if you just take a one-hour walk in the evening, it’s going to improve your glucose and your insulin. But what would be better is to actually take a two-minute walk every 30 minutes throughout the entire waking day – so 30, really short. So that has huge implications for our workday. Standing up every 20, 30 minutes and just taking a brief two-minute walk is actually going to have lower 24 hour glucose and insulin levels.

And they’ve done a similar study with taking 20-minute walks before every meal, taking 20-minute walks after every meal or taking two-minute walks every 30 minutes throughout the whole day. And again, it was the more frequent ones that was better. So moral of the story, be more active consistently throughout the day.

My thought on the mechanism of this is that when you stand up from a chair or even walk five feet, you’re having to activate basically every single muscle in your big muscle groups, your quads, your hamstrings, your calves, your abs, maybe not so much your arms, but that’s a lot of muscle contraction even just to walk across the room. And if you’re just doing that throughout the whole day, that’s a lot of activating those pathways, and it’s getting things moving and it’s reinforcing those adaptations. So, bottom line…

Dr. Mindy Pelz: [00:49:30] And it’s doable. It’s doable. So instead of waiting, I got to work out at the end of the day and then you don’t work out. If you think of it in shorter chunks… Again, now we’re back into making an effortless lifestyle.

Dr. Casey Means: [00:49:42] Right. But it doesn’t jive with our normal workday and the way schools and work is set up where it’s just like sit, sit, sit, sit, sit. So it doesn’t inspire the need to think a little bit differently about how we structure our time, but it’s very achievable. It’s very easy. It doesn’t hurt. So that’s just a few things about exercise.

Stress is the second one, really a key factor in maintaining stable glucose levels. When you stress, you release cortisol and epinephrine are catecholamine hormones and these travel the body and they tell our liver to dump our stored glucose to basically fuel our body for other stressful things we have to respond to. And this made sense way back in the day when maybe our stressful events actually were physical in nature. We were being chased by a lion and we got stressed and we had to run and our muscles needed sugar. That’s no longer the case. Now almost all of our stressors are actually psychological in nature. It’s a text. It’s an email. It’s going on a podcast.

Dr. Mindy Pelz: [00:50:40] Just go to your phone and…

Dr. Casey Means: [00:50:42] Cortisol… So we need to recognize this maladaptive physiology and realize that when we do evidence-based mindfulness activities, like taking a deep diaphragmatic breath, which activates our parasympathetic restful part of our nervous system, lowers our cortisol, we are actually… Our cells hear that, every cell hears that and it stops that pathway of glucose being released in this maladaptive way. You’re just basically causing little glucose spikes throughout the day if you’re having an uncontrolled stress response.

And the key point here is, we can control that stress response. We can do it. There are so many evidence-based strategies. The simplest is breathing. Every time we feel stressed, we should take a deep breath and realize that we’re actually having an impact on one of the key health pathways of our body, which is our metabolism.

Dr. Mindy Pelz: [00:51:31] And where we see that just in our community is people are like, “I’m doing everything, but I’m struggling to get into ketosis, or I’m not losing weight.” And what I want to add on to that sentence is, you might be doing everything with your food, but where is your stress? We don’t tend to think of stress as being this thing that elevates our blood sugar.

Dr. Casey Means: [00:51:53] It’s so true. I think we focus a lot on food and food is key, I think, but I like to say that food is necessary, but not sufficient for optimal metabolic health. You can’t meditate your way out of a terrible diet in terms of metabolic health, but you also, if you are chronically stressed, you are going to see problems with glucose, in my opinion, and from what I’ve seen in my patient population.

Dr. Mindy Pelz: [00:52:16] Absolutely!

Dr. Casey Means: [00:52:16] So the one that goes hand in hand with that is also sleep, which is kind of the third pillar that I think is under-recognized and I’ll keep this one brief. Basically, if you sleep one hour less per night than you should for your body’s needs, you will see a significantly higher insulin and glucose response the next day, and sleep deprivation increases cortisol, growth hormone, insulin. It also changes our ghrelin and leptin levels, which are satiety and hunger hormones, and just creates a profound hormonal cascade that is not good for metabolic health.

And just briefly, two quick studies. One, they took healthy young non-diabetic men and subjected them to four hours of sleep per night for six nights and took them from non-diabetic to pre-diabetic in that short amount of time. It was reversible, but a lot of college students out there are probably burning the candle at both ends, maybe four hours of sleep multiple times per week.

And the second one is that… There was a study that looked at people who needed 7.5 hours of sleep who got 6.5 hours of sleep. The next day, if you do that, so just one hour less, and you do an oral glucose tolerance test, which is a test where you chug a bunch of glucose, 75 gram glucose load, and then you see what your glucose and insulin do in the two hours after that. The people who slept an hour less had the same glucose response, but they needed to secrete 50% more insulin to get that same response. So they were insulin resistant the next day. So we do not want that.

Dr. Mindy Pelz: [00:53:47] In one night, missing one hour, one night increased your insulin resistance. Wow! That’s crazy.

Dr. Casey Means: [00:53:56] And  I’ll follow up with some of these links because it’s really interesting.

Dr. Mindy Pelz: [00:53:59] No, it’s great.

Dr. Casey Means: [00:54:00] So sleep, stress, food timing, exercise, and then the micronutrients one is really one of my favorites, because I really practice ‘ food is medicine’ and I love nerding out on the biochemistry of food. But I think the key thing here to remember is that for glucose to be processed by the mitochondria or for fat to be processed in the cells, that requires proteins, it requires enzymes, it requires pathways and all of those machinery require micronutrients like locks and keys to let them work. Some of the key ones for metabolism are vitamin C, zinc, magnesium, manganese, a lot of the B vitamins, lipoic acid. So these are things that come from food. We are eating the most nutrient poor diet we’ve ever basically eaten throughout history. Our soil is depleted, lots of issues with that. So we’re micronutrient depleted for a lot of these key nutrients. So we have to remember that for our machinery to work, it needs these micronutrient substrates. So it’s way more than just macros, it’s also micro. So that means getting back to that whole foods diet, really getting nutrient rich foods, making sure we’re getting lots of probiotic sources to basically optimize our machinery.

Same with microbiome. We know that dysbiosis and poor microbiome is associated with worse metabolic health and increased risk for obesity. So we’re doing a lot in our culture that hurts our microbiome, from chronic stress to nonsteroidal anti-inflammatory medications, to pesticides, to overuse of antibiotics, to so many other things. And so the more we can do there to seed our microbiome with healthy foods and probiotics and prebiotics, I think the better for metabolic health.

Dr. Mindy Pelz: [00:55:33] Yeah. And where we see that is that people are frustrated with their health and they don’t realize how many things are taking them down a bad path because they’re just living life the way they did 20, 30, 40 years ago.

But the environment has changed. The food has changed. The amount of information has changed. The toxic load has changed. Your microbiome is being destroyed. It’s overwhelming and it’s hard to grasp, and then you feel lost and you don’t really know what you can control, which again is why something like a monitor would be so great because I can see where it would just be like the way to claw yourself out of this modern world that has our health really mixed up.

Dr. Casey Means: [00:56:19] Yeah.

Dr. Mindy Pelz: [00:56:21] Okay. Talk about HRV, because I have to ask you about HRV. We’re mildly obsessed on HRV within my office and within my Resetter community. I love my Whoop. It’s just really been helping me understand all the different things that will affect my HRV. What is blood sugar and HRV? You talked a little bit about it. Is there a connection there?

Dr. Casey Means: [00:56:42] Yeah. So there is a connection and HRV is this objective measure of stress that we can see now, which is incredible. And so to me, I wear an HRV monitor. I actually wear the Lief Therapeutic HRV monitor, which I love and I love Whoop as well. But the Lief Therapeutic is actually a little stick-on that goes into your heart and it’s like an EKG that’s sending real time…

Dr. Mindy Pelz: [00:57:06] that would be neat.

Dr. Casey Means: [00:57:08] It is amazing. As opposed to averages, it gives you real time every second HRV because it’s actually an EKG on your chest. And you can see if you do breathing or whatnot. It immediately will  increase your HRV.

Yeah. So that’s what I’ve been using and trying to make some correlations between my glucose and my HRV and I certainly think that just from my anecdotal experience, that when I have more glycemic variability, meaning up and down spikes in my glucose, I tend to see my HRV go down. And so I do not think we have any research on non-diabetics to actually support a direct link there, but from the cortisol and the stress standpoint, I think there’s definitely something there that we’ll see more research into. But I think  it’s really bi-directional.

And so we can think of a glucose monitor, an HRV monitor together as a really powerful mindfulness tool. It could really become something that motivates us to both eat in a way that keeps HRV up. We want our HRV to be up.

Dr. Mindy Pelz: [00:58:06] HRV is confusing like that because you want it high and everything else we’re trying to get low.

Dr. Casey Means: [00:58:12] Exactly. So because I think the low HRV is telling us that we’re sort of objectively stressed, we’re going to see glucose potentially go up and if glucose goes up and is really fluctuating, it might also make HRV go down. So it’s this loop and the more we can tap into ways to improve our HRV, the more we might see glucose be controlled and same with glucose and HRV.

So I think there’s huge, huge potential there and something that excites me a ton, because I think all about mindfulness and mindfulness based stress reduction is how this tool that’s a glucose monitor could actually end up becoming a mindfulness tool. Like that just blows my mind, but I think we’ll get there.

Dr. Mindy Pelz: [00:58:47] Yeah.  And like I said, when I wore this monitor that my friend had given me… This was like three years ago and I just was shocked. Literally one disagreement with my teenage daughter, and she walked out of the room, and I looked down at my monitor and I believe it had gone up 20, 30 points. And I thought, “Oh my God!” At that point, I never realized the impact that stress was having on my blood sugar. I was more into looking at it from a food standpoint and a fasting standpoint. But that just was mindblowing.

Dr. Casey Means: [00:59:20] It is mindblowing. A very similar thing happened to me when all of this COVID remote work stuff happened. I had to give my first talk/ presentation on Zoom and it was just confusing. You had to share your screen and so much was going on and you can’t see all the people watching. And it was very stressful because I didn’t quite know if it was working. And I looked down afterwards and my glucose had gone up like 35 points right then. And I was like, “This is fascinating!” Because I did feel stressed. I didn’t feel profoundly stressed, but my body was telling me, “You are churning out stress hormones.” And so from then on out, I’ve been much more intentional about doing breathing when I’m feeling even a little bit activated, because I do not want it to be throwing off my glucose all day. So yeah.

Dr. Mindy Pelz: [01:00:05] Right. And if you have the monitor there, I mean, this is how the Whoop works. The other day my parents were over and they wanted to sit and chat and I was like, you got to go to bed because there’s people watching my sleep right now. And so I need you to leave so I can go to sleep so that I don’t have my friends tomorrow morning, our little whoop team and say, “Hey! What happened to your sleep last night?”

Dr. Casey Means: [01:00:26] What did you do?

Dr. Mindy Pelz: [01:00:27] Right. Exactly. So it’s awesome like that.

Dr. Casey Means: [01:00:30] I can’t wait to see how the social community emerges around glucose as well. Because I think it’s inherently very fun to share with people, and I think similar to Whoop, we’re going to start seeing people… We already see it on Twitter and Instagram with people using Levels that everyone screenshots their data and wants to share it, “Oh my God! I can’t believe this is what ice cream did.” “Oh my gosh! I can’t believe how much this walk decreased my glucose.” So much research has shown that social elements to health programs helps with success and I think this will be no different with glucose as well.

Dr. Mindy Pelz: [01:01:03] Yeah. One of my major principles is that, especially for women, is that we shouldn’t be doing health alone because we thrive off oxytocin and we get a burst of oxytocin when we’re connected to others and oxytocin brings down cortisol and cortisol can affect insulin and insulin can affect sex hormones. So if we do things in community, we really can have a massive impact on all of those hormones.

So I hope… Are you guys coming out with… Whoop has a team effect where you can all share data? Does your app do that?

Dr. Casey Means: [01:01:37] At this moment, we do not, but we just raised a round of seed funding and so we’re really investing in the product and community features are a big part of our roadmap because yeah, I’m a big believer in exactly what you just said. We do better with community and I think people inherently love talking about food. So it lends itself to that.

Dr. Mindy Pelz: [01:01:57] I love it. I love it. So how do people find your product? When I first heard about it… This is what I heard. It’s amazing and there’s like a 40,000 person wait list.

Dr. Casey Means: [01:02:09] People can find us at levelshealth.com and I definitely recommend our blog too. It’s levelhealth.com/blog. Lots of awesome, really forward thinking guest writers who are writing about metabolic health and how it relates to the average person, non-diabetic individuals, people looking for performance gains, disease prevention, all sorts of stuff. To get access to the product, which is continuous glucose monitors and an app that helps you interpret the data really effectively that we are now in a beta program for that. So we do have 54,000 people on the wait list now, but we have a code for your listeners and so they can skip the wait list if they want to sign up. And so we will get that to you hopefully in the Show Notes or something like that.

Dr. Mindy Pelz: [01:02:49] Yeah. We’ll put a code in there and I love that we could hop the waiting list. Is that correct?

Dr. Casey Means: [01:02:54] Yeah.

Dr. Mindy Pelz: [01:02:54] Is that how this works? Thank you.

Dr. Casey Means: [01:02:56] Yeah.

Dr. Mindy Pelz: [01:02:56] We have a motion motivated group of people that will definitely jump on board. So we’ll put the link in the Show Notes and I appreciate you doing that for us.

Dr. Casey Means: [01:03:05] Absolutely!

Dr. Mindy Pelz: [01:03:06] And then we also have… We’re taking the large amount of people that are fasting and applying variations to diet in our community and we’re having them all look at their Whoop. And what I’d love to do is be able to have everybody’s Whoop and have everybody share what they’re learning with your continuous glucose monitor and then it would be fun to give you guys the data back over hundreds of thousands of people and it would be fun to see what you do with it or what we can all pull out of that.

Dr. Casey Means: [01:03:34] Definitely. Yeah. I think especially with the recovery score and whatnot, which I believe we’ve had. The score…

Dr. Mindy Pelz: [01:03:40] It has a strain score.

Dr. Casey Means: [01:03:41] Right. Right. It would be interesting in your groups to see if people… We have a metabolic fitness score in our app and so starting to see how those things can connect. So yeah, that would be great to get some feedback on that.

Dr. Mindy Pelz: [01:03:54] We’ll go to town on this, so we appreciate it. Let me finish up with this. I have five questions for you. And so let’s start with this idea of ‘medicine is changing’ and if you were talking to somebody who was thinking about a career in western medicine, what advice would you give them?

Dr. Casey Means: [01:04:15] Wow! That’s a big question.

Dr. Mindy Pelz: [01:04:17] We  go deep on this podcast. Didn’t I tell you?

Dr. Casey Means: [01:04:21] I think I’m biased, but I think there’s no better career to be in than healthcare. I think it is just the intersection of so many things that are important. It’s the intersection, of our personal identity, of the environment, of all of our behaviors and also with the earth, because ultimately health is the intersection between the earth and our body and how those two things interact – food and environment and air and water. These are all things that translate in our bodies to our biochemical reality. And so to me, healthcare is a constant joy. It’s always evolving and it really brings philosophical and very meaningful thoughts and relationships into everyday life. So I can’t recommend it highly enough. Something that I would say is, I’ve taken a somewhat unconventional road through medicine. I was at Stanford for my whole training. I became a head and neck surgeon, and then I completely transitioned out of surgery because I wanted to really focus on doing everything I can to empower people to understand their own health better and to really look at tools that could help people make decisions in their life that would generate better health and just empower the individual as opposed to being really reactive and telling people things from this much more authoritative place. So that’s what my career is focused on now is empowering you with data to understand their bodies and their lives better and feel more agency and empowerment.

And in terms of my journey, I think what it really highlights, and I hope to others as well, is that you can take any path you want through healthcare. I think we often make medical students or students think that there’s one road in healthcare and you just have to follow it or you’re some sort of pariah or outcast. But the reality is that you can do whatever you want in this life that is the way that you want to make a stamp on the world and the sky is the limit. And so I think getting the education and the learning, whatever path that is, whether it’s MD, DO, nurse practitioner, nurse, physician assistant, whatever it is, having that knowledge gives you a lot of ability to have an impact in the world. So that’s what I would say.

Dr. Mindy Pelz: [01:06:29] It’s so well said. When we were in school, there was a very cookie cutter path for every degree you got and now it seems like you really do create your own career. So pick what you love.

If you could add anything into the medical school curriculum, like any courses, what would you add in?

Dr. Casey Means: [01:06:50] Nutrition. About 150 more hours of nutrition I would say. The average medical student gets, I think, less than 15 hours of nutrition in their whole medical school training and yet almost every leading cause of death in the US is related in some way to diet. And so it is one of the most massive disconnects in our country that doctors are not experts in nutrition.

Dr. Mindy Pelz: [01:07:12] Yeah. I really hope that changes. Again, when we look at how the world needs to change and look at health differently, gosh, I agree. Nutrition needs to be at the top.

What do you feel was the biggest lesson you have learned in 2020? We all got a big dose of life lessons. Do you have one that you feel was an ‘aha’ for you this year?

Dr. Casey Means: [01:07:33] Oh, so many lessons this year and these are great questions. I think this year has been wonderful for bringing me back to some of the simple pleasures. I think, never more than this year have I just really cherished a neighborhood walk or getting to connect with someone socially distant in a park. It’s just incredible. I think when everything changes and a lot of our flexibility and options are removed to realize that actually pure bliss and fundamental happiness can come from just the absolute simplest things. And it was really nice to have this forced stepping out of our normal hustle and bustle and flow and just realize that so much of that joy is not related to any of those externalities. And  I did say this spring especially, I was in Portland, Oregon. The flowers are blooming and the fruit trees were blooming all over the city and some of those walks were some of the happiest moments of my year and I think it’s because a lot of distractions were removed, so…

Dr. Mindy Pelz: [01:08:27] Yeah. Oh, amazing. Okay. Last question. If you had one message for the world that you could get implanted in everybody’s brain that would really move our world forward, what would that be?

Dr. Casey Means: [01:08:41] For me, that would be that health is in no way a one-way street. We can always improve and we can always… The body is such a resilient, beautiful machine, and it has the ability to self-heal and it’s constantly just churning and buzzing and wanting to get back into order. And the choices we make every day related to all the things we talked about today are the way that we can give ourselves and our bodies the instructions to move in the right direction. But there’s always hope with the body and with health. And that’s just a really beautiful thing about biologic organisms. And so never feel hopeless. There’s always a way to improve and there’s a lot of people out there who want to help others improve their health, starting with things like listening to podcasts like this and reading some of these wonderful integrative and functional medicine doctor’s books, and books like yours and instead of searching, looking at maybe WebMD or whatnot…

Dr. Mindy Pelz: [01:09:34] I was just going to say…

Dr. Casey Means: [01:09:36] Search a symptom or a term, and maybe tack on integrative health or functional medicine or root cause and start to see what else you see out there, because there’s a lot of evidence and research to support more holistic approaches to things that are very, very science and evidence based. And unfortunately we don’t see a lot of that in the mainstream, but it’s out there and so lots of great information, but just have to sometimes look through a slightly different portal to find that stuff.

Dr. Mindy Pelz: [01:10:01] Oh, well said. That was amazing. Thank you so much for taking your time. And it’s funny because I do get all these questions about blood sugar that people ask me all the time and you just took my understanding of blood sugar to a whole other level. And I love your science and I love what you guys are doing. So thank you so much for taking over an hour and a half with me and educating our community. You guys are doing incredible work. So thank you.

Dr. Casey Means: [01:10:28] Thank you so much for having me on, Dr. Mindy, and I really enjoyed this conversation. I’m very grateful to be here. Thank you.

Dr. Mindy Pelz: [01:10:35] Hey, Resetters, I just want to start off by saying thank you so much for all your wonderful reviews and those of you that have left me comments on iTunes. I just greatly appreciate your thoughtfulness and how much you guys are enjoying these episodes and then it seems like you’re enjoying them as much as I am enjoying doing them.

One of the things that I’ve learned in just interacting with so many people is that we’ve really lost the art of deep conversations and for me, the Resetter Podcast stands for having meaningful conversations with people who are thinking about health, about life, about mindset in a way that we may not be getting on social media or in mainstream media. And so I just want to say, give you guys a shout out and just say thank you for participating in this process with me, because as much as I absolutely love delivering the information to you, I love even more knowing that it’s impacting your life. So please let us know if there’s anything we can do to make this podcast more customized to you, to make it better. We are now officially in Season Two and we are working to bring you the best conversations that health influencers have, that mindset changers can give and to really deliver you something that you’re not able to get anywhere else.

So from the bottom of my heart, as I always say my YouTube, from the bottom of my heart, I am deeply appreciative of you. I am deeply grateful to be on this journey with you and let’s get healthy together.