Level Up your Metabolic Health with Dr. Casey Means #WellnessWednesdays

In this episode of The Be Well by Kelly Podcast, host Kelly Leveque speaks with Levels co-founder Dr. Casey Means. They dive deep into glucose analysis and the ways you can manipulate sleep, exercise, and food patterns to generate optimum health and sustainable energy throughout the day.

The role of blood sugar dysregulation

As a surgeon, Dr. Means eventually realized that there was a common thread to conditions marked by chronic inflammation: blood sugar.

One of the big triggers of chronic inflammation is disordered blood sugar. It’s when our blood sugar goes up and down really, really rapidly, we generate chronic inflammation. And that became really, really interesting to me because not only does it lead to the immune system getting revved up, but also a lot of the patients I was seeing in the hospital, so many of them did have really extreme blood sugar disorders, like severe obesity and diabetes type two diabetes. And in surgical patients, people who do have type two diabetes, it can make the recovery a lot more difficult. It can make wound healing more difficult. It can just make the whole postoperative situation much more difficult. So, I was seeing this from many, many levels, and really became interested in all this blood sugar dysregulation.

The missing link between lifestyle and blood sugar

The Levels program allows individuals to understand how food and daily habits impact their blood sugar for better or worse.

I thought I wanna create a product that empowers people to understand how food and lifestyle decisions are affecting their blood sugar in real time, so that hopefully we can make more informed decisions over the course of our lifetime, that will keep us out of trouble and also just help us feel better in the here and now. So that’s what Levels does, as you mentioned in the intro. It’s the first program that’s wearable, that you wear on your arm, and it tells you constantly 24 hours a day, in real time, how everything you’re doing food choices, sleep, exercise, if you’re stressing, how all these things are contributing to our blood sugar. And ideally, we want our blood sugar to be pretty low and pretty flat, a very gentle low rise after meals, but otherwise really in a low unhealthy range.

The reactive world of medicine

Instead of being reactive like so much of the medical world, Levels wants to empower people to be proactive bout health.

We’re really approaching medicine almost universally through this reactive approach, we’re just waiting for diseases to emerge and then we’re turning around, and we’re doing invasive things and we really need to be focusing on the front end. And that’s really a whole movement in medicine called system and network biology, which is so fascinating. We like to sort of think of diseases as isolated silos. Like diabetes is one thing, obesity is another thing, chronic liver disease is another thing, infertility is another thing. But in reality, if you look at the systems and the networks of what actually links those diseases on a physiologic genetic level, we actually see that there’s these linkages, and you can treat at that level and that’s much more efficient. because then instead of applying a drug to each of those things, you’re actually applying something to the root.

Signs of out-of-whack blood sugar

If you’re oddly tired and hangry, it may mean that you need to work on being more metabolically fit.

A lot of us might experience that hanger that we get between meals where our blood sugar is kind of getting lower and we immediately feel like this panic we need to eat, because our bodies are just so used to using glucose for energy. But if we train our bodies to actually get to a state where we can burn fat for energy pretty regularly, we become metabolically flexible. And when we don’t have enough glucose around or it’s getting a little bit low, we switch into fat burning. And that’s a great state to be in because we have a lot more fat stored in the body than we do have glucose for energy. So, we wanna be able to sort of bounce back and forth. And when we can keep our glucose spikes and our insulin spikes kind of in a more low and reasonable level, we allow our bodies to tap into fat burning much more frequently.

Why do Levels over a healthy diet?

It might seem extraneous to invest in something like Levels if you already eat healthily. But in reality, even something as innocent as a banana could be causing your blood sugar to spike.

I can imagine that some someone out there is listening and saying, well, why don’t I just follow a low-glycemic diet or like a low carb diet? Like, wouldn’t that just get my blood sugar to be flat? And why do I need this device in my arm? And I think that’s a great question. I think something that’s fascinating that’s only research has come out in the past five years or so is that, actually each person is gonna respond to carbohydrates completely differently in terms of how it raises your blood sugar. You and I, Kelly, could both eat like a banana and I could go up to a glucose level of 170 and you might go to 120. And so, for you, it’s gonna have less of that insulin surge. It’s gonna probably be a better metabolic choice for you than it is for me.

Three ways to measure glucose

If you want to measure your glucose levels, you can measure fasting glucose, oral glucose, or hemoglobin.

There’s really three ways of looking at glucose levels. There’s your fasting glucose, which is your glucose first thing in the morning after having consumed no calories for eight hours. And for that, if you’re below a hundred first thing in the morning after consuming no calories, that’s considered to be normal. 125 is pre-diabetic, and then 126 or above is diabetic. The second test is what’s called an oral glucose tolerance test. So, that’s where you take 75 grams of glucose in a drink called Blue Cola, and then your blood glucose is tested over the next two to three hours. And basically you’re seeing how high the spike goes, and then how quickly you come down to normal…And then there’s a third test, which is called hemoglobin A1C, which is, your measure of about three months of the average glucose. And that’s looking at your red blood cells and how much sugar is stuck to them. And that comes out as a percentage. So, if your hemoglobin A1C is below 5.7%, you’re considered normal.

Get a grade for every meal

When you wear a Levels CGM, you get immediate feedback in the form of a “meal score” after every meal.

We have a scoring system called zone scores that helps make that really simple for people. So, a zone score is, let’s say you eat some food and then we track it for two hours after that meal, and we take a bunch of composite metrics about what happened during that post-meal sort of event. How high did you go from baseline? How long did you stay elevated? And different factors like that, how quickly did you come back down to normal? And we just give you a one through 10 score. 10 is what we’d call like a perfect metabolic score, or you at a minimal glucose response, you came back down very quickly. Zero is like you shot up and you may have taken like a little while to come back down. That’s what we don’t want. And so, you can just sort of scan through all your own meals and say, okay, these are all tens for me, these are all nines, these are all eights, I wanna stick with those, and I really wanna avoid the things that were like zeros, ones, twos, threes, fours, or figure out ways to modulate those.

The benefits of a smaller eating window

Evidence shows that when you eat in a narrower time range, there are physical benefits.

There’s been some research showing that people who actually eat in a narrow window throughout the day, so more time restricted feeding, tend to have lower 24 hour glucose and insulin Levels. There’s a study that actually took people and gave them the exact same number of calories. But one group ate between 8:00 AM and 8:00 PM. So, like a full day of eating, and then one group eight between 8:00 AM, and I believe it was 2:00 PM. So, a very narrow window, and none of us wanna stop eating at 2:00 PM, but that was what the research looked at. So, it was a six hour feeding window versus a 12 hour feeding window, exact same number of calories though. And they found that the people in the narrow feeding window, even though they had the exact same number of calories, had lower 24 hour glucose and insulin Levels. So, that’s pretty interesting.

The benefits of a full night’s sleep

Another factor that can significantly impact glucose levels is whether or not you are well rested.

I certainly didn’t know how huge an impact sleep deprivation has on our metabolic health and our glucose. But it is profound. When people even sleep on average one hour, less than optimal. So, looking at like short sleepers, in some of these studies they’re called who sleep about 6.5 hours a night versus 7.5 to 8.5 hours. People have a significant decline in their metabolic health in terms of fasting glucose, their baseline insulin levels. So, we really wanna make sure we’re getting both consistent sleep and we’re getting enough sleep. And it seems that the optimal amount for supporting metabolic health is the 7.5 to 8.5 hour range.

The benefits of exercise

In addition to what you eat, when you eat, and how you sleep, the final piece of the puzzle is exercise. The bottom line is that any form of movement is beneficial.

Every single form of exercise that’s been studied, has a positive impact on metabolic health, whether it’s moderate aerobic activity or low aerobic activity. So, just walking or like a very easy workout, has a positive effect on insensitivity. Resistance training, like weightlifting, has a exceptionally good impact on, on glucose because muscle is one of our biggest glucose sinks in the body. It soaks up glucose, and it actually does it in an insulin independent way. Muscle contraction on its own can actually because glucose to be taken up into those cells without insulin on board, which is fascinating. So, it’s like a freebie way to get glucose into your cells to be used without even contributing to any of that insulin resistant, high insulin level physiology.

Kelly Leveque: Hey guys, welcome back to the show. I’m so excited about today’s guest. Dr. Casey Means is a Stanford trained physician, who is now the Chief Medical Officer and Co-founder of Levels. Levels is a science and technology company, putting continuous glucose monitors in the hands of regular people, allowing individuals to optimize their diet and lifestyle based on their unique blood sugar response. Casey and the team at Levels are democratizing access to DGM and are building greater awareness around the importance of understanding blood sugar response and its impact on metabolic health.

Kelly Leveque: I am so happy you’re here, Casey. I have been wearing my Levels continuous glucose monitor since we first got together and talked about the technology. I’m obsessed. We were both talking earlier before the podcast started that we feel naked without it. So, I mean, you’ve changed my life. I no longer need to prick my finger to figure out what’s going on. So, thank you so much for access to this and for coming on today’s podcast to talk about it.

Casey Means: Thank you so so much for having me, and you have changed my life too with all the incredible information you are putting out of the world. So, this is so great to get to chat.

Kelly Leveque: Oh, awesome. Well, can you take me back? I mean, a Stanford trained physician that all of a sudden is now working for a tech company? It sort of makes sense. because you’re geographically pretty close to San Francisco. But talk to me about how you started Levels and your backstory.

Casey Means: Yeah, absolutely. So, I actually trained as a head and neck surgeon, so I was doing ear nose and throat surgery and that’s what I studied in medical school, and then went on to residency up in Oregon. And it was really there that I started having some sort of revelations about actually wanting to practice medicine a little bit differently and have a different impact than I had originally thought I wanted to. So, I was treating all these conditions of the head and neck. And a lot of these are inflammatory conditions. They are things like sinusitis and thyroiditis, and all these itises. And itis in medicine, that is the suffix that means inflammation. I’m like, oh my gosh, I’m prescribing so many steroids, steroids tamped down on the immune system.

Casey Means: It’s just incredible how many steroids we use. It’s like topical, inhaled, IV, the oral, it’s a lot that suppresses the immune system. And then of course, when those don’t work, you take people under the knife, you take people to the operating room. And it sort of started occurring to me like, why are we doing so much pharmacologically and surgically for disorders of inflammation without actually asking what are the root causes of inflammation?

Casey Means: What’s causing the immune system to get revved up and be hyperactive and create a lot of these symptoms? So, that led me on really a long journey towards exploring physicians who are talking about these concepts of chronic inflammation. And I was reading lots of these books during my residency training by Terry Walls, and Mark Hyman, and Sarah Godfrey, and a lot of these sort of thinkers who were really approaching medicine for this root because approach as opposed to this reactionary approach. What can we do before disease emerges as opposed to waiting for diseases to become full minute and then reach for our prescription pads.

Casey Means: And that really got me very inspired. And something, a thread that sort of came through through a lot of this exploration was that, one of the big triggers of chronic inflammation is disordered blood sugar. It’s when our blood sugar goes up and down really, really rapidly, we generate chronic inflammation. And that became really, really interesting to me because not only does it lead to the immune system getting revved up, but also a lot of the patients I was seeing in the hospital, so many of them did have really extreme blood sugar disorders, like severe obesity and diabetes type one diet… I’m sorry, type two diabetes. And in surgical patients, people who do have type two diabetes, it can make the recovery a lot more difficult. It can make wound healing more difficult. It can just make the whole postoperative situation much more difficult.

Casey Means: So, I was seeing this from many, many Levels, and really became interested in all this blood sugar dysregulation. Digging deeper and sort of into the epidemiology, the statistics are absolutely astounding. 74% of the population at this point as overweight or obese in the United States. We have 128 million Americans with prediabetes or type two diabetes. That’s almost close to 40% of our country, and of the people with pre-diabetes, which is of that 128 million, it’s 90 million Americans, 90% don’t know they have it. So, it’s just astronomical. This is epidemic level stuff. And when you dig deeper, we really realized that so much relating to disorders of blood sugar are actually sort of they predispose you to so many of the other chronic conditions we’re dealing with.

Casey Means: So, for instance, stroke, Alzheimer’s disease, cancer, heart disease, infertility, erectile dysfunction, depression, anxiety, all of these link back to blood sugar problems, and resultant insulin resistance, which is sort of downstream of having blood sugar issues. And what’s interesting is that a lot of these diseases, were not even really on our radar, like a hundred years ago. They were not a big deal. And they were having so much less morbidity in the country. And so, it really comes down to changes in what we’ve been doing as a country. And a lot of that comes down to what we eat and how we live. When we are eating foods and living in a way that causes our blood sugar to be erratic over the course of days, weeks, years, decades, we end up having problems regulating this, and that leads to so many downstream problems.

Casey Means: So, I became pretty laser focused on this and really obsessed with, if this is something that’s been created in the past hundred years, how do we unpack that? How do we go in the opposite direction? because it’s contributing to now at this point, the vast majority of our $3.8 trillion healthcare costs, and just so much unneeded suffering. And I think it’s tough because you walk into the grocery store and you’re just surrounded by products that say, this is healthy, this is organic, this is gluten-free.

Casey Means: And really no one has any idea what’s actually healthy for their body. And clearly we don’t know, because a lot of people are trying to eat healthily and yet we’re still moving down this road of metabolic dysfunction. So, this is sort of how I got interested in starting Levels. I thought I wanna create a product that empowers people to understand how food and lifestyle decisions are affecting their blood sugar in real time, so that hopefully we can make more informed decisions over the course of our lifetime, that will keep us out of trouble and also just help us feel better in the here and now.

Casey Means: So that’s what Levels does, as you mentioned in the intro. It’s the first program that’s wearable, that you wear on your arm, and it tells you constantly 24 hours a day, in real time, how everything you’re doing food choices, sleep, exercise, if you’re stressing, how all these things are contributing to our blood sugar. And ideally, we want our blood sugar to be pretty low and pretty flat, a very gentle low rise after meals, but otherwise really in a low unhealthy range. We don’t want these peaks and valleys that we’re seeing all the time.

Casey Means: And so, that’s what Levels shows people how to do. And it’s really our first personalized nutrition product on the market. And so, that’s really where I shifted my clinical energy and I jumped ship from surgery and decided I wanted to really spend my life trying to keep out of the operating room, and just empower people with their own information.

Kelly Leveque: Well, I’m so thankful that you did. I mean, even just looking back on my history and my family’s history, I had chronic sinus infections growing up as a kid. I found out that I was intolerant to gluten and to dairy. And I was definitely a Costco kid, the Pepperidge farms, goldfish, and bagel bites, and candy. Like I could kind of have free range over my parents’ pantry growing up. And that’s interesting because you don’t want your kids to like grow up with like food disorders. But that was just a lot of processed foods. And there’s no doubt in my mind that all of that is created that inflammation. And I almost went to surgery in junior high for sinusitis. Like they were just, you’re chronic, I’m on antibiotics three to four times a year. And you look at that, and now we look at my dad, my dad’s got pre-diabetic numbers in his blood sugar and they’re looking at his cardiovascular health and saying like, we’d love for you to go on a statin and he’s borderline. And I’m like, no, that’s…

Kelly Leveque: You just need to get your blood sugar in check and bring that inflammation down and all this will clear itself up. And he has a Levels, now and he’s like showing me all of his numbers and it’s really, it’s empowering. So, I know how empowering Levels is for me and for my dad and for my clients, because you are getting those real-time numbers. You’re seeing that five to six small meals a day is not the best answer, that processed foods is not the best answer, that pairing foods can create like such an amazing, beautiful low curve without those changes in glucose. So, I wanna go deeper and deeper about what Levels is, like down to the user experience and all of it. So, what were some of the experiences that you had personally that led you to explore alternative forms of treatment?

Casey Means: Yeah, so for me, a lot of it had to do with sort of my journey through medicine, my intellectual journey and what I was learning. Like this idea that we’re really approaching medicine almost universally through this reactive approach, we’re just waiting for diseases to emerge and then we’re turning around, and we’re doing invasive things and we really need to be focusing on the front end. And that’s really a whole movement in medicine called system and network biology, which is so fascinating. We like to sort of think of diseases as isolated silos. Like diabetes is one thing, obesity is another thing, chronic liver disease is another thing, infertility is another thing.

Casey Means: But in reality, if you look at the systems and the networks of what actually links those diseases on a physiologic genetic level, we actually see that there’s these linkages, and you can treat at that level and that’s much more efficient. because then instead of applying a drug to each of those things, you’re actually applying something to the root because physiology of that can maybe mitigate all of them at one time.

Casey Means: And that’s where you approach things like chronic inflammation or insulin resistance, which is downstream of blood sugar dysregulation, which are actually the trunk of the tree for so many conditions. So, that was sort of the intellectual journey I was going on. Personally, I was also having some experiences too that were definitely influential in me reaching for this more holistic alternative medicine realm.

Casey Means: When I was in residency, my lifestyle went very quickly from being totally managed and totally in my control, to being completely out of my control. As a surgical resident, you’ve probably seen like Grey’s anatomy or the good doctor, these things like it’s just, you’re in the hospital all the time. I was two or three nights a week, wasn’t sleeping at all. I had to shifts that were 28, 30 hours. During that time, I was under constant high adrenaline, stress, running the emergency room to do a procedure running to the operating room to do a procedure. I was eating all cafeteria food. I was plant-based in medical school and not just went completely off the rails. It was all like processed food and cafeteria food, lots of refined oils, all these things.

Casey Means: And I wasn’t exercising that much, and I was not really seeing the sun that much. You would be in the hospital basically from sunup to sundown. So, my body just totally fell apart in residency. And it was actually almost funny to see how quickly it was falling apart. Like within the year I started taking call, which was when I was staying up multiple nights per week, I had so many symptoms develop. I developed IVs rapidly, I developed jawline hormonal acne, like immediately. I was definitely moodier than normal. And I developed chronic neck pain. My left arm was like numb. And it was, I was like, oh my gosh, this is fascinating. Like conditions changed. And within months my body just is falling apart.

Casey Means: And then basically what was interesting was it’s almost like a controlled experience experiment, I went on a six months research block where I was totally back to normal, like nine to five schedule, and was doing all my normal, healthy behaviors, yoga and running and sleeping normally, and beautiful plant-based eating. And within a few months, everything went back to normal. And then I went back to my training, and everything went off the rails again. And I was like, I need to focus more on health behaviors as a part of my practice. because in my own life I’m seeing the myself fall apart when I’m not sort of consistently doing the things I know that build good physiology in the body. Like ultimately each of our decisions translates into our molecular reality.

Casey Means: And when you do things regularly, we have a molecular reality that breeds excellent cellular biology, and ultimately lack of symptoms and good health. And when you’re not doing those things, it’s not a good system. And so, that was kind of what was sort of the nail in the coffin for me and my own personal experience, like helped build on the intellectual side of things, and say like my purpose and these experiences I’ve had in my life are driving you to practice a different type of medicine, where I really empower people with personalized information to make these good, consistent choices day to day, that will ultimately lead to better conditions in the body. And then the third piece of it was actually, what I studied in college, my real focus was on what’s called Nutrogenomix, which is how food compounds change gene expression.

Casey Means: So, I’ve always had this little seed inside of me knowing that what we put in our mouth actually changes our core physiology, and something I took from that was so many plant products and plants, they actually have chemical compounds. And then that change our gene expression for the better and certain thoughtfully chosen animal products do too. But the vast majority of what we’re putting in our body, what we eat sort of in Western society, is actually doing a number on our genes, and regulating gene expression that we do not want. And so, we have this power with every bite we take to actually fundamentally change the expression of our blueprint.

Casey Means: And to me, that’s just so exciting. And so, that whole life experience, personal professional over the past decade, kind of just congealed together to say, how can I support people to make the consistent, personalized decisions that ultimately generates health? And I think having tools to support knowledge is one thing, but tools, it is a whole extra thing. because knowledge takes us, I think, halfway there, but then to actually have some information and tools that can keep us accountable to make it personalized, I think is really helpful. So, that’s what we’re trying to do with Levels. And I think there’s a huge movement happening with wearables and throughout the health tech space that are kind of in this same vein, which is really exciting to see.

Kelly Leveque: Oh, definitely. I think about like the Aura Ring for sleep and Levels for glucose monitoring. I mean, it’s funny because you can look at tech and be like, oh, we’re just bombarded by wifi and tech and all of these things, and we wanna take a step back from that. But there is so much knowledge to be gained in your own personal experience of understanding. It’s not something you have to have forever, but it really can hold you accountable. Like I use my dad as an example, because he was just over here the other night, it was our anniversary and he was babysitting. He’s like, show me how to use the app. And he pulled up his little meal and he’s like my mom still buys stuff from Costco. It’s like a Pepperidge farms, like chocolate chip cookie. He took a picture of the bag. He’s like, I only had one.

Kelly Leveque: And I know my dad, like you wanna open those nets and had like three or four, but he’s like, I wanted to see where my blood sugar went. It’s like he doesn’t have to have a nutritionist or a coach on his back being like, “Now Steve, you can only have one of those or maybe let’s swap it out”. And of course I want my parents to choose like healthier options and not to like buy those things. But even seeing him change his behavior because he understands the impact of how high his blood sugar goes when he has something like that, I mean, that’s priceless. That’s allowing someone to have full autonomy and to make choices for themselves and to kind of also learn like, okay, like my body is pretty amazing.

Kelly Leveque: It’s gonna spike up and it’s gonna come back down. But I’m also gonna watch that curve. And in coaching my dad, I was like, dad, it’s gonna go up, and someone like me or someone even younger or maybe app super athlete, like they’re gonna bring that blood sugar right back down. But someone like you, that might kind of stay elevated after something like that for a little while. And you wanna watch that butcher cup come back down to a healthy level before you make the choice to indulge again. So, it’s really just like, I’m get getting the chills, like I’m so vast with the technology, because it gives people like you said, it’s a tool that is actionable. So, I wanna dumb it down though, because we’re like, CGM continuous glucose monitor. Can you take us explain it? Like no people have no idea what you’re talking about. What is a CGM and how it functions?

Casey Means: Absolutely. Yeah. So, a CGM is a continuous glucose monitor. And it’s this tiny wearable device that you stick on the back of your arm generally. And it’s the size of two quarters stacked on top of each other. So, really low profile. And it sticks on the back of your arm. And it has this tiny formal leader probe that actually goes under the skin, totally painlessly. It’s a flexible filament that goes under the skin, and that is in the tissue. And that’s measuring glucose in the what’s called interstitial fluid, which is the fluid around yourselves. And it’s measuring it every 15 minutes, 24 hours a day, and then sending that information to your smartphone. So, that’s sort of what it’s doing. You have to replace it every two weeks. So, it sticks on there with an adhesive for two weeks, you have to replace it if you wanna keep going.

Casey Means: And then you have this data stream on your smartphone, which you can imagine looks like a little up and down spiky curve. And you wanna really make that as flat and more rolling hills as possible and not peaks and valleys. And that’s our blood glucose. And the reason glucose matters, is because glucose is our core metabolic substrate in the body. It is our foundational unit of energy in the body. For every single cell in the entire body to function, to run, it needs energy, and it can either use glucose or it can use fat. And glucose is really our primary sort of the first one our body’s gonna use if it’s available. And the body tries really hard to keep glucose in a very narrow range. It’s so important to the body. We’ve got to keep it in a narrow range.

Casey Means: And when it goes above that range, the body works hard to get it back to normal and get that glucose absorbed from the blood that blood sugar into the cell so it can be used. So, every time glucose goes sort of above a certain level, our body releases a hormone called insulin, and that insulin takes that sugar out of the bloodstream, puts it into the cells for use or for storage, and brings the glucose back to the range that the body wants it to be in. And when that glucose goes very high, more insulin is gonna be released. And over time, what happens is, the body sees so much insulin around from all these glucose elevations, that the body actually becomes numb to insulin. It becomes what’s called insulin resistant, and it actually becomes harder to drive that glucose into the cells.

Casey Means: And then over time, what you can see is that, as insulin resistance sort of progressed over time from seeing so much insulin in the body from so much glucose elevation, is that blood sugar might rise over time, just like at baseline. So, that first thing in the morning, blood glucose may look a little bit higher, because it’s actually just harder for the body to utilize and get that energy into the cells. And so, that’s a state that we don’t wanna be on. We don’t wanna be moving towards insulin resistance. We wanna keep ourselves really sharp and really hearing that insulin really sharply. And we can do that by keeping our glucose down over time. What I call metabolic fitness. If we keep our glucose spikes in a reasonable level, aren’t kind of generating these insulin surges all the time. We keep ourselves sensitive hearing insulin. And that’s a really good thing.

Casey Means: The flip side of the insulin coin is that, because that’s a signal to the body, that glucose is around and that we should bring it into the cells and store it or use it, it also has the side function of blocking fat from being burned for energy, which is a really interesting side of insulin. because it’s basically telling the body we’ve got glucose for energy, we don’t need to use fat. And so, it is a break on fat burning for energy. And so, this is relevant to anyone who’s wanting to lose weight, or who’s moving towards wanting to be metabolically flexible. That’s a term we’re hearing a lot. What that means is, that we’re the type of body that can use glucose when it’s around for energy, but if there’s not a lot of glucose around, like in between meals or first thing in the morning, we just flip onto fat burning. And that’s a great state to be in.

Casey Means: A lot of us might experience that hanger that we get between meals where our blood sugar is kind of getting lower and we immediately feel like this panic we need to eat, because our bodies are just so used to using glucose for energy. But if we train our bodies to actually get to a state where we can burn fat for energy pretty regularly, we become metabolically flexible. And when we don’t have enough glucose around or it’s getting a little bit low, we switch into fat burning. And that’s a great state to be in because we have a lot more fat stored in the body than we do have glucose for energy. So, we wanna be able to sort of bounce back and forth. And when we can keep our glucose spikes and our insulin spikes kind of in a more low and reasonable level, we allow our bodies to tap into fat burning much more frequently.

Casey Means: And that’s really where we wanna be. So you can imagine when you’re wearing a CGM, a continuous glucose monitor, for the first time ever, you have awareness and to actually what’s happening inside your body about this. We’ve never had this information before. And so, it just can help you be aware of what foods are causing your biggest spikes, and what foods are keeping you pretty low and stable. Not just individual foods, but like you said, food pairing.

Casey Means: When we add fat, fiber, and protein to carbohydrates, we often see a much less of a glucose spike in the blood. Those carbohydrates are broken down more slowly, more of a gentle rise, and that’s good for our body. So, that’s kind of one of what we use it for. Traditionally, this technology, it’s actually been around for over a decade and it’s been used as a treatment tool for people with type one or type two diabetes. Individuals with these conditions have had to actually prick their fingers in the past to be able to see what their blood sugar is before and after a meal and to help with treatment decisions.

Casey Means: So, continuous glucose monitors have been a game changer, because not having to prick your finger as much, and you’re getting so much more of this data stream that really tells you just much more granularity about what’s happening with blood sugar. So, what our company is doing is taking this technology out of that medical use, and using it for a personalized nutrition use. So, that’s where we come in. So, we have a telemedicine network that evaluates people for this prescription device, it’s prescription only, and then if approved for prescription, the sensors are shipped to your home from our partner pharmacy, and then access to the app that takes this continuous data stream and makes it much more actionable, and insight driven, and helps people really understand how to move from that spiky picture to a more flat and stable picture.

Casey Means: And I can imagine that some someone out there is listening and saying, well, why don’t I just follow a low-glycemic diet or like a low carb diet? Like, wouldn’t that just get my blood sugar to be flat? And why do I need this device in my arm? And I think that’s a great question. I think something that’s fascinating that’s only research has come out in the past five years or so is that, actually each person is gonna respond to carbohydrates completely differently in terms of how it raises your blood sugar. You and I, Kelly, could both eat like a banana and I could go up to a glucose level of 170 and you might go to 120. And so, for you, it’s gonna have less of that insulin surge. It’s gonna probably be a better metabolic choice for you than it is for me.

Casey Means: And the research has looked into why people are different in this regard. And one of the big factors is actually microbiome composition. People can have different gut microbiome bacteria compositions that processes those carbohydrates differently in terms of how it’s converted to sugar and how fast. And so, the idea of the glycemic index is sorta like everyone responds to a piece of white bread, exactly the same in terms of how it raises your glucose, but that’s actually not really what’s happening. It’s much more personalized. And then when you add on the fact that stress sleep deprivation, how much or how little exercise you got, your micronutrient composition in the body, your microbiome, how all these things actually mitigate that processing of glucose, you get into a really complex situation. We’re actually having some of that. That feedback can really be helpful in tweaking and personalizing how you wanna live to keep glucose as stable as possible. So, that’s kind of the backstory on CGM.

Kelly Leveque: I love it. You mean there’s bio-individuality?

Casey Means: Oh my God. Can you believe that?

Casey Means: (music)

Kelly Leveque: I wanna give a huge shout out to ButcherBox for sponsoring today’s episode. And I wanna also tell you a little story. So when I first heard about ButcherBox, I thought to myself, I don’t need this. I live really close to a nice grocery store, I peruse the aisles for fun, and I love thinking about what I’m gonna make for dinner for Chris and I. And then I had kids. And I’m gonna tell you one of the number one ways that I stay consistent in my kitchen, cooking for my family, is getting my butcher box delivered. And I’ve seen it work for clients too.

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Kelly Leveque: I love that you’re explaining just the layers, because you can think about eating something and your enzyme and hydrochloric acid Levels, and then dropping down into your intestines and thinking about that microbiome, and like that first layer of defense, that mucin and all those microbes that are fermenting and breaking things down. Yeah. I’ve had some surprises on the CGM. I mean, I learned that I do better with potatoes than I do with apples. And someone might be like, oh, like potatoes, oh God, the starch, and that’s gonna wreck your blood sugar. But looking at it and you look at a couple of different ways that I tested it. I roast all our potatoes and do a lot of roasted veggies every couple of days, and they just sit in glass Pyrex in my fridge.

Kelly Leveque: So, there’s a little extra resistance starch there, it’s been cooked and cooled and like re cooked. Eating those with a meal versus maybe like, okay, I’m grabbing an apple with some nut butter, definitely seeing less of a spike by adding that nut butter, but still these apples that we eat today are like the size of my face versus what would you would normally find on at least 20 years ago or something. So, we have to think about all of that composition. I wanna go back to something that you said a little earlier, talking about the optimal range, and how Levels kind of explains your food choices, and if they’re good or if they’re they’re productive towards metabolic fitness, we’ll call it, versus maybe a little more or less productive or detrimental. So, what’s the optimal range, and can you explain the one to 10 system and the Levels are?

Casey Means: Sure. Absolutely. So, I think I’ll start by just talking about what are the standardized ranges for glucose that are put forth by the American Diabetes Association and sort of what you might see in your doctor’s office. So, for that, there’s really three ways of looking at glucose levels. There’s your fasting glucose, which is your glucose first thing in the morning after having consumed no calories for eight hours. And for that, if you’re below a hundred first thing in the morning after consuming no calories, that’s considered to be normal. 125 is pre-diabetic, and then 126 or above is diabetic. The second test is what’s called an oral glucose tolerance test. So, that’s where you take 75 grams of glucose in a drink called Blue Cola, and then your blood glucose is tested over the next two to three hours. And basically you’re seeing how high the spike goes, and then how quickly you come down to normal.

Casey Means: And for people who come down to below 140 milligrams per deciliter after two hours, that’s considered a normal response. So, drink the 75 grams of glucose, if you’re below one 40 after two hours, you’re normal. And then there’s a third test, which is called hemoglobin A1C, which is, your measure of about three months of the average glucose. And that’s looking at your red blood cells and how much sugar is stuck to them. And that comes out as a percentage. So, if your hemoglobin A1C is below 5.7%, you’re considered normal. So, that’s sort of the standard criteria.

Casey Means: And then what Levels talks about is, is really what’s more what we call our optimal ranges. And these are not sort of standardized ranges that you’re gonna see at the doctor’s office. This is more our us and our medical advisory boards, interpretation of the literature of what is likely gonna keep us in the best sort of shape possible. And so for us, we, really encourage people to try and stick with between 70 and 110 milligrams per deciliter for most the day. And that’s kind of what we consider our optimal range.

Casey Means: And the reason for that is because, if you look at the research, it let’s talk about fasting glucose for a second. So, less than a hundred right now if you walk into a doctor’s office, they’re gonna say you’re normal. You’re totally fine. But we actually looked at the research, as people’s fasting glucose moves from 70 milligrams per deciliter, up towards a hundred, their risk of developing diabetes and heart disease, and stroke actually increases significantly. So, if you’re in that lower chunk of fasting glucose, you’re gonna be much better off in terms of risk for cardiovascular issues or actually developing diabetes down the road.

Casey Means: So, saying that someone with a fasting glucose of 99, it’s the same as someone with a fasting glucose of 72 is totally inaccurate. But because of the way that we sort of categorize in medicine, we call it kind of all the same. And so, we’re trying to help people encourage people to think more about like, where do I really wanna be? And so, for fasting glucose, probably more between 72 and 85. That seems to be the lowest risk area for fasting glucose. And then in terms of after your meals. So, often people tend to, people who really have good metabolic fitness, will sort of spend their day somewhere between the high seventies and low nineties in terms of their just kind of like baseline glucose throughout the day. And then after a meal, we probably don’t wanna see our glucose go out more than 20 or 30 points up into that, like one 10 range and then come back down.

Casey Means: You can imagine like maybe you’re starting at 80 for a meal, you go up to 110, you come back. That would be a pretty reasonable response. But we don’t wanna see is that you’re starting at 80 and you’re going up to 180 after a meal and then coming down. That’s actually not that hard to do with a standard American diet. I’ve done experiments, and I’ve seen that happen to myself. Some of the ones that do that to me is like, if I eat just like a plain bowl of instant oatmeal, my glucose will go up like a hundred points. Whereas if I eat like another delicious breakfast, chia pudding with full fat coconut milk, it’ll go up like five points.

Casey Means: And so, that’s the type of example where it’s like I might have never known that one of those is vastly better for my health and the other one, I might’ve continued just living my life eating oatmeal every morning, because it says heart-healthy on the package. But the reality is, is that it’s causing a really, really big spike. So yeah, so, we encourage people to kind of stay in that tighter and narrow range. And then we have a scoring system called zone scores that helps make that really simple for people. So, a zone score is, let’s say you eat some food and then we track it for two hours after that meal, and we take a bunch of composite metrics about what happened during that post-meal sort of event. How high did you go from baseline? How long did you stay elevated?

Casey Means: And different factors like that, how quickly did you come back down to normal? And we just give you a one through 10 score. 10 is what we’d call like a perfect metabolic score, or you at a minimal glucose response, you came back down very quickly. Zero is like you shot up and you may have taken like a little while to come back down. That’s what we don’t want.

Casey Means: And so, you can just sort of scan through all your own meals and say, okay, these are all tens for me, these are all nines, these are all eights, I wanna stick with those, and I really wanna avoid the things that were like zeros, ones, twos, threes, fours, or figure out ways to modulate those, maybe adding fat, protein, or fiber, maybe only eating those things if you’re definitely gonna have a workout that day, making sure you’re only eating those things when you’ve had a good night of sleep. Like how does sort of modulating them to make them a better glucose response. So, trying to just make it really simple for people to see what works and what doesn’t.

Kelly Leveque: I love that so much. And what the Levels app does for clients is, when you think about that, when would you wanna eat? When would you crave one of those meals? That’s like a one through three or a zero? After a poor night’s sleep. Definitely not after a workout. And so, that’s the kind of stuff where, okay, you’ve had a poor night’s sleep, you didn’t get a workout in, you know that this meal is gonna impact your blood sugar, even creating this dysregulation. It’s a little bit. It is. It’s your trainer, it’s your nutritionist. It’s that reminder that like, Hey, this maybe isn’t the right time for me to do this. But it also empowers you if you did have a major workout and you wanna like, enjoy a cookie or celebrate a little bit with something, or if you’re going to a party and there’s gonna be a big buffet of food, that’s the time to get that workout and before, and, or make sure that you have a good night’s sleep the night before. It’s was like empowering.

Casey Means: Totally. And we definitely find that people who do a workout in the morning often find that their glucose is just more stable throughout the day, no matter what they eat. And so, it’s like knowing that, it’s not even motivation to like eat better, but it’s also motivation to get the workout in. Because it gives your body, primes you to be insulin sensitive for the next 24 hours. And so it’s just it’s, yeah, it’s great to see that. And it’s definitely been a good motivator for me about when I eat. Especially we know that food timing has an impact on how much your blood sugar is gonna raise. If I eat something really late at night, it often will spike my glucose a lot more than if I eat it earlier in the day. And there’s some science to that. That melatonin, when it’s released at night actually makes us a little bit less insulin sensitive.

Casey Means: So, eating something earlier in the day, we might respond to it better. But there’s other people who have different experiences with that, who can eat something at night and it’s okay. But for me, I know my sleep is better if I keep my glucose spikes down at night. And so, just knowing I could eat that cookie maybe earlier in the day, but not at 10 at night, it’s gonna have more collateral damage than I want. And so yeah, just getting really personalized I think is where we’re going and in medicine and it’s fun to see it happening.

Kelly Leveque: Definitely you guys are at the forefront, so thankful for it. I have a couple more questions, because spiked, like you create huge spikes, pun intended. I have some questions now. So, let’s talk about some other things that can support balanced blood sugar throughout the day, outside of getting a good night’s sleep and starting your day with a workout. Are there any types of foods or timing of like breaking your fast or anything that can affect blood sugar that you’ve seen in research?

Casey Means: Yeah, there’s a number of things that I’d break down into the sort of like the categories that we’ve kind of touched on that have sort of acute effects on glucose, which are food-related, stress-related, exercise related, and sleep related. And so, within food, there’s a number of things in that category. So, one is sort of food pairing, one is food timing, and one is food sequencing. So, on the food pairing, we’ve kind of touched on this, but eating naked carbohydrates are carbohydrates alone. Like just a straight apple, you’re gonna see more of a glucose response with that.

Casey Means: So, there’s a lot of research showing that if you pair or preload sort of naked carbohydrate with fat protein or fiber, you’re likely gonna have a better response. Some of the research showed that if you eat, like for instance, an ounce or two ounces of almonds while eating a piece of white bread, people had a significantly lower glucose response with the almonds than with not.

Casey Means: So, that makes sense. Out almond butter, if you’re gonna eat refined carbohydrates, but like you said, with fruit. I barely ever even reached for fruit now without thinking about adding some sort of whole food fat, like a tahini or an almond butter, or sprinkling chia seeds on top. That’s just now part of my routine, because I know that my glucose response is gonna be better. So, food pairing with that protein and fiber is definitely a big one. Some of my go tos for that are, I basically put chia seeds on everything at this point. They’re one of the best fiber sources out there. There’s about 10 grams of fiber in two tablespoons. And they’re just easy to put in salads, put on top of things add to smoothies, make a chia pudding. So, that’s one of my favorite fiber sources.

Kelly Leveque: You probably do this, but for our listeners, definitely make sure you’re hydrating. Drinking water with those meals just to make sure that those chia seeds don’t congeal together.

Casey Means: So true. Yeah. They absorb like 10 times their weight in water or something like that. And so, yeah, you don’t wanna get those like stuck in your belly with no hydration. So, definite hydration with those. And so, food sequencing is a really interesting one too. If you actually eat your carbs later in a meal, as opposed to front-loading your meal with carbs, people tend to have a better glucose response. So, what that might mean is, eating a big, low carb salad in the beginning of the meal, or eating some protein, like if you have chicken and a bunch of potatoes on your plate, like start with the chicken and then eat the potatoes, people tend to have a much better glucose response when you do that.

Casey Means: And so, definitely maybe instead of serving the whole dinner with salad and the other stuff altogether, like eat the salad first, and then go back in and get the rest of the food. That tends to have a pretty significant impact. And then I think food timing is an interesting one. There’s been some research showing that people who actually eat in a narrow window throughout the day, so more time restricted feeding, tend to have lower 24 hour glucose and insulin Levels. There’s a study that actually took people and gave them the exact same number of calories. But one group ate between 8:00 AM and 8:00 PM. So, like a full day of eating, and then one group eight between 8:00 AM, and I believe it was 2:00 PM.

Casey Means: So, a very narrow window, and none of us wanna stop eating at 2:00 PM, but that was what the research looked at. So, it was a six hour feeding window versus a 12 hour feeding window, exact same number of calories though. And they found that the people in the narrow feeding window, even though they had the exact same number of calories, had lower 24 hour glucose and insulin Levels. So, that’s pretty interesting. And you can imagine, like, if you’re just sort of keeping all your spikes within a narrower range, you’re giving your body, let’s say that six hour range, you’re giving your body 18 hours, where insulin is low and you’re tapping into a fat burning, and you’re getting those other metabolic pathways going, building that metabolic flexibility.

Casey Means: So, I think that is a takeaway point. I’m not gonna encourage people to eat only between eight and 2:00 PM, but you can imagine potentially eating in a six hour or seven hour window, between 11:00 AM and 5:00 or 6:00 PM. And what that’s gonna do is just give your body more time to have a low glucose, low insulin state, so that you can actually activate those other metabolic pathways, which are good for health, namely fat oxidation and fat burning. So, that’s kind of some of the food tips I would say.

Casey Means: And then there’s a couple other, just like fun little ones, like vinegar and cinnamon, which I think are interesting to just mention. Like both of these foods, vinegar, like vinegar, apple cider vinegar and Ceylon cinnamon, both have been shown to have insulin-sensitizing effects. So, if you can throw some cinnamon on your food, throw it in your smoothies, and then throw vinegar in your salad dressings, that’s gonna actually just like prime our cells to be more sensitive to the insulin. So, those are some tips that people can use.

Kelly Leveque: I love that so much. I feel like you have just given people the tools, if they don’t have a Levels app, to kind of modulate their blood sugar and support that homeostasis in the body as best as they can. A couple things that came up for me in what you just said was the sequencing. That’s really something that I have done with even my toddler. So, we throw the veggies, especially when he was first starting to eat, the veggies on the plate first, so that he’s eating those when he’s hungriest, and then the proteins, because those are the most satisfying on a hormonal level. And then we throw the starch, like the pasts or the rice, because it’s really easy to overeat those things. And you think about meals eating out at a restaurant. They’re like, here’s your chips, at Mexican food, or here’s the bread bowl. Just being able to say no to that until your meal comes, can make such a massive impact on your ability to support blood sugar balance.

Casey Means: That is such a good point about the chips and bread. It’s true. And it’s similar with breakfast. It’s like, have your OJ and then eat a meal. It’s like these are actually going against sort of our long term aims. And it’s not necessarily about deprivation. It’s about just being thoughtful about the biology of it, and just knowing that information, how we can just make these small tweaks to get the most out of our meals, and kinda get the most bang for our buck, for each choice that we’re making.

Kelly Leveque: Totally. I have another question. So, let’s say someone does decide to, not just intermittent fast, but may be time restricted. Maybe they’re a nine to five or… I love that that study looked at 8:00 to 2:00 instead of 2:00 to 8:00.

Casey Means: Mm-hmm (affirmative).

Kelly Leveque: I think there’s something to be said there. Just eating with our circadian rhythm, eating when it’s light out, like you were saying earlier, there’s no melatonin in the system, we’re staying insulin sensitive. So, I like to eat during the work hours and, or like my grandma, between eight and nine to five and six, like we call it a day. I think that is just so supportive. But let’s talk about that intermittent fasting time when we see our blood sugar drop. What is a normal, healthy level? If someone is metabolically flexible and able to burn fat substrates like beta hydroxybutyrate and they’re producing ketones. What is normal? Can someone drop into the forties and fifties? Is that considered hypoglycemic or is that considered metabolically flexible?

Casey Means: Yeah, I mean the short answer is that there’s not been enough research in people who are on ketogenic diets and are really fat adapted keto adapted to know what is normal for those types of people. There just has been so little actual scientific research in people who are not prediabetic or diabetic. So, much more research needs to be done in that regard. I would say people getting in the forties and fifties, that’s probably never gonna be very normal. That’s just my personal take on it. I think almost everyone’s gonna feel old symptomatic if they’re that low. I think people dipping into the high sixties and low seventies, people can tolerate that, especially if you’re really adapted to burning fat and are maybe not have any hypoglycemic symptoms. But I think much lower than that, you’re probably gonna get that little bit of like shakiness and hunger.

Casey Means: So, 70 is really that’s sort of an area where we’d say below that you might start seeing some issues. And glucose is not one of those things where like it’s the lower the better. It’s really about keeping it in the right range and having that really supporting homeostasis. And so it’s not like one of those lower is better things. It’s lower is better until a certain point. And then the body’s regulatory capacity kicks in. And one thing I’ll say about the… One interesting thing about the glucose sensors is that they actually are less accurate at lower and lower values. And so, they’re really optimized to be more between the range of about like 80 and 180 or so. That’s when they’re most accurate. And when you get really low, they can sometimes read lower than the blood sugar actually is.

Casey Means: So, it’s something to keep in mind if you’re using a glucose sensor, that if it’s reading in the seventies or the sixties, it’s actually more likely that the blood sugar is above 80. And so, that’s just something to keep in mind. And I think the sensors are getting more and more accurate over time. There’s just new generations of these sensors coming out constantly, but just something, if people are seeing really low values on their sensors, it might be worth doing a finger prick to double check or just checking in with how you feel. Like are you actually feeling help hypoglycemic? Are you having symptoms? So, just something to know.

Kelly Leveque: Cool. Let’s go through those other ways that we can support our glucose other than food, because you had three other buckets.

Casey Means: Yeah, well I think sleep is such a fascinating one. I don’t think most people, I certainly didn’t know how huge an impact sleep deprivation has on our metabolic health and our glucose. But it is profound. When people even sleep on average one hour, less than optimal. So, looking at like short sleepers, in some of these studies they’re called who sleep about 6.5 hours a night versus 7.5 to 8.5 hours. People have a significant decline in their metabolic health in terms of fasting glucose, their baseline insulin levels. So, we really wanna make sure we’re getting both consistent sleep and we’re getting enough sleep. And it seems that the optimal amount for supporting metabolic health is the 7.5 to 8.5 hour range. There was one… I know, I know.

Kelly Leveque: I’m like I have an 11 week old.

Casey Means: You’ll we’ll get back there, but yeah, it’s tough. It’s I mean, most of us are not getting that. In our former day, most people were getting that much sleep. Bu average sleep has declined over the past a hundred years, and knowing how much is actually acutely impacting our blood sugar, that’s been one of the biggest motivators for me to just like prioritize sleep so so much. There’s one study that I love, where they took, like, I think it was like 15 or so young, healthy men, totally healthy guys. And they subjected them to four hours of sleep per night for like about a week or so. And they took all those healthy normal guys from normal to pre-diabetic like within that one experimental phase. So, they could take them from just being out there, young, healthy, to straight up their reaction to a oral glucose tolerance test was in the pre-diabetic range, impaired glucose tolerance. Then they gave them sleep, like unlimited sleep for the next week or so of the experimental study. And people did get back to normal during that time.

Casey Means: But it’s just crazy to think. I mean, in college I can imagine probably multiple weeks where I had four to six hours of sleep per night for a week while I was study for finals. I can’t even imagine what must have been happening with my blood sugar. So, sleep is just one we really should orient around in terms of metabolic health. And I almost use my glucose tracker now as a secondary sleep tracker in a sense, because I know my baseline Levels are gonna be a little bit higher if I get less sleep.

Casey Means: There’s like a number of hormones that are involved in that process. So, when we don’t sleep enough, we actually have higher cortisol Levels the next day, it makes us less insulin sensitive, and it actually impacts our growth hormone levels and like a number of other hormones that are related to glucose. So, it’s just like a whole biochemical cascade that we don’t want. But it’s hard, because life modern life, it makes it difficult. But I think having at least the information helps us prioritize what different things differently. I know that’s easy for me to say not having an 11 week old, but it’s-

Kelly Leveque: No. I see it. I see it using the monitor. For me personally, I know that lack of sleep makes me crave carbohydrates, it makes me want out those processed foods and sugar, where I normally would be able to get up, and say, wait till 10 or 11 to have my smoothie. Like I have to have my smoothie when I wake up now with the sleep deprivation, because that protein and regulation, I see it support my blood sugar balance through to my next meal at lunch, I’m making better choices. And I will say like, making sure that I start my day, right whether that’s I have my smoothie at seven, or whether I have it at nine based on the sleep with Tasian. I do see that every single time though, that like smoothie is coming back at a nine or a 10:00, because it’s optimized with the protein, fat, and fiber.

Kelly Leveque: I don’t know, it’s been a game changer. It’s been awesome to see how the fab four works with Levels, and how it supports blood sugar. And I’ve tested it with vegetarian based meals and plant-based meals, I’ve tested it with protein-based meals. But for me starting my day right, and after a poor night sleep, just like having, almost it’s like a smoothie bandaid for me a little bit.

Casey Means: Yes, I love that.

Kelly Leveque: Okay. Okay. I’m like, even though I’m a little dysregulated right now, maybe a little elevated, it brings me right back down and it keeps me in that optimal range.

Casey Means: Well, I think that speaks also to one of the effects of sleep deprivation is it messes with our ghrelin and our leptin. These are like our satiety and hunger hormones. And just like you said, you crave more of like the higher carb foods and stuff when you’re sleep deprived. That’s totally hormonal. It’s actually sleep deprivation is changing our balance of our satiety and our hunger hormones. And so, I can imagine that when you’re eating the smoothie, which has amazing amount of protein, healthy fat fiber, and then greens, and all this you’re kind of resetting those hormone pathways in terms of satiety, whereas if people just went with maybe like a high carb breakfast without the fat, protein, and fiber, you might just be kicking off the rest of the day to be sort of out of whack with some of those hormones.

Casey Means: So, I think I love the idea of a smoothie band right after a bad night’s sleep. But I think on that hormonal level, it probably is doing that in a sense. So, that’s really interesting. So, I guess the third one to talk about is exercise. And this one, there is so much, I think you can learn about your own exercise and your training, by looking through the lens of glucose. I think one of the big areas of research in this… Well, first I’ll say every single form of exercise that’s been studied, has a positive impact on metabolic health, whether it’s moderate aerobic activity or low aerobic activity. So, just walking or like a very easy workout, has a positive effect on insensitivity. Resistance training, like weightlifting, has a exceptionally good impact on, on glucose because muscle is one of our biggest glucose sinks in the body. It soaks up glucose, and it actually does it in an insulin independent way.

Casey Means: Muscle contraction on its own can actually because glucose to be taken up into those cells without insulin on board, which is fascinating. So, it’s like a freebie way to get glucose into your cells to be used without even contributing to any of that insulin resistant, high insulin level physiology. And then high intensity neural training also has positive effects on insulin sensitivity. It’s almost instant, which is cool role. So, you can do a high intensity indoor training workout and be more insulin sensitive the next day. Like we actually can measure that. So, basically anytime you move your body, it’s good for glucose. And it makes sense. Again, looking to that lens of muscles are a glucose sink. They take up so much glucose.

Casey Means: And if you’re even like walking five minutes, you’re activating so many huge muscle groups in your body. And we spend so much time sitting. S, even little teeny chunks are important. And one of my favorite studies, this one was so interesting to me. So, they took a bunch of people and they put them into different categories. And one was, they were gonna work out for, I’m probably gonna get the number a little bit wrong here, but broad brush strokes here, it was like working out for 20 minutes before each meal, 20 minutes after each meal, or two minutes, every 30 minutes throughout the waking day. So, basically big, like big chunks before or after meals, or just like two minutes, every 30 minutes. So, stand up and walk around for two minutes. And they’ve done this study with walking and with jogging. And they showed that the people who actually walked and cumulatively in all of these groups, they ended up moving a total of 60 minutes per day, whether it was the 20 minutes broken up or the two minutes multiple times per day. But same number of minutes at the end of the day.

Casey Means: The people who actually moved for two minutes every 30 minutes all throughout the day, had better glucose and insulin levels over the course of the day, than the people who did the bigger chunks three times a day. So, the moral of that story to me, but they all did better than the people who didn’t move at all. So, move if you can, but consistency throughout the day is actually more important, it seems like, than big chunks. And I think this comes back again to sort of what I was talking about. Like, if you’re moving these muscle groups, you’re activating cellular pathways every 30 minutes that just keeps the body in this like burning state. And that’s what we want.

Casey Means: So, that research has really impacted me personally, because it’s not that hard to walk for two minutes, every 30 minutes. But you do have to set a time, you do have to remember, otherwise I will just, hours can go by. I also have a standing desk. And so, I’ll try and maybe like move a little bit at the desk, but it’s kind of just like, it doesn’t have to be big, just it has to be consistent throughout the day. Our body are meant to move. So. that’s one, that’s one that I love.

Kelly Leveque: I love that one so much. Just because all you need is a toddler and a scooter, and we’re good to go. No, I mean, it’s amazing how much they move throughout the day. Sebastian is constantly moving and I look at adults and we’re all just constantly just shoulders rolled in over our desks at our computers. And I mean, anyone can do two minutes.

Casey Means: Right, right. And it’s just walking. It just has to be walking. You don’t have to run, you don’t have to sprint. It doesn’t have to be hard. It just has to be moving those muscles and getting those pathways activated. And then I think one last sort of practical plug, there’s a big movement in the athletic world for low-carb athletes and keto athletes. And it used to be like the idea of, oh, we need to carbo-loading. We’re gonna have a pasta dinner before the marathon. And that paradigm is actually shifting quite a bit, as people realize that glucose management, it actually can be kind of like a super power with athletics.

Casey Means: The reason for that goes back to our conversation about metabolic flexibility and fat burning. You can imagine if you’re an endurance athlete, and you have like a three to six hour event, if you are metabolically inflexible, and you’ve only trained with a high glucose state, your body’s primed to burn glucose for energy during that event, your body’s not actually well adapted burn fat if you’re in a low glucose state. So, the whole event you’re dependent on shakes and bars and goose, and high glucose things, bananas, to get your glucose kind of up as much as you can during that event, because that’s what your body is used to.

Casey Means: But if you’ve actually trained in a lower carb, lower insulin state throughout your training, you’re someone who’s able to burn into fat in the second hour of that event. Interestingly, we only have two hours of glucose stored in our body at any one time. And that’s stored in chains called glycogen, which live in the liver and the muscles. And when we burn through that, if we’re not able to like quickly flip on that fat burning, we need exogenous glucose like those high glucose gels and all that stuff. So, these athletes who have trained this way, are able to sometimes run entire like marathons or longer, completely fasted, like no glucose on board.

Casey Means: And a lot of people we have, we actually have a guy on our team, Mike, he’s our head of customer success. He’s been really leaning into this like low carb training. He’s a great athlete. He’ll run like a marathon on his own every months, totally fasted, which I do not recommend to anyone listening to this. But the fact that it’s even possible, is so different than I ever imagined. And so, the takeaway, I think for the average person, not someone doing like Ironmans or marathons, is to consider sort of exploring what it looks like to work out and to be active without having a ton of carbohydrates on board. Because what you’re kind of doing, if you move towards that, is you’re giving your body this opportunity to burn through your stored glucose, get into that fat oxidation mode, and build that metabolic flexibility.

Casey Means: So, I will say it’s an adaptation. It takes time. It takes potentially months to get comfortable doing that. This is not something where you can just wake up tomorrow and do your pellets and workout fasted. It’s not gonna feel good, but you can slowly start inching towards that by eating maybe lower carbs snacks before or after your workouts, maybe instead of like a shake that as 20 grams of sugar or a Gatorade. Going more for like avocado or olives or almonds that have a tiny bit of carbohydrates, but it’s not gonna be this huge insulin surge. Because if you’re keeping your insulin low in the workout, you’re gonna burn more fat.

Casey Means: So, I’d say our team at Levels has really been exploring this just personally. And now I’m at the point where I’m doing a lot of my lighter jogs and my lower intensity Peloton workouts first thing in the morning, having not eaten anything. Because in my mind what’s happening is, I’m getting like double duty for my workout. I’m not only getting the cardiovascular and the muscle benefit, but I’m also getting this side metabolic flexibility benefit. So, definitely talk to your doctor about doing anything like this, but it’s just more conceptually kind of interesting to think about how we can use food to our advantage with getting the most out of our workouts.

Kelly Leveque: I love that you just mentioned that you’re doing that Peloton workout fast in the morning or your runs in the morning. I have seen it when someone wants to become metabolically flexible or wants to work out fasted. It seems easier for most of my clients to do it first thing in the morning, because they haven’t eaten all night. And they’re not coming from, say like they’re not doing an afternoon workout that came after a lunch, where their blood sugar went up, then came down and they’re feeling a little bit more depleted and or gasped at that three or four o’clock five o’clock hour. I just tend to see practically that it’s a lot easier if you wanna get into fast workouts to do them first thing in the morning, and to work your way up in time. I mean, you just let the listeners know you have two hours, friends, of stored glycogen in your body. That’s there for fuel. And I do think tapping into that glycogen becomes easier over time when we do those fasted workouts.

Casey Means: I think that’s true. And I think it’s helpful having the monitor on, because I think there’s sometimes during the day where we feel like our glucose is low, but it’s actually not low, which is really interesting. Sometimes I’ll be like, oh I need something, I’m feeling really low energy or whatever, and I look, and my glucose is actually like firmly in the eighties, I’m doing fine. And it’s like, huh, what’s actually going on? And what is often happening is actually that I had a glucose spike earlier in the day, and then what can often happen with that big glucose spike is that you release so much insulin that you actually crash. You overshoot your baseline. You go up and then you crash. And that’s called Reactive hypoglycemia. And that’s a feeling induced by a big spike where you can often feel like really low energy and sort of moody, and maybe a little in anxious.

Casey Means: And then usually your body regulates and you come back up to your baseline over time. But that’s often that moment where I’m back at normal, but I had this dip, where I’m like, oh, I need something, I need a snack or something like that. But to look at the sensor and be like, no, I’m actually fine. Like I don’t need to just jam something sweet in my mouth. And I’ll usually, because I see that and I know I’m fin, I’ll go with something like lower carb. Like I’ll do an avocado or coconut chips or something like that. Just something that’s like not gonna spike me again and maybe lead to the same roller coaster. And I think about athletes who are drinking like Gatorade or something like that to get that energy, and while it does provide a glucose source, which for some athletes may make them, in the moment, feel like they have more energy, what’s interesting is that I can imagine it often leads to actually that big crash during like the workout.

Casey Means: You have this surge of energy, glucose available in the bloodstream, but then in the middle of your workout, you’re actually having a crash which might be counterproductive. And so, even for people who aren’t doing the whole fasted workout thing, or really going in that road. Just knowing how your food around activities and sports, how much it’s getting you spiked or not, I think that’s helpful to know. If you do choose to have carbs before or after your workout, making sure that it’s giving you a gentle rise to like restore that glycogen and give you the energy that you want, but isn’t like overshooting and then crashing. So, just able to kind of keep you a little bit more stable around your workout, so that we’re not having collateral potential damage, when we’re actually just trying to help our bodies.

Kelly Leveque: Definitely. What you just explained is why Levels is successful. People are always like, oh, I’m, I’m gonna drink the smoothie. And then they’re worried about the caloric load, but it’s all of the subsequent meal choices that happen after it, that are all regulated because you’re not having that re reactive hypoglycemic vent, that then makes you go like, “I need to go to the pantry and have something sweet or a snack”, or, “It’s not sustaining me”, or” I’m moody, I’m irritable. I need the chocolate”, or, “I have to have a snack between breakfast and lunch”. A lot of times, it’s exactly what you just said. It’s that the choice that they made for breakfast or whenever they broke their fast, is actually detrimental to the choices they make through out the day. And we see that blood sugar curve instead of gradually coming up and sort of like the kitty train at Disneyland versus Montezooma’s Revenge at six flags magic mountain.

Kelly Leveque: It’s like I wanna see those rolling like just sort of, like rolling curves versus these high spikes and crashes, because you make better choices at lunch. You don’t feel like you need to snack, you feel like you have more energy, you’re more positive, you’re less in an anxious or depressed state, you feel better about self and then you feel that energy to say like, “Hey, I do wanna get a workout in”, or, “Hey, I do wanna like run outside with my kids”. And it impacts everything throughout their day. And so, it’s so hard for me when someone’s like, “But can I just omit the fat, because that’s like 200 calories?” And I’m like, “Whoa, it’s such a bigger picture than that”. We’re talking about metabolic health, we’re talking about energy, we’re talking about food choices and making them easy, and I just see it every day with Levels.

Kelly Leveque: Like when I use it, and I’m eating the way that eating the fab four and I’m food pairing, and I’m IM able to have that separation between breakfast and lunch, and lunch dinner. And even if I do need a snack in the afternoon or something, I can see how that supports blood sugar. I know I’ve taken up so much of your time, but I have a couple more questions.

Casey Means: Please. This is great. Yeah.

Kelly Leveque: Okay. Can you talk to me about snacking in its impact on blood sugar and what we’re seeing in the research in regards to separation of meals?

Casey Means: Yeah. So, the thing that’s so funny about the snacking conversation is that, if we lived in the nineties, we know that we were told you need to eat six small meals a day and you must eat breakfast because it will boost your metabolism. It will get your metabolism going. So, it’s so funny, because I think we’re seeing like a big at this point towards, no actually eat like less time during the day. And I think a lot of this comes back to this whole conversation of what this is doing to our hormones. You can imagine if you’re… So, first of all, I’m not anti-snacking. I’m more just like, let’s be thoughtful about what is the biochemical cascade that’s happening after we put something in our mouth. I think that if you are gonna snack, our goal, from a metabolic health standpoint, is to lower our body’s overall exposure to glucose throughout the day, and lower our body’s overall exposure to insulin throughout the day, and to avoid the rollercoaster, the Montezooma’s Revenge. Because that variability, and ups and downs, and crashes in the blood sugar, that variability is gonna mirror the variability in our subjective experience of the day.

Casey Means: Like if we’re spiky on our glucose, it’s very likely we’re gonna be spiky in our subjective mood, our energy, our anxiety, our fatigue, et cetera. So, I always say, I think for me personally, stable glucose means a stable day for me in all ways. And so, you just have to think about snacking, I think, in the context of that. There are ways to snack that are gonna keep insulin and glucose low, and there are ways to snack that are gonna because you to have as big of a spike as a full huge meal. And so, I would say, one thing we know from the research is that when we do time restrict our feeding, when we eat a narrow window, it seems to be better for metabolic health. And that’s because we’re giving our body more time without that insulin and glucose exposure.

Casey Means: So, the less time per day we’re eating seems to be the better. Then the second piece is, within that, if you’re gonna have snacks between meals, I would try to make those as stabilizing as possible. And so, some of my go-tos are; guacamole, avocado, I’ll put avocado with some tahini and some tamari on top, and some chia seeds, olives, slackers. I love, which are just crackers made outta slack seeds. Hummus doesn’t tend to affect me. So, I’ll do hummus with good amount of fat tahini in there, dipped with some lettuce, or zucchini slices, or peppers. These are all things that don’t touch my glucose. And so for a snack, it’s not gonna have this large form mono cascade that could be negative.

Casey Means: So, it’s just really, I think about being thoughtful, but what we do, what I know we do want to avoid is that each meal and each snack sends us on an individual glucose and insulin spike. Because then if you’re doing that six times a day, that’s unequivocally not gonna be good for your goals or your health. So, really trying to focus on minimizing the amount of those we have per day. And I think you can do that even with snacking. We just have to be really thoughtful about it. But yeah.

Kelly Leveque: Awesome. Now, I think the last question before I go would be looking at the different lifestyles that people live right now. I feel like it’s pretty segregated. Like the plant based community and like the paleo keto style community. What would you say are some best in class tips for each type of lifestyle that people might lead?

Casey Means: Yeah. Yeah. So, I think big picture, sort of what helps me think through all these different nutritional philosophies is that, at the end of the day, all food is molecular information. It’s molecules going into your body that tells your body what to do. That’s what food is. It’s also the building blocks for our body. We want good instructions and we want good building blocks. And I think you can really do that on a variety of different diets if it’s done well.

Casey Means: So, I’m primarily plant based. And so for me, it takes a lot of work to get the right molecular information in my body and it takes a lot of thought. And so, like omega threes is an example. I’m not getting the downstream omega threes that are critical for my body typically from food, the EPA and the DHA. I’m getting a lot more of the plant-based upstream omega threes like alpha and like acid that has to be converted to EPA and DHA.

Casey Means: And for my body to do that, we know that that’s multiple enzymes from ALA to EPA and DHA, which are necessary for human health. So, I have to think about, okay, how do I optimize that whole pathway, which involves manganese and vitamin C, and optimizing these enzymes. So, it’s like it’s kind of complex, but at the end of the day, it comes down to my body needs DHA and EPA, I have to think through how my food is gonna be the molecular information that gets me there. And so, and same on a carb, let’s say we’re talking about a carnivore diet. Like they need specific going into their body. And you can do carnivore where you’re eating crappy meat that’s full of omega six fats and just really high saturated fat, or you can do like really nice grass fed grass finished beef that’s gonna be much higher omega three content. It’s not gonna have pesticides, antibiotics, et cetera.

Casey Means: So, it’s all about choices within these diets to give your body ultimately what it needs to function properly. The same is true through any of these lenses of glucose. You can have a plant-based diet that’s an absolute glucose roller coaster; processed foods, refined grains, pastas, all potatoes, sweet potatoes, fruit, and very little healthy fats, proteins, and fiber. I mean, you could have a diet that has five grams of fiber a day, or you could have a plant-based diet that has 70 grams of fiber a day. And then the same is true of carnivore. You could be getting a hugely omega six focused carnivore diet, or a really high omega three focused diet. You could be eating liver, which is gonna give you vitamin C, which you otherwise can’t get on a carnivore diet, or you could be eating no liver and be totally vitamin C deplete.

Casey Means: And on carnivore, it’s gonna be difficult to have many glucose spikes. But it’s just thinking through how to make the most of each of these diets. And I think orienting through glucose is a really a really good one. We know we don’t want tones of glycemic variability, and whether you’re on paleo, whole 30 vegan whatever, you want that amongst all of them. So, having some feedback to sort of just be able to have the diet, whatever your choice is, to optimize it around these things, I think is important.

Casey Means: I’d love to see other trackers come online that do measure omega threes and omega sixes in all these sort of like pieces of molecular information that we know we want in our body, because it’d be great to be able to kind of have that biofeedback. But for now, I think glucose is a really straight great start. It’s one of the only things we can track at home, and amongst any diet that you’re on, it’s something that we do wanna optimize for. But certainly only one piece of the puzzle.

Kelly Leveque: I love it. I would love a continuous like nutrient monitor. Wow. Like the future. Can we just manifest that right now? That would be great.

Casey Means: I’ve been telling Genova diagnostics. They have one of my favorite tests, which is the NutrEval test, which the looks like 150 biomarkers of nutrition. And I’m like, when can we get the like, weekly, home NutrEval tests, because that would be so amazing. And there is like omega three and omega six home testing now, which I love, but yeah. It’s like, how can we get more of these so we can just shape the perfect diets for each of us. Like that would be… so, if they’re listening, keep working on it.

Kelly Leveque: Yeah. Seriously. Oh, Casey, this was so much fun. I can’t wait to release this episode. I’ll definitely share my link, because I know we have like an 80,000 person wait list to get with Levels, and I have a way for people to jump that list, which is so exciting. So, we’ll make right that that’s in the show notes, and I’ll follow this up with some extras for people. But where can they follow along with you? How can they learn more about Levels?

Casey Means: Yes, yes. So, I’m personally @DrCaseyskitchen, DrCaseyskitchen on Instagram and Twitter, and I post a lot about plant-based food, and metabolic health, and sort of swaps for people to learn some more tips about that. Levels is @Levels on Instagram and Twitter. And it’s really fun to follow those accounts, because everyone, all of our beta customers are doing experiments and it’s kind of cool to see how people are doing challenges for themselves and experiments, and kind of learning what’s working for people.

Casey Means: And then know we’re at levelshealth.com on the web, and there you can sign up for our wait list for a beta program, which also gets you on our newsletter. And there’s just amazing content on our blog. Lots of top physicians and researchers in the Y.S who are interested in metabolic health are contributing articles. And so, highly recommend checking that out for more info and kind of a deeper dive on anything we talked about on this podcast is on there. So, to highly recommend.

Kelly Leveque: Yeah, I love all of it. I love following along with the Levels Instagram, because it’s been so interesting to see what people post. Like no surprise to me, but when you start to look at like liquid sugar, like potentially coconut aminos, if it’s not paired correctly with a meal, with some fat, people were seeing spikes there, kombucha… Things that are touted as healthy alternatives, or something other than a teriyaki sauce or a soda. And then it may have metabolic impacts on people.

Kelly Leveque: But if you guys wanna skip the line for Levels, my link is Levels.link/kelly, and I’ll put that in the show notes as well, but you guys, it is a total game changer. I mean, for myself, for my clients, for my dad, for people that are really even resistant to changing the way that they eat, for people who are excited about tech and just optimizing, this is gosh Levels is such a game changer. Casey, I can’t even thank you enough for ditching the operating room for this. You’re making such a major impact on people’s lives. And it’s been fun to follow you personally too.

Casey Means: Thank you so much, Kelly. And thanks for having me on. And this is just always wonderful to chat with you and thank you for all that you’re doing to promote just holistic, healthy living. It’s incredible. And I’m definitely gonna go down and make my fab four smoothie after this. So, I’m very excited. But thank you so much for having me on.

Kelly Leveque: Yeah. And for anyone, you know that’s the thing with fab four, right? Plant-Based to, I would say carnivore, probably is it’s not gonna work for it, but plant based to paleo. I feel like if you understand that food pairing, you can really modulate your blood sugar and support that balance. So, oh, Casey, you’re the best. This is gonna be such an awesome episode.

Kelly Leveque: Thank you for listening to Be Well By Kelly, please subscribe to the show on Apple podcasts, Spotify, or wherever you listen to podcasts. Learn more at bewellbykelly.com, and follow me on Instagram @bewellbyKelly. I would love if you picked up my books; Body Love and Body Love Every Day. They’re sold on Amazon and at all major book sellers.