Master Your Glucose (ft. Dr Casey Means, Levels co-founder)

What’s better for you, veganism or keto? Oatmeal for breakfast or eggs? There is a lot to factor in when it comes to making the right nutrition choices, but a CGM can help you determine what works best for you personally. Dr. Casey Means, Chief Medical Officer of Levels, talked to Ali Spagnola and MaxNoSleeves about the importance of metabolic flexibility, how to find your own right foods, and the power of taking a walk.

04:59 – Optimize your nutrition choices

Using a CGM allows you to find the optimal food choices for you individually by giving you instant feedback.

From that information, you can see whether that oatmeal was an optimal choice for your breakfast. If you’re spiking really high and then crashing down, it’s possible that breakfast could actually be optimized to make it better for you. And what we mean by better for you is a more stable glucose result. And there’s lots of ways you can do that. You can add fat, protein and fiber to carbohydrates, you can walk after the meal. There’s lots of things you can do to stabilize the blood sugar. And so it’s about making those holistic choices and understanding that is what Levels is all about. It’s part of a bigger mission to not only help people understand their diets in a totally different way and their lifestyle, but also to help people gain metabolic awareness, which is this ability to understand what’s going on in your metabolism.

11:19 – Increase metabolic flexibility

Keeping your glucose levels stable gives your body the chance to switch between using glucose or fat for energy.

Glucose is like our short-term debit account and fat is like our long-term bank account, like savings. And so by keeping glucose a bit more stable and not always putting it in the body, we open up this opportunity for our body to tap into fat more often, which is awesome. And just translating this into our obesity epidemic, 74% of Americans are overweight or obese. That is emblematic of us not tapping into our fat stores for energy. And that is also called metabolic inflexibility. People have maybe heard the term metabolic flexibility, metabolic inflexibility, that’s exactly what I’m talking about. It’s flexible if we can swap between fat and glucose burning. We’re inflexible if we’re basically rigidly using glucose all the time.

14:12 – Train your metabolism like a muscle

By keeping your glucose levels stable and flat as consistently as possible, you’re increasing your metabolic fitness just like building muscle through weight training.

So I think one of the reasons we call metabolic health, we sometimes refer to it as metabolic fitness because it is something that you can train. And instead of doing like weightlifting reps, it’s like the reps are having more time and more days where you’re not spiking your glucose through food. Like that’s the reps. And so one sort of way that you can do this is by using a continuous glucose monitor, and really learning which foods spike your glucose and how to minimize those spikes. And then start eating in that way consistently. So you put glucose monitor for one week and eat your normal diet. You might identify three or five things that just happened to super spike you.

25:38 – Walking after eating sugar reduces glucose spikes

Levels carried out an informal experiment to test the impact of drinking a can of Coke with and without walking afterward. Walking had a significant impact.

We sent everyone on the team two cans of Coca-Cola and the idea was to see how the power of a walk after a high glucose load would impact our glucose response. And what we found was that when people chugged a can of Coke and then didn’t take a walk versus when they chugged a can of Coke, 12 ounces, and then took about a 30 minute to an hour walk afterwards, we saw 33% decline in the peak of the glucose spike. And so the average peak without a walk was 162 mg/dL, which is really high for just drinking a one small can of soda. And it was 132 after the walk. So really pretty significant decrease just by taking a gentle stroll afterwards. And then we expanded this to a bunch of our members and sent them cans of Coke and we saw a very similar results.

31:20 – Watch out for American breakfast foods

Levels now has a growing data set that shows which foods tend to score the best and worst with their users. Refined carb breakfast foods are some of the worst.

Definitely on our lowest scoring foods in the Levels data set we saw so many standard American breakfast foods. Every single one you could expect. It’s like bagels, pancakes, waffles, breakfast potatoes, things like that. Like scones, overnight oats Cheerios. These are all things that are listed in the 50 worst scoring foods. So I think breakfast is just this massive opportunity for people to make some shifts. Because if you look at our best food list, the top 50 best foods, we also see a couple breakfast items. But it’s the things we’d expect, eggs and avocado, even eggs and bacon is in there and a top-scoring food.

36:56 – Understand optimal glucose levels

As more biometric devices are rolled out, we’ll be able to have a fuller understanding of what the optimal glucose level range is for health.

If we see that everyone with a really low insulin level, which is indicative of good insulin sensitivity has a particular glucose pattern on their glucose monitor, that lends evidence to the fact that we want to shoot for this glucose pattern as an optimal range. If we see that everyone who’s moving more towards insulin resistance and more metabolic dysfunction as evidenced by their insulin levels or certain cholesterol Levels, triglycerides, et cetera, that they all have a very particular pattern of glucose on their monitor. That would also help us understand that’s probably not optimal. So this merger of additional lab tests and the glycemic parameters on CGM, I think is going to really unlock a lot.

42:52 – Develop interception

As you monitor your glucose for a long time, you can start having an awareness of how your body feels at certain levels so you might know if you’re spiking or dipping without checking.

This is essentially like building body awareness around glucose. And the term that I love for this is called interception, which is this word that basically means this awareness of what’s going on in the internal working of your body. And so you can have interception about your heart rate, which is where you’re just sitting quietly and you can kind of sense and feel your heartbeat beating. And I do think that that exists for glucose as well, where after monitoring for a long time, you start to be so attuned to what the subtle variations and how you feel are that you can kind of predict like, oh, I’m probably spiking right now. Or I’m probably really low right now. Or I’m maybe like 110 right now.

47:37 – Focus on whole foods plant-based eating

Eating plant-based can either be a way to eat a lot of glucose-spiking carbs, or a way to eat healthy whole foods that keep you stable. It’s about making the right choices.

There’s two ways of doing plant-based. There’s dirty plant-based and whole foods plant-based. And I consider dirty plant-based, like where you’re buying, I mean a big bowl of pasta covered in olive oil and vegan soy cheese, that’s vegan. But that’s obviously going to spike your glucose, but focusing more on whole foods and unrefined foods, unrefined grains, not eating refined sugars, that’s going to get you a lot of the way there. Then within that healthy version of a plant-based diet, you can tweak even more using a CGM. So I found that, we talked about grapes, corn, sweet potatoes, rice, lot of grains, these were spiking my glucose. So I swapped out basically all rice for cauliflower rice and broccoli rice, which is very easy to do. And now I love that, it doesn’t spike my glucose at all.

52:17 – Stop the nutrition wars

A CGM is useful for all types of diets from vegan to keto to carnivore. It lets you see which foods are most optimal for you and can actually open up your diet to more options.

even if you’re on a more conventional keto diet, which is going to be more animal protein-focused. Even there, you can definitely use the CGM to tweak it, to make it as good as possible for you. And we found a lot of people on a conventional keto diet actually really change what they’re eating with the use of a CGM. And in that case actually liberalizing their diet, because they’ve been told maybe like they can’t have any carrots or they can’t have any fruit. They find that, oh, I actually can have carrots and pear and have no glucose spike, it won’t kick me out of ketosis. So that’s one of my favorite things is like how this device might actually help us get past nutrition wars and get past just the really loud dogmatic voices in the nutrition space and let people have the power to actually create a diet that fits with their values, but also is supporting optimal cell biology.

57:46 – One drink a day can help with glucose levels, but it’s complicated

Studies have shown that one drink a day is best for metabolic health, but alcohol can have other negative effects, so it’s hard to recommend it.

If we look at epidemiologic studies like large populations, interestingly people who drink about one drink per day. like wine, tend to have better overall long-term metabolic health than people who don’t drink anything or people who drink two or more drinks per day. So it’s a J shaped curve is what it’s called. Or basically it’s like, nothing has a higher risk than just one a day. So that’s what the studies show in large populations. I don’t quite know how to feel about that to be perfectly honest, because the idea of making yourself drink one drink a day for metabolic health seems kind of irresponsible to me. As if you’re doing it as part of your supplement process.

Ali Spagnola (00:00:00):

Hey Fitheads, today we talk with Dr. Casey Means, one of the co-founders of Levels. And you probably have heard us talk about Levels and metabolic fitness. This is awesome to do a deep dive with her, and we touch a lot on metabolic flexibility, which is so freaking cool. And I love that we could really get into it about that.

MAXNOSLEEVES (00:00:25):

Yeah, she was great. She’s super fun to talk to. I mean, we started off talking about this from the beginning. But she is wicked smart, but doesn’t make you feel like an idiot for asking questions, which is the perfect type of smart in my opinion. But it was funny because we’ve talked about Levels before but this was real, like we got into metabolic health, metabolic fitness, metabolic flexibility, that type of thing.

Ali Spagnola (00:00:54):

Ketones, the future of continuous data stream monitoring

MAXNOSLEEVES (00:01:00):

Why it’s so important to measure this stuff. I mean, we talked about this a lot. We talked about this with, I forget what it was. I think it was one of the just straight body building things or the first way to improve something is to track it. And Levels is one of the first ways we’ve ever been able to track our blood sugar glucose levels in real time. And then you can actually say, “Okay, that thing affecting this and this thing is directly doing that.” You know what I mean? Actual strategies versus-

Ali Spagnola (00:01:33):

Right, make a connection between how food affects your health.

MAXNOSLEEVES (00:01:40):

Yeah. And walking, and when you eat-

Ali Spagnola (00:01:43):

Chugging Cokes too, that was super interesting.

MAXNOSLEEVES (00:01:45):

Chugging Cokes and I’ve never heard more anti-grape slander. Didn’t see that coming, but it was amazing.

Ali Spagnola (00:01:54):

Stay tuned.

MAXNOSLEEVES (00:01:57):

Welcome to Total Fitheads.

Ali Spagnola (00:01:58):

Serious fitness for not so serious people. Hey Dr. Casey, welcome.

Dr. Casey Means (00:02:04):

Hello Ali and max, thanks for having me.

Ali Spagnola (00:02:06):

Yeah. Thanks for joining. So stoked to talk to another Levels member. So in case-

MAXNOSLEEVES (00:02:14):

Level two.

Ali Spagnola (00:02:14):

Level two. They seem like they’re on level 100. I swear I keep getting updates that this is the trajectory of this company. But you are like the OG member, so it is so fun to talk to you. You guys are good at that too, making us feel like a part of something. Actually, I just want to talk about that. When I’m like looking at your Instagram or any of the stuff that you’re putting out there, it’s really cool that I feel like I’m learning, but not talk down to. Do you know what? Like I’m getting smarter, but I’m in on it so I’m a part of the smart people. I think you guys do a really good job of that. If that makes sense.

Dr. Casey Means (00:02:52):

Thank you. I feel like you do a really good job of that too in your content and bringing people along the health journey in a really flexible way. But I think it’s because it comes down to just, we’re all in this together. It’s like 88% of the country has metabolic dysfunction. It’s something we all need to know about to live our healthiest lives and it all starts with education. And so we really do see it as a community, this is not like company and members. It’s like, we are all a community in this together.

Ali Spagnola (00:03:20):

Yeah. We’re all fighting the good fight. It’s crazy how prevalent and how much lack of knowledge there is. So thanks for doing that. Actually, some of the Fitheads have not seen the original Levels episode, can you just give us an overview of what Levels does, maybe why we should care about glucose?

Dr. Casey Means (00:03:43):

Absolutely. So Levels is a product that helps people understand exactly what food is doing to their body in real time. This is not a tool we’ve had access to before where like you eat something and you immediately know what’s happening in your body. We’ve had all these lagging indicators with nutrition, like your weight on the scale the next day, or maybe your cholesterol panel six months down the road. But those lagging indicators make it really hard to actually learn which particular choices and particular aspects of your diet are affecting you in a positive or negative way. So that’s what Levels does.

Dr. Casey Means (00:04:21):

And we do this through the use of continuous glucose monitor, which I’m sure anyone who’s following you has seen you wear it. But you wear this little device like a wearable on the back of your arm and it’s measuring your blood sugar 24 hours a day, seven days a week for the length of the sensor, which is you wear it for two weeks. And that information is sent to your smartphone and then our software, the Levels app helps people really interpret that data stream. So an example of this would be like you eat oatmeal first thing in the morning for breakfast. Over the next two hours, you see your blood sugar going up to a certain peak and then coming down.

Dr. Casey Means (00:04:59):

And from that information, you can see whether that oatmeal was an optimal choice for your breakfast. If you’re spiking really high and then crashing down, it’s possible that breakfast could actually be optimized to make it better for you. And what we mean by better for you is a more stable glucose result. And there’s lots of ways you can do that. You can add fat, protein and fiber to carbohydrates, you can walk after the meal. There’s lots of things you can do to stabilize the blood sugar. And so it’s about making those holistic choices and understanding that is what Levels is all about. It’s part of a bigger mission to not only help people understand their diets in a totally different way and their lifestyle.

Dr. Casey Means (00:05:42):

But also to help people gain metabolic awareness, which is this ability to understand what’s going on in your metabolism. Your metabolism being this core pathway in your body that generates the energy for every single cell in your entire body. It’s so important and it’s not something we really I think have our heads around on a day-to-day basis. The reason we need to care is because unfortunately, problems with metabolism are underlying a lot of the chronic diseases that we’re seeing in this country. Metabolic dysfunction is a term I think more and more people are hearing, largely in part to a study that came out two years ago that showed about 88% of American adults have metabolic dysfunction, at least one biomarker of poor metabolism.

Dr. Casey Means (00:06:27):

And what that really means is that we’re having this like energy crisis in our bodies, in the United States, where we are not converting the food we’re eating into usable energy properly. Or we’re storing it improperly, we’re storing a lot of it as fat. And this is underlying our obesity epidemic or diabetes epidemic and all the downstream sequela of these conditions like heart disease, and Alzheimer’s and stroke, cancer, many, many others. And so getting our metabolism in check and in large part, that’s related to getting our blood sugar under control is really critical for almost every American.

Dr. Casey Means (00:07:08):

So there’s kind of two parts of this, which is like personal empowerment, understanding your own diet, how to eat and live. But big picture, how that feeds into keeping us healthy over the long-term. And having a population that’s empowered and has the understanding to really take control over their health, over their lifespan.

Ali Spagnola (00:07:27):

Yeah. When you’re talking about finding your personal diet, right? I’m that exact example where I ate oatmeal, and was spiking like I was diabetic and had no idea. So I mean, I just want to reiterate this, if the audience is not familiar. I could have that spike that high and Max could eat the same thing and have a very low steady nice glucose response. So the crazy thing is we’re getting this diet information that is supposed to be for the general population when really everyone is completely different.

Ali Spagnola (00:08:06):

And the only way to know is to really look at your own data and find the diet that’s great for you. I mean, you’re also talking about long-term health and I kind of want to dive into short-term performance versus like that longevity thing that you’re mentioning, right? How do you balance those? Because as I’ve been using Levels, it seems almost like they’re at war with each other.

Dr. Casey Means (00:08:36):

Yeah. That’s an interesting question. So in terms of what we want to see on our day-to-day, the goal really is for most of the time to be staying in a stable and healthy range for your blood sugar. Glycemic variability are the ups and down swings in glucose, just like mountain valley, mountain valley, mountain valley. And a lot of people are dealing with that day in and day out, just because of the nature of the standard American diet. The majority of the calories we’re eating in this country involve refined carbohydrates or refined sugars. It makes up a lot of our diet, which is not normal from historical perspective.

Dr. Casey Means (00:09:19):

And so that puts us on this glucose roller coaster throughout the day. And the more we can tighten that up and turn it from like peaks and valleys to gentle rolling hills, the better that is for our day-to-day performance and our long-term health. So focusing on day-to-day performance, taking the oatmeal example as sort of a use case here. If we’re thinking about mental performance and how we’re showing up to our day and to our meetings, that big spike after oatmeal and then followed by a crash that could very much lead to us feeling really lethargic and almost having some brain fog during that crash portion of that.

Dr. Casey Means (00:09:57):

So like we go up and then we come down, the body sort of overshoots in its response to that glucose load and we can dip. And that dip after a big spike is called reactive hypoglycemia. And reactive hypoglycemia is often associated with that fatigue, and that lethargy, and that brain fog and maybe even some like moodiness or anxiety. So something I really think about is how like more glucose stability often translates to just more subjective stability in my own day-to-day life. And to me that really feels like power. Like I’m no longer at the mercy of this up and down liability that doesn’t feel good.

Dr. Casey Means (00:10:35):

And another way that it can impact performance more on an athletic perspective is that when we keep our glucose more stable and we don’t have all these spikes all the time, our body actually becomes less reliant on glucose for energy. So we have really two forms of energy in the body, we have glucose and we have fat. And if you’re always giving your body glucose, the body will use that preferentially. And we become these like glucose monsters who like can really only use that, like those are the pathways that are active in our body. And we actually get fairly rusty at using fat for energy because the glucose is available and we’re going to use that at first, it’s quick and easy.

Dr. Casey Means (00:11:19):

Glucose is like our short-term, like debit account and like fat is like our long-term bank account like savings. And so by keeping glucose a bit more stable and not always putting it in the body, we open up this opportunity for our body to tap into fat more often, which is awesome. And just translating this into like our obesity epidemic, like 74% of Americans are overweight or obese. That is emblematic of us not tapping into our fat stores for energy. And that is also like called metabolic inflexibility. People have maybe heard the term metabolic flexibility, metabolic inflexibility, that’s exactly what I’m talking about.

Dr. Casey Means (00:11:59):

It’s flexible, if we can swap between fat and glucose burning. We’re inflexible, if we’re basically rigidly using glucose all the time. And that’s something we can train our bodies in by basically shifting up what we sort of push it to use. But by always having that glucose roller coaster on we’re pushing in towards glucose use. This impacts performance because if you’re metabolically flexible and you can burn fat when you need to, when you’re low on glucose. For endurance athletes this can be really powerful, because as opposed to being like, “I need a banana every 30 minutes on my ultra marathon, or I need the goose, or I need the gels or I need the Gatorade.”

Dr. Casey Means (00:12:39):

A lot of people are sort of tapping into, what does it look like if I just burn fat for these like four or eight hours? And we’re seeing several people start to do like, and I’m not recommending this. But like have the ability to do fasted marathons and things like that. Actually a member of our team just did the Fasted New York Marathon. And it’s like amazing because if you were not metabolically flexible, that would be impossible because you would basically burps. You would burn through all your glucose and then you would not have biologic ability to tap into fat burning because you haven’t essentially flexed that metabolic muscle.

Dr. Casey Means (00:13:20):

So those are just two examples of like where glucose management can help with performance, both mental by avoiding the reactive hypoglycemia and then physical by tapping into metabolic flexibility and how maybe with some of our endurance performance. There’s several more examples of this but those are two that I certainly feel in my own life.

Ali Spagnola (00:13:43):

Yeah. That’s crazy.

MAXNOSLEEVES (00:13:45):

You touched on it a little bit, but can you expand on it a little bit? Sort of two things are happening right now, one is that people are realizing what is going on. This food maybe spikes, this food doesn’t, this timing, blah, blah, blah. But then it’s also something you can train, it’s not just what do I do, how do I do it? But it’s also something that you can improve upon. Can you talk about some strategies can you expand on that a little bit?

Dr. Casey Means (00:14:12):

Absolutely. So I think one of the reasons we call metabolic health, we sometimes refer to it as metabolic fitness because it is something that you can train. And instead of doing like weightlifting reps, it’s like the reps are having more time and more days where you’re not spiking your glucose through food. Like that’s the reps. And so one sort of way that you can do this is by using a continuous glucose monitor, and really learning which foods spike your glucose and how to minimize those spikes. And then start eating in that way consistently. So you put glucose monitor for one week and eat your normal diet. You might identify three or five things that just happened to super spike you.

Dr. Casey Means (00:15:01):

For me, I’ve been wearing one for two years but when I first started, there were some surprising things. Like I could eat a bunch of fruit and not spike, but if I ate grapes, I spiked 80 points. Or I could eat a bunch of vegetables and then I ate corn and I spiked through the roof. Or well I’ll eat sweet potatoes because they’re better than potatoes, but they actually spiked me more than regular potatoes. And same with brown rice, the brown rice and the white rice did the exact same thing. So a lot of these conventional things I’d been taught like brown rice is better than white rice, sweet potatoes are better than potatoes. From a glucose perspective, they weren’t.

Dr. Casey Means (00:15:37):

And so by learning that I can minimize the portions, I can pair them with fat, protein and fiber. I can make sure to walk more after I eat those foods, I can make sure to eat them earlier in the day when I might be more insulin sensitive. There’s all these ways to basically keep them in your life if you want to, but build a context around them that keeps the spike down. So that’s kind of one of the ways that you can, I guess, train to keep glucose down. Another option is kind of timing when you do your workouts. And this gets into this concept of fasted workouts that’s and coming up, I think quite a bit more in the fitness space.

Dr. Casey Means (00:16:15):

Which is this idea that you intentionally do your training in a time when your glucose is low or lower like first thing in the morning, because what you’re doing then is you’re burning through whatever glucose is still in the bloodstream or stored in a liver, in the muscle, in a storage form of glucose called a glycogen, which we have a small amount, like a few hours worth. And I should be clear, you’re not burning through like all the glucose, your body knows how to keep the glucose above a certain minimum, because we always do need glucose in the blood and the body has amazing ways of keeping it in a healthy sort of stable range by actually even making glucose from other substrates in the body.

Dr. Casey Means (00:17:04):

But basically the idea is burn through the excess glucose in the body, muscle, liver, bloodstream. And then you’re basically forcing your body during that workout to switch flip gears, flip on the switch of fat burning. You can think of the alternative, which is like, you drink a Gatorade before your workout. Now you have an extra 40 grams of glucose in the bloodstream. Your body’s just going to use that primarily before it starts tapping into all these other things. And it’s very unlikely you’re going to actually ever get to the point where you need to burn the fat.

Dr. Casey Means (00:17:39):

And so the idea of the fasted workout is like burn through your storage bank, force yourself to get into the fat burning. That’s another thing that people are talking about a lot. It’s something you want to definitely like talk to your coach about, talk to your doctor and not just like jump into it. You don’t want to run 10 miles fasted if you’ve never done this before, because your body’s not going to be prepared to do that. So it’s something you can like ease into.

Dr. Casey Means (00:18:03):

And for me, like I started by not eating of high carb things before workouts, saw how that felt. Then started just like fasting for a few hours before workouts, see how that feels. And then wake up in the morning and do a Peloton ride, and like see how that feels and kind of like ease into it. So those are kind of two ways, like one focus on minimizing your spikes over time, two like consider things like fasted workouts. But really it’s about keeping the spikes down day after day and pushing our body towards a place where it’s more comfortable in that lower glucose state.

Ali Spagnola (00:18:42):

Yeah. It all seems like focused on like longer cardio workouts, right? What about the more high intensity kind of stuff. So you guys keep repeating your statement about how it Levels helps you understand, I don’t want to get it rolling. So like Levels helps you understand how your body is affected by food.

Dr. Casey Means (00:19:08):

How food affects your body.

Ali Spagnola (00:19:09):

Food affects your body. Okay. But like my favorite thing about wearing Levels is watching what happens in a high intensity workout. It’s the same thing for anybody who’s not done this, like you watch your heart rate on your Apple Watch and you want to see it, get up there, you want to see those peaks in your intervals and it’s really motivating to get it up higher. And that’s how I feel when I’m watching my glucose in a workout like that.

Ali Spagnola (00:19:36):

I’m just curious, is that even a good way to look at this? Or is it actually better if during a high intensity workout, my body doesn’t do that because it’s so prepared it doesn’t even need to dump all of that into my blood. And should I be aiming to lower those peaks as well with time and effort?

Dr. Casey Means (00:19:58):

Yeah. To be totally transparent, I don’t think we fully know the answer to this question yet, but there’s a lot here that we can unpack. So I think just for people who are listening, who might not understand this, there’s this fascinating thing that happens in the body during high intensity training or like power work where glucose actually rises even if you’re fasted. It will often rise during a high intensity workout. And this tends to be seen when people are above about 80% of their VO2 max or a rough estimate, 80% of their max heart rate. And above that threshold, we tend to see glucose go up during a workout.

Dr. Casey Means (00:20:38):

Totally paradoxically, people are like “What, I’m using my muscles why is it going up?” And I know you know this Ali, but just to explain it for the listeners. Like the idea is actually that the body during those high intensity training is under stress and your body secretes all the stress signals cortisol, catatonic hormone. And that tells the body there is a threat that we need to probably run from, so we need to mobilize some glucose stat for our muscles. That’s what the workout is kind of saying into your body through hormones. And so what it actually does is cause the liver to immediately dump a lot of its stored glucose into the bloodstream to feed the muscles.

Dr. Casey Means (00:21:17):

This is a very different physiology than what’s happening when food enters our body and like exogenous glucose comes into the bloodstream. And the big difference is that our muscle are physiologically primed in that moment to take up glucose, to be quite insulin sensitive. And even muscles have this unique ability to take up glucose without insulin. Just the muscle contraction itself causes the muscles to take up glucose in the absence of the hormone that usually is required to uptake glucose. So you have a sync for glucose and the sync is primed to take it up and use it immediately for energy.

Dr. Casey Means (00:21:53):

So it’s like there’s a flow of that glucose towards something and then processing. If you’re just sedentary and sitting at the dining room table and spike your glucose, 50, 100 points, there’s no sync for it, to take it up and to use it. And so it’s a very different physiology and on top of that, with the food, you’re going to be secreting lots and lots of insulin to take up that glucose. Whereas in a workout, there’s not going to be that same need for the body to secrete all that insulin. So it’s a very different thing and what the evidence seems to point towards is that those exercise and spikes are probably not a big problem. They’re short, they’re self-limited.

Dr. Casey Means (00:22:38):

The glucose is going somewhere and being used. And we know that high-intensity interval training, even over the course of a few days improves our metabolic health, improves our insulin sensitivity. So it seems to have really positive results for our metabolic health, even after just a couple workouts. So not something to fear, but like I said, we need to understand this better over the long-term. Because there is some research that’s come out recently showing that too much high-intensity interval training, can potentially cause so much sort of oxidative stress in ourselves. That it could actually be damaging if we do too much of it.

Dr. Casey Means (00:23:18):

But the study that I’m thinking about, it was like over 150 minutes of high-intensity interval training per week. Like, no one’s recommending you going at like 80 or 90% of your max heart rate for 150 minutes a week. And so I don’t think it’s actually quite relevant to the average population for whom short spurts of high-intensity interval training is extremely helpful for metabolic health. So not something to fear, I actually do the same thing as you Ali, like I get motivated sometimes by seeing spikes during like a really, really hard workout.

Dr. Casey Means (00:23:55):

Like a CrossFit workout or something like that, or like a really hard power zone training workout on Peloton because I’m like, “Yeah, I went hard, my body recognized it and it responded by mobilizing my glucose on my muscles.” And almost like the extent of that peak is like a representation of like how hard I went.

MAXNOSLEEVES (00:24:19):

Have you ever tried a beer mile?

Dr. Casey Means (00:24:21):

I have not. I played rugby my freshman year of college and there was a lot of beer involved in that.

MAXNOSLEEVES (00:24:31):

Less formal, yeah.

Ali Spagnola (00:24:31):

I love it. So wait, the muscles is taking in glucose without insulin, is that specifically in high intensity because of what’s going on with the body or is that also going to happen with a walk after a workout per se?

Dr. Casey Means (00:24:45):

You know I don’t know exact answer to that question. I assume it’s all the time because it’s muscle contraction itself that helps take up the glucose, but that’s a great question.

Ali Spagnola (00:25:00):

Okay. Yeah. Well we can talk a little bit about the Coke experiment you guys did, right? That was fascinating.

Dr. Casey Means (00:25:06):

Yeah. This was really fun. So we took a group of people who hate sugar, a bunch of Levels employees.

MAXNOSLEEVES (00:25:14):

Where could we find such a group, I wonder?

Dr. Casey Means (00:25:20):

And we’re like, “Hey, everyone should pound some Coca-Cola.” So this was totally voluntary, anyone who wanted to participate in the company could do it. But basically what we did is we… And we actually expanded this out to our members as well after we did the initial study with the team. But we sent everyone on the team two cans of Coca-Cola and the idea was to see how the power of a walk after a high glucose load would impact our glucose response. And what we found was that when people chugged a can of Coke and then didn’t take a walk versus when they chugged a can of Coke, 12 ounces and then took about a 30 minute to an hour walk afterwards. We saw 33% decline in the peak of the glucose spike.

Dr. Casey Means (00:26:10):

And so the average peak without a walk was 162 mg/dL, which is really high for just drinking a one small can of soda. And it was 132 after the walk. So really pretty significant decrease just by taking a gentle stroll afterwards. And then we expanded this to a bunch of our members and sent them cans of Coke and we saw a very similar results. So this was just like really lended to a lot of other research, this was not formal research. Of course it was just like a more anecdotal experiment. That literally just getting up and walking for 15 to 20 minutes after a meal is so powerful for soaking up some of that glucose and reducing that glycemic variability that we want to avoid.

Ali Spagnola (00:27:01):

Yeah. It’s crazy how short that is. I would expect that you would need an hour or so to make a difference, but it’s not.

Dr. Casey Means (00:27:08):

Yeah. It’s like the simplest hack that you can possibly do. I think after meals to shuttle that glucose into use.

Ali Spagnola (00:27:17):

And what seems interesting is that we keep talking about personalized health and how it’s different for everyone. This seems to be the one thing that is kind of universal, right?

Dr. Casey Means (00:27:27):

It definitely feels like it is. I mean, there’s very few people who take a walk and don’t see some improvement. What’s interesting is you might take a walk for 20 or 30 minutes after a very high carb meal and you see a stark decline in glucose. And you might actually go up right when you stop walking, and that’s because your body is still processing and digesting the glucose. So I’ve seen this many, many times myself where I’m like going rapidly up, I jump on the bike or whatever, and it comes right down.

Dr. Casey Means (00:27:59):

But if I only do it for 20 minutes, the glucose is still processing, it’ll go up again. So you may need to do it longer to kind of get through more of the glucose if it’s a particularly high carb meal. But honestly this is not about perfection, this is about like generally limiting trends that are damaging over the long-term. So anything is good in terms of a quick walk after a meal or some movement.

MAXNOSLEEVES (00:28:26):

It’s just surprising with the amount of data that you guys have collected, but that’s the only thing that happens to everybody. Are there food-

Dr. Casey Means (00:28:38):

Well, I wouldn’t say.

MAXNOSLEEVES (00:28:39):

I mean, is there be years? I don’t know, is there something that’s like a definite killer from all the data you guys have been collecting? I mean, you guys have been…

Dr. Casey Means (00:28:48):

Yeah. Coke. I mean, there’s a lot of trends that we have seen around our data set of sort of like what spikes people almost universally. When you look at sort of like what the worst foods are amongst the data set of 15,000 people who have gone through the program, over 50 million glucose data points. You see a lot of things that you would expect in the bottom. Like if we’re looking at the bottom 50 scoring foods. It’s a lot of things you would expect, it’s like, Chick-fil-A, McDonald’s, Chinese takeout, Thai food. It’s like a lot of takeout and fast food. But there’s also a lot of things there that are kind of surprising. Like grapes, that was one that hit me. And that’s one of the ones that we see really big spikes from.

Dr. Casey Means (00:29:48):

And I believe there’s an average post-meal rise just from grapes alone of like 35 points. And in comparison, like if I eat an apple, it usually really goes up like 10, 15 points. But grapes, for some reason like 34 points if you look across our data set. We also saw some other surprising things like sushi, which may not be surprising since there’s a lot of rice. But like, I think a lot of people assume there’s fish, there’s avocado, sometimes there’s rice, but it’s one of our top scoring foods in terms of large glucose spikes. We saw acai bowl on our lowest 50 scoring foods, which was interests-

Ali Spagnola (00:30:29):

But it’s so healthy.

Dr. Casey Means (00:30:29):

But it’s so healthy, I know. And I think it’s one of the-

MAXNOSLEEVES (00:30:32):

Did you see the label?

Dr. Casey Means (00:30:33):

Yeah. And like the cost and the price tag. But I think that’s one of the ones where yes, there lots of great nutrients in it from fruit antioxidants, et cetera but it’s like a naked carb. It’s like all fruit forward and you don’t really have much like fat or protein or fiber in there. Like it’s blended fruit typically. So that’s one where I’d like really switch it up and be like, “Okay, can we do some yogurt with like maybe a little acai bowl, dollop on top. And then like hemp seeds, and walnuts, and almond butter and like chia seeds.” And how can you balance that to get the benefits of the fruit without making it just such a naked carb that’s just going to hit your bloodstream so fast.

Dr. Casey Means (00:31:20):

And definitely on our lowest scoring foods in the Levels data set, we saw so many standard American breakfast foods. Like every single one you could expect, it’s like bagels, pancakes, waffles, breakfast potatoes, things like that. Like scones, overnight oats Cheerios. These are all things that are listed in like the 50 worst scoring foods. So I think breakfast is just this massive opportunity for people to like, make some shifts. Because if you look at our best food list, like the top 50 best foods, we also see a couple breakfast items. But it’s like the things we’d expect, eggs and avocado, even like eggs and bacon is in there and like a top scoring food.

Dr. Casey Means (00:32:10):

So things that are like more whole foods, and not based on refined grains or carbs, and more of a fat and protein heavy breakfast. So definitely from what we’re seeing in the data set, like there’s a massive opportunity for people to clean up breakfast and start their day off without this big spike. So there’s one simple tip, it would be to try and eliminate the refined grains and carbs from breakfast and move towards things that are going to be a bit more like whole foods, vegetables-

Ali Spagnola (00:32:43):

Lets have a marathon for breakfast.

Dr. Casey Means (00:32:45):

Exactly. Yeah, just do that.

MAXNOSLEEVES (00:32:49):

But it’s funny though, because you categorize McDonald’s and Chick-fil-A as bottom foods or whatever. But how do you categorize that? Because a lot of the other things that you’re talking about like eggs, eggs is not a breakfast sandwich. You see what I’m saying? Like there’s so many things that go into like a lasagna, like I always sort of pointed this as like 50 different things that are possibly in there. So how do you categorize that on your end?

Dr. Casey Means (00:33:16):

Well, So when we’re looking at this type of pulling, this type of data, these are sort of the caveats. This is people who logged one single food at a time. So like the log that they log said Chick-fil-A or the log said McDonald’s. So we don’t exactly know what’s in that, but we know that that’s what the log said. So we can look at the data and say, “Okay, 3000 people logged the word Chick-fil-A and the average spike was 42 milligrams.” I don’t know what it is off the top of my head. And the words like that, that showed up in the bottom were things like Pad Thai, McDonald’s, dim sum, these categories.

Dr. Casey Means (00:34:03):

So it doesn’t give us the exact food because that’s not how the person chose to log it. But across a large population, we can see this come up over, and over and over again. And so it doesn’t give us the exact answer about what ingredient is, but it gives us a bit of a stall of like, if you’re going to Chick-fil-A, you’re probably in the market for a bit of a spike. And actually something we’re really working on in our back end is creating more of a friction free like logging experience. So that people are encouraged to log more of the individual components of their meal, such that we can draw out more clear relationships between what exact part of the meal is causing the spike because I think that’s getting at what you’re talking about.

Dr. Casey Means (00:34:51):

Like that is kind of the next layer of this, in a lasagna we kind of know it’s the noodles that’s like spiking the glucose. But like maybe it’s the tomato sauce that has sugar in it or maybe there’s something else in there. And to be able to pull out with that granularity, I think is kind of the next frontier. And there’s really cool technology like to potentially get at some of that like optical recognition of photographs and other of things. So the more we can make it easy for people to get that type of granular data, I think the better. And that’s the future.

Ali Spagnola (00:35:29):

Interesting. I’m definitely not helping you guys out there. I just take a photo, I don’t even put a note, so good luck. Could be Chick-fil-A, I don’t know. So when you’re talking about the data set, not specifically foods, but you guys are basically pioneering what actual optimal glucose is, right? And you’re looking at average variability range, you’re gathering all this data. How has that shifted, are you seeing that you’re changing what you think is optimal after you’re gathering more information?

Dr. Casey Means (00:36:08):

Yeah. I think we’re actually going to start to make some progress with that in the coming years. In part, because of this new product offering that we’re actually rolling out right now, which is additional lab testing that Levels members can do to understand the full spectrum of their metabolic health. And that’s things like cholesterol panels, fasting, insulin, different markers of insulin, sensitivity, inflammatory markers, hemoglobin A1C. And the reason that’s important is because to understand what optimal is on the continuous glucose data stream we need to know how that pattern on the continuous data stream maps onto underlying health metrics.

Dr. Casey Means (00:36:56):

Like if we see that everyone with a really low insulin level, which is indicative of good insulin sensitivity has a particular glucose pattern on their glucose monitor, that lends evidence to the fact that we want to shoot for this glucose pattern as an optimal range. If we see that everyone who’s moving more towards insulin resistance and more metabolic dysfunction as evidenced by their insulin levels or certain cholesterol Levels, triglycerides, et cetera, that they all have a very particular pattern of glucose on their monitor. That would also help us understand that’s probably not optimal. So this merger of additional lab tests and the glycemic parameters on CGM, I think is going to really unlock a lot.

Dr. Casey Means (00:37:43):

And there’s certainly a lot of research labs and academic institutions that we’re partnering with that are also interested in this exact question. We’re working with Dr. Sara Gottfried at Thomas Jefferson University, to look at that exact question, which is like how can CGM data point us towards understanding like what someone’s underlying health is. Because we’re kind of going off general principles we know from the research. Like glycemic variability, more ups and down spikes, we know that’s associated with future progression towards diabetes. And is independently associated with heart disease and stroke.

Dr. Casey Means (00:38:22):

So like knowing that we want to push people towards less glycemic variability, but the next step is unlocking, what exactly should we be shooting for? Like what exact level of glycemic variability and whatnot. So that’s kind of the next frontier of this type of research.

Ali Spagnola (00:38:40):

Interesting. Yeah. It’s like you’re tying this continuous data stream to the one time lab. Do you see that some of these one time lab things will also become continuous? Talk to me about the future.

Dr. Casey Means (00:38:57):

I think that is the future. I think more continuous data streams and understanding how those relate is absolutely what’s going to unlock a movement towards more ownership over our health. Because when we have a single data point, it’s information but it’s not really a story. And so it’s not really helpful for us to understand cause and effect, it’s just information. A continuous data stream gives us a story that we can then understand, it breeds understanding over just information. So the more we can do that with all sorts of health metrics, the better. Having your cholesterol once a year, helpful information about where you stand that day, but not helpful in understanding what behaviors to change in your life to do better.

Dr. Casey Means (00:39:52):

So there’s lots of groups definitely working on this and think it is definitely the future. I mean, certainly having a continuous insulin monitor would be so incredible because glucose is very helpful. But downstream of glucose is insulin and insulin has lots of effects in its own right. And it’s not a one to one relationship between a glucose value and insulin. And so we can kind of use it as a proxy, but it’s absolutely not perfect. Having that extra layer of detail would unlock a lot. And a specific example of this is like, let’s say you and I had the exact same fasting glucose level, like let’s say all three of us had the same fasting and glucose level. And it was like 80 mg/dL.

Dr. Casey Means (00:40:39):

So all of our doctors say to us, “You are in perfect health, you have no glucose problems. Your fasting glucose, is in exactly the right range.” So we all go home feeling like we’re fine, but let’s say your insulin is 2 minus 10 and Max is 15. That means that we are actually all on a different level of the spectrum of metabolic dysfunction. And what’s happening is our bodies are increasingly compensating for metabolic dysfunction by producing more insulin, to keep the glucose at a certain level. And that will potentially go on for a decade.

Dr. Casey Means (00:41:14):

Our bodies will overcompensate by producing more insulin to keep glucose down and our glucose will stay the same until it reaches some critical threshold where our body can’t produce more insulin or become so insulin resistant that our glucose starts going up. So without that additional information of insulin, we’d all think we’re exactly fine, when in fact Ali’s doing fine, I’m on the spectrum of getting worse and Max is really kind of in hot water. So that’s where having this additional type of data can be super helpful in contextualizing single data points.

Ali Spagnola (00:41:52):

Yeah. And you talked about metabolism also includes ketones. Do you test yours?

Dr. Casey Means (00:41:59):

I do. I test my ketones most days actually. I use several different devices, I use a blood monitor by Keto Mojo, and then I use a breath monitor by Biosense. And I kind of find that the blood just feels easier for me to track day-to-day. It just feels a little bit more accurate and like what I expect to be on the monitor is what I see more often. So that’s what I typically go with.

Ali Spagnola (00:42:27):

Yeah. Tell me about what you expect to see on the monitor after having worn glucose monitor for two over two years, you said. Is there an awareness that you can sense without looking at your graph that maybe you’re spiking or crashing? Have you made the connection between what you feel and then what you’d end up seeing on Levels?

Dr. Casey Means (00:42:52):

I think definitely. This is essentially like building body awareness around glucose. And this is the term that I love for this is called interception, which is this word that basically means this awareness of what’s going on in the internal working of your body. And so you can have interception about your heart rate, which is where you’re just sitting, and you can kind of sense and feel your heartbeat beating. And I do think that that exists for glucose as well, where after monitoring for a long time, you start to be so attuned to what the subtle variations and how you feel are that you can kind of predict like, oh, I’m probably spiking right now. Or I’m probably really low right now. Or I’m maybe like 110 right now.

Dr. Casey Means (00:43:38):

And kind of be pretty on the spot about it, which is neat. And that’s one of the biggest things I think that’s promising about this technology is that it taps people into what’s going on in their body. It helps you hear these super subtle signals like in a louder way. And so the idea is not to make you feel like you have to be attached to technology for the rest of your life, but actually that it helps you tap into what’s just going on inside with or without the technology. So that’s something I love about it, but with the ketones, that’s one where I feel very much like I know of ketones are probably going to be.

Dr. Casey Means (00:44:17):

Because I don’t know if in your experience with getting ketones high, like I can kind of feel that as like this sense of clarity, and focus and almost like elevated in my body if my ketones are above a certain level. Usually it have to be above about 1.5 for me to feel really like I’m in ketosis. If they’re between about 0.5 and 1.5, which is mild nutritional ketosis, I can’t tell so much. But if I’m totally not in ketosis, like I don’t have any of that sort of like subjective feeling so I’m pretty clear that I’m not. What’s fun is like to see, okay, I had a big spike last night at dinner and then watch my ketones basically plummet the next morning and vice versa. If I can stay really flat for a few days, seeing my ketones go up.

Dr. Casey Means (00:45:03):

And the way that works for people listening is that ketones are a product of fat burning. So getting back to that conversation about metabolic flexibility. If I have a big glucose spike for dinner, what’s going to happen is that my body’s going to use all that glucose, it’s not going to need fat for fuel. And my body’s going to release insulin to help take up that glucose out of the bloodstream. And that insulin, a secondary effect of it is to block fat burning. So basically that spike is a signal to me that I’m kicking my out of ketosis. And I can kind of counter it a little bit by maybe taking like a long walk after dinner or something like that. But generally speaking, I’ve seen that relationship of like big spike on Tuesday, probably out of ketosis on Wednesday.

Dr. Casey Means (00:45:46):

The longer I’m in ketosis, the more my body can buffer some of those spikes a little bit and stay ketosis, but generally that’s a good sort of like relationship that I see. Similarly, if I’m keeping my glucose really flat and stable for several days in a row, my ketones are going to go up because I’m not overloading my body with glucose. And so it’s going to basically ask the body to burn more fat. So I like the two data streams together because it’s almost like the ketones are a readout of what you’re learning continuously with the glucose monitor. So it’s like proof that the behavior change stuff you’ve learned from the glucose monitor is having the outcome you want, which is metabolic flexibility. So that’s the way I typically use it. How about you?

Ali Spagnola (00:46:33):

And whats crazy Fitheads is that she’s getting these ketones readings with a plant-based diet. What? Its cool. I mean, I just always assume plant-based means that you’re just going to eat a ton of carbs and spike a lot probably. And that’s obviously not the case.

Dr. Casey Means (00:46:53):

It’s been a journey and I will be totally honest, like I was strict vegan for like almost three years and I’m a little bit off that wagon now. Like I do eat a little bit of eggs and fish, so full disclosure. But I was able to figure out over the course of two years of a plant-based diet and using these monitor how to basically turn a vegan diet into a ketone diet. It’s very, very, very doable. And there’s two things to think about here. Like one is if you’re focusing on whole foods and not like processed vegan crap, you’re going to be a lot of the way there.

Dr. Casey Means (00:47:37):

Like there’s two ways of doing plant-based, there’s like dirty plant-based and whole foods plant-based. And I consider like dirty plant-based, like where you’re buying, I mean a big bowl of pasta covered and olive oil and vegan soy cheese, that’s vegan. But like, that’s obviously going to spike your glucose, but like focusing more on whole foods and unrefined foods, unrefined grains, not eating refined sugars, that’s going to get you a lot of the way there. Then within that healthy version of a plant-based diet, you can tweak even more using a CGM. So I found that, like we talked about grapes, corn, sweet potatoes, rice, lot of grains, these were spiking my glucose.

Dr. Casey Means (00:48:16):

So I swapped out basically all rice for cauliflower rice and broccoli rice, which is like very easy to do. And now I love that, it doesn’t spike my glucose at all. I’ve minimized grapes for sure, I just don’t really eat them. I eat tons of fruit, but I don’t eat fruit that causes a gigantic spike. So that was a good learning. I definitely eat fewer sweet potatoes, but like sometimes I’ll roast sweet potatoes and like sprinkle them on of a meal as opposed to making it like a huge part of my plate. And if I eat them, I’ll drizzle Tahini on it for fat. I’ll put some chia seeds on it for fiber and protein. I will make sure that it’s not just like all hitting me with that glucose at once.

Dr. Casey Means (00:49:01):

So it’s all about, I think learning swaps and learning how to balance the food properly. It’s also just been fun to be creative, like I now make cauliflower rice sushi exclusively, and it’s so easy to make. It takes literally five minutes. I take a frozen bag of cauliflower rice, I dump it in a glass bowl. I microwave it for like three minutes, I put some Tahini for stickiness, some rice wine vinegar, some chia seeds. I let it sit for like 20 minutes. And then you just use it like regular sushi rice. And then I can have a ton of sushi, like of bazillion pieces and like, feel fine about it. So that’s one of my favorite things about a plant-based diet is I feel like I can eat so much food and it’s fine.

Dr. Casey Means (00:49:44):

And then I found that when… So a big part of my protein is beans, legume and tofu. Beans and legumes like lentils can spike some people, but interestingly, something we’ve seen really anecdotally is that as people increase fiber in their diet, really intensively they’ve found that they actually spike less to beans. And so I don’t spike really at all to beans or lentils. One of my co-founders David was spiking a lot to beans and lentils. And then he went on this experiment where he basically ate like a ton of fiber for a month in the form of chia seeds and flaxseeds, and noticed that he actually spiked less to beans and lentils after that.

Dr. Casey Means (00:50:31):

Totally not scientific experiment, but we know that microbiome has such a big impact on how we respond to different types of carbohydrates. And if all three of us ate the same meal and we all had different glucose spikes to it, microbiome definitely has some impact on that. That’s what the research shows. So I wonder if the fiber and especially if a plant-based person eating a very high fiber diet, part of the reason I don’t spike as much to some of these carb rich foods like beans and lentils is maybe somewhat microbiome mediated. So that’s kind of how I approach optimizing the diet.

Dr. Casey Means (00:51:10):

And then the second piece is I think that there’s an element of like… Like were talking about, each person responds differently to different carbohydrates. But metabolic health is not just about avoiding carbohydrates, like metabolic health is about a body that processes carbohydrates well. And there’s a lot of things about a plant-based diet that do create a metabolically healthy body. For instance, microbiome support through fiber. But a second thing is micronutrients, like for the mitochondria in our cells to work properly and actually process energy into ATP, you need all these little micronutrients. Like vitamin C, and manganese, and magnesium, and B vitamins and things like that.

Dr. Casey Means (00:51:56):

And so I think eating a very whole foods diet is giving you a lot of those micronutrients to kind of help with that processing. So that’s the kind of the way I approach it. But what I love about CGM is that you can almost tailor any diet to be more optimal for you through the lens of this personal data. And so even if you’re on a more conventional keto diet, which is going to be more animal protein focused. Even there, you can definitely use the CGM to tweak it, to make it as good as possible for you. And we found a lot of people on a conventional keto diet actually really change what they’re eating with the use of a CGM.

Dr. Casey Means (00:52:37):

And in that case actually liberalizing their diet, because they’ve been told maybe like they can’t have any carrots or they can’t have any fruit. They find that, oh, I actually can have carrots and pear and have no glucose spike, it won’t kick me out of ketosis. So that’s one of my favorite things is like how this device might actually help us get past nutrition wars and get past just the really loud dogmatic voices in the nutrition space and let people have the power to actually create a diet that fits with their values, but also is supporting optimal cell biology.

Dr. Casey Means (00:53:14):

Because there’s a lot of different ways to get to optimal cell biology. And it really comes down to putting the right molecular information in your body. And you can get that molecular information from lots of different types of food if it’s done really thoughtfully. So that’s what I’m hoping that people kind of move towards.

Ali Spagnola (00:53:29):

Right. Yeah. When you’re talking about nutrition wars, what are your thoughts on carnivore? Do you have any members that are doing it because it seems so polar opposite to you?

Dr. Casey Means (00:53:41):

Yeah. We have a lot of members who… Well, not a lot. There’s definitely members who have tried carnivore. And this is one of those things like where it does come back to some of the basics about how we need to think about nutrition in my opinion, which is just what I just mentioned that like really food is chemical information, it’s molecular information. Our Bodies are just a big molecular jumble, right? And we need to give it the right things so that it functions properly. And like you can get those things from different diets. A carnivore diet you’re going to get omega-3s from hopefully the well sourced meat that you’re getting.

Dr. Casey Means (00:54:21):

In a plant-based diet, I’m going to get omega-3s from flaxseeds and chia seeds. And I’m going to have to go through more of a conversion process to convert those omega-3s to the downstream omega-3s that you can get from animal products but we’re both getting them. For me, I might get B vitamins from nutritional yeast, they’re going to get B vitamins from eggs and beef. So it’s really just about like how can you get the right information from these different diets? They might get vitamin C from eating liver, which is one of the only animal products that can give you vitamin C. I’m getting it from red peppers.

Dr. Casey Means (00:54:57):

And so at the end of the day, if people can get the information their body needs to have optimal function. I’m like, that’s great. But we do have to be really thoughtful about what we’re eating. And the other thing is like there are actually so many similarities, this is going to sound crazy, between carnivore and plant-based, that I think are more important to focus on than some of the differences. The top ones being that a whole food plant-based person and a carnivore both believe in eating no refined foods. So that means not eating refined carbs, not eating refined sugars, not eating refined seed oils.

Dr. Casey Means (00:55:36):

That’s a part of both philosophies and to focus on eating like whole foods as close to the earth as possible. Those two things alone, if people do those avoid refined and processed foods, eat whole foods, I don’t think it really matters what you’re eating. You’re going to do better than 99% of people eating the standard American diet. And so it comes down to those things, I think.

Ali Spagnola (00:56:03):

Yeah. Interesting.

MAXNOSLEEVES (00:56:04):

Nice. Now, you’ve talked a lot of trash on grapes.

Dr. Casey Means (00:56:11):

I know [crosstalk 00:56:12].

MAXNOSLEEVES (00:56:12):

Now I’m not an expert, but I think that you use grapes to make wine. How do you feel about wine?

Dr. Casey Means (00:56:25):

Well, the nice thing about wine is that a lot of the sugar has been fermented off, so that’s good. But wine is a really interesting one. So what we see with alcohol and most like straight spirits, so like wine or like hard alcohol without any mixers or anything like that, is that actually people find that it lowers their glucose. And I know you’ve experimented with some of this Ali, but it’s funny, because people they’ll have like a pasta dinner when they’re using Levels and they’ll drink a glass of wine with it and their glucose won’t go up. Even though pasta spiked them the last time they had it and they’re like, “What’s going on.”

Dr. Casey Means (00:57:03):

And they go to our blog and they see there’s a lot of content about this, which is basically that alcohol blocks your body from making glucose in the liver. And so it makes it look like your glucose is lower even if you’ve put carbs in the body from a meal. This is not to say, this is a good strategy for keeping your glucose more stable because it’s not actually changing the amount of glucose that’s going into your body through the food. It’s changing what’s happening in the liver and kind of blocking a pathway that the body typically needs to make glucose. So not a good strategy, like taking a walk after a meal, but it is something that you’ll see on the glucose monitor if you drink wine with a meal.

Dr. Casey Means (00:57:46):

If we look at epidemiologic studies like large populations, interestingly people who drink about one drink per day, like wine tend to have better overall long-term metabolic health than people who don’t drink anything or people who drink like two or more drink per day. So it’s a J shaped curve is what it’s called. Or basically it’s like, nothing has a higher risk than just like one a day. So that’s what the studies show in large populations. I don’t quite know how to feel about that to be perfectly honest, because the idea of like making yourself drink one drink a day for metabolic health seems kind of irresponsible to me. Like as if you’re like doing it as part of your supplement process.

Dr. Casey Means (00:58:36):

And I can feel like crap after one glass of wine these days. At 34 now, if I’m like tired, and dehydrated and have a glass of wine, I could feel all hung over the next day. And so I don’t want that certainly every day of my life, but that is something that is interesting in the research and I think probably has to be understood better. But a key point also is that more than about two per day, then you start really having increased risk of metabolic disease. And of course, heavy drinking can of affect the liver adversely, which is like the key side of our metabolism.

Dr. Casey Means (00:59:11):

The liver is where a lot of our energy is processed and stored. So you don’t want to obviously go into like the alcoholic liver disease or fatty liver disease because that’s going to really tank metabolism. But something around a drink a day in the research seems to be okay for metabolic health. So time will tell.

Ali Spagnola (00:59:30):

I’ve been testing this and then I get to Saturday, I forgot to supplement all week, so I have to have seven drinks. Just kidding folks. It’s funny because I see you wearing a WHOOP and that’s probably one of the most convincing things to tell me not to have that even just one with dinner. You just immediately get that feedback, I mean, besides feeling like crap.

Dr. Casey Means (00:59:56):

The WHOOP is a buzz kill, that’s for sure. Like I –

Ali Spagnola (00:59:58):

You heard it here folks.

Dr. Casey Means (01:00:02):

No. I mean, I love the WHOOP so much, but like it has absolutely changed my relationship with alcohol, like no question. Because you can feel crappy after a couple drinks and be like, “Oh it’s probably because I’m stressed or whatever.” But the WHOOP is just like, “Nope, it was the alcohol.” I found one glass of wine will bring my heart rate variability down to like the ’30s and it’s been impactful for me because I’m like, “Wow, if I do that like many, many times per week, like that’s a lot of changes to my heart physiology that I’m not aware of.”

Dr. Casey Means (01:00:42):

So I think it’s a great tool, but it can be a little scary sometimes, because every once in a while having a drink, you don’t want to feel like terrible about it, but I think it’s really good awareness and it’s definitely been eye-opening for me.

Ali Spagnola (01:00:58):

Totally. Me too. Have you seen other connections between your glucose or what you’re eating and your WHOOP?

Dr. Casey Means (01:01:05):

I mean the biggest one I’ve seen is that when I eat late at night, which I have a terrible habit of doing like all the time, even though we know it’s not good for metabolic health. I love midnight snacks, like so much like. And whenever I eat late at night, my recovery score is in the yellow. Like, I don’t think I’ve ever had a green meaning high recovery score if I’ve had a late night snack. And really my best recovery scores ever are after 36 hour fast, which are usually always.

Ali Spagnola (01:01:37):

Same. Yeah.

Dr. Casey Means (01:01:38):

So I was doing Sunday to Tuesday, 36 hour fast, most weeks for a lot of the summer. And it would be like 40, 50, 40, 50 for my recovery scores. And then I’d do that, it would be like 98, 89. And I’m like, “Dem this is amazing.” So I think that’s the biggest takeaway I’ve had about it. How about you?

Ali Spagnola (01:01:57):

Yeah. I’ve learned the same thing that rest and digest are not things that happen spontaneously, even though we lump them together. You should not be doing them at the same time. Have you seen … So it’s really just eating at all that time is the problem and it’s not what you’re eating. So you can’t even eat for something that’ll help you recover better at midnight?

Dr. Casey Means (01:02:22):

For me, I haven’t found. It’s basically like anything, unfortunately.

Ali Spagnola (01:02:27):

Fascinating. Cool that you’re doing those long-term fasts, is that like once a week just doing that so?

Dr. Casey Means (01:02:38):

Its been more of just like an experiment, like my brother and I are like, “Can you do it? Can you do it”? And now we’ve like challenge each other. And so we just text each other and should talk each other all day while we’re fasting.

Ali Spagnola (01:02:49):

Still not eating.

Dr. Casey Means (01:02:50):

Are you still fasting? And it’s good fasting buddy, peer pressure. But it was more to see like we read so much about fasting and how good it is for autophagy, and aging and all this stuff. And was trying to see if I was like seeing any benefits in my own life, by doing it pretty consistently. And I would say absolutely, I did. Like, I felt great and obviously just like leaner and sort of more uninflamed like after those experiences and totally reset my glucose for sure. Because like by the end of those 36 hours fast, you’re like just in the flat low healthy range.

Dr. Casey Means (01:03:31):

And to give my body that opportunity to just know that like my insulin’s low, I’m getting into fat burning. I’m promoting metabolic flexibility. I’m letting my gut lining and my microbiome have a break it’s really motivating. But it’s certainly not fun. I don’t enjoy the process. Well, I mean eating is so wonderful and everyone’s like “It gets so easy after doing it a bunch of time.” And I’m like, “It never got.” We probably did it 10 times, it was never fun. So, I need to get through the breakthrough where I could enjoy fasting.

Ali Spagnola (01:04:07):

Well, I’ve had struggles with coming out of my fast. I’ll get really high spikes even if I’m trying to eat a little better. Although, when I’m come out of a spikes, a lot of times it is eating stuff that we would spike me anyway. But have you noticed that at all where it seems almost paradoxical, right? Because I feel like I’m so insulin sensitive at this moment, but then anything I eat just shoots me up.

Dr. Casey Means (01:04:36):

Yeah. We’ve definitely seen that. People mention that before, even with a fair really low card meal after a fast. And I don’t really know the answer to that. Ben Bikman talks about this a little bit and this concept of reverse metabolic inflexibility, which is kind of an interesting concept. Which the way I understand it is that if you are in sort of a bit of a keto state or a long fasting state, that your body kind of having not seen insulin for a while, like may actually kind of go into this transient sort of insulin resistant state. Because it hasn’t really like needed insulin. It’s kind of hard to…

Dr. Casey Means (01:05:21):

I’ll link the blog post for you, for the show notes. But there might be something going on there with the hormone ghrelin, which is of our satiety and hunger hormones. And basically when insulin is low, it rises and kind of basically tells our body to like make more glucose in the liver. And so it might be that there’s something going on with some of the other hormones, the counterregulatory hormones that like is impacting glucose when you eat your post-fasting meal. So the bottom line is like, we need to understand it better basically.

Ali Spagnola (01:06:04):

Yeah, it is interesting. But I still feel like, I’m doing something good for my body regardless of perhaps a spike afterward. I guess those long ones, like you’re talking about doing 36 or more that’s when I’m like, “Yeah, this is not as fun.” But I do like the morning fast. Max is like, “Screw this.” He’s eating while we’re podcasting.

MAXNOSLEEVES (01:06:28):

I don’t believe in fasting. I just don’t believe it. When you hungry you should eat. You’re tired, you go sleep. You’re hungry, eat you. Whatever.

Dr. Casey Means (01:06:39):

I like that, that’s intuitive eating. That’s good. Also, I just said ghrelin earlier, I met glucagon. I misspoke on the hormone. But I think it’s good to listen to your body though Max. I mean there’s a lot of truth to that.

Ali Spagnola (01:06:55):

All right. Well this has been enlightening. Thank you so much for joining us.

Dr. Casey Means (01:07:01):

Thank you guys for having me. It’s always fun to talk about glucose monitoring and metabolic health. It’s my favorite topic.

Ali Spagnola (01:07:08):

Yeah. All right. And thank you to the Fitheads. If you want to check out Levels, it’s levelshealth.com. And anywhere else you want to direct them, the Instagram perhaps?

Dr. Casey Means (01:07:19):

Yes, absolutely. So for lots more on all the topics we spoke about today, I think levelshealth.com/blog is an awesome resource, to sign up for the wait list or the newsletter levelshealth.com. Our Instagram and Twitter is @Levels and I’m on Instagram at @drcaseyskitchen.

Ali Spagnola (01:07:38):

Yeah. And you can watch your insane Instagram stories of complex plant stuff going on. It’s always impressive.

Dr. Casey Means (01:07:45):

Thank you.

Ali Spagnola (01:07:47):

All right. And thanks to the Fitheads. If you can rate and review on Apple Podcast, that helps us out a whole lot. And we’ll see you next week.