Metabolic Health: Why You Should Care About It with Casey Means, MD

Our bodies are incredible machines capable of converting fuel into energy. But the wrong fuel can have devastating consequences. Dr. Casey Means of Levels thinks that nutrition is the true secret to a long and healthy life, and that it’s shocking how small of a role nutrition playing in modern medical training. Quality food is the key to longevity, and can help keep our bodies working properly on a daily level – not to mention protect us from threats like COVID-19. As a guest on The Sonya Looney Show, Dr. Means talked with Sonya about why the exciting world of continuous glucose monitoring biowearables should replace out-dated glucose testing models and change our lives for the better.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out The Sonya Looney Show
• Connect with Sonya Looney on LinkedIn or Twitter

07:30 – Metabolic dysfunction is an energy breakdown

Metabolism is the process by which the food we eat is broken down into energy in our cells. When our cells can’t process food effectively and create energy, they start breaking down. That leads to metabolic dysfunction.

“When we’re talking about metabolism, we are talking fundamentally about the core pathways in the body that let us create energy from the food that we eat. We take in food multiple times a day. And we, as a human organism, have to convert those substrates, those carbohydrates, those fats into something that our body can actually use, a currency that our cells register. And that’s usually things like ATP. And this happens in ourselves, in the powerhouse of the cell called the mitochondria. It’s this conversion process, and that’s what metabolism is. Every single cell in the body needs the energy to function. When we don’t produce energy effectively from the food that we eat, we see dysfunction and we see breakdown. Cells that aren’t getting really high quality energy production are not going to function properly. When this happens in a specific place in the body, we start to see symptoms.”

09:11 – The rewards and repercussions of metabolic health

When our daily choices about food, sleep, exercise, stress management, and diet all work well together, our metabolic system stays stable. That’s the key to well-being.

“What metabolic fitness is, is when those processes are working really efficiently and really well. It’s when we are producing energy efficiently from the food we’re eating without undue damaging byproducts to those processes, and we are reaping the benefits of having really robust, strong, efficient energy production in our body. And what that looks like is improved exercise performance, good energy, stable mood, good sleep, high cognitive function. We really see this high performance and stability in our lives when our metabolic function is efficient and stable. To get that metabolic fitness, it actually really comes down to the choices we’re making every day, like how we eat, how much sleep we’re getting, how much exercise we’re doing, how we’re managing stress, how many times per day we’re eating. We are basically sending signals to the body of how our metabolism should work. A lot of the choices we’re making in our sort of Western diets and our modern-day and age actually really impair our metabolic function, our metabolic fitness. And we see lots of symptoms and diseases emerge from this, most notably things like obesity and diabetes, but lots of other symptoms that we may not typically relate to metabolism like mood issues, infertility, brain fog, poor energy, things like that. So it’s really getting on top of our glucose and our metabolic health is really a key to unlocking a lot of these benefits.”

12:09 – Early warning signs of insulin issues

Do you have fat around your abdominal area that you just can’t shake? If so, this may be a visible indicator of metabolic dysfunction.

“Midline abdominal fat is hard to lose. This often is a sign of metabolic dysfunction when we are producing energy poorly in the body, when we are exposing ourselves to so much glucose and sugar in our diet that we are constantly going on this up and down swing of glucose. What that does is it stimulates a hormone called insulin. And insulin is a metabolic hormone that lets our body take up sugar into the cells so that we can use it. But when it’s stimulated too much over and over and over and over again, the cells can become numb to insulin. And then the body actually has to produce more insulin to get the same amount of glucose into the cells to be used for energy. What happens when your insulin is high is that it actually tells your body to store fat around the midline, around your organs. And that’s called visceral fat as opposed to the fat under our skin, which is called subcutaneous fat. So midline, hard to budge, fat around the middle can be a sign of underlying high insulin levels, which is a sign of metabolic dysfunction.”

14:38 – Current glucose tests are not effective

Insulin dysfunction builds up slowly over time, and we don’t test glucose often enough to be able to spot a problem. Often, tests can look normal even when a problem in present.

“So the tests that you’re typically going to see done for assessing metabolic health in a standard fashion is a fasting blood sugar test that a doctor might do yearly for you. The current recommendations are to do this starting at age 40, or what’s called a hemoglobin A1C test, which is a 90 day average of your blood sugar levels. You also might get a cholesterol test. And when certain parts of the cholesterol panel are high, particularly the triglycerides, that can be a sign that you have excess blood sugar that’s being converted to fat. So there are different blood tests that you can look at. The issue is that, as you said, this can really creep up on you. And sometimes our lab work can actually look okay, when in fact there are things under the surface that are actually moving us down that spectrum of metabolic dysfunction.”

17:30 – An exciting time for biowearables

There are already wearables on the market that measure things like sleep and stress via heartbeat. With CGM, we now have a biowearable that measures nutrition in real-time.

“We’re seeing wearables all over the place crop up. We’ve got our Fitbits, we’ve got our Oura Rings, we’ve got our Whoop straps. We’ve got beds that measure our sleep now, like the Eight Sleep bed. We’ve got heart rate variability monitors that measure our stress objectively. So for fitness, sleep, and stress – three pillars of health – we’re seeing wearable data that the research shows actually does move people in the right direction. If you were a step-counter, people take more steps. So that’s fantastic. It’s hard to improve what you can’t measure. And what we’ve really struggled with is that we’ve never had a way to measure nutrition in real-time. There’s no way to get instantaneous feedback on how food is affecting your body. And so something I really love about continuous glucose monitors as a tool is that for the first time ever, we have this wearable that’s giving us that biofeedback and closing that loop on how an individual food decision is affecting our health in real-time. And when we have that closed-loop, one-to-one relationship, we can start to make precise, targeted adjustments that move us in the right direction. So I think it’s a really exciting time for biowearables.”

19:46 – Why medical students need more nutrition training

The average med student gets less than 10 hours of training on nutrition. Dr. Means said this number should be much higher, considering that healthy eating from an early age can ward off a huge percentage of diseases.

“The research suggests that the average medical student is getting about less than 10 hours of nutrition training in their entire medical school. And that’s actually mind-boggling to me because the majority of the conditions we’re seeing in the hospitals these days and the things that are plaguing our country and our economy and our human capital are chronic illnesses. These are not acute infections or traumas. These are illnesses that develop over years and are very much rooted in diet and lifestyle. The highest value intervention that we can do for patients is help teach them how to eat healthy from an early age to ward off a huge percentage of these diseases. Right now, we have 128 million Americans in the US with pre-diabetes or diabetes. That’s about a third of the country with overt blood sugar dysfunction. 83% of diabetes is thought to be completely avoidable, if we actually just reduced our modifiable risk factors, which include diet, smoking, and movement. We’re at $3.4 trillion healthcare costs per year. Diabetes is a huge contributor to that. And 83% of it is preventable. So it would seem logical that as trainees of medicine, we would become absolute experts on nutritional science to help counsel our patients.”

21:41 – Food = medicine and longevity

Continuous, real time feedback is a lot more powerful than a two doctors visit in a year. This feedback can empower everyone to make better food choices every day, leading to a longer and healthier life.

“I’m really personally passionate about how we empower people to make better decisions. As a physician, no matter what I say in a 15 minute doctor visit, I’m not going to be with the patient 24 hours a day, when they’re making a hundred micro-decisions about diet, stress, sleep, and food that are ultimately going to generate health in their body. We needed to do more to really empower individuals with knowledge. And that’s where I get passionate about biowearables and how people can actually have the data themselves and make decisions based on that. I don’t want it to be that someone has to wait a year to walk into a doctor’s office and get a surprise about their metabolic health and they get counseled about it. What if we could actually give that information in real-time to people to make decisions day in and day out? So I think from both sides, patient-up and doctor-driven, we’re going to see movement. And that’s what really excites me. Bottom line is we need way more nutrition training and in medical schools. It’s something I’m passionate about. I actually just guest lectured at Stanford last week and was brought in to teach in a class on longevity. And my whole lecture was about glucose. Food is medicine and longevity.”

23:23 – Your food can change your gene expression

Food is a signaling molecule that tells our body what to do. The spice turmeric, for example, can change the expression of the gene NF-kappa B, which is the master inflammatory gene in our body.

“I focused on this concept of what’s called Nutrigenomix. So Nutrigenomix is how individual food compounds affect gene expression. I had worked at 23andMe in college when it was very, very early and I was just fascinated about how we’ve got this biochemical, we’ve got this biologic blueprint, but the difference between health and disease is how it’s expressed. And that’s up for grabs. And what I mean by up for grabs is that we can impact that by how we choose to live. And one of the biggest factors there is what we put in our mouth. Food is both the biologic substrate that builds our body, but it’s also the signaling molecule that tells our body what to do. It’s so powerful. So Nutrigenomix was just fascinating to me. And an example of that would be tumeric for instance, a root that’s been used for millennia as medicine in other cultures, and unfortunately has kind of fallen to the wayside in Western culture. But we now know from more modern research that it has a compound in it called curcumin, which is a compound which actually, when digested, goes into the cells, changes the expression of the gene NF-kappa B which is the master inflammatory gene in our body. So when NF-kappa B is activated, it just activates a number of different inflammatory cytokines in the body. And curcumin can down-regulate the expression of this. That’s so cool. This is like, you’re eating something and you’re changing your own gene expression.”

30:44 – Blood sugar and COVID-19

Diabetes and most other metabolic diseases are reversible. The key to tackling a pandemic like COVID-19 lies in improving the metabolic health of our society and country.

“Back in April, I published a paper in the journal Metabolism because I was poring over the data about risk factors for worse COVID outcomes. Even back in April, very beginning when I published this paper, there were over a hundred papers showing that increased blood sugar worsened outcomes from COVID. And there has been really fabulous research out there from Virta Health, which is a group that is run by Sarah Hallberg, that’s really leading the effort on showing that diabetes and high blood sugar metabolic dysfunction are reversible conditions. We’ve often thought of something like diabetes as a one-way street. Like you get it, and then you have it. But it’s actually not true. We can move back towards normal blood sugar on that spectrum. And their particular intervention focuses on a low carb, ketogenic diet and nutritional counseling, but they were able to get people from a diabetic state to a non-diabetic glucose level in 10 weeks of this dietary intervention program. So you can imagine it’s been much longer than 10 weeks of COVID. We have the potential to make huge shifts in the overall metabolic health of our country, if we really focused our energy on that. And so that’s where I’d love to see a movement towards taking control of that and giving people the tools and the access to food and the access to data and information that lets it be possible and achievable.”

46:35 – Sugar is in everything

Processed food is the enemy. The answer is to move towards a diet of fiber-rich plant foods that support metabolic health by supplying essential micronutrients and creating an optimal microbiome.

“There are gains that we can make without going full plant-based. The first thing people can do is eliminate processed refined foods. These processed foods that are not real foods are just going to load the body with refined versions of macronutrients and a bunch of toxins on board as well, which is going to be bad for the body. Any way that we’re moving away from processed to whole food is a step in the right direction. Then I would say we really have to think about cell biology. For the cells to produce energy properly, we need the microbiome to be functional. We need digestion to be functional. We need hormones to be functional. We need the mitochondria to be functional. We need the vascular system to be functional. All of this has to actually work properly for us to metabolize well. And that requires having really rich plant foods, because fiber is going to support the microbiome and a lot of the micronutrients and antioxidants we’re going to find in plant foods are going to support the cell biology. So I would just say anything we’re doing to move in that direction of loading the body with these like beautiful simile molecules and substrates is a step in the right direction, as much as we can be avoiding the sugars that come in everything, and being more cognizant of labels. It’s just incredible how much sugar is in everything.”

Sonya Looney: [00:00:00] This is episode number 229, Metabolic Health, why you should care about it with Casey Means MD.

Welcome to the Sonya Looney Show and to 2021. This is a podcast about how to live a high-performance life spanning the categories of mindset, plant-based nutrition and inspiring stories to help you be better every day.

Dr. Casey Means: [00:00:30] We’ve got this biologic blueprint. The difference between health and disease is how it’s expressed and that’s up for grabs. What I mean by up for grabs is that we can impact that by how we choose to live and one of the biggest factors there is what we put in our mouth. Food is both the biologic substrate that builds our body, but it’s also the signaling molecule that tells our body what to do. It’s so powerful.

Sonya Looney: [00:00:55] And we are into it, friends, the very first week of a brand new year, and it feels good. Fresh starts always have a lot of optimism associated with them. People feeling like they can make changes in their lives and a clean slate. For many people the new year is a time to look at some of their habits and usually changing your diet or eating a healthier diet is something at the top of most New Year’s Resolutions lists.

And today’s podcast episode might be really interesting to you if you are looking to optimize your health. Metabolic health might be something you’ve never considered. It was something I have never thought about or considered until recently. Metabolic health is way more than just about the number on the scale or your BMI. It’s considering things like having ideal levels of blood sugar, triglycerides, HDL, cholesterol, blood pressure, waist circumference and more without the use of medications. These factors directly relate to a person’s risk for heart disease, diabetes, and stroke. And maybe you aren’t worried about that now, but these types of things tend to show up later in life as a lagging indicator of your health as you get older. Your metabolic health also affects things like sleep and energy levels, recovery, appetite and more. And if you’re an athlete, you’re probably really thinking about things like sleep and your energy levels and recovering. A study published from UNC Chapel Hill noted that only one in eight people had the optimal level of metabolic health, only 12%.

Now, I’ve mentioned that I love the company Inside Tracker on this podcast because you can order a very comprehensive blood test that teaches you all about your metabolic health and so much more to optimize your health. You can look at things like all of your vitamins and minerals and you look at things like triglycerides and cholesterol and blood sugar and so much more. So if you’re interested in starting to look at your metabolic health, check out Inside Tracker. They have been a previous podcast sponsor and they are just a great friend and I love their company.

In today’s podcast. I got to sit down with Stanford MD Casey Means. She is also the Co-founder and Chief Medical Officer of pioneering digital health startup Levels. Levels Health is where you can find that on the Internet. Dr. Casey is focused on using continuous glucose monitoring to solve the epidemic affecting the health and wellbeing of 88% of the US adult population. She also promotes plant-based nutrition for optimal health. She’s been featured in all of the mainstream amazing magazines like Forbes, Entrepreneur, Business Insider, Healthy Human Revolution, Well + Good and so much more. She’s also an award-winning biomedical researcher with past research positions at the National Institutes, Stanford School of Medicine and NYU. Her clinical work focuses on Functional & Lifestyle Medicine with an emphasis on whole foods, plant-based nutrition, mind-body connection and physical activity as foundations of metabolic and overall health. So whether or not you eat plant-based, all of these different things surrounding optimal health are probably of interest to you and especially kicking off the new year.

An app that some of my friends have recently released is called 80/20 Plants and it offers one-on-one coaching for changing your diet to a plant-based diet. There are daily lessons with videos, meal planning help and hundreds of recipes and a supportive community. So if you’re looking to find an app that is going to give you a lot of guidance, check it out. There is a link in the Show Notes. Check out 80/20 Plants and it will send you directly to where you need to go.

In today’s podcast, we talked about defining metabolic fitness and why you should care about your metabolic health, how Dr. Casey started integrating lifestyle medicine and nutrigenomix, COVID comorbidities and glucose, how athletes can have glucose issues, how to optimize a whole foods plant-based diet and how lack of sleep affects glucose negatively. And that was really interesting for me to learn about as well.

I wanted to take a moment to give you a huge thank you to those of you who are supporting my work financially on Patreon and PayPal with your donations. Those donations do not go unnoticed and they go to pay my audio engineer Roma, who has been with me since Episode one and now we’re on Episode 229. So we have both invested a lot into this podcast and we thank you so, so much for those of you who have done so as well. And you can find that at the Show Notes at sonyalooney.com/podcasts and you can also find that at patreon.com/thesonyalooneyshow.

If you’re enjoying my content, I have an exclusive newsletter that comes out every single Sunday with my thought of the week, a question for you to ponder and the podcast of the week. I also have some really big announcements that are going to be launched in that newsletter and I cannot wait to share it with you. You can get that at sonyalooney.com/newsletter.

And last I just wanted to thank you guys. A lot of you have supported me and my company, Moxy & Grit, moxyandgrit.com. I have worked for years to create the funniest and somewhat crazy sock designs and apparel designs and so many of you have been ordering those over the holidays so much so that we’re out of stock on many, many items and those are going to be replenished shortly. I actually put in an order before the holidays and I just want to say thanks, you guys. It puts a big smile on my face whenever I can see you rocking these designs and knowing that they’re making your day or your ride or maybe your life just a little bit better.

Don’t forget to rate and hit the subscribe button. What all podcasters say, it really does help others find the show. And if you are finding value in it, make sure you’ve shared the show with your friends. We super, super appreciate that and we try so hard to bring you the best content to help you be better every day and to help your friends be better everyday, too.

And with that, let’s get into today’s episode with Dr. Casey Means.

Welcome to the show Dr. Casey.

Dr. Casey Means: [00:07:03] Thank you so much for having me Sonya.

Sonya Looney: [00:07:05] It was so funny. We were chatting right before I hit record and we just started going, I was like, “Ah! I’ve got to start and hit record because all this stuff we’re talking about is so awesome.”

Dr. Casey Means: [00:07:13] I know. It’s always fun to jump right in when there’s so many common interests.

Sonya Looney: [00:07:17] Yeah. So we were just talking about glucose monitoring and metabolic – And you used the term metabolic fitness instead of metabolic health. So I think a good place to start is, what is metabolic fitness?

Dr. Casey Means: [00:07:29] Yeah. So when we’re talking about metabolism, we are talking fundamentally about the core pathways in the body that let us create energy in our bodies from the food that we eat. We take in food multiple times a day and we, as a human organism, have to convert those substrates, those carbohydrates, those fats, into something that our body can actually use, a currency that our cells register, and that’s usually things like ATP. And this happens in our cells, in the powerhouse of the cell called the mitochondria. It’s this conversion process. And that’s what metabolism is. Every single cell in the body needs energy to function and when we don’t produce energy effectively from the food that we eat we see dysfunction and we see breakdown. Cells that aren’t getting really high quality energy production, they’re not going to function properly and when this happens in a specific place in the body, we start to see symptoms. You can imagine if you’re not producing energy well in the brain, you could see things like brain fog or lack of energy or pain or mood issues like anxiety or depression. And that’s exactly what we see in metabolic dysfunction. We see increased rates of all of those things: dementia, chronic pain, fibromyalgia, chronic fatigue syndrome, depression, anxiety. If this is happening in another part of the body, like the heart or the cardiovascular system, it could look like high blood pressure or heart disease or small vessel diseases like retinopathy or erectile dysfunction. If poor energy production is happening in the ovary, it could look like polycystic ovarian syndrome, which is a metabolic disease that is the number one cause of infertility and menstrual irregularity in our country. So really we’re talking about metabolism, we’re talking about a core fundamental pathway of how we make energy for the cells in our body.

And what metabolic fitness is, is when those processes are working really efficiently and really, really well. It’s when we are producing energy efficiently from the food we’re eating without undue damaging byproducts to those processes and we are reaping the benefits of having really robust, strong, efficient energy production in our body. And what that looks like is improved exercise performance, good energy, stable mood, good sleep, high cognitive function. We really see just this high-performance and stability in our lives when our metabolic function as efficient and stable. And to get that metabolic fitness, it actually really comes down to the choices we’re making every day, every single day, by how we eat, how much sleep we’re getting, how much exercise we’re doing, how we’re managing stress, how many times per day we’re eating, we are basically sending signals to the body of how our metabolism should work. And a lot of the choices we’re making in our Western diets in our modern day and age actually really impair our metabolic function, our metabolic fitness and we see lots of symptoms and diseases emerge from this, most notably things like obesity and diabetes. But lots of other symptoms that we may not typically relate to metabolism like mood issues, infertility, brain fog, poor energy, things like that. So really getting on top of our glucose and our metabolic health is really a key to unlocking a lot of these benefits.

Sonya Looney: [00:10:34] Yeah. We’ve talked a lot about health and diet and how everything affects everything holistically in your body and a lot of times we talk about gut health and metabolism is such a massive part of gut health. It basically is how it all works. It’s the underlying functionality of everything. But the interesting thing about metabolic syndrome or dysfunction is that maybe people don’t realize it’s sneaking up on them. You mentioned brain fog and I know that a lot of us don’t even realize we have it until it lifts. So how can somebody even know that metabolic dysfunction is starting to manifest?

Dr. Casey Means: [00:11:08] Yeah. It’s a really, really great question. I think the first thing is really understanding the many different faces of metabolic dysfunction. It can really, really show up anywhere and in our conventional healthcare system, we often take symptoms that are occurring in different parts of the body and we like to think of them as totally separate entities, like isolated silos. If it’s happening in the brain, it’s a brain thing. If it’s happening in the heart, it’s a heart thing. If it’s happening in the eye, it’s an eye thing. But we’re a unified system, just like you said. And so I think the first step is really awareness of what these different things might be and it really runs the full gamut. We could run head to toe and actually really talk about each different system and how it’s related to metabolic health.

And so there’s really no part of the body that can escape it because we’re dealing with these core pathways here. I think some of the most practical things that the average person who’s non-diabetic might see is – Belly fat is one of them, midline, abdominal fat that’s hard to lose. This often as a sign of metabolic dysfunction when we are producing energy poorly in the body.

When we are exposing ourselves to so much glucose and sugar in our diet that we are constantly going on this up and down swing of glucose, what that does is it stimulates a hormone called insulin. And insulin is a metabolic hormone that lets our body take up sugar into the cells so that we can use it. But when it’s stimulated too much over and over and over and over again, the cells can become numb to insulin. And then the body actually has to produce more insulin to get the same amount of glucose into the cells to be used for energy. What happens when your insulin is high is that it actually tells your body to store fat around the midline, around your organs and that’s called visceral fat as opposed to the fat under our skin, which is called subcutaneous fat. So midline, hard to budge fat around the middle can be a sign of underlying high insulin levels, which is a sign of metabolic dysfunction. If we are overweight, a BMI above 25, this can be a sign that we’re starting to have trouble with our metabolic system. 72% of the country right now has a BMI over 25, overweight or obese and what that means is that we’re – Generally, it means we’re storing too much fat and we’re not using that fat. We have an excess and a lot of that, again, is related to this hormone insulin. When insulin is high, what it actually tells the body is to store fat and to not burn it. It’s assigned to the body that there’s tons of glucose, sugar around, we don’t need to use fat for energy. These are two of our key sources. And when you have too much of one, you’re not going to use the other. Since our diet is so high in refined carbohydrates and sugar. We end up spiking that insulin blocking, the fat oxidation. So if you have excess weight in the form of fat, it’s often a sign that you’re not burning through it. You may need to get your insulin down and that’s done by improving how much sugar we’re eating, how frequently we’re eating it. We want to get those insulin levels down.

So a simple test that people can do is actually what’s called a waist to hip ratio. So you measure the thinnest part of your waist and then your lower down on your hips. And when that ratio is elevated, when the waist compared to the hips is actually too high of a number. That’s a sign that you may have this midline fat that’s associated with insulin resistance.

So that’s just some very, very basic things. You can also, of course, go to the doctor and get lab tests done. So the tests that you’re typically going to see done for assessing metabolic health in a standard fashion is a fasting blood sugar test that a doctor might do yearly for you. The current recommendations are to do this starting at age 40 or what’s called a hemoglobin A1c test, which is a 90 day average of your blood sugar levels. You also might get a cholesterol test and when certain parts of the cholesterol panel are high, particularly the triglycerides, that can be a sign that you have excess blood sugar, that’s being converted to fat. So there’s different blood tests that you can look at.

The issue is that, like you said, this can really creep up on you and sometimes our lab work can actually look okay when in fact there are things under the surface that are actually moving us down that spectrum of metabolic dysfunction. So something that’s worth noting is that, like I mentioned, we can become insulin resistant over time and our body has to produce more insulin to get the same amount of glucose into the cells. And because we’re quite resilient, our body can do that for a long time without our glucose numbers actually changing that much. And there is research evidence that suggests that our insulin levels change and our insulin sensitivity changes 13 years before glucose levels actually change in the blood. There are many physicians, really more in the longevity health movement who are really focusing on, we should probably be testing for insulin levels to screen for people who are starting to be on this spectrum of metabolic dysfunction.

And that’s something that I certainly do in all of my patients is order of fasting insulin test and see where that is. And the second thing is you can use other more novel tools like a home finger prick test or a continuous glucose monitor, which is a little device, a sensor that you wear on your body and actually measures your glucose every 15 minutes and what you can start to see is how high your blood glucose is actually spiking after a meal. And when those spikes after a meal are very, very high, it can tell you that you’re probably moving down a path that you don’t want to go down. When we spike our glucose frequently throughout the day by eating meals that tend to raise our blood sugar, we know that we’re spiking our insulin and moving down that pathway of insulin resistance.

So fasting insulin tests, continuous glucose monitoring, those are some of these more novel things that people are starting to talk about to get a better sense of what’s actually happening under the surface, above and beyond what we can maybe see at the doctor’s office.

Sonya Looney: [00:16:45] Yeah. Knowing your biometrics in real time is something that can be really powerful because whenever you get a blood – A fasted blood test is a fasted blood test, but what’s happening in real time is actually way more useful information than a snapshot of time.

Dr. Casey Means: [00:16:58] Definitely. I think of a fasting glucose test that you might do at home with a finger prick or at the doctor through a blood test as a photograph of your body. Whereas real-time monitoring is a movie and you can get so much more from the movie the nuances of what’s happening. And so it’s very exciting that we’re moving in that direction in health. We’re seeing wearables all over the place crop up. We’ve got our Fitbits, we’ve got our Oura rings. We’ve got our Whoop straps. We’ve got beds that measure our sleep now, like the Eighth Sleep bed. We’ve got Heart Rate Variability monitors that measure our stress objectively. So for fitness, sleep, stress, three pillars of health, we’re seeing wearable data that the research shows actually does move people in the right direction. If you wear a step counter, people take more steps.

So that’s fantastic. It’s hard to improve what you can’t measure and what we’ve really struggled with, I think, is that we’ve never had a way to measure nutrition in real time. There’s no way to get instantaneous feedback on how food is affecting your body. And so something I really love about continuous glucose monitors as a tool is that for the first time ever, we have this wearable, that’s giving us that biofeedback and closing that loop on how an individual food decision is affecting our health in real time. And when we have that closed loop, one-to-one relationship, we can start to make precise, targeted adjustments that move us in the right direction. So I think it’s a really exciting  time for biowearables and  for that feedback about nutrition

Sonya Looney: [00:18:24] And you’re a Stanford trained physician and you said to me that you eat a plant-based diet with the food as medicine lens and that’s the way that I eat as well. In medical school these days, because I think – Did you graduate in 2014?

Dr. Casey Means: [00:18:38] I did.

Sonya Looney: [00:18:39] Yeah. How much of your training now had nutrition in it? Because I know that in the past, a lot of physician training had no nutrition. Has that changed?

Dr. Casey Means: [00:18:47] It’s changing bit by bit. So it’s still a fraction of the medical school curriculum, unfortunately, but there’s very exciting programs cropping up around medical schools. Harvard, for instance, has actually started a culinary medicine program within their medical school that is teaching physicians how to cook healthy meals. This is huge, a teaching kitchen. In fact, actually I’m on the planning committee for my high school. So not even med school or college and they’re actually starting to build a scientific teaching kitchen in the school to teach about genetics and how food impacts genetics. So there’s movement happening, but the research suggests that the average medical student is getting about less than 10 hours of nutrition training in their entire medical school and that is actually mind boggling to me because the majority of the conditions we’re seeing in the hospitals these days and the things that are plaguing our country and our economy and our human capital are chronic illnesses. These are not acute infections or traumas. These are illnesses that develop over years and are very much rooted in diet and lifestyle.

So really the highest value intervention that we can do for patients is help teach them how to eat healthy from an early age and ward off a huge percentage of these diseases. Right now we have 128 million Americans in the US with pre-diabetes or diabetes. That’s about a third of the country with overt blood sugar. 83% of diabetes is thought to be completely avoidable if we actually just reduced our modifiable risk factors, which include diet, smoking and movement. We’re $3.4 trillion healthcare costs per year. Diabetes is a huge contributor to that and 83% of it is preventable.

So it would seem logical that as trainees of medicine, we would become absolute experts on nutritional science to help counsel our patients. But I think there’s hope we are moving in that direction in some capacity. I think one, because economically our healthcare system is moving towards more of a value-based care system, meaning that instead of just paying for procedures, we’re actually going to be paying more for outcomes over cost. So the value equation is outcome over cost. You want good outcomes over lowest costs. That’s a high value intervention and when you look at all the interventions out there, actually preventative nutrition counseling is extremely high value. It’s fairly low cost and it has excellent long-term outcomes.

So I think we’re going to see a lot there, but that’s a systems level thing. That’s really top down how doctors can enact this. But I’m really personally passionate about how do we empower people to make better decisions? Because as a physician, no matter what I say in a 15 minute doctor visit, I’m not going to be with the patient 24 hours a day when they’re making the hundred micro decisions about diet, stress, sleep, and food that are ultimately going to generate health in their body. So for me, I think we need to do more to really empower individuals with knowledge. And that’s where I really get passionate about bio wearables and how people can actually have the data themselves and make decisions based on that. I don’t want it to be that someone has to wait a year to walk into a doctor’s office and get a surprise about their metabolic health and they get counseled about it. What if we could actually give that information in real time to people to make decisions day in and day out. So I think from both sides, patient up and doctor driven, we’re going to see movement and that’s what really excites me.

But yeah, bottom line, we need way more nutrition training in medical schools and it’s something I’m passionate about. I actually just guest lectured at Stanford last week and was brought in to teach in a class on longevity and my whole lecture was about glucose, food is medicine and longevity. And so really wonderful to see that my alma mater is interested in bringing more of this in.

Sonya Looney: [00:22:21] Yeah. You’re doing an incredible amount of work in this area and you’re also the associate editor of the International Journal of Disease Reversal and Prevention. So, if you didn’t learn about longevity and food as medicine in school, where did you learn about that? And how did you decide to integrate it into your practice and your research?

Dr. Casey Means: [00:22:38] Yeah. Food has always been a passion of mine. I’ve been a lover of food always, and it really stemmed from my undergraduate training. So I studied personalized genetics as an undergrad and that’s what my research and honors thesis and all of this stuff was in and specifically I focused on this concept of what’s called nutrigenomics. Nutrigenomics is how individual food compounds affect gene expression. I had worked at 23andMe in college when it was very, very early and was just fascinated with, “Okay. We’ve got this biochemical, we’ve got this biologic blueprint, but the difference between health and disease is how it’s expressed and that is, that’s up for grabs.” And what I mean by up for grabs is that we can impact that by how we choose to live and one of the biggest factors there is what we put in our mouth. Food is both the biologic substrate that builds our body, but it’s also the signaling molecule that tells our body what to do. It’s so powerful.

So nutrigenomics was just fascinating to me and an example of that would be like tumeric, for instance, a root that’s been used for millennia as medicine in other cultures and unfortunately has fallen to the wayside in Western culture. But we now know from more modern research that it has a compound in it called curcumin, which is a compound which actually is digested, goes into the cells, changes the expression of the gene. NF-kB, which is the master inflammatory gene in our body. So when NF-kB is activated, it just activates a number of different inflammatory cytokines in the body and curcumin can down regulate the expression of this. So that’s so cool. This is like you’re eating something and you’re changing your own gene expression and we know how much inflammation is rooted with so many different conditions. And so it’s magic. So that became really fascinating for me. Flash forward, I finished medical school. I trained as a surgeon, a head and neck surgeon, which is a surgeon of conditions of the ear, nose and throat. And in that field, most of the conditions since I was seeing were conditions that were inflammatory in nature.

So sinusitis, thyroiditis, laryngitis, all these ‘itises’. That suffix means inflammation and I was just slinging steroids left and right – nasal steroids, topical steroids, IV steroids, inhaled steroids. Steroids are immune suppressant and I was slinging a lot of antibiotics and when those things don’t work, we do surgery, which is highly morbid.

And I stepped back and said, these are conditions that are rooted in chronic inflammation. That means the immune system is too revved up. Why is the immune system so revved up? And why aren’t we talking about that? Why are we just tamping it down with medicine and then going on to surgery, which actually is a little bit strange to think about because you can’t operate on the immune system. You can certainly change – You can suck pus out of a sinus, but you’re not actually changing the core physiology that’s making someone chronically inflamed. So I really stepped back and went back to those roots of nutrigenomics and what drives inflammation. Thinking about all the different modifiable risk factors that drive inflammation like exposure to toxins in our food, water, air and personal care products, the foods that we’re eating. These refined seed oils, the high sugar foods, the low fiber diets, how our microbiome dysbiosis impacts inflammation, how sedentary behavior and lack of sleep and too much stress impacts inflammation.

These are all well-established pathways, but we weren’t talking about it and I just knew I had to step back and merge my history of this genetic side of things and the observations I was seeing in surgery and create some new vision for how we were going to help patients really approach that at scale.

So I got additional training through the Institute for Functional Medicine. I was reading books upon books, upon books from a lot of the longevity medicine leaders. People like Mark Hyman, Joel Fuhrman, Michael Greger, Sara Gottfried, Jason Fung, Cyrus Khambata. A lot of these authors who are really thinking deeply about root cause approaches to health and started my own practice, really focusing on helping people heal from within, focus on the modifiable aspects of health and disease, on the root cause nature of disease and then decided to really start consulting and working with entrepreneurs to help scale some of these efforts. How do we take technology and digital health to make this bigger? In a given week, I can maybe see 20 patients and help them with their diet and lifestyle in this very personalized approach, but how can we actually do this for millions of people? And so that’s why I got started with engaging with the digital health community and then also wanting to amplify this message through the journal, the International Journal of Disease Reversal and Prevention, which really focuses on plant-based food as medicine in a very evidence-based way to just really do as much as we can to get this out there.

Sonya Looney: [00:27:17] Yeah. Lifestyle or genetics load the gun, lifestyle pulls the trigger. I love that phrase. That’s why I changed my diet about – Gosh! Seven or eight years ago I changed the plant-based because I really wanted to be healthier and then as an athlete, I’ve found out that, wow, this is actually a benefit as an athlete because inflammation is a problem. Inflammation contributes to not being able to recover. It contributes to over-training and also it contributes to a lot of other lifestyle factors, such as autoimmune diseases and lots of other issues that you’ve mentioned.

So, yeah, I think it’s amazing that there’s more and more people in the medical community who are promoting eating a whole foods plant-based diet, or even trending in that direction because many people look at their doctor and they go to their doctor as the number one expert in preventing disease. But that’s not necessarily the role of the doctor in the medical world right now. It’s treating the symptoms of the disease. So I think the more and more doctors that are trained in lifestyle medicine are out there then that’s going to be a really positive thing for people who are going to their doctor, hoping that they can get all the answers from their doctor.

Dr. Casey Means: [00:28:24] Absolutely. I agree completely and nothing could be more important right now. We’re in the midst of, as we’re recording this, an uptick in COVID cases and metabolic dysfunction and underlying preventable comorbidities, like heart disease, diabetes and obesity have been shown to be the key risk factors that increase morbidity and mortality from COVID. And while it’s important that we have had public health measures that focus on masks, sanitation, social distancing, and a vaccine, these are all reactionary measures that have nothing to do with our internal resilience. The reality is we have massive impact on our immune function by how we live, the choices we’re making every day, and as of yet, we have not seen a large-scale public health effort addressing that internal biologic resilience. And the research is very clear that these largely preventable metabolic conditions are key drivers in worst outcomes. And so, it could not be more important now, especially since we’re not really seeing a huge movement on the large public health scale that I think more people just start talking about this, podcasts, doctors, etc., focusing on how do we do everything in our power, be it food, food timing, stress management, quality sleep, good exercise, avoidance of toxins, to improve our underlying biologic function, our metabolic function and give us the best shot of basically being hard to kill from this virus.

Sonya Looney: [00:29:56] Yeah. And I’ll put a link in the Show Notes to your research. You published a paper in this, right?

Dr. Casey Means: [00:30:00] Yeah. I did. Back in April, I published a paper in the journal Metabolism because I was poring over the data about risk factors for worse COVID outcomes and even back in April, very beginning when I published this paper, there were over a hundred papers showing that increased blood sugar, worsened outcomes from COVID. And there has been really fabulous research out there from Virta Health. It’s a group that is run by Sarah Hallberg that’s really leading the effort on showing that diabetes and high blood sugar metabolic dysfunction, these are reversible conditions. We’ve often thought of something like diabetes as a one-way street. You get it and then you have it. But it’s actually not true. We can move back towards normal blood sugar on that spectrum and their particular intervention focus on a low carb, ketogenic diet and nutritional counseling. But they were able to get people from a diabetic state to a non-diabetic glucose level in 10 weeks of this dietary intervention program. So you can imagine, it’s been much longer than 10 weeks of COVID. We have the potential to make huge shifts in the overall metabolic health of our country if we really focused our energy on that. And so that’s where I think really what I’d love to see is a movement towards us taking control of that and giving people the tools and the access to food and the access to data and information that lets it be possible and achievable.

Sonya Looney: [00:31:23] Yeah. Just a few resources for people in the diabetic realm. Reversing Type 2 diabetes is possible with a whole foods plant based diet as well. And I had Cyrus Khambata and Robbie on the podcast and we recorded about mastering diabetes and Brenda Davis has done a ton of work. Her cookbook the Kick Diabetes Cookbook and she’s been on the podcast multiple times. So if anyone’s listening and they’re like, “Gosh, I just got diagnosed with Type 2 diabetes,” or “I’m pre-diabetic.” These resources are going to be really helpful for you.

But for us, I’d like to start driving our conversation towards talking about glucose and athletes, because a lot of athletes think that they’re immune to having issues with their glucose or their insulin and your research and your continuous glucose monitoring has shown a little bit different. So how can even the fittest people have issues with their glucose?

Dr. Casey Means: [00:32:14] Yeah. Actually, it’s a great question and the origin story of our company actually has to do a lot with this exact question. My Co-founder and the President of the company, Josh Clemente, he is a brilliant aerospace engineer. He was a life support engineer at SpaceX and he was also a CrossFit instructor.

So super jacked guy really, really fit and he was really intrigued by glucose monitoring, had noticed that in the astronauts and in these top tier people who had to have maximal performance, metabolic health was a huge, huge focus and he became interested in “I wonder how my metabolic health is?” So he actually bought a finger prick monitor and started pricking his finger and noticed that his fasting blood sugar was quite high. And so then he wanted to get a continuous glucose monitor because he was actually pricking his finger 50 times a day to try and see what was happening after meals. And he’s like, “Oh my gosh! There must be a better way.” Heard about these painless continuous glucose monitors, but couldn’t get access to one. No doctor would prescribe it for him because they’re like, “Wait. You’re in your twenties and you’re super fit. There’s no way I’m prescribing you a device that’s intended for diabetic management.” He said, “No. No. No. My finger pricks are showing high glucose. I really need to do this.” He ended up basically having to get one on his own, through a friend who was a medical resident and prescribed him one and he put it on and he found out that he was basically in the pre-diabetic range after many, many of his meals, especially his meals around workouts.

So here he is, very fit, had a lot of muscle, but he was pounding Gatorade, which is filled with high-fructose corn syrup and all this refined sugar crap. He was eating a lot of bars, protein bars and things like that that have tons and tons of sugar. He was eating the shakes. He was eating the gels. All these things have these huge amounts of refined sugar and he was basically seeing that his glucose would spike through the roof before a workout from these foods that he was eating for “energy”. But then what happens is you get that huge insulin surge and you actually, your body will soak up all that glucose and crash and in that crash, when you have a big spike and a big dip, that’s called reactive hypoglycemia and that’s associated with fatigue, irritability, anxiety. So people are putting themselves on these rollercoasters before and during their workouts. And sometimes for the recovery drinks and things like that afterwards, they’ll see this big spike and research has shown that actually eating a lot of carbohydrates right after a workout can diminish some of the metabolic benefits that you get from doing the workout itself.

So it was really interesting for him to start to understand how the fuel he was choosing was actually maybe thwarting his efforts and by actually focusing on much gentler carbohydrates around workouts, enough to give some glucose to actually replete the glycogen stores in the muscles and the liver, but not so much that you’re getting this collateral damage of an insulin rollercoaster and dip, he was able to totally both uplevel his endurance in his workouts, but also get himself into a much better metabolic health state. So he just started experimenting with all the food he was eating. He was eating oatmeal for breakfast. It was shooting him through the roof. Now he eats a much more protein and fat based meal for breakfast and his energy is much more sustained, his fasting glucose has come down, he’s back to totally normal optimal metabolic health.

And so it’s been fascinating and we’ve seen a lot of similar experiences with many of the professional and recreational athletes in our program. And a number of them who are actually specifically trying to focus on a low carb diet for performance so that they can not have to rely so much on sugar and glucose during their workouts and actually tap into more of the fat burning during their workout. So that’s a whole other topic, but I think there’s a lot of opportunity for athletes to understand how their fuel is affecting them.

Sonya Looney: [00:35:56] Yeah. It’s funny. I’m on sponsored by GU Energy Labs and we did a discussion where there were four athletes and some of us are about eating high quality carbohydrates, not the – We’ll have the gels and then the sports drinks while we’re exercising, but off the bike, we’re eating lots of the whole grains. But there was one guy who was an ultrarunner and he was a low carb guy. But he wasn’t – So I want to ask you about plant-based, how plant-based fits into all this, because people are like, “Yeah. I am low carb, but I don’t eat plant-based. I can’t eat plant-based or eating all these foods.” How does low carb work with plant-based and do you need to be eating plant-based to have good glucose levels while you’re doing this?

Dr. Casey Means: [00:36:36] Yeah. So I think there’s absolutely a way to do optimal metabolic health with plant-based, but it means being really smart about your plant-based diet. Plant-based can mean many, many different things, like vegan plant-based. It could be, vegan can mean french fries, potato chips, protein bars, Gatorade, a huge bowl of white rice. That’s all plant-based, but plant-based can also be 13 servings of colorful green, leafy vegetables and other vegetables per day. It can mean beans and legumes and nuts and seeds and antioxidant spices and all of these things. I guess right off the bat, I’d say that processed vegan plant-based, that’s not going to be good for your metabolic health. That’s refined, processed carbohydrates that are going to turn into glucose rapidly in your bloodstream and causes this glucose rollercoaster or causes insulin rollercoaster that’s going to basically have you all over the place during the day and also block you from burning fat because your insulin’s high. You don’t want that.

Then what’s in actually the whole foods plant-based realm, which is where I am, I think there’s really even room for optimization there. So what I found 18 months ago when I started wearing a continuous glucose monitor, I was eating a lot more like oatmeal and quinoa and taro and brown rice and things like this. And what I actually found on my glucose monitor that I was just going way up, pre-diabetic glucose levels up to 160, 180, 200 sometimes after these meals. And so I was really – And I noticed that a couple hours after, I’d be really, really tired and that would correspond with these dips. So the first thing I did was really go back to the research and understand how do you create a better balanced meal? You really don’t want to eat naked carbohydrates, I like to say, where you’re just eating a straight carb. By adding fat, protein and fiber, you can greatly diminish the way that those carbohydrates are absorbed into the body and have a much gentler spike.

Also food sequencing makes a big difference. So if you eat your high carb foods later in the meal, you can see a much lower glucose response. So if you actually fill the tummy with greens and protein and fat first, and then put in your carbs, you’re going to see less of a glucose response, typically.

And food timing matters. So if you eat your higher carbohydrate plant-based foods earlier in the day, you tend to see a lower response than if you eat them late at night, because we’re actually more insulin resistant naturally at night. So food pairing combinations, food, timing, food sequencing, all make a difference.

I also just learned about some really great swaps for some of those foods that I like just as much, but that have a much gentler glucose rise. So for instance, instead of rice, I’m doing a lot more cauliflower and broccoli rice. At this point I can barely tell the difference. I make my sushi out of cauliflower rice, and I still get a little glucose elevation, but not enough that it’s going to be this crazy surge. It’s enough for energy, but not for that collateral damage. Pasta, I’m doing zucchini noodles now. Instead of tortillas, I’m either doing almond flour tortillas, or I’m doing collard wraps for my tortillas or I’ll wrap a burrito in seaweed like nori instead of bread, which – Even a whole grain bread could really spike me I’ll now do something like an almond flour bread or something like that. So just really figuring out these swaps has been very, very helpful to keep my glucose stable.

Then fruit is like a whole other category. So I was eating a lot of naked fruit, basically. So just a whole apple or a whole peach or something and I found that sometimes that would just really shoot my glucose up and then cause me to crash right after. So now I pretty much never reach for fruit without fat. I’ll typically put tahini or almond butter plus chia seeds or flax on top of the fruit I’m eating. And I tend to favor less ripe fruit now and very organic, locally grown more heritage fruit because that’s going to have a lot less fructose than these massive sugar bomb fruits that you see in the grocery store. So pairing, again, being smart about timing very very important. And then there’s just certain fruits that are never going to work for me. If I eat five grapes, my glucose goes up 50 points. It just doesn’t work for my body.

The interesting thing is that every single person is going to respond to carbohydrates differently. You and I can each eat five grapes and your glucose might not spike at all and my glucose would go through the roof. And this has been studied quite a bit, why this happens. A big factor might be our microbiome composition. If our microbiomes are different, we might actually process carbohydrates differently. So what’s good for you might not be good for me.

So it’s been this really interesting process of experimentation, observations and then optimization. And now I still eat tons of carbs. I probably eat 200 to 300 grams of carbs. Oh, don’t say tons. I know Cyrus he’s mentioned he eats 700 grams of carbs a day. So I would say I eat somewhere around 200 to 300 grams of carbs a day, but it’s all carbs that don’t tend to spike my glucose and are paired thoughtfully. So I eat primarily my carbs are beans, legumes, a little bit of starchy stuff like butternut squash, delicata squash, and then some fruit that is low-glycemic for me paired with that. And then I would say I’m eating a lot more fat than I used to, tons of nuts, seeds, nut butters, tahini and then just the base of my diet is greens and colorful fruits and veggies. I’m eating 10 to 13 servings a day. My breakfast is all veggies with – Basically all my meals look pretty similar, like tons of veggies plus the protein beans, fat, fiber and as many antioxidant filled spices that I possibly can, and that keeps my glucose totally flat while still being plant-based and getting all the benefits of a plant-based diet. So it’s been working, it’s been just transformational for my own life and also for my athletic pursuits. I run half marathons fairly frequently. I do a lot of outdoor road biking, totally recreationally, not even close to your level. But now, because I’ve been keeping my glucose low and keeping my insulin low, like we’ve talked about on this episode, that unlocks the ability to actually burn fat. When glucose is low, your body gets better at burning fat for energy. And so I now basically am able to do most all my workouts fasted. So I run usually in the morning having not eaten for eight to 10 hours. I’ll do really hard, high intensity interval training without any glucose or sugar on board because my body is now burning fat for energy and I can check my ketones, which are a product of fat burning after the workout. And I’ll see that my ketone levels have gone way up during the workout. And so what that tells me is that my body’s adapting. So you basically eliminate this bonking phenomenon for many people. We’re seeing this in some of our endurance athletes, because your body’s not relying on glucose. It’s not needing the glucose hit. And if you’re eating the glucose all throughout the workout and getting those little insulin spikes, you’re basically preventing your body from being able to burn fat during the workout. So it’s either you’re on the glucose train or you’re on the fat burning train. And there’s a mix of that, but certainly we know that if you’re super spiking your glucose with something like a Gatorade, you’re probably going to have trouble burning fat during that workout, but there’s probably a middle ground that’s ideal for a lot of people.

Sonya Looney: [00:43:34] Yeah. I think that there’s a lot of differences between people, like you mentioned. You said, you need 200 to 300 grams of carbohydrates, whereas Cyrus who I believe he’s a Type 1 diabetic, eats 700 grams of carbohydrates. So if you can monitor your glucose, you can understand how food affects you what your own personalized nutrition program needs to be. And also a word of caution for people who are, yeah, low carb. I want to do fasted workouts. You need to know what you’re doing before you actually just start doing it because you could actually cause some major issues in performance and probably beyond that.

So yeah, I think it’s really interesting that everybody is really different when it comes to glucose sensitivity, regardless of your fitness level.

Dr. Casey Means: [00:44:16] It’s so true and I think that’s such an important point. It’s not the type of thing that you want to just jump in and try. It’s really about building metabolic flexibility, being able to go back and forth between burning fat burning glucose. But that takes time. It’s not like the first time you work out without having glucose, having had a glucose rich meal, it’s going to feel great. It’s training your body. These are adaptations that happen over time and the body wants to burn different fuel sources when they’re available, but it’s not something that we can just flip on and off like a light switch. It’s very much slow adaptations. That should be taken on very carefully and with monitoring of some sort. So I think that’s such a key point for sure.

Sonya Looney: [00:44:58] And what if someone listening to this is like, “You guys are talking about plant-based. I don’t want to go plant-based, but I still care about my glucose and my longevity and my health. Can I do this if I don’t want to change my diet?”

Dr. Casey Means: [00:45:10] Yeah. So I guess the question is, “Can we improve our metabolic health without improving our diet?”

Sonya Looney: [00:45:14] Yeah, without going plant-based.

Dr. Casey Means: [00:45:16] Without going plant-based. Certainly I’m going to say, yes, there are gains that we can make without going full plant-based.

The first thing people can do is eliminate processed refined foods, these frankenfoods that are not real foods that are just going to be basically like loading the body with refined versions of macronutrients and a bunch of toxins on board as well, that are going to be bad for the body. Any way that we’re moving away from processed to whole food I think that’s a step in the right direction. Then I would say, we really have to think about cell biology. The cells to produce energy properly, we need the microbiome to be functional. We need digestion to be functional. We need hormones to be functional. We need the mitochondria to be functional. We need the vascular system to be functional. All of this has to actually work properly for us to metabolize well, and in my opinion that requires having really rich plant foods because fiber is going to support the microbiome and a lot of the micronutrients and antioxidants we’re going to find in plant foods are going to support the cell biology.

So I would just say anything we’re doing to move in that direction of loading the body with these beautiful simile molecules and substrates is a step in the right direction. And then as much as we can be avoiding the sugars that come in, really everything, and being more cognizant of labels, it’s just incredible how much sugar is in everything. You’re going to find it in salad dressing. You’re going to find it in ketchup. You’re going to find it in every type of drink out there. You’re going to find it in yoghurt. It’s in marinades on different foods. It’s everywhere. So just starting to be cognizant of that. It certainly doesn’t have to be all or nothing, but I think anything we can do to move in the direction of giving our body what it needs to thrive on a biologic level and avoiding the things that are going to hurt it. That’s all going to be a pro.

Sonya Looney: [00:46:54] Yeah. I saw something in an article you wrote. It was about a market research company. Mintel found that 31% of Americans are practicing meat-free days and 58% are drinking non-dairy milk. So I think that’s amazing and I think it’s important to go back to this whole foods based eating approach like you mentioned, that if you want to trend towards eating more plant-based making sure that you’re doing it in a healthful way, not just adding in more processed foods, but adding in foods that have nutrient value in nutrient density.

Dr. Casey Means: [00:47:26] Yeah. Exactly. Exactly. We are just a very, very complex biologic machine and we need that machine to be working properly, which means that it needs to have these building blocks and we get those from whole foods. We don’t get those from highly ultra refined processed foods. So we just got to take care of it and take care of the maintenance and we do that by fueling our body with the best fuel possible. And when you do that day after day, week after week, even if it’s small increments, you’re going to see huge, huge changes in your mind, in your body, in your ability to show up in the world and ability to thrive. So I believe that very, very deeply.

Sonya Looney: [00:48:02] Can we talk about glucose and how it affects sleep? Have you guys done any research in that area?

Dr. Casey Means: [00:48:07] Yeah. There’s a lot of research in this area and it’s pretty fascinating and it’s actually a bi-directional link. So glucose levels actually can affect our ability to have high quality sleep, but also lack of sleep can have a huge impact on glucose levels. So I don’t know if one of those is more interesting than the other two, but happy to talk about either.

Sonya Looney: [00:48:28] Let’s actually go from the sleep to glucose, because I think a lot of people think, “I’ll just skip an hour of sleep so I can get in my early morning workout and then it’ll even out.”

Dr. Casey Means: [00:48:37] So I would say, don’t do that. First thing I’ll say is everyone does need different amounts of sleep. That’s for sure. There’s no exact golden amount for each person, but skimping on the sleep that you need for your body is a really good way to pull out the rug from your underlying metabolic health and ability to perform effectively.

So really interesting piece of research. They took these two groups of healthy people and they put one group, it was called the short sleeper group, and they made them get 6.5 hours of sleep per night. Then the regular sleeper group got between 7.5 and 8.5 hours for sleep. So just a one hour difference, like what you were just talking about. And what they found is that the next day they put these people on a glucose challenge where they basically had them drink 75 grams of glucose in a drink form. And then they checked their glucose for two hours after that drink. And actually, both groups had the exact same glucose response to the drink, but the short sleepers had to produce 50% more insulin to keep their glucose levels at that same amount. So they’re producing 150% as much insulin as the people who got regular sleep.

And you can imagine how that’s going to throw your body on this roller coaster. That insulin is coursing through your blood, causing you to have trouble with fat burning, potentially making you keep the fat on and it’s going to change the dynamics of the workout and everything. So that’s a huge, huge amount. And you can imagine day after day, if you’re secreting that extra insulin, you’re going to become more insulin resistant and it’s going to lead down this whole process of metabolic dysfunction.

Also, there’s another really interesting set of young, healthy men split them into two groups. One group got four hours of sleep at night for six nights. So that’s very little sleep. But you can imagine there’s people in college who are probably doing this. And then they did their blood sugar tests throughout this experiment, six nights of four hours of sleep at night. Then they did six nights where they could get as much sleep as they wanted. And in those six nights of four hours of sleep per night, these healthy men went from totally normal glucose response to pre-diabetic in that period of time. Yeah. It was reversible. But that’s crazy.

So sleep has a number of biological effects. One, sleep deprivation makes us more insulin resistant, even in one night of sleep loss. The second is it increases our cortisol levels, which is our stress hormone levels. When our cortisol goes up because we’re not getting enough sleep, what that does is it tells our body that we’re under threat, we’re under stress. It’s going to mobilize inflammation and it’s actually going to tell our liver that there some threat and we need glucose in the bloodstream to fight that threat. So it’s going to actually have you dump your stored liver glucose into the bloodstream and raise your glucose just because you got less sleep. The third thing it does is it actually changes our hunger and satiety hormones, ghrelin and leptin, and it’s going to make you more hungry the next day. And when these hormones are out of whack, it’s going to make you more hungry for carbs. So that’s the third thing. And the fourth thing is it directly stimulates inflammation. So we see an increased level of inflammatory cytokines, things like TNF-α and interleukin-6, CRP one day after a night of poor sleep. So for all these reasons, it’s just going to basically affect your metabolic health.

And while food is one of our primary drivers to improve our metabolic health, I would say you can’t do it with food alone. I don’t think you can overcome sleep deprivation and if you look at huge epidemiologic studies, the sweet spot seems to be between seven and eight hours of sleep.

Interestingly, it’s what they call a J shaped curve, meaning that less than seven hours of sleep increased risk of metabolic dysfunction, but actually over eight hours of sleep, you also see increased risk of metabolic dysfunction. And I think the reason for that is because it’s not just about sleep loss or too much sleep. It’s about circadian rhythms. It’s about regular rhythms of the body hormonally. We want our cortisol and our insulin and our melatonin, all these hormones to have a pattern to them and when that’s out of whack, which can happen with too much sleep too, you can see some issues. So bottom, line seven-eight hours. Don’t skimp. And I’m a big fan of sleep trackers for staying accountable for this.

Sonya Looney: [00:52:32] Yeah. And also something interesting with sleep is that if you’re training really hard, you might need more than eight hours of sleep or if you’re in a time of lots of stress, you might need more than eight hours of sleep so your body can recover. Is that true also for optimal glucose? Or is that just for sports performance?

Dr. Casey Means: [00:52:49] To be honest, I don’t, I actually am not super familiar with the data of fluctuating sleep needs in response to performance. I certainly know after a tough race or something I’ve been able to sleep for 12 hours straight and just don’t want to get out of bed, but I don’t know about the recovery aspects of that. That’s a really, that’s an interesting one.

Sonya Looney: [00:53:06] Yeah. That’d be cool to look into that. And can we talk about the other direction, how glucose or having more steady glucose can help you sleep better at night?

Dr. Casey Means: [00:53:15] Definitely. This one’s really interesting. When glucose spikes, when you get a big surge in glucose, it actually can make our bodies heat up a little bit. It can affect our blood vessels and actually make it difficult to convect heat and make our core body temperature go up just a little bit. But higher body temperature actually is associated with insomnia and not sleeping as well and poor sleep quality, which is why you often hear you want to be in a cold room when you’re sleeping and you want to make sure it’s not too hot. That’s key. So thermal regulation might be a piece of why a spike at night affects our glucose.

The other thing is if we eat, let’s say a really high carb meal or a meal, not necessarily high carb, but a meal that happens to spike our glucose late at night, because we’re more insulin resistant at night, we’re going to see more of an effect from that meal than we would earlier in the day. So let’s say you eat a big dessert or huge bowl of rice right before (and rice doesn’t affect everyone, but it does for me) and you get a really big surge and your insulin, you’re a little insulin at that time because it’s nighttime. You can just imagine you’re bouncing around all throughout the night and that up and down can lead to some arousal during the night where you’re wakeful and as you go up and down, it can throw you for a loop.

So my recommendation for optimal sleep would be to really think about stopping eating quite a few hours from bedtime. If you go to bed at 9 or 10, thinking about stopping eating around 5:30 to 6:30 or so, giving your body time to really have that insulin response come back to normal and really be in a steady state as you’re easing into bedtime.

And to really focus more on the fat and protein rich meals later in the day I tend to try and front load more of my carbohydrates and then ease into more of that ketogenic fat protein later in the evening. So for me, a lot of my evening meals have become things like a big spinach salad with lots of tofu, avocado, tahini, maybe some vinegar. Vinegar is actually an insulin sensitizer. But basically I’m going to be avoiding the squash or the fruit or the raisins or the sweeter honey, dressings with honey in them, at night because all of those things are going to keep my glucose – So it’s really much more of a protein, fat, fiber rich, some beans in there too, sometimes, but really focusing on that in my evening meal to keep glucose steady as I get towards bedtime.

Sonya Looney: [00:55:34] Wow! You’ve given us so much to think about in today’s podcast and you also talked about a company that you co-founded for continuous glucose monitoring. Where can people find that and where can people find you? Because we just barely scratched the surface with a lot of these topics.

Dr. Casey Means: [00:55:48] Yeah. So my company is called Levels Health, and we are taking this technology, continuous glucose monitoring, and making it mainstream for people. So this has been a technology that’s typically been used just in individuals with Type 1 or Type 2 diabetes as a wonderful treatment tool. And we really just see this potential for unleashing that power of that data stream to so many people for precision nutrition and performance. So that is what our company does is it makes this technology accessible for health seeking individuals then pairs it with software that makes this really interpretable.

So you can find us at levelshealth.com and me and a bunch of other guests writers have written a lot about these topics on our blog at levelshealth.com/blog. Also a lot of this is put on our Instagram and Twitter @Levels and then for me personally, I write a lot more about metabolic health and plant-based diets. And I am @DrCaseysKitchen. So D-R-CaseysKitchen on Instagram and Twitter. And yeah, certainly happy to field follow-up questions on those platforms and if anyone’s interested, definitely feel free to get in touch.

Sonya Looney: [00:56:48] Awesome. Thanks so much for coming on the show and I look forward to learning more.

Dr. Casey Means: [00:56:52] Thanks so much, Sonya. Great to talk with you.

Sonya Looney: [00:56:59] Thank you so much for listening to today’s episode. I hope you learned a lot about metabolic health and if you want to take the reins, check out Levels Health. Checkout Inside Tracker and also check out 80/20 Plants if you want to consider trying a plant-based diet with some one-on-one coaching, meal planning and nutrition planning as well. And I have a link in the Show Notes for 80/20 Plants. If you click that link, it will also help support the show. I love you guys. My community is everything to me and I’m with you on this journey of personal growth, adventure and our mission to be better every day.