Q&A: Blood Glucose & Gut Health with Dr. Casey Means

For Dr. Casey Means, food is magic. It is both the instruction manual that tells our body what to do, and the building blocks that comprise our body’s very substance. Dr. Means is particularly focused on metabolic health: the careful balance of factors that keep your glucose levels in check. That’s why she helped co-found Levels, a company that is bringing real-time continuous glucose monitoring technology to the masses. As a guest on Biohacker Babes, Dr. Means chatted with host Lauren Sambataro about how glucose impacts the body, why daily choices are so important, and where to start when it comes to taking control of your health.

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out the Biohacker Babes Podcast
• Connect with Lauran Sambataro on Instagram
• Connect with Renee Belz on LinkedIn

06:14 – The effects of insulin resistance on mental health

Insulin resistance manifests as depression, anxiety, chronic pain, dementia, fatigue, and chronic pain, among other things.

“As you become insulin resistant, your body has more trouble actually getting and processing energy. When this happens in specific tissues, that can be really problematic. If your brain, for instance, is insulin resistant and you are having more difficulty getting glucose into your brain cells, you can imagine that causes lots and lots of problems. Which is why insulin resistance, even in the brain, is related to depression, anxiety, dementia, fatigue, and chronic pain. This can show up like anything when your cells aren’t getting the energy they need. So you don’t want insulin resistance. The more we can do to keep our spikes lower, keep insulin exposure lower, keep the cells sensitive to insulin, the better off we’re going to be.”

08:15 – The individuality of glucose reactions

Not all carbs are created equal. Furthermore, each individual can have completely different reactions to different carbohydrates based on a variety of factors.

“If the food has a bunch of carbohydrates, carbohydrates are broken down into glucose, and so of course you might get a big spike. But that’s actually too simple of an answer, because what we know is that two people can eat the exact same amount of carbohydrates and actually have totally different glucose responses. I think we talked about this in the last episode. All three of us could eat a cup of oatmeal with the exact same carbohydrate content. One of us could go up five milligrams per deciliter of glucose, one of us would go up a hundred points. That’s where things get so interesting and where we start getting into the complexity of the physiology of digestion and glucose management and whatnot.”

09:49 – Maintaining a healthy microbiome

A healthy microbiome produces metabolic intermediates that are absorbed through the colon cells and used to manage metabolism.

“The microbiome also produces a lot of really interesting mediators. Basically, the microbiome eats fiber and they are converted into other products that our body uses as molecular information. And some of those are essentially metabolic intermediate. You want your microbiome to be in the right ratios while they’re producing these metabolic intermediates so that we can then absorb through our colon cells and use them to manage our metabolism. There’s not an easy silver bullet to figure out exactly how to balance out these ratios. You don’t just take anti-firmicute probiotics or pro-bacteroidetes. I always get back to the fundamentals of improving microbiome health, which is really sticking to as much of a whole foods diet as you can, getting a ton of fiber. I recommend 50-75 grams of fiber per day from whole food sources, and then avoiding things that are going to hurt the microbiome. Chronic stress hurts the microbiome, they hear all our thoughts and they don’t like it when we’re stressed. Focusing on avoiding pesticides and toxins in our food that can hurt the microbiome, avoiding super high sugar that can hurt bacteria in the gut.”

14:23 – The impact of metabolic dysfunction on health

Metabolic dysfunction and insulin resistance can look like different things or different people. But it’s important to remember that the underlying condition is the same, and that’s what needs to be treated.

“There are different levels of insulin resistance in different parts of the body. However, we do have to also remember that we are one unified system. We do have to think of ourselves as this sort of holistic body, where a systemic process, like insulin resistance or inflammation, it’s happening everywhere, but certainly, it’s showing up differently in different people. And so for one person, insulin resistance might look like obesity and that’s it for another person it could look like depression, fibromyalgia, polycystic ovarian syndrome, and brain fog. And for another person, it could look like fatty liver disease, the kidneys numbers are off, and erectile dysfunction. And for another person, it could be nothing until they have their first heart attack. All of a sudden they get diagnosed, Oh, you had high blood sugar and insulin resistance and endothelial dysfunction. It can look so different, but fundamentally a lot of that is linked to this increased risk factor of cells being insulin resistant and chronic exposure to high glucose. It has so many faces, which is fascinating. And they can look very different between different people, which is part of why it’s been confusing to track how much metabolic dysfunction has an impact on so many health-related things.”

16:28 – How food choices become intuitive

Once you start receiving feedback on how diet, sleep, and stress impact your body, you start to understand your body better and learn to make better decisions intuitively.

“Having less sleep, you will see likely higher glucose spikes after the exact same meal that didn’t spike you on a day when you got good sleep. If you’re very, very stressed, the same meal can cause a higher glucose response likely because of the way cortisol is impacting our glucose. And if you have or haven’t exercised, it’s going to change the way your muscles are picking up glucose. That can change your spikes. So those three things are big. And just the last one I’ll mention is micronutrient status. It takes micronutrients like manganese, magnesium, zinc, vitamin C, a lot of the B vitamins for our mitochondria and our cell membrane receptors to actually function properly. Baseline micronutrient status can have a really big impact on how two different people will respond to the same carbohydrate source…So it’s a lot to think about, but I think when you’re tracking your glucose regularly and you’re learning about all this stuff, a lot of it becomes intuitive after a while. You just notice like, Oh, if I eat oatmeal earlier in the day versus at night, it’s a lower spike. There must be something to that. So a lot of it ends up becoming intuitive, but there is a lot to think about with this stuff.”

18:39 – The endless variations in healthy combinations of food

No food is inherently good or bad. What’s more important is to test things like food pairing, eating at different times, and controlling levels of stress and sleep to see what works best.

“Calibration tests like that can be helpful in starting to experiment with the differential effect of these things in our toolbox – actually testing the food and then testing it under different conditions. So if you can get a baseline like, yeah, brown rice causes me to go to glucose of 170 milligrams per deciliter. But then you can potentially repeat that experiment under different conditions. You can start to parse out how those other mitigating factors are impacting your carb responsiveness. So how I might structure it is eat something, for me, a sweet potato spikes me through the roof. It was so disappointing when I did this calibration, I basically did one full cup of completely plain sweet potato, which I would sometimes potentially eat a sweet potato on its own, but it put me up to 170, which was one of my highest spikes ever. But then you can take that knowledge and start doing the other variables. I got an extra two hours of sleep on the weekend. What if I eat that again? Oh, I did a high-intensity interval training Peleton workout one day. What if I then ate the sweet potato after that? Oh, I’m giving a talk in front of 500 people. What if I eat the sweet potato right around then? I’ve been taking my vitamins for a month and then I do a sweet potato and start doing this as an experiment.”

23:03 – Get the low hanging fruits first

There are many different things an individual can learn with CGM, but the easiest way to get the biggest benefit would be to stop eating the food that causes big spikes in blood sugar levels.

“Food is necessary, but not sufficient for medical metabolic health. You need to be eating properly for your body and in a personalized way to have optimal metabolic health. But you also need a lot of these other things in harmony to really achieve perfect physiologic function. You also need sleep. You also need stress management. You also need exercise. You need all these things to work in concert, but the food is the key driver. So if someone just wanted to start and basically get the lowest hanging fruit, get as many wins in the beginning, I would just say, put a CGM on and stop eating the things that are spiking you to the roof. That’s the easiest thing you can do. If you see that oatmeal and Oreos and your morning mocha are taking you to 180, that is such easy information to just like pull them out for a little bit and start seeing how you feel. On the flip side, you’re going to start to see a lot of foods that you love, that aren’t spiking your glucose, and you can start to emphasize those more in the diet.”

29:07 – The catch 22 in gut health

Underlying gut dysfunction can preclude people from eating the foods with the right micronutrients. Rehabilitating gut health is complicated and can sometimes take months.

“Gut health is a really tough thing. You get into a catch 22 situation sometimes where if there’s underlying gut dysfunction like leaky gut or SIBO or something like that, it can preclude people from eating the foods that ultimately are going to be potentially very healing and provide lots of micronutrients and lots of nutrients we need for cellular function because your body’s not really able to process them effectively. These are some of the most challenging cases I see in my practice, and I think of it very much in a tiered step-wise function to get to the place where you can process vegetables and fibers and things like that effectively. It often doesn’t start with just throwing all those things into the gut and kind of seeing what happens…The next step would be building a healthier gut. That’s a complex question as well, but that’s gut lining integrity. So you’re making sure you’re getting the nutrients that are required to build a healthy colon wall. Building up the microbiome through potentially probiotics or probiotic foods, sealing up the leaky gut, or whatnot. And then after that, it might be the introduction of a lot of these foods that can be potentially inflammatory in the wrong context. So it doesn’t often involve starting with a bunch of super high fiber foods, but I like to get everyone worked up so that we can actually get there, but that can take months, and often involves treating the underlying root causes of gut conditions first.”

36:57 – Food as a molecular information checklist

It’s important to look at food and see where all the macro and micronutrients needed for a healthy metabolism are going to come from.

“The way I look at food is that food is molecular information. That’s what food is. I’m just trying to get a certain amount of molecular information per day. And some of the key things on my molecular information checklist are all things that I know are going to help with physiologic function. So that’s going to be fiber, so I can make short-chain fatty acids. It’s going to be Omega threes, which are anti-inflammatory mediators but also building blocks of healthy cell membranes. It’s going to be as many antioxidants as I can possibly get because antioxidants are going to buffer free radicals, minimize inflammation, help with DNA repair, and things like that. It’s going to be protein for obviously anabolic processes in the body. It’s going to be micronutrients…And then I’m looking at the foods around me and I’m like, well, where can I get this stuff without having collateral damage, like a glucose spike?”

40:10 – How food is both the building blocks and the builder

Food has the nutrients the body needs, and it also has the chemicals that tell the body what to do in terms of gene expression.

“What I love about food that makes it so magical to me is that it is both the information, it is both the thing that tells our bodies what to do like the instruction manual for ourselves, but it’s also the building blocks. It’s like two different functions. So that’s kind of amazing. It’s like being the builder and the architect, like the bricks and the builder at the same time. We only get so many calories per day. We only can eat a certain amount per day. If you think that it’s both making up your body and also telling your body what to do, these are telling your genes how to be expressed, telling your cell membranes how to function. It feels imperative to make those choices wisely because that’s all we’ve got. We’ve got those calories. And if you start wasting those calories with things that are either not adding value or are adding anti-value, you can imagine how quickly the body’s going to break down.”

Host : [00:00:00] We’re digging deep and asking the questions and we need to ask.

Host 2: [00:00:05] Years of stress, and not just emotional, I was depleting my body, I was malnourished, and working out like crazy. I’m eating all these healthy foods, how could I not be well?

Host : [00:00:19] We have to get back to the basics. We can change the way our genes are expressed.

Host 2: [00:00:23] Anyone that wants to improve their health or upgrade their health, they should be biohacking. My name is Renee.

Host : [00:00:30] And I’m Lauren. We are the Biohacker Babes. We’re sisters and we’re joining forces to empower you to become your own biohacker and upgrade your life.

Host 2: [00:00:40] The Biohacker Babes podcast aims to create insight into the body’s natural healing abilities, strengthen your intuition, and empower you with techniques and modalities to optimize your health and wellness. Because life is too short to not feel your best every single day.

Host : [00:00:55] This podcast offers health, fitness, and nutritional information and is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Thank you for joining us and welcome to the show.

Host 2: [00:01:21] Welcome to the Biohacker Babes podcast. I’m Renee, and I’m here with my sister Lauren, and we have a special guest for you today. And this is the first time we have a guest back on for a second time. So she is officially our ~~~~most popular guest, I would say. So we have Dr. CaseyMeans, she is back. We had her on for episode number 58. So if you have not listened to that, definitely go back and check it out, because we really got a lot of great information that’s going to set us up for today’s episode. And we got so much great feedback, so many questions and responses on social media that we’re like, “Okay, Dr. Casey, we got to get you back on here immediately.” So, welcome back to the show. We’re so excited.

Dr. Casey Means: [00:02:01] Oh, thank you so much, Renee and Laura, and I’m so excited to be back.

Host : [00:02:04] Yeah, it seems like this topic is really exploding. I mean, we got so many inquiries from our audience, but also, just selfishly, I have so many more questions for you. And both Renee and I, are just so fascinated with glucose and reactions and how it affects our health right now. So, I dunno, maybe we’ll have you back 5 more times, because I don’t foresee this conversation wrapping up anytime soon. But we’re going to use this as sort of a Q&A, just to dig a little bit deeper on some things that we didn’t quite get to in the last episode. And hopefully answer everyone’s questions that were sent in and also our own.

Dr. Casey Means: [00:02:39] Perfect. I can’t wait to dive in.

Host 2: [00:02:41] Yeah, and stay tuned for the end. We have a nice surprise coming for you if you want to get your hands on a CGM, I know we got a lot of questions about that, so we will give you more information at the end of the episode.

Host : [00:02:51] Okay, to kick this off, Dr. Casey, I have, kind of a general question, but last time we talked about trying to achieve, like the nice rolling hills, with our glucose trends. That’s the ideal snapshot that we want for using this continuous glucose monitor. We don’t want anything that’s spiking too high. And we definitely, if we are getting a little bit of a hill, we want it to come back down. Can you explain the mechanism or what’s happening in our body? Or some reasons why we may get a spike that’s a little too high or a dip that’s a little bit too low?

Dr. Casey Means: [00:03:24] Yeah, absolutely. So, I guess just going back to some of the stuff we talked about in our first episode, but if people haven’t listened, going back to, sort of, like the spikes vs rolling hills. So when you consume food, you’re going to have some natural, probably small amount of, even if there’s low carbohydrates in the meal, you’re going to have some glucose release into your bloodstream. And you might see a little bit of an elevation with your glucose. And a little bit up and a little bit down, is generally, what’s optimal for health. We don’t want these sharp peaks and valleys, that can be problematic to health for a number of reasons. And really, there’s 5 main reasons that I’ll run through pretty fast, but one is that high glucose spikes can cause inflammation. It can tell the body, it’s just not normal to have a super, super high spike. So it can, kind of tell the body like, “We’re on threat mode.”, like, “What’s going on?” and can cause some inflammation and inflammatory cytokine release. The second thing, is it can cause oxidative stress. So that’s, free radical exposure in the body, and those can be damaging to our tissues. And the third is, it can cause glycation, which is where, basically just sugar molecules, if they’re in high concentration in the bloodstream, they can stick to things. And they can stick to red blood cells, they can stick to proteins, they can stick to fat, and that causes dysfunction in the actual activity of those cellular structures. So we don’t want glycation.

Glycation, you hear about, kind of colloquially, when you think about the hemoglobin A1C test, that’s a test of glycated hemoglobin. So it’s looking at how much sugar is stuck to your red blood cells. And is a measure of, essentially our 3 month average of blood sugar. Because blood cells last for about 120 days, or about 90-120 days in the bloodstream, about 3 months, 3-4 months. And so by looking at how much of these red blood cells are glycated, we can get an average of glucose over that time period. And then the other 2 reasons have more to do with insulin. So when you have a big glucose spike, you’re going to have, it’s going to tell your pancreas, “Hey, you need to release a bunch of insulin.” Cause this is the hormone that allows us to actually take glucose into ourselves. And every time, and it’s very normal – you eat something, glucose rise in the bloodstream, release the insulin, get it into the cells, that allows you to take that glucose into the cell. Have your mitochondria process it. Turn it into cellular energy that we can use. So that’s great. But when this happens over and over with these high spikes, the more glucose you’re spiking in your bloodstream, the more insulin you have to release. And when you do that over and over your body actually becomes numb to insulin. It’s like, “Oh, my gosh, there’s so much insulin around. We need to kind of protect ourselves from all of this.” and you yourselves can become insulin resistant. And then you still need to get that glucose into the cells for energy, so your pancreas actually produces more . And then you can develop what’s called hyperinsulinemia, where just at baseline, to get a normal amount of glucose into your cells, you’re actually having to produce a lot more of this insulin to drive it in. And that insulin, it can cause problems. And so, one, as you become insulin resistant your body has more trouble actually getting and processing energy. When this happens in specific tissues, that can be really problematic.

If your brain, for instance, is insulin resistant and you are having more difficulty getting glucose into your brain cells, you can imagine that can cause lots and lots of problems. Which is why insulin resistance, even in the brain, is related to depression, anxiety, dementia, fatigue, chronic pain. I mean, this can show up as anything, when your cells aren’t getting the energy they need. So you don’t want insulin resistance. And the more we can do to keep our spikes lower, keep insulin exposure lower, keep the cells sensitive to insulin, the better off we’re going to be.

And then the fifth thing, is that when you spike and you release that huge amount of insulin, it can cause your glucose to just sort of crash. Like your body surges out this hormone, all this glucose gets sucked up in your cells, and then that can cause, almost like an overcompensation. You soak up all this glucose and it actually dips lower than it was before your meal. And that’s called reactive hypoglycemia. So big spike, reactive hypoglycemia. And that dip after a high glucose spike meal can be associated with some anxiety. It can be associated with, sort of a post-meal slump or fatigue and just that, a general sort of bad feeling after a meal. So being able to kind of see this and visualize all this on CGM is nice. Because you can actually link some of those post-meal subjective feelings, that I think a lot of people sometimes experience after a big meal, and actually see like, “Oh, this was, likely in-part, because my glucose spiked and crashed and I had a reactive hypoglycemia dip.” When you have the more gentle rolling hills, you don’t really see that reactive hypoglycemia. You go up and then you kind of come down right back to baseline. You don’t overshoot into the, you’re not getting that overcompensation.

So those are, kind of 5 main reasons why you don’t want to have a spike. And when a food is doing this to you, there’s a, and this gets back to your question, Lauren, “Why is that happening?” Well, the easiest answer is carbohydrate concentration in the food. If the food has a bunch of carbohydrates, carbohydrates are broken down into glucose. And so, of course you might get a big spike. But that’s actually too simple of an answer. Because what we know is that 2 people can eat the exact same amount of carbohydrates and, actually have totally different glucose responses. I think we talked about this on the last episode, but like, all 3 of us could eat a cup of oatmeal and 1 of us could have, the exact same carbohydrate content, 1 of us could go up 5 milligrams per deciliter of glucose, 1 of us would go up 100 points. And that’s where things get so interesting and where we start getting into the complexity of the physiology of digestion and glucose management and whatnot. So the things that we know feed into that, a lot of this comes out of this study that we talked about, which was from the Weizmann Institute in Israel. Which was,  Personalized Nutrition by Prediction of Glycaemic Responses, that showed, it really looked into  why would the 3 of us all respond differently to the exact same carbohydrate meal. And one of the big things they found was that a lot of it had to do with microbiome.

Two of the bacteria that have been closely associated with metabolic effects is the bacteroidetes and the firmicutes family. These are just family of bacteria in the microbiome, that when they’re in the wrong ratios, you can see  increased propensity to develop metabolic disease. And also increased propensity to develop obesity. They’ve done a lot of really interesting studies in, you know, mice, to basically show that microbiome is a very deterministic factor in how we process carbohydrates and how that converts into glucose in our bloodstream. The microbiome also produce a lot of really interesting mediators. They produce, so basically, the microbiome, they eat fiber and they convert it into other products, that then our body uses as molecular information. And some of those are, essentially metabolic intermediate. So you want your microbiome to be in the right ratios, that they’re producing these metabolic intermediates, that we can then absorb through our colon cells and use to manage our metabolism. There is not an easy silver bullet to figure out exactly how to balance out these ratios. Like, you don’t just take a anti-firmicute probiotic or something like that. Or pro-bacteroidetes, but really, I always get back to the fundamentals of improving microbiome health, which is really sticking to as much of a whole foods diet as you can. Getting a ton of fiber. So I recommend 50-75 grams of fiber per day from whole food sources and then avoiding things that are going to hurt the microbiome. So chronic stress hurts the microbiome, they hear all our thoughts and they don’t like it when we’re stressed. Focusing on avoiding pesticides and toxins in our food that can hurt the microbiome. Avoiding super high sugar. The bacteria in the gut, they ferment sugar very differently than they ferment other fibers and things like that. So you don’t want to load them with a bunch of processed foods. Avoiding too much animal products, so certainly some amount of animal products are probably healthy for the body, but just like excessive amounts of conventionally raised animal products are going to, potentially interact with the microbiome in a way that makes toxic byproducts like TMEO, trimethylamine oxide. And then avoiding medications that hurt the microbiome. So antacids and acid reducing medications. NSAIDs like Advil. And then of course, unnecessary antibiotics. And certainly there are times we have to take these medications potentially, but avoiding, just totally unnecessary antibiotics. Ibuprofen, NSAIDs, and medications that mess up our acid production or our digestion, those are all things. So that’s kind of the landscape of keeping things healthy on the microbiome front, but that’s a big deterministic factor in how we convert carbs in our food to glucose in our bloodstream.

There’s a lot of other things too. One other thing they showed in this study was that just baseline body type and insulin sensitivity, of course has an impact. What body the food is coming into is going to really change the way that glucose curves happens. If you’re super insulin sensitive and you just need a tiny bit of insulin to soak up glucose, your spike is going to be lower than if you’re insulin resistant, and that glucose comes in and you’re not absorbing it quickly. You know, it’s gonna look bigger, this is super dynamic process. So if you’re just, that glucose is entering the bloodstream and immediately being soaked up by cells, that spike is going to look lower. So insulin baseline, insulin sensitivity, and then they talked about anthropomorphic features in the paper. So that is, basically comes down to body type and that can be a proxy for insulin sensitivity, in some ways. So we know , which is like the tire around the middle, more central adiposity or fat, that is often associated with insulin resistance. So more visceral adiposity, which is the type of fat that’s around organs. We have 2 types of fat, the fat that’s under our skin, subcutaneous fat, and the fat that is actually surrounding our organs or in our organs, which is visceral fat. Visceral fat is associated with insulin resistance. So the more of that you have, which often shows up with that around the middle, can be suggestive of more insulin resistance. So they showed, in the paper that that sort of thing can relate to how you spike.

Host 2: [00:13:09] Now, did the insulin resistance cause the fat to be settled there? Or vice versa?

Dr. Casey Means: [00:13:15] It’s, you know, that’s such a great question. I have to do a plug for this book, Why We Get Sick by Ben Bickman. It just got published 2 months ago, in July. He talks a lot about this, which is the bi-directional relationship between obesity and insulin resistance. So, there’s evidence in both ways, that insulin resistance on its own can cause us to store more visceral fat, and the existence of visceral fat can also cause us to become insulin resistant. So it’s likely that it’s bi-directional. But certainly, if we are insulin resistant at baseline, we are going to likely, any carb exposure we have in the diet is going to look like a bigger spike because we’re just not soaking it up into our cells efficiently and processing it well.

Host 2: [00:13:58] So sticking with the insulin resistance, you mentioned insulin resistance in the brain. And I’ve heard, yes, it can lead to dementia and Alzheimer’s. Can you be insulin resistant in just specific areas of the body? Or it’s really overall, it’s just kind of where you’re expressing symptoms?

Dr. Casey Means: [00:14:13] That’s a great question. I think the answer is you can be more or insulin resistant in certain parts of the body. Certainly where people’s insulin resistance shows up as symptoms can be very different amongst different people. And so, that suggests that there’s different levels of insulin resistance, in different parts of the body. However, we do have to also remember that we are one unified system. We do have to think of ourselves as this, sort of holistic body, where a systemic process, like insulin resistance or inflammation, it’s happening everywhere, but certainly, it’s showing up differently in different people. And so for one person, insulin resistance might look like obesity and that’s it. For another person, it could look like depression, fibromyalgia, polycystic ovarian syndrome, and brain fog. And for another person, it could look like fatty liver disease, the kidneys are kind of going a little, the kidney numbers are off, and erectile dysfunction. It is so, and for another person, it could be nothing until they have their first heart attack. And then all of a sudden, they get diagnosed with, “Oh, you had high blood sugar and insulin resistance and endothelial dysfunction.” It can look so different, but fundamentally, a lot of that is linked by this increased risk factor of cells being insulin resistance and chronic exposure to high glucose. So, it has so many faces, which is fascinating, and they can look very different between different people. Which is, I think, part of why it’s been confusing to track how much metabolic dysfunction has an impact on so many health things.

Host 2: [00:15:52] Right. And even in twins, you can see variation, right? So, you know, 2 people that are genetically very similar. That’s amazing. I can see why it’s so complicated.

Dr. Casey Means: [00:16:04] Absolutely. Yeah, I’ve gone, long answer to your question, which is basically, microbiome, baseline insulin sensitivity, and then all these other mitigating factors that we talked a lot about on the last episode. Like sleep quality, how much exercise you’re doing, and how you’re managing stress. Those 3 other things, I think, are big factors that impact how you’re going to respond to a specific carb in your bloodstream, in terms of glucose. Having less sleep, you will see, likely higher glucose spikes after the exact same meal that didn’t spike you on a day when you got sleep. If you’re very, very stressed, the same meal can cause a higher glucose response, likely because of the way cortisol is impacting our glucose. And if you haven’t exercise or have exercise, it’s going to change the way your muscles are picking up glucose. And so that’s good, that can change your spike. So those 3 things are big. And just the last one I’ll mention is micronutrient status. So people, it takes micronutrients, things like manganese, magnesium, zinc, vitamin C. A lot of the B vitamins for our mitochondria and our cell membrane receptors to actually function properly. So baseline micronutrient status can have a really big impact on how 2 different people will respond to the same carbohydrate source. So yeah, microbiome, insulin insensitivity, micronutrients, sleep, stress exercise. And then of course, carb content, and then a lot of the things we talked about last time, like carb content, how you’re pairing the foods, when you’re eating the foods, what time of day. Those would be the main things that create differences. It’s a lot to think about, but I think when you’re tracking your glucose regularly and you’re learning about all this stuff, a lot of it becomes intuitive after awhile. You just notice like, “Oh, if I eat oatmeal earlier in the day versus at night, it’s a lower spike. There must be something to that.” So a lot of it ends up becoming intuitive, but there is a lot to think about with this stuff. So those are the main factors.

Host 2: [00:17:55] It’s really where the, that’s where the CGM is just priceless, to be able to do that on your own. So, I’m curious, I mean, you keep talking about carbohydrates. I’ve heard about the carb test where you would just test like 1 cup of brown rice with nothing on it, 1 cup of oatmeal with nothing on it, like every day you do a different carb. My question is – is it really important to test those foods if you’re never going to eat them that way? Like, I would never eat Brown rice with nothing on it.

Host : [00:18:23] I was wondering that as well, I’m never going to do that because I’m going to do that. Plain doesn’t work for me.

Host 2: [00:18:26] Right. I’m going to put some butter, olive oil, some vegetables in there with fiber. So yeah, what’s the answer to that?

Dr. Casey Means: [00:18:33] I think, were carved calibration tests like that can be helpful is starting to experiment with the differential effect of these things in our toolbox. So actually testing the food and then testing it under different conditions. So if you can get a baseline like, yeah, brown rice causes me to go to a glucose of 170 milligrams per deciliter. But then you can potentially repeat that experiment under different conditions, you can start to parse out how those other mitigating factors are impacting your carb responsiveness. So, how I might structure it is, eat something, for me, a sweet potato spikes me through the roof. It was so disappointing when I did this calibration, I basically did 1 full cup of completely plain sweet potato, which I would, sometimes potentially, eat a sweet potato on its own. But it put me up to 170, which was like, I think one of my highest spikes ever, but then you can take that knowledge and start doing the other variables. So, oh, I got an extra 2 hours of sleep on the weekend. What if I eat that again? Oh, I did a high intensity interval training Peleton workout one day. What if I then ate the sweet potato after that? Oh, I’m, you know, giving a talk in front of 500 people. What if I eat the sweet potato right around then? Or, “Oh, I’ve been taking my vitamins for a month” and then I do a sweet potato. And sorta start seeing, like, doing this as an experiment of how are each of these things impacting my response and create what I would consider your, sort of toolbox or what are your most effective go-to tools to blunt a spike. And then of course, like you said, adding butter, I mean, adding fat, adding protein, adding cinnamon, adding vinegar. Trying it with berberine, all these different things that we know have an impact on spikes, you can start to experiment with that stuff.

Host : [00:20:14] Gosh, the variables are endless. Now I’m understanding why you are keeping your CGM on indefinitely. The experiment just goes on and on and on.

Host 2: [00:20:23] Are you still learning new things every day with how long you’ve had your CGM?

Dr. Casey Means: [00:20:27] I,  still do. You know, some of the experiments are, have been longer term experiments. Like, I more recently, kind of made a commitment that I was just going to be even more zealous about sleep. And I was, basically not going to let anything get in the way. I can always make excuses for, you know, going to bed later, stay up a little late. And that’s one thing I do kind of struggle with, but I was like, “You know what, for 2 weeks I am going to, there is nothing that is going to stop me from getting at least 7 1/2 hours of time asleep on my Fitbit. And so, I even would like sleep in a little bit later to make sure I got that. And I noticed a huge impact on my glucose. Like it was a, it was market. And so, it made me realize that that consistency is so important. So I think doing some of the longer timeline experiments are fun when you’ve had it for a long time.

But I do think there’s kind of 2 phases to using CGM. There is, like the rapid insights part of things, which is like the first few months where I think you’re just learning so much and you’re really testing a lot of these variables. And then, I think there’s then phase two, which is really using it more to stay accountable and to just keep yourself on track. And that’s more the phase I’m in now. Which is, I don’t want to see a spike. I don’t want to go into the red. And so having it there is just this little angel on my shoulder saying, “Don’t do it, not worth it.” And that, I think ,is going to be valuable for ever. I mean, I have no intention of ever taking this off just like I don’t take off my Fitbit.

Host : [00:21:51] I’m overwhelmed by all this information, in a positive way. But for people that are listening, you mentioned all of those, the mechanisms for why we could have these negative reactions. Is there a way to prioritize that list? Like if we’re talking about inflammation, oxidative stress, glycation, is A1C enough of a predictive marker or do you just encourage using the CGM over time? Do you start there? Do you start with, like a GI map and do a gut panel?

There’s so many things to look at, which is actually causing a little bit of stress right now. How do we guide people to get started if they are that far end of the spectrum where inflammation really is a problem? Or insulin really is?

Dr. Casey Means: [00:22:36] Yeah. I mean, I think the really nice thing is that this can get so ultra-nuanced-down. Yeah, like we can start talking about firmicutes  but that becomes like., “Wow, this is getting really difficult to feel actionable.” But the beauty is, is that I think, you know, the biggest driver is food. Food is, I like to say food is necessary but not sufficient for metabolic health. You need to be eating properly, and for your body, and in a personalized way to have optimal metabolic health. But you also need a lot of these other things in harmony to really achieve perfect physiologic function. You also need the sleep. You also need the stress management.

.You also need the exercise. You need all these things to work in concert, but food is the key driver. So, if someone just wanted to start and, basically get the lowest hanging fruit, get as many wins in the beginning, I would just say, put a CGM on and start and stop eating the things that are spiking you to the roof. That’s the easiest thing you can do. If you see that oatmeal and Oreos and your morning mocha, and these things are taking you to 180, that is such easy information to just pull them out for a little bit and start seeing how you feel. On the flip side, you’re going to start to see a lot of foods that you love, that aren’t spiking your glucose, and you can start to emphasize those more in the diet. Over-time,

as you just take away the low-hanging fruit, things that are just totally zapping your, you know, giving you  these hyperglycemic spikes and zapping your metabolic health, what’s going to happen is that as you have less and less of those spikes, just by avoiding these obvious foods, you’re going to likely regain some insulin sensitivity. You’re going to start moving down the path of just being more sensitive and things are going to start shifting.

So, in terms of  the product that I’ve built at Levels, which is the software that helps make this a lot easier for people, we have developed what’s called the Zone Score, which is, essentially just an easy number 1-10, was this a good or bad meal for you. And so, I tell people, like in the beginning just find out what’s causing your 1s, 2s, and 3s, which are a very pronounced metabolic response. And see the ones that are 7s, 8s, and 9s, which are a very minimal metabolic response, and just start eating more of the 7s, 8s, and 9s and not the 1s, 2s, and 3s. And that’s, like the first step. All this other stuff is definitely icing on the cake, but it doesn’t have to get to that exponential level of complexity to start seeing some wins. And then after that first, really just like the obvious food stuff, get rid of the killers, like the mocha or whatever it is that’s spiking, you then start making some of those little nuanced tweaks that we educate about in the product and in our educational resources. Which is like, yeah, if you’re spiking on a food that you love, that seems actually kind of healthy, like quinoa or whatever, add fat, add protein, add a vinegar dressing. These are things that all, you know, vinegar is an insulin sensitizer, fat and protein tend to blunt glucose spikes. So start now adding some of these evidence-based ways to bluntyour spike. Get those zone scores up even more. And then, after that, start bringing in some really easy lifestyle stuff. So like, take a walk for 20 minutes after meals. If you’re really stressed during a meeting and your glucose is going up, take 5 deep diaphragmatic breaths. If you can, try and bump up your sleep from 6 1/2 to 7 hours, like simple stuff. But first step is just remove the crazy spikers from your diet, I think.

Host 2: [00:26:02] That was really helpful.

Host : [00:26:03] I think that also really speaks to the benefit over something like a finger prick glucose. I love the idea of the Zone Scores and just making that visual, just really powerful. It, like takes all the guesswork out. Really awesome.

Host 2: [00:26:15] Yeah, funny story real quick about the walking – the study that you shared with us last time, where you said, like just walking 2 minutes, I think it was every 30 minutes. I was telling one of my clients, who’s a high-schooler about that. He’s not really ready to exercise yet, we’re just starting with the basics. So I told him about this walking thing, and he said that now that they’re back in school with COVID that they have to walk outside, around the whole school building to get to their classes. But it’s a one-way walkway. So if your class is here and your next class is just right next door to the left, you actually have to go outside, walk all the way around. And so he was like, “I’m going to be walking miles every day at school.” I was like, “This is a great thing.”

Dr. Casey Means: [00:27:01] That’s brilliant. We should keep this.

Host 2: [00:27:04] One way walking.

Host : [00:27:05] What is silver lining for metabolic health?

Host 2: [00:27:08] So I’m excited to see how he’s doing in a couple of weeks. Yeah.

Dr. Casey Means: [00:27:11] If only in my house, you know, to get to the bathroom, I had to exit the house, walk around, just to get, you know, it’d be great.

Host : [00:27:18] Yeah, go up the stairs, down the stairs.. Yeah.

Host 2: [00:27:20] Yeah, how complicated can we make this?

Dr. Casey Means: [00:27:24] New business idea – mazes inside your house.

Host 2: [00:27:29] Just walk more. Sorry, I had to add that.

Host : [00:27:31] I love that. I love that.

Dr. Casey Means: [00:27:33] It’ll be interesting to see if he notices, you know, if it makes him feel better to be walking a bunch during the day.

Host : [00:27:39] Yeah, much different than the last 6 months, where a lot of people have been sitting on their couch more than they’re used to. So yeah, I’m excited to see.

Host 2: [00:27:47] Yeah, I noticed a huge difference, just personally, with walking. Especially after meals, the drop that happens is so powerful. It’s such an easy tool. So Dr. Casey, I really want to talk about the plant-based diet. You follow a plant-based diet and I’m just curious, because you mentioned the carbohydrate concentration being a factor. But we know it goes a little bit deeper with microbiome and just the status of, like your personal gut health. Can you explain, you talked about getting 50 to 75 grams of fiber, and then also not, like avoiding things that hurt your microbiome. What about the people that have some kind of gut distress, leaky gut, that need to avoid things like fermentable carbohydrates or someone that’s following more of a carnivore type diet that can’t get fiber for health reasons? Where do we start with that?

Dr. Casey Means: [00:28:37] That’s a great question. And that’s where things get really complex and where, I think, working with an amazing functional medicine doctor, integrative health physician, gut-focused physician coach, or naturopathic medicine physician. That’s like, where I think bringing in someone like that to really help optimize gut health is sometimes really necessary. You know, gut health is a really, really tough thing. And you get into a catch-22 situation sometimes, where if there’s underlying gut dysfunction, like leaky gut or Sibo or something like that, it can preclude people from eating the foods that ultimately are going to be, potentially very healing and provide lots of micronutrients and lots of nutrients we need for cellular function. Because your body’s not really able to process them effectively. And this is, these are some of the most challenging cases I see in my practice. And I like to think of it, very much in, like a tiered sort of step-wise function to get to the place where you can process vegetables and fibers and things like that effectively. It often doesn’t start with just throwing all those things into the gut and kind of seeing what happens, because if there is leaky gut and there is Sibo, that can just exacerbate symptoms. So usually it starts with identifying what the causes and what the triggers of those conditions are. What is underlying, potentially the Sibo, small intestinal bacterial overgrowth. Is it hypothyroidism? Is it a bacterial, is it IBS? And some sort of GI parasite or something that’s causing some issue that’s leading to this? Get to the root of what’s causing those GI issues, treat the root cause of those things. And then, the next step would be building a healthier gut. So that might mean, and that’s a complex question as well, but that’s gut lining integrity. So you’re making sure you’re getting the nutrients that are required to build a healthy colon wall, building up the microbiome through, potentially probiotics or probiotic foods. You know, sealing up the leaky gut or whatnot. And then after that, it might be introduction of a lot of these foods that can be potentially inflammatory in the wrong context. So I don’t, so it doesn’t often involve, just like starting with a bunch of super high fiber foods, but I like to get everyone worked up so that we can actually get there. But that can take months and often involves treating the underlying root causes of gut conditions first. And that’s where having, I think, a really seasoned practitioner can be helpful in that journey.

Host 2: [00:31:00] So complex. So ideally we’re getting back to a healthy gut that can tolerate this fiber because that’s really helpful for our glucose response, right?

Dr. Casey Means: [00:31:10] Exactly.

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Host : [00:33:28] So I guess, on a more personal level, for me, I’ve always stayed away from purely plant-based because my glucose tends to spike and I do pretty well with a little bit more protein and fat. How, I guess I need to play around with the variables, but would increasing the fiber, not necessarily just strictly carbohydrates, help with them?

Dr. Casey Means: [00:33:52] Yeah. I think that’s a big factor. So, we, like large epidemiologic studies show that people who eat higher fiber diets tend to have less metabolic disease. So the more fiber people eat, the less likely they are to develop, diabetes and other metabolic conditions. Which can feel counterintuitive, cause they’re kind of in the carb family. But these are not necessarily carbs that are going to show up as a glucose spike because they’re eaten by the microbiome first and they’re being turned into, actually really helpful chemical compounds. Things like short chain fatty acids and butyrate, and these anti-inflammatory, pro-metabolic health substances. So, I don’t tend to think of fiber, these are not really accessible as glucose in my bloodstream. So I’m mostly thinking in the terms of net carbs. So a carbohydrate concentration minus the fiber, which is why something like beans, even though they have a high carbohydrate concentration, their net carbs can be fairly low. And then when you pair them with a bunch of other metabolically friendly things, like fat, they have a lot of protein in them but I’ll often add protein, and then adding something like a vinegarette or something that has an insulin sensitizer, that’s a way to just further blunt the spike.

So, I do think it is a lot about thinking about fiber as you eat carbs and thinking, you have to think of those two things, I think, in conjunction. And then what are they being paired with. You know, and then what is the other context with which you’re eating these foods in terms of sleep, stress, exercise, etc… Yet these days, it’s almost, this might sound extreme, but I feel like it’s almost unfathomable to me to think of just eating a straight carb source. You know, that doesn’t have a fairly significant composition of fiber, protein, and fat, because I just know it’s gonna spike me.

Host : [00:35:35] And that involves fruit?

Yeah. I mean, for me, these days, and I’m certainly not recommending this for everyone, but I’ve been experimenting with CGM for a year. So I know what keeps my glucose flat. I’m now down to eating pretty specific fruits and I, reflectively reach in my cabinet for the fruit and then the nut butter or the tahini or whatever, and the chia seeds. Like it’s just, now it is second nature for me to do that because I know that I can get a 10 Zone Score and have a glucose change of like 4 or 5 with an entire apple, an entire pear, if I put those extra things on it. So for me, it’s just reflexive at this point. So that’s just from a lot of experimentation, that’s based in the literature that shows that these things, other macros, can impact our response to the carbs.

Yeah, I’m the same way. I have to stay away from just, like a fruit alone. But it’s interesting, like I could add almond butter, but then it becomes like, am I just adding this just so I can get away with eating the apple? Maybe I just shouldn’t eat that at all. Maybe I should go towards something green or a protein. So, I guess it depends on what nutrients you’re trying to get out of that food, correct?

Dr. Casey Means: [00:36:45] Exactly. Yeah, I mean, everything, the way I look at food is that is food is molecular information. That’s what food is. And so I’m just trying to get a certain amount of molecular information per day. And some of the key things on my molecular information checklist are – all things that I know are going to help with physiologic function. So that’s going to be fiber, so I can make short chain fatty acids. It’s going to be Omega 3s, which are anti-inflammatory mediators, but also building blocks of healthy cell membranes. It’s going to be as much antioxidants as I can possibly get, because antioxidants are going to buffer free radicals, minimize inflammation, help with DNA repair and things like that. It’s going to be protein, for obviously, anabolic processes in the body. It’s going to be, and then micronutrients, I’m thinking about micronutrients all the time as molecular information. So getting the widest range of B vitamins, vitamin C, A, E, coenzyme Q-10. All the B vitamins, not just B12, manganese, magnesium, zinc, all these things, chromium, biotin. So that’s like on my mental checklist.

And then I’m looking at the foods around me and I’m like, “Well, where can I get this stuff without having collateral damage?” like a glucose spike. And for fruit, fruit is an amazing source of some of that molecular information. It’s going to have a lot of the vitamins and minerals, it’s also going to have a lot of antioxidants. So I’m choosing fruits that are going to maximize those things. Fruits have very wide differential, in terms of antioxidant composition, with things like organic berries, blackberries, blueberries, goji berries, things like that. Having super high antioxidant composition and then some other fruits not having that much. And so I want that stuff, and fruit may be the thing I turn to to get that. But obviously, since I’ve been doing that, I want to make sure I’m minimizing the spike. So I’m going to say, “Okay, well, what can I add that gets me other things on my checklist?” Like tahini, which has wide compounds, some antioxidants, it’s got fiber, tahini has fiber, it’s got fat, it’s got protein. So it’s, kind of, just mixing and matching all this stuff. But each food, in my mind, has a utility, it has a purpose. And it’s really, just all day thinking about, how am I getting all of these things that are necessary for cellular function. And avoiding things that are essentially, either empty of those things or potentially detrimental.

So for instance, a refined vegetable oil, not only has none of those things that I mentioned, but it is going to have really high concentration of Omega 6 fats, in this form that are highly oxidizable. So it doesn’t fit anything on the molecular information checklist. So it’s out. I’m not going to eat it. Yeah, that’s kind of the framework through which I look at food. Which lets me eat fruit here and there cause it’s got those things. But certainly, has to be balanced by getting enough of the other foods that fill the other things on the list for me.

Host : [00:39:33] Yeah, it’s kind of like a chemistry experiment. Like where do I get these different things? And I love what you said… go ahead Lauren.

Host 2: [00:39:40] It’s also just fulfilling the what we need out of food. I think so many people are just operating under the, like satiety principle. It’s like, what can I eat to fill me up? Or what can I eat to make me feel better? Or make me happy rather than looking at food as nutrients, which is really the sole purpose, right?

Dr. Casey Means: [00:39:59] Yeah, food is nutrients. And then, and what I love about food that makes it so magical to me is that it is, both the information, it is both the thing that tells our bodies what to do. It’s like the instruction manual for ourselves, but it’s also the building blocks. It’s like two different functions. So that’s kind of amazing. It’s like being the builder and the architect. Or like, the bricks and the builder, at the same time. And we only get so many calories per day, right? Like, we only can eat a certain amount per day. And if you think that it’s both making up your body and also telling your body what to do, it is telling your genes how to be expressed. Telling your cell membranes how to function. It becomes, it feels imperative to make those choices wisely because that’s all we’ve got. We’ve got those calories. And if you start wasting those calories with things that are, either not adding value, or are adding anti-value, you can imagine how quickly the body’s going to break down.

And unfortunately, the foods we have access to today add either negative value, a lot of them, the processed, highly refined, manufactured frankenfoods, either add negative value or they don’t add positive value. And so when you start filling a lot of your calories per day with that stuff, you can see how the body will fall apart. So, you know, I love having conversations like this and helping maybe people think about food as this really empowering tool, to both build ourselves and tell our bodies what to do. And go into each meal thinking what can I get out of this to help me express the highest version of myself.

Host : [00:41:29] I just got an overwhelming sadness right now. I’ve been in a lot of gas station stores recently, cause I’ve been in the car a lot, and just, I mean, this is nothing new, but you walk in there and you’re like, there’s no real food in here. But to think that that is normal for a lot of people, just to go in there and it’s like, you’re hungry, what can I buy, purchase, eat so that I’m not hungry anymore. It’s just like a completely different mindset. It’s really sad.

Host 2: [00:41:55] Yeah. And I liked what you said about the anti-value. Cause I think people don’t really think about  what you’re depleting from your body, eating that sugar, right? You’re not getting any nutrients, but then you’re depleting your B vitamins and your magnesium and your chromium and whatever, that you’re probably paying a fortune to supplement with a multivitamin. People don’t think,  save that money. Maybe just skip the stuff, that’s pulling it out of your body. Really different way to look at it. And I love what you said too, about just nutrition being this information. You know, when people ask me, why did I go back to school to study nutrition? And I’m like, cause it’s the one thing that everyone is putting into their body every day. I mean, unless they’re fasting of course. But it’s this information that everyone needs to be thinking about every day of their lives. Really incredible when you think about it that way

Dr. Casey Means: [00:42:42] It is. It is. And you know, I think we were talking about like, what are the small ones you can do with glucose, like the easy low-hanging fruit stuff. And I think that that’s kind of the same for bigger picture nutrition too. There’s a lot of intense complexities to it, but there’s also just a lot of really simple principles that we can do. Like, you know, don’t spike your glucose, get Omega 3s, get antioxidants, and eat whole foods, get fiber. Like there are some basic principles and then, you know, you can make it, it can get a lot more complex too. And that’s where I think we don’t have  great answers for how we’re going to scale getting some of the more nuanced information about nutrition, out to people. And one thing that I think about, being plant, we were talking about plant-based stuff, is like a lot of people ask me like, “Well, what about Omega 3s?” You’re getting plant-based Omega 3s, which are like upstream, they’re alpha linoleic acid. But that’s not actually the Omega 3s that you need to have the anti-inflammatory factors that go into your cell membranes, which is downstream of those, which is EPA and DHA, which come from fish and, mostly, and also algae.

And what’s interesting about, so basically to get EPA and DHA from a plant-based diet, from alpha linoleic acid, which you’re getting from plants. Like chia seeds and flax and walnuts. It has to go through a 4 and 5 step conversion to get to those things. It has to be molecularly converted by enzymes into all these other things, likestearidonic acid, and all this stuff before you can even get to EPA and DHA. And to do each of those enzymatic reactions, through these enzymes, like elongase and Delta 60 saturates and Delta 5-D saturates, these conversions, it actually requires 5 to 10 micronutrients for each of those enzymes to work. So like, Delta 60 saturates alone, requires B2, B3, B6, vitamin C, zinc, and magnesium. And you can imagine, okay. yeah, someone eating a plant-based diet, who’s not thinking about the conversion and the micro-nutrients required to get to EPA and DHA. Sure., they could have a huge problem with EPA and DHA and end up having a lot of biologic dysfunction.

if they’re not thinking about that whole pathway. And how do you even know how much of those micronutrients to have? But you do have to. So I’m thinking every day, “I know I need to do this conversion.” And so I need to get all of those co-factors for those enzymes. But we have not figured out a way, I think in healthcare, to scale that type of detailed information that people need to require. And this is why, I think, a lot of people on a plant-based diet or a vegan diet run into a lot of problems, is because we are just not thinking at the level of detail that it takes to achieve optimal biochemical function.

It’s not that hard, but it is detailed. And the average doctor obviously, is absolutely not going to be talking about these things with a patient. And so this is, I don’t have an answer, but I think it’s an interesting challenge. And this is where I think digital health could be really interesting, coaching and digital health, because we can start to help people, inform these nuanced decisions, at home, every day. But we’re not there yet. Unfortunately.

Host 2: [00:45:44] Hopefully heading that way. Actually, someone the other day just asked me, what’s wrong with a plant-based diet? And I said, ” Well, there’s nothing wrong with it. It can be great if you do it right.” And like you said, just so many people are doing it wrong because they don’t have the information. And the other thing about the Omegas, so I actually have a genetic snip, where I do not make that conversion well, from the ALA to the EPA, DHA. So I supplement with fish oil. And then I eat fish occasionally, not a lot. So do you ever supplement, with like algae or fish oil? Or you really just focused on that conversion?

Dr. Casey Means: [00:46:17] Oh, for sure. Yeah, I checked my Omega 3 and Omega 6 levels every 6 months or so. And there’s a lot of times when I have to supplement. And I use fish oil, I’ll use algae, but yeah. Certainly, if I’m really staying on my game with my co-factors and making sure I’m eating foods that I know maximize those things, I see better levels, better conversion. But I’m very open to supplementing in a really thoughtful, targeted way, to help with these things. Cause it’s so important to have those EPA and DHA  levels be really on point.

But it comes down, again, as always, to daily choices. Like I am, you know, in my fridge, I’ve got like 15 mason jars of nuts and seeds. Cause I’m eating those all the time. If I know my magnesium is low, for certain, or I need, functionally more magnesium for certain processes based on what my lab testing is showing, I should choose the pumpkin seeds over the Brazil nuts. But that if I do that just once, it’s not going to do anything. I have to do that regularly, for weeks, to build up my magnesium sources. So it’s really like looking at food as this is a toolbox of molecular information. I have to actually make the choice and do it. And then do it regularly for weeks to see an effect. I mean, that’s kind of required. But I’m looking at each sort of thing in my fridge as like, okay, my Brazil nuts, obviously that’s a selenium source. My pumpkin seeds, that’s a magnesium source. They’re just, each thing has sort of a different value add. But just doing it one-off, like isn’t going to help. So this is where it does get complex. And where, in that framework, it’s easy to actually stay, I think, really on target with a healthy diet. Because you realize if you just start eating some crap, that has like nothing of value in it, you’re never going to get the amount of micronutrients and macronutrients you need to have a really optimally functioning body. It has to kind of be – every bite serves a purpose.

And some might say that gets a little obsessive. But I really, to me it feels very second nature and empowered at this point. That this is a way we can serve our body and serve our purpose and serve the people around us. Because as we invest in ourselves, through good choices about our food, we’re actually building a body that can serve others, both mentally and physically.

Host 2: [00:48:31] You’re really looking at food as medicine.

Host : [00:48:32] Yeah. That’s great.

Host 2: [00:48:34] So Casey, you have such a wealth of information about your own micronutrient status, and you also have access to, I guess, regular lab testing, which could be expensive for some people. What would you say to the person that’s jumping on this plant-based bandwagon to save the planet or to, I guess, upgrade their health, when they’re not aware of the status, their own health, metabolic health status, micronutrient status? Would you recommend them go in that direction, without having that information and access to the lab? I know it’s still complex and it’s so different for every person. And Renee and I are more in the camp of supporting sustainable agriculture and getting those nutrients from animal products. But we also have access to the labs and are keeping an eye on our nutrition. But for the people that don’t have access to that or barely gotten their feet wet, what would you recommend?

Dr. Casey Means: [00:49:29] Great question. I think that to do a plant-based diet, in our current food culture, well, like I think you need to go into it really thoughtfully. And I will say that there are a few lab tests that people should definitely be getting every year. Cause you can get into a very big problem. So I think B vitamins, especially B12 is important. And I do think testing Omega 3s is also important. Although, that’s one where I think supplementing empirically is probably okay, like just taking a supplement. But you can get yourself into a very Omega 3 problem and a B12 problem if you’re not thinking about those things actively on a vegan diet. So I think it’s important to to track it. There’s so many different faces of a vegan diet. You could be, basically eating pasta and Pop Tarts all day, every day. I don’t even know if Pop Tarts are vegan. But like, you could eat all packaged.

Host : [00:50:24] That was my college roommate. She ramen noodles and gummy bears. That was her vegan diet.

Host 2: [00:50:28] And she was vegan?

Host : [00:50:29] Yeah. Horrified.

Dr. Casey Means: [00:50:30] Yeah. Exactly. And that’s going to lead to poor health rapidly. So, there’s no two ways around it. You can’t overcompensate for that amount of deficiency, in terms of key things we need for biologic function. So I would recommend, at a minimum, reading some of the key thought leaders in the plant-based space and reading 5-10 books before going on a vegan diet. So that you can  really understand the ins and outs of what’s important. So I’m just like looking at my bookshelf over here, I would certainly read Michael Greger’s How To Not Die or How To Not Diet. I would read Caldwell Esselstyn’s book. He is the vegan doctor who writes a lot about heart disease. I’d probably read Joel Ferman’s, Garth Davis’ Proteinaholic. There’s just a lot of great plant-based authors out there who’ve taken a really nuanced approach to these things. Yeah, I’d say in the plant-based space, yeah, Caldwell Esselstyn, Michael Greger, Garth Davis, Cyrus Kambada. Those are some of my faves. So really educate yourself, absolutely.

Host : [00:51:38] We’ll put those in the show notes, we’ll share those resources. Yeah.

Host 2: [00:51:40] So all this talk of like plant-based and vegan, I have to go the other extreme and just get your opinion. The carnivore diet is really gaining popularity right now. It seems like people are having great benefits short-term. But there’s no long-term research, obviously, at this point. Do you have any thoughts on what we’re going to see in 5-10 years with people doing this kind of diet?

Dr. Casey Means: [00:52:04] It’s really hard to know. It’s a very, yeah, I mean it’s extreme. And I listened to a lot of the thought leaders in this space, you know, Paul Saladino, and I think it’s fascinating. And one thing I really appreciate about, I think the people who are in this space, is that they’re very fixated on metabolic health. They’re very aware of how metabolic health is, we are very aligned on that and they’re reading the literature really, really critically and taking a slightly different interpretation. And I think that’s all fine. I mean, this is really important for us to be having this type of discourse. The other thing that I really appreciate about the carnivore community, is that a big focus on sustainable agriculture and how there’s almost no disagreement that the way we’re raising animals and sourcing animal products these days is hugely problematic for human health and the planet. And that if we’re going to move in a direction of eating a lot of meat, it needs to be raised sustainably, in a way that is good for the earth, good for humans. And it also comes down to this, the same concept of food as molecular information. I think someone like Paul Saladino is looking at food as molecular information and actually, really thinking deeply about what is in the meat and how is that serving the body? And if you take a cow that was raised in a factory farm and a cow that was raised free range, in a stress free environment, on a beautiful farm in California, the molecular information of those two different cows is vastly different. Totally different chemical compounds in those two animals. And so I’m super, yeah, I’m super impressed by, I think, a lot of the, there’s a lot of actual alignment between some of the things that I think these different groups are talking about, but just the mechanisms are different.

Host 2: [00:53:40] The nutrients that you talked about, I know Paul Saladino is really looking at, “Well, what nutrients am I getting when I eat nose to tail?” They’re not just eating the muscle, right. They’re looking at, like you said, micro nutrients.

Dr. Casey Means: [00:53:52] Exactly. Like there are certain animals who can, humans don’t have the ability to make vitamin C. And so that’s one argument for why we need to eat plants, is because we need to get exogenous vitamin C sources. But certain animals can actually store some vitamin C in their livers. And so if you are eating nose to tail, there is the idea that you could actually get some of these things that we can’t make exogenously. And when you think about something like carnivore diet, very low in fiber, of course, many of these thought leaders have addressed that question of, well, what about the microbiome? But if you get into deep ketosis by being on a carnivore diet, theoretically, you are making your own butyrate. Which is also a by-product that microbiome makes when you eat fiber. So I think, really it comes down to, there’s a lot of really interesting redundant pathways in the body that you can make things through different ways. You can eat them and have your body make them, or your microbiome make them. Or you can get into a really interesting, different metabolic state and actually generate them a different way. So butyrate is kind of the perfect example of that. So, I think time will kind of tell how things proceed with this, but I do really believe in redundant pathways in the body and that there’s a lot of different ways to make or produce the same things. So yeah, I think time will, kind of, tell on this.

Host 2: [00:55:11] That was a great answer.

Host : [00:55:12] Yeah,, it was incredible. Thank you for that. So is it possible to wrap all of that? Like, there’s so much complexity and so much we don’t know. I’m assuming that you would say, in the meantime, we need to just focus on ourselves, right? Use the CGM to see how our personal health is being affected and try to do small experiments, within reason.

Dr. Casey Means: [00:55:33] Yeah. Right on the money. Yeah, I really do think it comes down to that. I do think there are foundational principles that we can all align on. Like Paul and I, which is like, you don’t want glucose spikes. And I don’t get any glucose spikes on my vegan diet, he doesn’t get glucose spikes on his carnivore diet. So that’s great for both of us. So, certain things like that, that are key. We do not want excessive glucose spikes in our body. We have zero need for a single gram of refined sugar in our diet. No one needs it. We weren’t evolved to eat it. We don’t need it. We don’t need a single gram per year of refined sugar. So we can avoid that. We do not want to be eating readily oxidized foods. We do not want to be eating oxidized, refined oils. And so, when you start getting into some of these things of like, we don’t want glucose spikes, we don’t really need to eat refined sugar, there’s no positive benefits to the body, and we don’t want to eat oxidized foods. Which I think, most people can agree on those 3 things, but maybe I’m wrong. I’m sure there’s people who can disagree. But I know that Paul and I agree on those things, and I’m a vegan and he’s a carnivore, that automatically takes you into, essentially the whole foods world of eating whole foods.

I think we also can agree that we don’t want to kill our environment. And these monocrop, pesticide riddled foods are not good for our environment. And so now we get into a realm of whole foods, unprocessed, that are hopefully more local and organic and aren’t covered in Roundup. And so right there, you’ve moved to the direction of, essentially moving into a very whole food, sustainable diet. Whether that includes vegetables or meat, that is going to be variable. But that right there would take away, I think, if people ate that way, would take away a lot of the suffering on our planet. Yes. It comes down to biohacking and tracking. But even if we just take core principles about what we do and don’t need for human health and actually adhere to those, we’d move to a place where people could achieve a lot of health improvements, just by doing those simple things.

Host 2: [00:57:34] Amazing.

Host : [00:57:35] Incredible. I am so satisfied. Thank you so much.

Host 2: [00:57:39] Blown me away and I’m sure all of our listeners, again. I want to be respectful of your time, so I’ll let you get on with your day, but before you run, can you share with everyone, if they are interested in getting a CGM, the possibility of that?

Dr. Casey Means: [00:57:54] Yes, absolutely. So we are going to have a code for you guys that you, actually your listeners can use this code to come to the Levels website and sign up for our program. If you actually didn’t listen to the first episode where we talked a lot about Levels, I can just explain it briefly – this is the company that I am a co-founder of. And this is a company that, essentially gives people access to continuous glucose monitors as a health optimization tool. Our program is a month. We pair you up with a telemedicine physician who will evaluate you for a prescription for a continuous glucose monitor. If they approve that prescription, we will ship you 2 continuous glucose monitors, each of which you wear for 14 days. So together, these 2 will set you up for a month of continuous glucose monitoring. And then access to Levels app, like we’ve been talking about in the program, that basically makes a lot of this glucose data stream highly actionable, let’s you know what is causing a big metabolic response, what isn’t, and let’s you start to adjust your diet and lifestyle based on that. So this month-long Levels program, you can sign up for with this code and skip the wait list, which currently is 30,000 people, so get ahead of the line. And we’re happy to do that for the Biohacker Babes listeners.

Host : [00:59:05] Thank you. So that’s so incredible. I’m so excited that we had such an overwhelming response. So I think our audience is going to be so thrilled. Dr. Casey, again, so many amazing resources, we’re going to put all of that in the show notes. We are so, so happy that you came back to share so much information with us. And I still have more questions, but we will be respectful of your time. So, I’ll just say thank you, again, thank you so much for joining us.

Dr. Casey Means: [00:59:29] Thank you so much for having me.

Host 2: [00:59:31] And thanks to everyone for tuning in.

Host : [00:59:32] If you loved this episode of the Biohacker Babes podcast, head over to Apple podcast, to subscribe, rate, and leave a review. We truly appreciate your support. Until then, happy biohacking .