The Secret to Longevity, Reversing Disease and Optimizing Health: Fixing Metabolism with Dr. Casey Means

In this episode of The Doctor’s Farmacy, host Dr. Mark Hyman interviews Dr. Casey Means about the scientific ins and outs of metabolic health. They cover the interconnection between metabolism and the immune system, the role of insulin, the definition of glycation, and how biowearables like Levels allow us an opportunity to escape from the modern rollercoaster of negative dietary choices.

You can’t operate on the immune system

In an attempt to better understand the root cuases of disease, Dr. Means realized that many chronic issues came back to metabolic dysfunction.

You can’t operate on the immune system. So really we’re operating on these downstream effects of these diseases, but we’re not actually changing the physiology that’s leading to these diseases. You’re seeing a lot of recurrent, revision surgeries, and it really gets you thinking, are we actually getting at the root cause here? And so, that really led me on a journey and a journey to looking at those root causes. What we know is that so much of the way we’re living our lives these days in the western world is what’s triggering that inflammation. One of the key root causes is metabolic dysfunction. It’s blood sugar. It’s insulin resistance. It’s the way we’re creating and processing energy in the body.

The solution lies in our choices

There is no pill to resolve metabolic dysfunction. Only improved daily choices can make an impact for the better.

Let’s talk about how to mitigate some of these root causes.Fundamentally, that comes down to not a pill, not a doctor’s visit, not a surgery. It comes down to the choices that we’re making every day about our exposures, about what we’re eating, about how much sugar we’re having, about how much sleep we’re getting, the movement we’re doing, the toxins we’re exposing ourselves to, how we’re supporting our microbiome, our micronutrient status. These are the hundreds of microdecisions we make every single day.

Metabolic health is low-hanging fruit

Achieving improved metabolic health is both simple and difficult. The power lies entirely in an individual’s hands, but also relies on proactively making better choices.

My belief is that by optimizing our metabolic health and really stabilizing our blood sugar levels and keeping them stable and healthy throughout our lifetime, it is really the quickest way and the lowest hanging fruit way to achieve really almost any health goal that you have, whether it’s to look good, feel good, to have longevity, to avoid chronic disease, to have athletic performance, to have your brain functioning properly. It’s really the trunk of the tree of so many of these pain points we’re dealing with today.

The result of an energy deficit

When your body doesn’t have the energy it needs, the result can be a whole slew of serious complications that can be traced back to lifestle choices.

Metabolic dysfunction underlies so many of these seemingly disparate symptoms we’re dealing with today, so many of which you’ve talked about in so much of your work. But metabolic dysfunction, this problem with producing energy in the body, is underlying some of the big heavy-hitters, big killers in the US, obviously heart disease, diabetes, Alzheimer’s, dementia, cancer, chronic liver disease, chronic kidney disease. All these other things that people don’t even realize: depression, brain fog, infertility, erectile dysfunction, chronic pain, gout. There are so many of these that we don’t really relate when in fact a lot of these are just this energy deficit, this problem creating energy and processing energy showing up in different cell types. But that core physiology is really the same. So the main issue is that our lifestyle and what we’re eating and what we’re doing and how we’re living is hijacking that process, that food to energy process.

The role of insulin

Insulin is released when we eat sugar and carbs. When this happens daily, our cells become resistant to the role of insulin.

When we eat carbohydrates and sugar, the body releases insulin, a hormone to help you take that sugar out of the bloodstream into the cells, that it can be used for these metabolic processes. When that’s happening all the time, day after day, huge spikes in blood sugar, the cells become resistant to this insulin. There’s so much insulin being poured out, the cells are like, “We cannot process all of this. This is too much,” and the cells block it. So now you’ve got this issue where you’ve got tons of this glucose substrate. You’ve got all this insulin being poured out, trying to force more glucose into the cells. The whole machinery essentially gets gummed up. That’s really the root of metabolic function.

The definition of glycation

When sugar literally sticks around in your system, dysfunction soon occurs.

Glycation is the process where sugar just sticks to things in your body. It’s actually just like sugar molecules sticking to things like fats and proteins and DNA, and that can cause dysfunction. It can cause those cellular parts to be dysfunctional. And so, that’s an issue. We don’t want that. It can generate inflammation immediately, too. This huge surge of sugar is unusual for the body. It’s like what a is going on? Why is this big change, this homeostatic shift happening? We don’t want that. Then it can cause oxidative stress, which is this reaction where your body’s producing metabolic byproducts that are reactive and can be damaging to the cells. So these unpaired electrons that go around and want to bind with things.

Get off the glucose rollercoaster

High insulin prevents fat burning, which prevents weight loss. Stabilizing foods can assist in breaking the cycle and achieving results.

Insulin is a signal to the body that glucose is around for energy. It’s also signal to the body that because there’s so much glucose around, we don’t need to use fat for energy. Glucose and fat are the two main ways that we produce energy in the body. When that insulin’s high, it blocks us from tapping into fat burning. It says to the body, “Nope. You don’t need to tap into fat burning. We’ve got a bunch of glucose around.” And so, this is relevant to anyone who is trying to lose weight or who has the excess belly fat, because that insulin is a real block on helping us achieve those goals. And so, for us to tap into our copious fat stores in our body, we need the insulin to be lower. So by getting off that glucose roller coaster, by eating foods that keep us more flat and stable throughout the day, which is what we want for optimal health both in the short term and the long term, we give our body a break from producing that insulin.

The downside to being American

Most Americans eat numerous daily meals filled with processed food. You must cultivate awareness of healthy choices to break the cycle.

The average American, with the vast majority of our calories coming from ultra-processed foods, and I believe more than 70% of processed foods in the US have refined sugar in them – and we’ve been told, of course, to eat six small meals a day – you are on, as an American, this up and down glucose roller coaster all day. And so, you’re really never giving your body this time in a low insulin state. So you really do have to be quite aware and think differently. I mean the reality is, as an American adult, you’re on a treadmill towards being overweight and chronic disease. Unless you are doing something different, you will end up sick. That’s where having a little more awareness, I think, can be helpful.

Wearables are empowering

In a system designed to hurt us, wearables can help us get to know our bodies to make informed dietary decisions.

It comes down to personal empowerment and really understanding our own bodies. We’re not going to fix healthcare without fixing health, and you can’t fix health without fixing the decisions that we’re making every day about what we’re eating, how we’re sleeping, how we’re stressing, how we’re moving, how we’re supporting our microbiome, all these things. It really comes down to choices. Right now we don’t have a lot of help to understand what choices to make for our own body. That’s where wearables and especially biowearables, I think, can be very, very helpful. I’m not the type of person who wants to be strapped to technology for the rest of my life. It’s not my goal to be a cyborg and be wearing a sensor. I want to be unplugged in the back country, like camping. However, the reality is that the system that we’re living in right now is designed to hurt us. It’s designed to keep us sick. It’s designed to keep us dependent and coming back for medications and surgeries and whatnot. So in the world we’re living in where our taxpayer money is going towards subsidizing refined sugar and refined corn and wheat and disease-causing foods, I think we need a little bit extra support, and I think that wearables can really help with that.

Nutrition shouldn’t be a black box

With a biowearable like Levels, nutrition is no longer a mystery. It becomes a closed loop complete with valuable real time feedback.

From what I’ve seen with my patients, when you really understand your body and understand how the environment is affecting your body, it’s very motivating. Nutrition has been a black box. It’s always been an open-loop system where you make a choice and you actually don’t really understand what the result is often for a long time. Maybe you eat healthy one day and then the next day you step on the scale. That’s the lagging indicator. How do you create a relationship between what specific food led to that result? Maybe it’s six months from now you get a blood sugar test or a cholesterol test, but that one-to-one relationship has been missing. Now it’s not with these biowearables.

Narrator: Coming up on this episode of The Doctor’s Farmacy …

Dr. Casey Means: By optimizing our metabolic health and really stabilizing our blood sugar levels, and keeping them stable and healthy throughout our lifetime, it is really the quickest way and the lowest hanging fruit way to achieve really almost any health goal that you have.

Dr. Mark Hyman: Hey, everyone. It’s Dr. Mark. Whole body wellness is obviously a huge part of my life, and I’m always looking for new ways to make feeling great easier. One of my non-negotiables is getting a daily dose of healthy light. For years now, I’ve been using Joovv light therapy devices to easily do that all year long. I especially of it during these shorter cold winter days.

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Dr. Mark Hyman: Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s farmacy with an F, a place for conversations that matter. If you are one of the people in America who suffers from belly fat or any metabolic issues, you better listen up. Honestly, this is probably most of Americans. We’re talking about almost nine out of 10 Americans.

Dr. Mark Hyman: So for the 1% who this doesn’t relate to, I’m sure somebody in your family or who you care about relates to it. So you should listen up. We’re going to talk about blood sugar, which is one of my favorite topics, with none other than an extraordinary Stanford-trained physician, chief medical officer and co-founder of a metabolic health company that I have invested in because I believe in it so much and I’m an advisor for, Dr. Casey Means. Welcome, Casey.

Dr. Casey Means: Thank you so much, Dr. Hyman. It is a true pleasure and honor to be here with you today.

Dr. Mark Hyman: It’s great, Casey, to have you, too. I think we were just chatting a little bit before about how you went from being an ENT surgeon to being a functional medicine doctor. Now you’re a lecturer at Stanford University. Your goal is really to maximize human potential and reverses epidemic of preventable chronic disease primarily caused by imbalances in blood sugar, by empowering people with the tools about their body, that can help them understand what’s going on and then help them make personalized decisions to optimize their diet and lifestyle.

Dr. Mark Hyman: Your perspective is just so refreshing and it’s work that’s been featured in The New York Times, Wall Street Journal, Men’s Health, Forbes, Business Insider, and on and on and on. I’m most excited about your goal, which is to empower individuals to understand their bodies in a way to reclaim their health, you call it giving them agency over their health, as opposed to being victims.

Dr. Mark Hyman: You go to the doctor and the doctor does healthcare to you. No, no, no. This is really about the decentralization of modern healthcare systems and the empowerment of individuals to take back their health, and to understand what’s going on in their bodies.

Dr. Mark Hyman: So, all right, just quickly, tell me, how did you go from being a Stanford-trained ENT surgeon … Which, by the way, is no small task to get there, requiring decades of study and a tough residency. How did you go, “Nah, I’m going to focus on functional medicine and blood sugar and start a company”?

Dr. Casey Means: Well, thank you so much for that introduction. It was an interesting path. So I’m nine years into my postgraduate training. So four years of medical school, five years of head and neck surgery residency. I’m looking around me and I’m taking stock of what I’m doing every day with my life, and I realized that most of the conditions that I’m treating are inflammatory in nature. It’s sinusitis, laryngitis, thyroiditis. It’s all the -itises, which, as you know, Mark, -itis is the suffix … In medicine, it means inflammation.

Dr. Casey Means: I’m realizing, huh, I’m prescribing a lot of steroids every week. I’m prescribing oral steroids, IV steroids, topical steroids, nasal steroids. These all turn down the immune system. It got me thinking, I’m doing a lot to really tamp down on the immune system, but inflammation is the body’s sign that there’s a threat. It’s perceiving a threat-

Dr. Mark Hyman: There’s something wrong here.

Dr. Casey Means: … that it needs to fight. We were never talking about what is that threat?

Dr. Mark Hyman: No. Right. That’s so true. In medical school, we never learned how to be inflammologists or how to be detectives to figure out what the heck’s causing the inflammation in the first place. We got very good at suppressing the inflammation with aspirin and nonsteroidals and steroids and immune suppressants and on and on. We get better and better drugs with more and more side effects, but we don’t really ever ask the simple question, is why?

Dr. Casey Means: Well, you can’t code for chronic inflammation. And so, it’s not something that we really think about. And so, you got me saying what is causing all this inflammation? What is the root cause? What I really started to … And why are we just turning to medication and then, when the medication doesn’t work, going to surgery?

Dr. Casey Means: Then it got me thinking, you can’t operate on the immune system. So really we’re operating on these downstream effects of these diseases, but we’re not actually changing the physiology that’s leading to these diseases. You’re seeing a lot of recurrent, revision surgeries, and it really gets you thinking, are we actually getting at the root cause here?

Dr. Casey Means: And so, that really led me on a journey and a journey to looking at those root causes. What we know is that so much of the way we’re living our lives these days in the western world is what’s triggering that inflammation. One of the key root causes is metabolic dysfunction. It’s blood sugar. It’s insulin resistance. It’s the way we’re creating and processing energy in the body that can be a huge … When this is not going well, it can be huge driver of inflammation in the body.

Dr. Casey Means: What I then also realized was, okay, so ENT is this niche part of the body, but all the other killers of Americans, the main killers of the Americans, are also being caused by chronic inflammation, heart disease, diabetes, obesity, Alzheimer’s, dementia, cancer, the same cytokines, the inflammatory molecules that are upregulated in sinusitis, it’s the same ones in all these diseases. So let’s talk about that and let’s talk about how to mitigate some of these root causes.

Dr. Casey Means: Fundamentally, that comes down to not a pill, not a doctor’s visit, not a surgery. It comes down to the choices that we’re making every day about our exposures, about what we’re eating, about how much sugar we’re having, about how much sleep we’re getting, the movement we’re doing, the toxins we’re exposing ourselves to, how we’re supporting our microbiome, our micronutrient status. These are the hundreds of microdecisions we make every single day.

Dr. Casey Means: And so, it became really imperative to me to think about how do I … If I’m a physician and my goal is to generate health, how do I actually empower people to make the decisions every day that are going to create conditions in the body that will ultimately lead to proper metabolic functioning, cellular biology, and ultimately health?

Dr. Casey Means: And so, that became a real shift for me, from really being embedded into what is a highly reactive medical system that really benefits off people being sick and staying sick. That was another thing that really impacted me as a surgeon was realizing that I make money, I profit if people who are sick come to me. I actually don’t make money, really, as a surgeon if people are all healthy. I don’t think that type of thought process really is affecting the average doctor day-to-day, but it’s built into our system, and those systems factors can be very troubling.

Dr. Casey Means: I guess long story short, it came down to a real reckoning for me five years into my surgical training, where I looked up and I said we’re spending $3.8 trillion a year on healthcare costs in the US. The reality is that people are getting sicker, people are getting fatter, and people are getting more depressed.

Dr. Mark Hyman: It doesn’t sound like much fun.

Dr. Casey Means: We are increasing that spending year over year. I am a steward of this system. I am a leader in the system. I’m a doctor. If you’re a doctor and you’re looking at those realities, which are true, we’re spending more and more every year and people are getting sicker, fatter, and more depressed, what are you doing if you’re not stopping and saying why?

Dr. Mark Hyman: t’s just amazing to me that we never asked that question, is why is our ship filling up with water? Let’s just keep bailing the boat. No, let’s figure out where the holes are and fix them. In medicine, we don’t do that.

Dr. Mark Hyman: We were talking about your goals as a doctor is to create health for people. I would disagree with you. I don’t think that’s what we’re trained to do. We’re trained to treat disease. We never took that course. I mean maybe at Stanford, they have a course in Creating Health 101. I surely didn’t get that class in medical school.

Dr. Mark Hyman: It’s really a very subtle distinction. But if you go to the average doctor and say, “How do I create optimal health? How do I create profound metabolic wellbeing in health? How do I optimize my brain?” they’re like, “I don’t know. Eat better, exercise, sleep. I don’t know. Take a multivitamin”. There’s really no depth of understanding of the science of health.

Dr. Mark Hyman: Your company, Levels, is really not looking at necessarily disease per se only, but it’s actually helping people understand the subtle variations in their biology that determine the quality of their health, which determines the quality of your life.

Dr. Casey Means: Exactly.

Dr. Mark Hyman: That is what’s so profound about this shift of disempowering the average patient in our medical culture. I mean the average traditional doctor was you go to the doctor, they tell you what to do, you just do it. There’s no questioning. The reverence for that is starting to slip, for sure, but there’s still this understanding that you go to the doctor to get fixed. It’s just not how it works.

Dr. Mark Hyman: The doctor’s like an emergency room. You just go there when things are really bad. They help a little bit, which is fine. There’s nothing wrong with that. Or sometimes you do need surgery or an intervention. It’s fine. But for most of us, we’re not really dealing with the fundamental issues that are causing us to not be well.

Dr. Mark Hyman: I want to come back to metabolic health, because this is really the focus of this conversation. What is metabolic health and what is poor metabolic health? Because recently a study was published that showed that 88% of Americans are in poor metabolic health. So how is that defined? What is that and why should we care?

Dr. Casey Means: Right. Yeah, that study was fascinating. UNC, two years ago, 88% of American adults have at least one biomarker of metabolic dysfunction.

Dr. Mark Hyman: Because 75% of us are overweight, which means a lot of the skinny people are also poor metabolic health, right?

Dr. Casey Means: Exactly. Exactly. Really, my belief is that by optimizing our metabolic health and really stabilizing our blood sugar levels and keeping them stable and healthy throughout our lifetime, it is really the quickest way and the lowest hanging fruit way to achieve really almost any health goal that you have, whether it’s to look good, feel good, to have longevity, to avoid chronic disease, to have athletic performance, to have your brain functioning properly. It’s really the trunk of the tree of so many of these pain points we’re dealing with today.

Dr. Casey Means: So what is metabolism? Fundamentally, metabolism is the way that we produce energy in the body. So we have 30 trillion cells in the body, and all of-

Dr. Mark Hyman: Before you get in there, I just want to come back a little bit, because I think it’s really important to define this poor metabolic health. There’s really three biomarkers that are looked at, right?

Dr. Casey Means: Yeah.

Dr. Mark Hyman: It was blood sugar, blood pressure, and cholesterol.

Dr. Casey Means: Right, exactly.

Dr. Mark Hyman: So 88% of Americans have a problem with one or more of those. The cause of all of those poor metabolic health markers is …

Dr. Casey Means: Blood sugar dysregulation and insulin resistance.

Dr. Mark Hyman: Yes.

Dr. Casey Means: Yeah. And so, what happens is we have these 30 trillion cells, and every single one, trillions, needs energy to function. We need to convert food to energy, an energy form that we can use in our cells, namely ATP, for our cells to function. When that process isn’t going properly, the metabolism, when that conversion is not working properly, we don’t produce energy properly in cells.

Dr. Casey Means: What happens when you don’t have energy? You get cellular dysfunction. When you have cellular dysfunction, you get tissue dysfunction. Tissue dysfunction leads to organ dysfunction, and organ dysfunction is symptoms. That’s what it is.

Dr. Casey Means: And so, this is why metabolic dysfunction underlies so many of these seemingly disparate symptoms we’re dealing with today, so many of which you’ve talked about in so much of your work. But metabolic dysfunction, this problem with producing energy in the body, is underlying some of the big heavy-hitters, big killers in the US, obviously heart disease, diabetes, Alzheimer’s, dementia, cancer, chronic liver disease, chronic kidney disease-

Dr. Mark Hyman: Depression.

Dr. Casey Means: … depression. But, yeah, all these other things that people don’t even realize, depression, brain fog, infertility, erectile dysfunction, chronic pain, gout. There are so many of these that we don’t really relate when in fact a lot of these are just this energy deficit, this problem creating energy and processing energy showing up in different cell types. But that core physiology is really the same.

Dr. Casey Means: So the main issue is that our lifestyle and what we’re eating and what we’re doing and how we’re living is hijacking that process, that food to energy process, by … One of the big, big key players is the amount of sugar that we’re eating in our diet. The average American these days eats 152 pounds of refined sugar per year. 100, 200 years ago, we were probably eating around one pound of refined sugar per year. That’s 152 times the amount of substrate that these poor little cells have to process. They break down. They just say no. What that looks like is insulin resistance.

Dr. Casey Means: As I’m sure many of your listeners know, when we eat carbohydrates and sugar, the body releases insulin, a hormone to help you take that sugar out of the bloodstream into the cells, that it can be used for these metabolic processes.

Dr. Casey Means: When that’s happening all the time, day after day, huge spikes in blood sugar, the cells become resistant to this insulin. There’s so much insulin being poured out, the cells are like, “We cannot process all of this. This is too much,” and the cells block it. So now you’ve got this issue where you’ve got tons of this glucose substrate. You’ve got all this insulin being poured out, trying to force more glucose into the cells. The whole machinery essentially gets gummed up.

Dr. Casey Means: That’s really the root of metabolic function. You’ve got poor energy production in the cells. So by, day after day, like learning what is spiking our blood sugar and then learning how to optimize that, keep the blood sugar down, figure out what foods are affecting you, you essentially let the body rest a little bit. If you can keep the glucose down day after day by learning what’s affecting you, you can keep the insulin down. Then the cells start to perk up again to that signal and say, “Okay, we can do this. This factory can run a little bit better.”

Dr. Casey Means: So that’s what Levels is helping people do is really to learn how different foods and these products that we’re maybe told are healthy are actually affecting our blood sugar. With that information, it’s the first time ever we’ve had a closed-loop biofeedback system about what we’re putting in our body and what it’s actually doing to our health.

Dr. Casey Means: I believe that people should know what food is doing to their bodies. Right now it’s a black box and it’s a mystery and we have to trust food marketing. We have to trust the different nutritional ideologies. There’s a lot of conflicting information out there-

Dr. Mark Hyman: That’s so true.

Dr. Casey Means: … it’s a hugely confusing landscape.

Dr. Mark Hyman: That’s so true.

Dr. Casey Means: I really do feel that objective data, like through a wearable device that’s giving you this real-time biofeedback, can just cut through a lot of that marketing, a lot of those loud voices. A lot of the information from governing bodies that we know is not actually helping us achieve our goals. You can just see this works for me, this doesn’t, and then improve your metabolism with that information.

Dr. Mark Hyman: Yeah. I mean here’s the thing, Casey, is that, as doctors, we really don’t learn about metabolism. We have nutritional biochemistry lessons and we study the Krebs cycle in first year medical school, and the joke among all the medical students is this is just a grunt class. Basically you’re going to forget it as soon as you’re finished. Just cram for the exam and don’t worry about it.

Dr. Mark Hyman: Turns out it’s probably the most important class in medical school. We don’t understand metabolism as doctors. We don’t understand even blood sugar and insulin resistance. 90% of the cases of pre-diabetes, which affects about one out of every two Americans, are not diagnosed because doctors don’t know how to diagnose them. They’ll say, “Oh, your blood sugar is normal on your test.” Well, what is normal? What is optimal? They’ll say, “Your A1C is great. You’re fine. No problem. No problem.”

Dr. Mark Hyman: But after practicing this for decades, I have really learned that there are other ways to get the science of what’s happening, which is what you’re really doing with Levels is you’re giving people the opportunity to measure in real time what happens when their body ingests food and how that affects their particular blood sugar, because everybody eating exactly the same food might have very profoundly different responses to that food. I can drink a can of Coke and my blood sugar and insulin might go to X and Y, somebody else might go to A and B. That’s not something that you would inherently know. The other thing that struck me was that the metrics that we have are just really poor.

Dr. Mark Hyman: I want to share a story of a patient, which taught me so much about metabolic health. This was a woman who had an enormous girth. I mean she looked like the Pillsbury doughboy. She was just round around the middle, skinny arms and legs. Just big circle around the middle. Clearly, she was in poor metabolic health.

Dr. Mark Hyman: Blood sugar was perfect. I measured her blood sugar. I said, well, maybe we should do a glucose tolerance test. Her A1C, which is the average blood sugar, was perfect. It wasn’t like it was 100. It was like 80 fasting, which is really optimal.

Dr. Mark Hyman: I said, “Let’s do a glucose tolerance test and measure your blood sugar. We’re going to also measure insulin,” because most doctors … This was probably 25 years ago. Most doctors just never measure insulin, even today, 25 years later. But it probably is … We were discussing earlier, probably one of the most important tests.

Dr. Mark Hyman: So her blood sugar after she took the equivalent of two Coca-Colas, perfect, like never went over 110, even after drinking the equivalent of two Cokes. Her A1C was perfect. Her insulin, on the other hand, normal should be about five or less. Hers was over 50 fasting, which is super high. 10 times. When she had the sugar drink, it went to 200 or 250, which you just almost never see. She’d never go over 30 after a sugar drink. I was like, wow, here’s someone who, if she went to a regular doctor, would have a perfect test, even if they did a glucose tolerance test.

Dr. Mark Hyman: And so, the importance of really digging down to understand what’s happening with your own body is so key. That’s what’s so exciting to me about Levels is it gives people real-time access to data through a continuous glucose monitor, which is a really relatively non-invasive procedure where you track your blood sugar on your phone. Super easy and fun and gives you so much insight.

Dr. Mark Hyman: I was sharing this story before. I was using the Levels app and I had the device on my arm. This friend of mine, we were having a meal in Martha’s Vineyard last summer. It was farm-to-table meal, but we got it brought in. It was COVID. We didn’t go out. We had it delivered. It was a huge amount of extremely healthy food. It was so delicious that we ate an enormous amount.

Dr. Mark Hyman: But even the idea that you could eat healthy and it still causes a problem if you overeat, is nothing that most people really understand. So I can eat all this healthy stuff, but actually our sugars, both of our sugars really, really spiked, even though we’re both really metabolically healthy. So it’s a fasting lesson in, gee, we don’t really always know what’s going on inside our bodies until we start looking.

Dr. Casey Means: I think that’s absolutely right and I think you bring up the great point about biochemical individuality when it comes to metabolic health and metabolism. What might affect you might affect me very, very differently. I’d wonder if you and your friend at this dinner might have had actually eaten the same thing and had different responses. That is really an important piece.

Dr. Casey Means: There was a really fascinating paper that was published in the journal Cell about five years ago by the Weizmann Institute. It was called Personalized Nutrition by Prediction of Glycemic Responses.

Dr. Mark Hyman: This was based on the microbiome.

Dr. Casey Means: Yes, yes. They took 800 healthy people, so non-diabetic individuals, and they put continuous glucose monitors on them, these little devices that measure your glucose 24 hours a day in real time, sends that information to your smartphone. They give them standardized meals.

Dr. Casey Means: So they said like, “You all are going to eat an identical meal,” or an identical cookie, “and see what happens.” Based on what we know about the glycemic index, which is this idea that each food has an inherent property of how much it will raise your blood sugar, they actually found something very different.

Dr. Mark Hyman: Wait, wait, wait. What she’s talking about, Casey’s talking about, is that scientists that come up with this chart of if you eat a banana, it’ll raise your blood sugar this much. If you eat an apple, it’ll do this much. If you eat chicken, it’s going to do this much. What you’re saying is that was all thrown out the window because it depended on what was going on in the microbiome.

Dr. Casey Means: Right. Exactly. They had some people who raised 10 points to a banana and others that … 10 glucose points and others that went up a hundred milligrams per deciliter. So-

Dr. Mark Hyman: Wow.

Dr. Casey Means: … what might be a really okay metabolic choice for you might not actually be for me. They actually found equal and opposite reactions between people. So person A could have a huge spike to a banana and no spike to a cookie and person B could actually have the exact opposite.

Dr. Casey Means: So this is where I think testing can be really helpful because we have this culture where there’s loud voices in the nutrition space saying there’s a one size fits all diet. But I do think there’s probably some more nuance to that. So that gets into the nitty-gritty of the biochemical individuality.

Dr. Mark Hyman: Yeah, good personalization.

Dr. Casey Means: Like you said, in that study, the microbiome was a key determining factor of how people responded to those different foods differently, which was pretty fascinating.

Dr. Mark Hyman: That’s so true. I had a patient once that taught me a lot also. I mean most of the stuff I learn, I learn from my patients, because you start looking at the biology and you start asking questions, you start thinking.

Dr. Mark Hyman: Most of us as doctors, honestly, just are pretty arrogant. We got trained in this guild in which we were told that this is sacred knowledge that’s True with a capital T, that anybody who questions it is a heretic and is not “evidence-based”, which is the way we crusade against people who have ideas different than us. We’re basically often blind to the very things that are in front of us. When a patient gets better or changes something, pay attention.

Dr. Mark Hyman: So this guy had this diabetic regulation problem where his sugars were really volatile and brittle, and it was tough to control. We did get dramatic improvements by changing his diet and putting him on a super low glycemic diet. But it still wasn’t great. He kept complaining about his gut. So we started working on his gut.

Dr. Mark Hyman: One time he was saying, “Oh, I’m just having all this gas and blah, blah, blah.” I said, “Why don’t you just … To deal with your GI symptoms, just take some charcoal,” as an emergent stop-gap measure to help fix what was going on with him. Next time I talked to him, he was like, “That was a miracle.” I said, “What do you mean?” He says, “My sugar dropped a hundred points when I took charcoal.” I’m like, “Well, how did that happen?” It’s not like the charcoal’s not absorbing the sugar.

Dr. Mark Hyman: What’s happening is that in the intestinal tract, he had a whole bunch of bad bugs that were producing endotoxins, which are these really nasty toxins that certain bacteria produce called lipopolysaccharides. They get absorbed over the gut. They activate the immune system.

Dr. Mark Hyman: The immune system … And this is just all technical stuff, but it activates these things called cytokines, which then bind to receptors on the cell that’s causing some resistance. So basically these toxic bugs in his gut was causing his blood sugar to be all up. Fixing that fixed his blood sugar. So it’s very complicated.

Dr. Mark Hyman: Hey, everyone. It’s Dr. Hyman. I’m all about using food first when it comes to nutrition, but there are certain nutrients I recommend everyone supplement with because it’s simply impossible to get adequate amounts from your diet alone. One example is magnesium, which our soils … Well, they’re not too healthy. Because there’s no organic matter, they can’t extract the magnesium from the soil, from industrial farming, which is a drag.

Dr. Mark Hyman: That leads to 50% less of these minerals in our food than there was 50 years ago. Then, of course, we’re doing things that cause us to lose magnesium, like sugar, caffeine, fluoride, even stress, which none of us have, right?

Dr. Mark Hyman: 80% of Americans are actually deficient in magnesium. That may mean insufficient, not necessarily true deficiency, but like just not enough for optimal functioning, because magnesium is so important. It’s a huge problem for our health.

Dr. Mark Hyman: Considering the pandemic of stress, along with the pandemic of COVID that we’re facing, we should all really be conscious about our magnesium intake because it activates the parasympathetic nervous system, which keeps us calmer and more relaxed. Magnesium is crucial for more than 300 other chemical reactions in the body and impacts everything from metabolism to sleep, to neurologic health, energy, pain, muscle function, and lots more.

Dr. Mark Hyman: My favorite new magnesium is from a company called BiOptimizers. Their Magnesium Breakthrough formula contains seven different forms, all of which have different functions in the body. There is truly nothing like it on the market. I really noticed the difference when I started taking it, and I’ve tried a lot of different magnesium products out there.

Dr. Mark Hyman: I also love that all their products are soy-free, gluten-free, lactose-free, non-GMO, free of chemicals, fillers, and made with natural ingredients. Plus, they give back to their community. For every 10 bottles sold, they donate one to someone in need, and there’s a lot of those.

Dr. Mark Hyman: Right now you can try BiOptimizers Magnesium Breakthrough for 10% off. Just go to magbreakthrough.com. That’s M-A-G-B-R-E-A-K-T-H-R-O-U-G-H.com/hyman and use the code Hyman 10 and you’ll get 10% off this really great formula. I think you’re going to like it as much as I do. Now let’s get back to this week’s episode of The Doctor’s Farmacy.

Dr. Mark Hyman: I want to get into something with you that I think is really important for people to understand, because we touched on the metabolic health and poor metabolic health. But I wonder if you can take us through a story of what actually are all the things that are happening, because you created a list of conditions that are related to poor blood sugar.

Dr. Mark Hyman: What is the biology of what’s happening when your blood sugar’s out of control? What happens to your microbiome, to your immune system, to your brain, to your hormones? Take us through what actually happens in the body when you are eating the average American diet?

Dr. Casey Means: Yeah. So there’s four things that I think are worth focusing on. There’s the direct effects of high blood sugar. So you eat something and your blood sugar spikes, and then there’s biological effects of that. Then there’s a fourth thing, which is the longterm stuff.

Dr. Casey Means: So in terms of those short term things, like you drink a Coke and your blood sugar goes up from 75 milligrams per deciliter to 150 milligrams per deciliter. That blood sugar spike can cause glycation. It can cause oxidative stress.

Dr. Mark Hyman: Wait, wait, wait. What is glycation?

Dr. Casey Means: So glycation is the process where sugar just sticks to things in your body. It’s actually just like sugar molecules sticking to things like fats and proteins and DNA, and that can cause dysfunction. It can cause those cellular parts to be dysfunctional. And so, that’s an issue. We don’t want that.

Dr. Casey Means: It can generate inflammation immediately, too. This huge surge of sugar is unusual for the body. It’s like what a is going on? Why is this big change, this homeostatic shift happening? We don’t want that.

Dr. Casey Means: Then it can cause oxidative stress, which is this reaction where your body’s producing metabolic byproducts that are reactive and can be damaging to the cells. So these unpaired electrons that go around and want to bind with things.

Dr. Mark Hyman: They’re resting.

Dr. Casey Means: It’s resting, exactly. So big glucose spike, you can have immediate effects on oxidative stress, location, and inflammation. Then the fourth thing is this thing that’s happening both immediately but also really has cumulative effects, which is the insulin surge. So when you have that big glucose spike, your pancreas is releasing all this insulin to help you soak up the glucose out of the bloodstream into the cells so it can be processed and bring the glucose back down.

Dr. Casey Means: What can happen there in the short term is that if you’ve got a big spike, so that big up and down, the insulin can actually sometimes overshoot. It can actually do too good a job in soaking up all that glucose and you can have what’s called reactive hypoglycemia, which colloquially is known as the post-meal crash.

Dr. Casey Means: So if you’ve had lunch and then after lunch feel tired and you want to have that second cup of coffee at 1:00 PM, and maybe you feel a little bit more anxious, that might just be the fact that your blood sugar has gone up. You’ve released all this insulin. The insulin’s overshot. You’ve crashed down. Now you’re in this dip and the body’s trying to get back into balance. That roller coaster with insulin-

Dr. Mark Hyman: And that gets a secondary cascade of hunger hormones-

Dr. Casey Means: Cravings.

Dr. Mark Hyman: … cravings.

Dr. Casey Means: Exactly. And so, that’s happening in the short term. Then that insulin process, going back to what we were talking about before, can over time lead that insulin resistance, where the cells see that huge surge in insulin so frequently that they actually say, “We can’t keep doing this. This is too much insulin and we get numb to it.” That’s insulin resistance.

Dr. Casey Means: Then what happens is your insulin levels, they start creeping up because your body’s trying to overcompensate for that block by producing more. Then that leads to so many of the downstream conditions that we’ve been talking about. When you’ve got this high insulin, one of the secondary effects of that, we can talk about obesity.

Dr. Casey Means: Insulin is a signal to the body that glucose is around for energy. It’s also signal to the body that because there’s so much glucose around, we don’t need to use fat for energy. Glucose and fat are the two main ways that we produce energy in the body. When that insulin’s high, it blocks us from tapping into fat burning. It says to the body, “Nope. You don’t need to tap into fat burning. We’ve got a bunch of glucose around.”

Dr. Casey Means: And so, this is relevant to anyone who is trying to lose weight or who has the excess belly fat, because that insulin is a real block on helping us achieve those goals. And so, for us to tap into our copious fat stores in our body, we need the insulin to be lower.

Dr. Casey Means: So by getting off that glucose roller coaster, by eating foods that keep us more flat and stable throughout the day, which is what we want for optimal health both in the short term and the long term, we give our body a break from producing that insulin. That can have real significant impact on our ability to lose weight, to get rid of that belly fat, to tap into this alternate metabolic fuel source, and to generate what we call metabolic flexibility, which is this ability of the body to flip between using glucose when it’s around and using fat when it’s not around.

Dr. Casey Means: That state of being able to do both is a really healthy state. It’s adaptive. But the average American, with the vast majority of our calories coming from ultra-processed foods, and I believe more than 70% of processed foods in the US have refined sugar in them … And we’ve been told, of course, to eat six small meals a day … you are on, as an American, this up and down glucose roller coaster all day. And so, you’re really never giving your body this time in a low insulin state.

Dr. Casey Means: So you really do have to be quite aware and think differently. I mean the reality is, as an American adult, you’re on a treadmill towards being overweight and chronic disease. Unless you are doing something different, you will end up sick. That’s where having a little more awareness, I think, can be helpful.

Dr. Mark Hyman: 100%. All the things you mentioned earlier, people don’t relate to this. They don’t relate to blood sugar. They get diabetes, it’s related to blood sugar. But what about cancer and Alzheimer’s and depression and heart disease and so many other issues, infertility, gout you mentioned, sexual dysfunction, acne? I mean whatever.

Dr. Mark Hyman: It’s just unbelievable how much of our modern ailments and how many of those ailments are driven by this single process. You don’t have to treat all these diseases separately. If you dealt with that, then these other things would get better.

Dr. Mark Hyman: I think it’s something that … I don’t know why, but it’s just such a dark black hole in medicine. There’s a lot of literature on it. There’s no lack of science. But in practice, the average doctor doesn’t know how to diagnose or treat insulin resistance.

Dr. Mark Hyman: One of my patients came to me and said, “My doctor … ” I saw his blood sugar. It was like 115 or something. I’m like, “Hey, your fasting blood sugar is a little high. You’re heading towards diabetes.” He was like, “Yeah.” I said, “Has your doctor recommended anything?” He was like, “Well, yeah.” I said, “What?” He said, “Wait until it gets to be higher and then he’ll put me on medication.” I’m like, “Oh, okay.” That is not a very enlightened understanding of how our bodies work. The biological processes are so central to every age-related disease.

Dr. Mark Hyman: I was at a longevity conference once and I was walking with Leonard [Guarte 00:38:11] who was from MIT and discovered sirtuins, which are these incredible regulators of our mitochondrial function or energy, which we were talking about earlier and that are so important in longevity and aging. I said, “So what’s the secret? How do they work?” This was years ago. He was like, “The data we’re just trying to come out is sugar.” I’m like, “Don’t eat sugar.”

Dr. Mark Hyman: It’s like that’s what’s causing these systems to fail and for us to age and for all these chronic elements. Most people listening are probably, “Well, I’m not diabetic,” and like, “All right. Why should I worry about it?” Well, if you have high blood pressure, high cholesterol, if you have any belly fat, if you’re even thin but you eat a crappy diet, this is going on under the hood.

Dr. Mark Hyman: And so, tell me why you feel that continuous glucose monitoring, which is part of this whole new movement of what we call biosensors or quantified self or portable metrics, people have these scales that send their data up to the cloud, or blood pressure cuffs or the Oura Ring or Fitbits, or now there’s continuous glucose monitors, why are these important and why should the average person even care? Because if you’re not diabetic or pre-diabetic … Which most people don’t know that they’re pre-diabetic because doctors don’t diagnose it. But why should people care?

Dr. Casey Means: Yeah. So I think that we’ve touched a little bit on why probably more people should care than they maybe realize. With 88% of American adults having metabolic function, this is relevant to the vast, vast majority of us.

Dr. Casey Means: But I really think it comes down to personal empowerment and really understanding our own bodies. We’re not going to fix healthcare without fixing health, and you can’t fix health without fixing the decisions that we’re making every day about what we’re eating, how we’re sleeping, how we’re stressing, how we’re moving, how we’re supporting our microbiome, all these things.

Dr. Casey Means: It really comes down to choices. Right now we don’t have a lot of help to understand what choices to make for our own body. That’s where wearables and especially biowearables, I think, can be very, very helpful.

Dr. Casey Means: I’m not the type of person who wants to be strapped to technology for the rest of my life. That’s not really … It’s not my goal to be a cyborg and be wearing a sensor. But I want to be unplugged in the back country, like camping.

Dr. Casey Means: However, the reality is that the system that we’re living in right now is designed to hurt us. It’s designed to keep us sick. It’s designed to keep us dependent and coming back for medications and surgeries and whatnot. So in the world we’re living in where our taxpayer money is going towards subsidizing refined sugar and refined corn and wheat and disease-causing foods, I think we need a little bit extra support, and I think that wearables can really help with that.

Dr. Casey Means: So that’s where I’m really passionate about this is empowering people to understand their own bodies and to make decisions for themselves in the face of a healthcare system that isn’t being really proactive about metabolic health.

Dr. Casey Means: Like you were mentioning with your patient, those numbers, when we reach the pre-diabetic or diabetic threshold, it’s likely that we’ve probably had issues going on with our insulin for 13 years is one study from the Lancet showed that. 13 years before we get that diagnosis.

Dr. Casey Means: So how can we as individuals have tools that can help us during this time? I mean if you can keep your blood sugar in a stable and healthy range throughout your lifetime, I’m fairly confident that you’re never going to walk into a doctor’s office one year and get a huge bomb dropped on you, that you have a metabolic condition.

Dr. Casey Means: If you’re looking day after day, year after year and knowing that what you’re putting in your body is not causing these huge spikes, you have unlocked the door to essentially minimizing your risk drastically of all of the conditions that are killing Americans. Eight of the 10 leading causes of the death in the US are directly related to blood sugar.

Dr. Mark Hyman: Absolutely.

Dr. Casey Means: So that’s-

Dr. Mark Hyman: Then the cost and the suffering and on and on and on.

Dr. Casey Means: Right. And so, I think having a tool in the face of the modern world that we’re living in can be great. I also think that, from what I’ve seen with my patients, when you really understand your body and understand how the environment is affecting your body, it’s very motivating.

Dr. Casey Means: Nutrition has been a black box. It’s always been an open-loop system where you make a choice and you actually don’t really understand what the result is often for a long time. Maybe you eat healthy one day and then the next day you step on the scale. That’s the lagging indicator. How do you create a relationship between what specific food led to that result?

Dr. Casey Means: Maybe it’s six months from now you get a blood sugar test or a cholesterol test, but that one-to-one relationship has been missing. Now it’s not with these biowearables. So for me, for instance, I was eating oatmeal for breakfast-

Dr. Mark Hyman: Oh yeah.

Dr. Casey Means: … I mean frequently.

Dr. Mark Hyman: I guess you had read my Ultrametabolism book then.

Dr. Casey Means: Exactly. The box literally says heart healthy on it and good source of whole grains and fiber. I ate it with a continuous glucose monitor on and my blood sugar … And I’m talking plain oatmeal, zero sugar, zero fruit, zero juice. Plain, plain, boring oatmeal. My glucose went up about 85 points.

Dr. Mark Hyman: Oh wow.

Dr. Casey Means: For me, there is no chance that that food is heart healthy for me, because glycemic variability, these ups and down swings like that … I mean I never really want my glucose to go above 20 to 30 points above my pre-meal levels. This was like 80.

Dr. Mark Hyman: 80. 80. Yeah.

Dr. Casey Means: So for me, it is not a heart healthy food. Anecdotally, for most of our members at Levels-

Dr. Mark Hyman: It’s not.

Dr. Casey Means: … it’s also not a heart healthy food.

Dr. Mark Hyman: It’s not, no.

Dr. Casey Means: We’ve seen very few people. If you look at the advertisements for this food, almost universally, it’s the oatmeal with brown sugar, with fruit, with OJ, maybe with a piece of toast. I can’t even imagine.

Dr. Mark Hyman: Yeah, it’s terrifying. It’s terrifying.

Dr. Casey Means: So I think that’s where some of this technology can really help and I think it honestly can also improve the relationship between the doctor and the patient. I think this is not like people going to Dr. Google and coming in with a bunch of theories and questions. This is real information. It’s real objective data. I think it can equalize that playing field and that power dynamic between the doctor and the patient.

Dr. Casey Means: I think sometimes doctors will recommend things and patients will try them and it doesn’t work. Their labs don’t get better. They don’t lose weight. There can be a lot of frustration, there can be some mistrust, but if you can use a wearable to help personalize and almost be like a coach to help you achieve your goals, that can be great. The reality is that 49% of Americans every year try to lose weight. So people are trying.

Dr. Mark Hyman: And probably 75% should be.

Dr. Casey Means: Right. Right. But that’s hundreds of millions of people who are trying, who are making the mental commitment to, “I want to do the work. I want to do better. I want to try,” and we don’t have much to grasp onto to help us.

Dr. Mark Hyman: That’s true.

Dr. Casey Means: And so, I’m very passionate about how we can, for all these people who want to do better, give some tools, sort of a lifeline.

Dr. Mark Hyman: Here’s the secret that most people don’t understand, especially around weight, is that the key to losing weight is low insulin. Not necessarily low blood sugar, but low insulin, because insulin locks the calories and the fat in your fat cells. It’s like a one-way turn cell. So once the glucose gets into your fat cells and your belly, it can’t get out if the insulin’s high, which people don’t realize.

Dr. Mark Hyman: And so, the key really to weight loss, in addition to addressing all these chronic diseases, is to really get the insulin low. The tool of Levels, which is just an amazing technology that help people in real time track their blood sugar, correlate with what they’re eating, with their activity, with their stress, with their exercise, it gives them a window into their biology that we really haven’t had before. We’re just going to get better and better and better at it. Can you tell me, from the people who’ve used it … Because now it’s in beta, right?

Dr. Casey Means: Yeah.

Dr. Mark Hyman: It’s not quite out, and it will be soon. By the way, for people listening, there’s a closed beta happening now, but there’s a wait list of over 120,000 people who want to sign up. If you want to skip the line, you came to the right place because all you have to do, because you listen to this podcast, is get early access through going to levels.link/hyman, that’s levels.link/hyman, to get to be part of the wait list top of the line. So you get to cut the line.

Dr. Mark Hyman: So in all the people who’ve used it, tell me what are some of the cases that just were the most instructive, the things you learned from people’s experience. You mentioned a few things, I’ve mentioned a few things, but give us some real patient stories.

Dr. Casey Means: It has been so exciting to see what our members are learning by putting these continuous glucose monitors on and using Levels. Some of the most fascinating things … I mean there’s a lot of low-hanging fruit. It’s like if you drink a soda, your blood sugar often goes through the roof. So that’s the obvious ones. But then there is the nots-

Dr. Mark Hyman: But what’s really interesting is that … Sorry to interrupt you, but I just remembered a study in the New England Journal years ago, where they looked at first degree relatives of type two diabetics who were actually healthy. When they did a challenge with them, they found that they had higher spikes of sugar and insulin than people who didn’t have first degree relatives.

Dr. Mark Hyman: So even if you look fit and great, you might be headed there if you’re not careful. If you’re a Pima Indians, even if you were living a hundred years ago, if you had a can of Coke, you’re going to be in trouble.

Dr. Casey Means: Definitely.

Dr. Mark Hyman: That’s how they got to be the second most obese population in the world after Samoans.

Dr. Casey Means: Absolutely, yeah. But I think even those simple learnings can be really helpful because we know we shouldn’t drink soda, although most Americans do. But you walk into the grocery store and it’s everywhere. It’s subsidized by our government. You might get the impression like, “Oh, well, if it’s subsidized by the government and it’s covering Safeway, it’s probably okay.” But then you see the data and you’re like, “Oh, wait. It’s definitely not okay. This is going way out of range.”

Dr. Casey Means: But then it gets into some of the more nuanced and exciting stuff. So one big learning is people realizing the importance of balancing their meals. What I mean by that is adding fat, protein, and fiber to their carbohydrates.

Dr. Casey Means: So people will eat, let’s say, an apple all by itself and have a pretty significant glucose spike. But they take that apple and they put some almond butter and some chia seeds on it, and they might have a very different response, because we know that that additional fat protein and fiber from the chia seeds and the nut butter can actually slow the time to absorb the glucose. It can really change the dynamics. It also impacts the microbiome. And so, it may even make us absorb less of the glucose because we are putting fiber in there. So that’s been a major thing that we’ve seen is fat, protein, and fiber. Another-

Dr. Mark Hyman: We call that the glycemic load, which is what is the total effect of the meal? Even the timing, right? You learned about what happens when people eat what.

Dr. Casey Means: Yeah, exactly. The timing has been a huge thing. We’ve seen that people often find that if they eat something very late at night versus the exact same meal earlier in the day, they’ll often have a larger response at night and it can impact their sleep quite a bit.

Dr. Mark Hyman: Even if it’s the same meal.

Dr. Casey Means: Exactly, same meal. Part of this is because we’re a little bit more insulin resistant at night naturally, and this has to do with melatonin secretion to help us-

Dr. Mark Hyman: So we could have dessert earlier in the day.

Dr. Casey Means: Basically. I mean I would say that if people are going to eat dessert-

Dr. Mark Hyman: For lunch, for lunch, not breakfast.

Dr. Casey Means: … I do tend to now front load my carbs in the day because of what I’ve learned from continuous glucose monitoring. I also know that those up and down swings, called glycemic variability, at night can really impact sleep.

Dr. Casey Means: We integrate our glucose data stream with sleep and activity tracking. So you can start to make some of those higher level insights about how sleep and glucose are related. We’ve seen a lot of people comment on how when they get less sleep, their glucose is quite a bit more or erratic the next day.

Dr. Mark Hyman: [crosstalk 00:51:09].

Dr. Casey Means: It’s a huge impact.

Dr. Mark Hyman: Sleep.

Dr. Casey Means: Massive.

Dr. Mark Hyman: Exercise.

Dr. Casey Means: Sleep and then, of course, exercise. So one of the biggest takeaways is people realize that just getting up and walking for 15 minutes after a meal can have a significant effect on your post-meal spikes. It can bring your glucose down faster. If you look at a lot of traditional cultures-

Dr. Mark Hyman: They take a walk after dinner.

Dr. Casey Means: … getting up and taking a stroll, it’s super common. Now we have the biometric data to back up why. It makes a big difference.

Dr. Casey Means: The last one, I think, that’s been really interesting, and again supported by the research, is that stress definitely causes people’s glucose spikes to be higher. We’ve had people who are fasting first thing in the morning and they have to give a talk to their company or their on a podcast or something like that. They might get a glucose spike just from the stress alone.

Dr. Casey Means: The mechanism of that is really interesting. The cortisol and the catecholamine hormones that are released when we have stress, they tell our liver to actually dump glucose into the bloodstream.

Dr. Casey Means: Evolutionarily, the purpose for this was because when we had a stress signal, like a threat, we thought, oh, we’re probably going to have to run from something. We’re going to have to run from the lion or whatnot. And so, the body was like, “Okay, cool. You need to use your muscles. So we’re going to help you mobilize some glucose from the liver to feed the muscles.”

Dr. Casey Means: But now what we’re dealing with are mostly these psychological stressors, an email, a honking horn, a stressful phone call, whatnot. And so, that glucose from the liver is not actually helping us. It’s just sitting in the bloodstream causing problems.

Dr. Casey Means: So what I’m loving seeing in our members is that this is not just about, okay, put on a glucose monitor and eat low carb and get a flat glucose line. It’s about having a holistic picture of your health and all these different lifestyle behaviors that feed into building a body that processes food effectively. That includes the amount we sleep, how we’re responding to stress, how we’re moving throughout the day. Of course, how we’re pairing and timing foods. Altogether, those things can work to let us have a better glucose response.

Dr. Mark Hyman: Yeah. I mean people don’t even know. They have a glass of wine when they go to a restaurant at the beginning of the meal. It’s very different than adding it in the middle of the meal. Same glass, very different effect on your body. So those kinds of things. Or having bread which they put at the table. Obviously, it’s to spike your hunger, which it does, because it spikes your blood sugar. So if you have the bread in the middle of the meal … I mean we shouldn’t eat that much bread anyway. But it’s like basically there’s a very different thing.

Dr. Mark Hyman: So how have you found that Levels has helped people change behavior? Because at the end of the day, people want to change behavior so they can change the outcomes of their health, weight loss, reversing diabetes, improving the way they feel, right?

Dr. Casey Means: Yeah, absolutely. So I think it’s twofold. I mean one is that it’s really helping people understand that this is, again, not just about eating the low carb bar that has no sugar. This is about really building a comprehensive lifestyle that supports our metabolic health and how to pull those different levers to do that, whether it’s moving more …

Dr. Casey Means: Exercise, for instance, the beautiful thing about muscle that I don’t think most people or doctors know is that it can actually take up glucose without insulin. It’s this glucose sink that soaks up glucose from your bloodstream without the insulin signal. So the more we can just get up and move around the day, even for two minutes, walking here and there, it contracts those muscle groups and helps you soak up that glucose out of your bloodstream.

Dr. Casey Means: So we’ve really seen people learn about foods that are very surprising to them. A lot of people who have been on diets and haven’t had success and then realize that there are foods they thought that were healthy, that are actually not working for their body.

Dr. Casey Means: Some of the key ones … I’ll use me as an example. I learned … I’ve been using this now for about 18 months, but in the first month I realized … corn, rice, grapes, sweet potatoes, oatmeal, and most grains all sent me above 150. So if I were-

Dr. Mark Hyman: [crosstalk 00:55:18] totally eat whole grains.

Dr. Casey Means: Right, and sweet potatoes and grapes. I mean it’s fruit. It’s not to say those are unhealthy foods, but if I were trying to lose weight or if I were-

Dr. Mark Hyman: Might not be good for you.

Dr. Casey Means: They wouldn’t have been right for me. So that’s the type of behavior change we’re really seeing. I think athletes have been a fascinating one as well. A lot of athletes are eating the standard recovery foods, whether it’s a shake, a Gatorade, or a sports bar, and seeing that they’re just going to the moon and that that’s actually not supporting-

Dr. Mark Hyman: Oh boy.

Dr. Casey Means: … their goal with recovery. So that closed-loop biofeedback, the ability to have awareness, control, some agency, I think that’s where we’re really just seeing people feeling great. It’s not just about the food. It’s about feeling like we finally have something to hold onto, some form of control in what is a very complex food ecosystem.

Dr. Mark Hyman: Yeah. Well, this is such a tremendous advance, that now we have the technology at a relatively low cost to measure our blood sugar continuously. It’s just the beginning. I mean Levels is going to be working on lots of other biomarkers that we need to measure, insulin, for example. We’re going to be seeing this technology of biosensors, quantified self, wearables becoming just part of the standard of care as a way of helping to understand what’s happening in our bodies and giving us the ability to be proactive about it and to be in charge.

Dr. Mark Hyman: My friend Kris Carr got cancer and she decided she was going to take ownership of her own health because it was an incurable cancer. So she jokingly says she was the CEO of Save My Ass Technologies.

Dr. Mark Hyman: I think that’s where we all need to be thinking because, sadly, our healthcare system is not a healthcare system. It’s a sick care system. If you want to create health, you have to learn how to do it outside of that system most of the time. These companies like Levels and others that are helping people get the data that they don’t traditionally get from their doctor is going to just revolutionize healthcare.

Dr. Mark Hyman: I’m just so honored that you’re on our podcast, we’re talking about this. I’m learning to be an advisor and investor to Levels. I encourage everybody to check out levelshealth.com to learn more about what’s going on. If you want to get bumped up to the top of the list, okay, ahead of 120,000 people, which might be a little wait, go to levels.link/hyman. That’s levels.link/hyman.

Dr. Mark Hyman: If you’ve been listening to this podcast and you loved it, share with your friends and family. Please make sure you subscribe wherever you hear your podcast. Leave a comment. How have you learned about your own blood sugar and how has it affected you?

Dr. Mark Hyman: Check out that link to get on the waiting list for the Levels so you can try it yourself and see what’s going on, because I learned so much from doing it myself. We’ll see you next time on The Doctor’s Farmacy.

Dr. Mark Hyman: Hey, everybody. It’s Dr. Hyman. Thanks for tuning in to The Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do, and introducing you all the experts that I know and I love and that I’ve learned so much from.

Dr. Mark Hyman: I want to tell you about something else I’m doing, which is called Mark’s Picks. It’s my weekly newsletter. In it, I share my favorite stuff, from foods to supplements, to gadgets, to tools to enhance your health. It’s all the cool stuff that I use and that my team uses to optimize and enhance our health.

Dr. Mark Hyman: I’d love you to sign up for the weekly newsletter. I’ll only send it you once a week on Fridays. Nothing else, I promise. All you have to do is go to drhyman.com/picks to sign up. That’s drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter. I’ll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week’s episode.

Narrator: Hi, everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services.

Narrator: If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.