Top 10 Worst Foods For Blood Sugar + How Blood Sugar Impacts Women’s Hormone and Metabolism w/ Dr. Casey Means

In this episode of Essentially You, host Dr. Mariza Snyder invited Dr. Casey Means, Chief Medical Officer and Co-founder of Levels, to discuss the important role of blood sugar and metabolism. They cover the 10 worst foods for blood sugar, and chat about the deep connection between metabolic health and women’s reproductive hormones.

06:16 – Growing the Levels dataset

Thanks to user data collected from CGMs, Levels is gaining more and more insight about when Americans are eating and how it impacts their glucose levels.

When you look at all that research that’s been put out showing where is the lowest risk category for fasting glucose, really 72-85 milligrams per deciliter is that sweet spot. So that’s really awesome news from your recent labs. And I’m so excited to talk a bit more about, it’s been several months since we did our first podcast and we have a lot more data points in the Levels’ database. We have over 1.5 million food logs. And then that’s paired with continuous glucose data, which gets into the probably tens of millions in terms of actual data points. And so pairing all of that information about what people have logged for their meals with that continuous glucose data has allowed us to learn a lot about what is happening to people at this large scale. And that’s the type of data that we’ve never had before for nutrition.

16:49 – The impact of fruit on glucose

Some fruits can cause a high spike in glucose. Often, pairing fruit with other things can blunt the resulting glucose response.

For anyone listening, I’m definitely not anti-fruit. I eat a lot of fruit and I enjoy fruit and it’s not like I think it’s something that’s going to inhibit people’s weight loss goals. It’s just that different fruits affect different people in different ways. And some fruits just happen to be a lot more impactful for the glucose response than others. And that could vary between you and I. We could both eat these same fruit and have totally different responses because of our microbiome or this or that. It’s really just about dialing again for your own body. And then of course, figuring out how to pair those foods properly, such that you’re not getting the full glycemic impact of the meal. So one of the reasons I think that grapes potentially score so high in terms of glucose response is that we, well, one, they have low fiber and we know fiber blunts glucose responses, berries have a ton of fiber, grapes don’t. We also often tend to eat fruit with other things. Like we eat apples with almond butter, we eat berries with yogurt sometimes or with chia pudding, which has fiber and fat and protein. But we are usually just popping grapes. We’re not eating them with something else and it’s mindless. And so I think that’s a testament to why some of these things are surprising, is because of the context in which we eat them.

18:08 – Start each day with a savory breakfast

Dr. Means believes that one of the best changes you can make it to eliminate sweet breakfasts in favor of savory ones.

One of my biggest takeaways from seeing what we’ve seen in the Levels’ dataset and also in my own personal experience is don’t start the day with a sweet breakfast. Biggest life hack, easiest life hack, switch to a savory breakfast, whatever that means to you, eggs and avocado and greens, tofu veggie scramble. There’s a lot of different options. But the sweet breakfast were a big portion of our lowest 40 scores on our Levels’ dataset. Things like donuts, pastries, croissants, oatmeal, a lot of cereals, all were in that bottom chunk from the large dataset which is basically saying the highest glucose responses. And in the best scoring, top 40 for the best scoring, it was a lot of savory breakfast like the eggs avocado, things like tofu scrambles, things like that. So definitely one of the takeaways we saw in the dataset.

25:37 – The Coke experiment

Dr. Means described what happened when the entire Levels team drank a can of Coke.

So we did this experiment at Levels. This was not a research experiment, this was not a double-blind, placebo-controlled IOB experiment, this was just a in-house experiment that we did. We’re doing a lot of these because people are really interested in doing these group challenges and learning what happens when you do different variables and permutations. So this one was about what happens when you eat something that you know is going to raise your blood sugar and then do it again under as similar conditions as possible, but take a walk after it. And so people in our company volunteered to do this, which was to drink a 12 ounce can of Coca-Cola which of course being a glucose monitoring company, no one in the company was thrilled to be drinking a can of soda. It’s been decades since I’ve had a can of soda…the idea was to chug it and then see what happens. And so for our team, the median glucose peak for the Coke alone was 162, and most people were starting in the 70s to 80s. So it was a very large, very quick peak.

31:51 – Walking is underrated

Even a simple, gentle walk can have a positive impact on lowering glucose levels. Any movement is better than none at all.

A walk, even though it’s gentle, you’re moving all these major muscle groups, the quads, the hamstrings, it all has to be activated. So you’re using those, but also why resistance training. So lifting weights and strength training has been shown to be so powerful for overall metabolic health because you’re growing the organ in the body, essentially that is a glucose sink. And so just 24 hours a day, you’re having to feed that muscle, whether you’re using it or not. And the more you have the better it is. So I certainly just can’t pound home that message enough of how movement, even if it’s gentle walking after a meal or throughout the day, two minutes here or there during your workday or resistance training or high intensity interval training, all these things have been shown to lower our glucose levels and really make a much bigger difference than I’d expect.

34:03 – The benefit of a fasted workout

Dr. Means said that working out in the morning before breakfast aids in metabolic flexibility.

The benefit of working out in a fasted state. So this would be like maybe first thing in the morning before you have breakfast. The beauty of this is that it helps with metabolic flexibility in a way that working out after meals doesn’t. And the reason it aids and metabolic flexibility is because overnight, so in our bodies, we have different banks of energy. Our circulating glucose is our quickest form of energy. It’s in the bloodstream, we can just pull it out really quickly. Then we have our liver, which stores about a few hours of glucose for use. It’s basically like our debit account, it’s like a short-term checking account to pull money out. And that is like two or three hours of cardio training or more like if you’re just resting overnight, you’ll deplete that stored glucose, which is called glycogen. And then we have this energy in the body that’s stored as fat, that has to be basically broken down by the mitochondria, and that’s our like long-term savings. And that based on how much body fat you have, you might have anywhere between two weeks and a year worth of stored fat. And actually there are people who have fasted for 387 days, which I’m not recommending to anyone, but that’s how much energy that some people have stored in fat in the body.

42:50 – Metabolic health in women

Glucose monitoring can be particularly valuable for women due, to the interplay of female hormones on the body.

One thing I’m so excited about with continuous glucose monitoring and more broadly, the advent of being able to take our metabolic health into our own hands through personal data is that women uniquely need to be on top of their blood sugar, in different ways than men. And in a sense, almost more than men. Because blood sugar of dysregulation affects women at essentially all parts of their life cycle in ways that it will never affect men because of our unique female hormones. So what I mean by this is in our 20s and 30s, it’s affecting our fertility. As you’ve talked about on your podcast. I know your audience knows this already, but PCOS, polycystic ovarian syndrome, leading cause of infertility in our country. A disorder of insulin resistance and really fundamentally has roots in metabolic health and is interlinked with it and can be improved by stabilizing our blood sugar. Menstrual irregularities and how we feel during our cycle blood sugar changes throughout the menstrual cycle and knowing how it changes in the follicular phase and the luteal phase can help us eat in a way that makes us feel better during that time.

54:43 – Food swaps and alternatives

Simple swaps seems too simple, but if you can get a few of those recipes dialed in, it can make a big impact.

One thing I love that we’re publishing a lot on the Levels blog is essentially swaps. You don’t have to give up everything you love or what’s culturally resonant for you, but there’s ways to modulate it to just make it so much better. And I’m sure a lot of people would roll their eyes when they hear this, because it’s like it’s not the same, but delicious mashed cauliflower versus mashed potatoes, you can make that really good. I have had really bad mashed cauliflower. I’ve also had Vitamixed cauliflower that’s whipped with cashews and nutritional yeast and freshly roasted garlic that literally is better than any mashed potato I’ve ever had in my life. So it’s like, yes, I understand it can be gross, but it can also be really good.

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

It’s not surprising given that that is when women start what I call going off this metabolic cliff after menopause and that we can absolutely intervene upon by being more in control of our metabolic health before menopause and during menopause, use it not as something that’s scary, but as this opportunity to really get on top of it. And unfortunately the average doctor is not going to be bringing this up with a patient. They’re not going to be saying in these appointments about maybe menopausal symptoms, “Hey, something we really have to dial in right now is focusing on metabolic health because you are at higher risk starting now for these things.” And so if you’re not going to hear it from your doctor, you can hear it from both of us today. This is something to focus on.

Dr. Mariza (00:00:43):

Welcome back to the Essentially You Podcast. I am your host, Dr. Mariza Snyder and I’m here to help you rock your hormones and feel great in your body so that you can reclaim more energy, vitality and joy and become the CEO of your health. Let’s jump on in. I’m just going to say it here today, and I have a feeling that deep down you know it’s true as well, that one of the biggest root causes of hormonal imbalances is metabolic dysfunction, which is an inability for ourselves to efficiently use energy from sugar and fat. Now, along with that metabolic dysfunction comes insulin resistance. Now, I don’t know about you, but the spectrum of metabolic dysfunction concerns me because it can start so young. It’s one of the areas I believe that we’ve got to focus on, not just for our overall health, but also for our long-term longevity. See, our metabolism is tied to how we age. So you got to ask yourself, how do you want to age?

Dr. Mariza (00:01:51):

Now, because I think this is so critical for us, I invited Dr. Casey Means back to the show to share her newest insights about metabolic health, given the data that they are assessing at Levels Health. Now we’ll be discussing the biggest trends that she is seeing right now, the top 10 foods that you may not know that are impacting your blood sugar and metabolism. And lastly, we’re going to touch on the deep connection between metabolic health and our reproductive hormones. Lastly, Dr. Casey and I are going to explore the many benefits to monitoring our metabolism by using continuous glucose monitors and tracking our blood sugar levels throughout the day to fully know which foods are sabotaging insulin and our blood sugar, along with our metabolism and our energy levels, because guess what? It’s all tied together. And I don’t know about you, but I can always use as much energy as I can get, especially from the food that I’m consuming on a daily basis.

Dr. Mariza (00:02:49):

Now, I’m super stoked to jump into this interview with Dr. Casey Means, but before I do, I want to quickly sing her praises. Dr. Casey Means is a Stanford trained medical doctor, biomedical researcher and surgeon turned metabolic health renegade. She’s also the chief medical officer of the pioneering digital health startup, Levels. She’s leveraged through breakthrough technology to solve the epidemic threatening the health and wellbeing of 88% of the US population known as metabolic dysfunction. Let’s welcome her to the show.

Dr. Mariza (00:03:21):

Hey, one more thing. I want to share something that I’ve been consistently using for my energy levels this year. See, as a new mama, I am always on the lookout for effective and easy ways to boost my energy, especially my mental energy. And this year I added Organifi’s Green Juice to my morning routine, and I love it. Their organic green juice is made with 11 super foods and it’s easy to make and it tastes amazing. And luckily Organifi has given me a promo code to share with you so that you can add it to your morning ritual. Use promo code, drmariza, D-R-M-A-R-I-Z-A and get 15% off of your order at organifi.com/drmariza. Now I’m going to have the link in the show notes for this episode, and I can’t wait for you to try it. Well, welcome back to the Essentially You Podcast, Dr. Casey Means. How are you doing girl?

Dr. Casey Means (00:04:14):

I am doing so great. I am so glad to be chatting with you again, Dr. Snyder. Thank you for having me on.

Dr. Mariza (00:04:21):

I am obsessed with the Levels technology and everything that we get to learn about our metabolic health, especially for us as women, especially for myself being 42, just a couple of weeks ago and just really wanting to saunter into my 40s and my 50s getting rid of the constructs that the aging thing that our reproductive system just goes offline. I know so much has to do with our metabolic system and how we take care of our body. And that always starts with how we manage our blood sugar, how we manage our insulin levels. And so the last five months I’ve been wearing a CGM. You can’t see it right now, because I’ve got this little cute dress on, for you today, but it’s on. And it has been the most incredible journey just to really learn about not only what my body is doing, but also what substrates I’m bringing into the body and seeing how they respond.

Dr. Mariza (00:05:13):

I have learned so much about my body and girl, I got a fasting blood sugar. I just had my fasting blood sugar looked at, 74 milligrams per deciliter and it’s super… I mean, and I’ve had it even, it’s in that sweet spot and that just makes me so, so happy. And it’s all because I’ve learned so much with Levels. So today I brought you back so that we could talk a little bit about what you guys have been learning, utilizing this technology with so many of us, because you’re collecting so much information regarding how our bodies are functioning, what kind of foods are lighting us up and even what are some of the things that we can do to blunt our blood sugar spike, which I think is a huge part of learning how to manage our metabolism.

Dr. Casey Means (00:05:56):

That’s exactly right. And first of all, it is so worth celebrating a fasting glucose of 74. That’s amazing. That is in the exact optimal range that I always tell people for fasting glucose, which is not just less than 100 milligrams per deciliter, which is what we call quote unquote normal in terms of fasting glucose, but it’s actually really more in the optimal range. So when you look at all that research that’s been put out showing where is the lowest risk category for fasting glucose, really 72 to 85 milligrams per deciliter is that sweet spot. So that’s really awesome news from your recent labs.

Dr. Casey Means (00:06:30):

And I’m so excited to talk a bit more about, it’s been several months since we did our first podcast and we have a lot more data points in the Levels’ database. We have over 1.5 million food logs. And then that’s paired with continuous glucose data, which gets into the probably tens of millions in terms of actual data points. And so pairing all of that information about what people have logged for their meals with that continuous glucose data has allowed us to learn a lot about what is happening, people at this large scale. And that’s the type of data that we’ve never had before for nutrition.

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

We’ve really had to take things at face value, like what does the box say? Does the box say it’s heart healthy? Does the box say that this is low sugar? And just believed that and really go off food marketing. And now we’re able to move past that. We can say actually, “No, it doesn’t really matter what the box says for me. If this is spiking my blood sugar, 70, 80, 90 points, it’s not heart healthy for me.” And so there’s a lot of foods that have, in my own personal life, I’m sure in yours too and then amongst our greater member base and dataset, that really highlights some of these things where cutting through the marketing or the nutritional dogma and actually getting into real data can help move us forward.

Dr. Mariza (00:07:48):

I 100% agree. I was sharing with you a story where I had the highest blood sugar I had ever had, because most of the time, my biggest spike was like 135, 140, 150 milligrams per deciliter. Sushi before that was my biggest offender. And I know that you guys had come out with an article with the 10 surprising foods and sushi was definitely on that list, including acai bowls and grapes. But this… So it was a Starbucks run that my husband was doing and he was supposed to just get me a blended espresso drink with almond butter or almond milk sorry not almond butter, almond milk. And he ordered it online and ended up picking a Frappuccino. Didn’t realize that there was sugar in it, but there were an opportunity to lower the amount of pumps of something. It wasn’t really clear what it was.

Dr. Mariza (00:08:36):

And so he goes and picks it up. He drops it down to one just in case. He’s like, “I don’t know what this is, but let me just drop it down to one pump.” And then ran in and asked the girl at the counter he’s like, “Is there any sugar in this? My wife, she doesn’t do sugar. Is there any sugar in this?” And she’s like, “Absolutely not.” So he brings it to me and girl, I was telling you, I am a bloodhound for sugar. I can taste it a mile away. I’m like, “Oh, there’s sugar in this.” But I was like, “You know what? I’ve got the CGM on. I’m curious what it’s going to do. It says early afternoon,” and my blood sugar shot up like the big scary spike it goes and it jumped all the way to 190 milligrams per deciliter. And I was just like, “Oh, my goodness.”

Dr. Mariza (00:09:19):

And I thought about all the people, and this was a tall, this was a small one too. This was a very small one. This wasn’t a medium or a large or the extra large that they have. And this wasn’t the regular amount of pumps in here. This was one. I think he maybe even had to do a half pump. And I thought to myself, how many people, every single day, millions of people walking out with Talls Grande Frappuccinos, just ordering it as normal, which I think is three or four pumps of sugar. And I’m thinking the average person, we’ve got to be seeing over 200 milligrams per DEC. Over. Well over, something super scary.

Dr. Mariza (00:09:57):

And my husband as I’m breaking this down to him and he is listening. He’s like, “This should be a crime. This shouldn’t be allowed. Because I don’t think people know what is happening to their bodies in the two hours after they consume this.” And what a lot of people don’t realize is, girl, it took me days to cover from this blood sugar spike, as it does. Your body’s got to figure this out and then go and repair. And so I always tell people that big old ice cream brownie sundae that you’re about to have, it’s going to take about 36 hours for your body to re-acclimate back down to a normal, fasting blood glucose if that’s where you’re normally at.

Dr. Casey Means (00:10:39):

Absolutely. First of all, so many kudos to your husband for being willing to even try on this. I mean, this is me in a nutshell, I feel like you and I need to go to a coffee shop together because I am always the person asking, are you sure this doesn’t have sugar in it? And what’s funny about coffee shops in particular is I’m actually usually just getting a coffee with milk in it or sometimes an Americana with milk. So not even drinks with a lot of milk. And I always say, “Which of your milks has the lowest sugar?” Because I’ll just basically I don’t care if it’s coconut, almond, whatever, just which one has the lowest sugar? And they almost universally will say, “Oh, none of them have any sugar. It’s just nut milk.” And so of course I’m like, “Can I take a look at the carton?” [crosstalk 00:11:23].

Dr. Mariza (00:11:23):

My husband always asks-

Dr. Casey Means (00:11:25):

Always.

Dr. Mariza (00:11:25):

… for the carton. He’s like, “Can I look at it?”

Dr. Casey Means (00:11:27):

Always.

Dr. Mariza (00:11:28):

Always seven grams, six grams.

Dr. Casey Means (00:11:30):

I was going to say it is always seven grams. I’m certain that the barista brand or whatever it is that they’ve studied that somehow seven grams is what makes it foam perfectly or whatever. But a long time ago, I’ve wearing continuous glucose monitors for two years now. One of the first things I did was start to make my own nut milk at home because it’s so delicious. It takes three minutes to make your milk for the week and there’s no sugar and it’s so creamy and so delicious. It doesn’t spike my blood sugar. But that seven gram of sugar, even a splash of it in my coffee, it’s going to make my blood sugar go up. And what’s tough is that people aren’t even aware that it has sugar in it. They think they’re making a good choice by getting in the coffee with some milk. And unfortunately we just get bamboozled.

Dr. Casey Means (00:12:16):

So having the data to be like, “Huh. This is actually doing something to my blood sugar.” Often will make me go back and be like, “What did I have and what might have been in there?” Whether it’s a salad dressing or sometimes ketchup will do this where its like you’re really surprised by your spike because you thought you made a good choice. And then you’re like, “Oh, it was snuck in there.” Sugar was somehow snuck in there and there’s like 56 names for sugar. So it’s sometimes really sneaky how it gets in there. And coffee is just one example.

Dr. Casey Means (00:12:49):

And similarly a spike that was super surprising to me was oatmeal. This is one that often gets people when they start Levels, because they’ve been told by their doctor that oatmeal is a great breakfast, it’s heart healthy, this and that [crosstalk 00:13:04].

Dr. Mariza (00:13:04):

It’s heart healthy girl. It’s heart healthy.

Dr. Casey Means (00:13:06):

Heart. Yeah for me. So my blood sugar started at 80, went to 180 and then came crashing down. So it went 100 points up. For context. I’m trying to never get above generally, when I’m cooking for myself on a good day above about 110. Sometimes when I got out to restaurants, like you said, it’ll go up to 130, 140 it happens. But if I’m cooking and I’m controlling the variables, I like to keep it below 110 after meals. So 180 is really, really high. And then you have that post meal crash because you’ve spiked so high. And that was just oatmeal, two packets of Instant Oatmeal, nothing else on it.

Dr. Casey Means (00:13:43):

Then if you go to the Quaker Mills or whatnot, General Mills Quaker Oats’ website, when they show the oatmeal, it’s got berries on top, brown sugar on top. There’s a glass of OJ next to it. There’s toast next to it. And like you said, people are probably going above 200 all the time just eating what they think is considered a balanced breakfast that’s heart healthy. And yeah, and I think it’s just the hardest part is that people are trying and then just get the rug swept out from under us because we just don’t know what’s happening in our body. And I was reading a statistic recently from the CDC website that 49% of Americans try and lose weight every single year. That’s amazing. 49% of people are making the intentional effort to try and lose weight. And you can assume, all those people, they have a plan, they’re going to give it their best shot. And of course as a country, it’s not working. We’re getting heavier. Obese and overweight rates are going up and our metabolic health crisis is getting worse.

Dr. Casey Means (00:14:49):

And so there’s a mismatch between the effort and the outcomes. And I think a lot of that lies in the fact that we’re eating these food products that we don’t really know what they’re doing to our bodies. And that’s where monitoring, whether it’s glucose monitoring or if people are measuring their ketones or whatever, can just give you a little bit of insight into why you might be stuck and why things that you think are serving you and are healthy, may not be. Oatmeal is one of those really obvious examples and was actually scored in our bottom of all our members in the entire Levels’ dataset, bottom 40 foods in terms of worst glucose spikes. And there were other surprising things like grapes, for instance. A lot of fruit, not big spikers, grapes, huge spikers for a lot of people.

Dr. Casey Means (00:15:35):

And so again, you can imagine people are like, “Well, I’m increasing the fruits in my diet. This is a healthful diet.” But if it’s spiking your glucose that high, it may actually inhibit the goal that you have set out for yourself, which might be weight loss or improve metabolic health or whatever. So it’s pretty fascinating sometimes to see these surprises when you’re wearing this and just like, “Whoa, what just happened?”

Dr. Mariza (00:15:57):

Agreed. There’s a lot of misinformation. I remember we were at our little restaurant a couple of weeks ago out of town and I was looking at the healthy version of the menu, the little section over here and it was all carbs and sugar and sugary fruits. And I was like, “Oh, my gosh, there’s nothing on this little part of the menu that isn’t going to drive someone’s blood sugar up.” But that was considered the healthy choice options. Oatmeal was on there as well. And I looked at my husband, I was like, “Look, do you see this list? How crazy is this? This is going to just drive…” Somebody who probably is concerned about their metabolism and concerned about their blood sugar levels are going to potentially choose something here that’s going to just do the opposite of what they were hoping for as a healthy choice. And so really, really way in which that we’re looking at what are healthy foods, there’s definitely a lot of misinformation.

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

Yeah. Absolutely. And for anyone listening, it’s just certainly I’m done definitely not anti fruit. I eat a lot of fruit and I enjoy fruit and it’s not like I think it’s something that’s going to inhibit people’s weight loss goals. It’s just that different fruits affect different people in different ways. And some fruits just happen to be a lot more impactful for the glucose response than others. And that could vary between you and I. We could both eat these same fruit and have totally different responses because of our microbiome or this or that. It’s really just about dialing again for your own body. And then of course, figuring out how to pair those foods properly, such that you’re not getting the full glycemic impact of the meal.

Dr. Casey Means (00:17:29):

So one of the reasons I think that grapes potentially score so high in terms of glucose response is that we, well, one, they have low fiber and we know fiber blunts glucose responses, berries have a ton of fiber, grapes don’t. We also often tend to eat fruit with other things. Like we eat apples with almond butter, we eat berries with yogurt sometimes or with chia pudding, which has fiber and fat and protein. But we are usually just popping grapes. We’re not eating them with something else and it’s mindless. And so I think that’s a testament to why some of these things are surprising, is because of the context in which we eat them.

Dr. Casey Means (00:18:08):

So I certainly, one of my biggest takeaways from seeing what we’ve seen in the Levels’ dataset and also in my own personal experience is don’t start the day with a sweet breakfast. Biggest life hack, easiest life hack, switch to a savory breakfast, whatever that means to you, eggs and avocado and greens, tofu veggie scramble. There’s a lot of different options. But the sweet breakfast were a big portion of our lowest 40 scores on our Levels’ dataset. Things like donuts, pastries, croissants, oatmeal, a lot of cereals, all were in that bottom chunk from the large dataset which is basically saying the highest glucose responses. And in the best scoring, top 40 for the best scoring, it was a lot of savory breakfast like the eggs avocado, things like tofu scrambles, things like that. So definitely one of the takeaways we saw in the dataset.

Dr. Mariza (00:19:08):

I agree, savory breakfast all the way. Really savory, lots of things all the way. Because breakfast isn’t even where… We’re more insulin sensitive in the morning than we are in the evening. And so I have found that the evening is where I have to be the most mindful. I used to think that having sweet potatoes with my salad and sweet potatoes are a big, big red flag for me. And so that was one of the things where we really scaled back on the sweet potatoes in our house, but I realized, at least for, and I know every woman is different and every person is different, but especially anything after 5:00 PM, it’s protein and veggies for this girl. Because anything else, girl, ooh. On Levels I could be at 99% that day, and then I head into dinner and I make one wrong move and I jump into the 80s. I go into 80. I was like, “Oh. That was so close.”

Dr. Casey Means (00:20:09):

I think it’s a really good take home point. I mean, I feel bad. For people listening, they’re like, “Oh, wait, you just said, I have to have a savory breakfast and now I have to have a savory dinner.” And like you said, it’s like a lot of savory everything is a good policy. And then just really being thoughtful about where you’re eating your sweet things. If it’s fruit, eat it around a time when you’re active during the day, when you know you’re going to be able to take that 15 minute walk after that snack.

Dr. Casey Means (00:20:34):

And if you’re going to do it, which is fine, fruit has wonderful, healthy benefits or maybe it’s the piece of whole grain toast or whatever the higher carbohydrate thing that you’re eating is, just make sure you’re packaging it well. Eat it with the fat protein and fiber. Make sure if you can, that you can take a 15 to 20 minute walk after it such that you can burn through some of that glucose and front load it potentially into the earlier part of the day. Since like you said, we tend to become a little bit more insulin resistant at night.

Dr. Casey Means (00:21:03):

But I’m definitely with you. I have definitely shifted towards my evenings becoming more of my fat and protein and veggies part of the day and really try and avoid the carbs at night, because they’re just going to pack a bigger punch for the exact same amount of carbohydrates that I could eat earlier in the day, I’m going to have a higher glycemic response at night. And so it’s like you’re getting a double whammy there.

Dr. Casey Means (00:21:27):

And if I do, if I do happen to be eating a meal that does have a little bit higher carbohydrate content, I always lean on the walk. Just a quick walk after dinner, a nice stroll around the block can just totally do wonders or sometimes I’ll even jump on the Peloton for 20 minutes after dinner, just do a light and just clear, activate those muscles. It’s the biggest glucose sync we have in the body, pull some of it out of the bloodstream and then it’s not going to be bouncing around quite as much throughout the night while you’re trying to sleep.

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

But my brother has been a Levels member now for a long time, and it’s been interesting to see, he doesn’t have a huge nutrition background, but it’s been interesting to see his diet. And he doesn’t love cooking, but now after using Levels, basically, his plate for dinner is three quarters vegetables. So he’ll throw an entire package of organic broccoli in the air fryer with a tiny bit of olive oil and then chicken or salmon or tofu. And it’s so easy for him. Every night, it’s a different three quarters of the plate vegetables, Brussels sprouts, broccoli, sauteed spinach and then his pasture raised chicken or Omega-3 rich salmon. And it’s like, that’s now his zero glucose response, gets lots of phytonutrients and protein and Omega-3s and doesn’t even have to think about it.

Dr. Casey Means (00:22:39):

But before it’s like you’re always wondering, “Well, what starch should I have and what grains should I have?” And this and that. But if you get into the mindset through the glucose lens on your dinner, it actually makes it pretty simple in a lot of ways. And you can, of course have… Most of my dinners have many, many ingredients in them. So that’s just an example. But just being able to dial in and knowing what works for you, I think has been pretty liberating for him and many of our members.

Dr. Mariza (00:23:07):

Oh, I absolutely agree. And it does, it keeps it really, really simple for dinner. You’ve got your protein, you’ve got your veggies, whether it’s a salad or you’re roasting them or we’re getting into the fall season where everything’s going to be getting roasted. You can keep it super simple and keep it super healthy, and you’re not going to bed with this major spike heading into the bedtime, which can totally mess with your sleep and can totally mess with mood, cravings. Could lead you to having a craving later on in the evening. I mean, there’s a lot.

Dr. Mariza (00:23:36):

And so for us, one of the things that we do is we try to eat pretty early, one, because we have a baby and he has a bedtime at 7:00. And so we got to start winding him down at 6:30 anyway. So a lot of our things are around the bay around Kingston. And so we try to have dinner before 6:00 and that really is a good place for me and my husband, Alex. I’ll be honest with you girl, his blood sugar was not as dialed as my blood sugar was and I was so surprised. I just thought he was going to kick my butt left and right. And that was not true. And so I was like, “Okay, good to know. We are on the same page. We both got to do the same thing.”

Dr. Mariza (00:24:14):

And so we do dinner early. If we can get a walk in, because we can’t always get a walk in because of the baby. And so we’re really mindful. But then we always allow ourselves three to four hours before bedtime from our meals so that we can really give our brain the car washing that it deserves at nighttime as well. But yeah, that was the big takeaway was, let’s keep this simple, proteins, all kinds of yummy veggies. I’m like the salad master in the house. And that has just done wonders for us. And since I’m breastfeeding, I know that Kingston’s getting a lot of that good nutrition as well. Again, because we don’t have a lot of wiggle room on the walking or me hopping on the Peloton, which is right there, we really dial in the dinner to make sure that we’re not seeing a big blood sugar increase. We’re not going above 110 or 115 milligrams per deciliter.

Dr. Mariza (00:25:02):

But there are people who are going to go out to dinner. There are people are going to have those potatoes with their meal. So talk to me, I wanted to segue into the Coca-Cola experiment and they’re going to… People are like, “You know what? I am having my dessert cupcake at lunch or whenever we’re going to do it.” And I’m mindful, I’m making that decision. I’m going for it. But they have that opportunity to potentially, again, leverage those muscles to bring up that glucose. Talk to me about the Coca-Cola study and what was one of your biggest findings for blunting a blood sugar response.

Dr. Casey Means (00:25:37):

Yeah. So we did this experiment at Levels. This was not a research experiment, this was not a double-blind, placebo-controlled IOB experiment, this was just a in-house experiment that we did. We’re doing a lot of these because people are really interested in doing these group challenges and learning what happens when you do different variables and permutations. So this one was about what happens when you eat something that you know is going to raise your blood sugar and then do it again under as similar conditions as possible, but take a walk after it. And so people in our company volunteered to do this, which was to drink a 12 ounce can of Coca-Cola which of course being a glucose monitoring company, no one in the company was thrilled to be drinking a can of soda. It’s been decades since I’ve had a can of soda.

Dr. Mariza (00:26:24):

Decades.

Dr. Casey Means (00:26:25):

It was actually very interesting.

Dr. Mariza (00:26:26):

I think I would’ve said no. Girl, I cannot stand that stuff. It’s so syrupy.

Dr. Casey Means (00:26:32):

Oh, gosh. I mean, I don’t want to be too dramatic because it’s going to make it sound like I’m totally afraid of sugar. But I mean, when I opened that can and was about to chug it, I had a little anxiety. I was like, “This is more sugar than I’ve had in one sitting in a really long time and what’s it going to do? And how’s it going to feel?” The funny thing is we actually, the first permutation of the experiment was that everyone’s going to do an oral glucose tolerance test. So everyone, we actually shipped them to everyone in the company who had volunteered to do this. And these are the 75 gram glucose drinks that of course people in pregnancy are given to see if they have gestational diabetes.

Dr. Casey Means (00:27:11):

So then you did these on your own time, you choose a day to do each version of the experiment. And the first three people who did the Glucola experiment with the 75 gram glucose drink, it affected them so much that two of them had to take the rest of the day off of work. They were so exhausted. They had such a big glucose spike and then crashed that they were, literally one of them was shaking, one of them was really tired. And I mean, again, I know people are going to be listening to this saying, it’s just a sugar drink. This is probably a little bit of like psychosomatic, but that’s a lot of sugar and these are people who are not dramatic in any way, shape or form and really had a physical effect. So it’s crazy to think that every pregnant woman is going through this experiment, but we actually nixed the rest of the team doing Glucola experiment and switched to a can of Coke, because it’s a lot less sugar actually than that.

Dr. Mariza (00:28:10):

And at least it’s fizzy.

Dr. Casey Means (00:28:11):

I know.

Dr. Mariza (00:28:12):

A little distraction. It was a year ago that I did the glucose tolerance test and it was so disgusting. It was so disgusting. And I get why we have to do it. But yeah, it was… I remember my doctor, I think I told you too, is that my doctor had told me that I wasn’t going to pass the one hour. She was like, “You’re going to have to do the three hour.” She goes, “Because you’re 41.” She’s like, “No one passes the one hour.” And I was like, “Oh, hell. No.” I was like, “I am passing that one hour test. I’m not doing…” Because the three hour you have to drink even more of it. Or you have to do it in multiple segments. And so I was like, “I’m passing this test with flying colors.”

Dr. Casey Means (00:28:50):

Oh, yeah.

Dr. Mariza (00:28:51):

And girl, you know I did.

Dr. Casey Means (00:28:52):

Of course, you did.

Dr. Mariza (00:28:53):

Because I had been dialing my insulin. I mean, my blood sugar levels for so long. And she didn’t know that. [crosstalk 00:28:58].

Dr. Casey Means (00:28:58):

If anyone’s going to pass this test, it’s going to be Dr. Mariza Snyder, truly. But I bet they were very impressed.

Dr. Mariza (00:29:05):

She was very impressed. Yeah, I remember. I was just so grateful. Because I’m like, “I’m not doing this a second time. And then in more of it.” So I can imagine, no surprise that you had employees that got sick. It’s really awful.

Dr. Casey Means (00:29:19):

And they’re also, I think part of it is that people were starting, because it is a glucose monitoring company and everyone’s thinking about their blood sugar all the time, this is a group of people who’s very sensitive to sugar because they’re just not exposed to it a lot. And so I can imagine there’s something of that in it too, where if you’ve been eating a little bit more sugar at baseline, you might be used to how that feels. But regardless we switched to Coke, which is still around, I think around 39 grams of sugar. And some of that, it’s partially high fructose corn syrup and high fructose corn syrup is usually some blend of something like 55% fructose, 45% glucose. It varies based on brand of high fructose corn syrup, but basically you’re getting somewhere in the 20 to 30 grams of liquid glucose in the Coke. So the idea was to chug it and then see what happens.

Dr. Casey Means (00:30:14):

And so for our team, the median glucose peak for the Coke alone was 162 and most people were starting in the 70s to 80s. So it was a very large, very quick peak. I actually peaked after only about 18 minutes, which is amazing to think that, first of all, with the continuous glucose monitor, we’re not checking blood glucose, we’re checking interstitial fluid glucose, which means that the glucose actually has to seep out of the bloodstream into the fluid around the cells. And that’s usually like a five minute delay. So you’re drinking this and it’s going through my GI tract, being digested into the bloodstream, into the interstitial fluid, all in 18 minutes. Amazing. Peaked and then came crashing down. So it was 162 for the no walk scenario and 132 for the walk scenario. So we saw a median of a 30 point difference and that represented a 33% decline just from taking a brief walk after it.

Dr. Casey Means (00:31:15):

So really just drilled home a point that we’ve seen in numerous research studies, which is basically the power of a walk. It doesn’t have to be a walk. It can be anything. The idea is that muscle is just this beautiful thing in our body that can essentially take up glucose in the absence of insulin, which is amazing. Almost every cell needs insulin to bring glucose into it, but muscle, just the sheer contractions of muscle, it can take glucose in for use independent of insulin. So it’s this magical part of the body that can help you bring down your blood sugar, just all by itself.

Dr. Casey Means (00:31:51):

And that’s why a walk, even though it’s gentle, you’re moving all these major muscle groups, the quads, the hamstrings, it all has to be activated. So you’re using those, but also why resistance training. So lifting weights and strength training has been shown to be so powerful for overall metabolic health because you’re growing the organ in the body, essentially that is a glucose sink. And so just 24 hours a day, you’re having to feed that muscle, whether you’re using it or not. And the more you have the better it is. So certainly just can’t pound home that message enough of how movement, even if it’s gentle walking after a meal or throughout the day, two minutes here or there during your workday or resistance training or high intensity interval training, all these things have been shown to lower our glucose levels and really make a much bigger difference than I’d expect. I mean, a 33% difference just from taking a walk is not insignificant over time.

Dr. Mariza (00:32:49):

No, not at all. And I can hear people taking this away of like, okay, if I’m going to have my gelato, let me walk with it.

Dr. Casey Means (00:32:57):

Yeah.

Dr. Mariza (00:32:57):

Or if I’m have that cupcake, let me do a workout afterwards. And there’s a lot of debate. One definitely breakfast that is savory. We discussed that. And I’ve had so many people ask me, “Do I work out while I’m still fasted before I break my fast in the morning or do I work out after I have breakfast because I’ve broken my fast and my blood sugar is going to go up depending on what it is that I consumed?” And there are definitely different camps on that. But as I’ve thought about it myself and I’ve looked at my CGM, I’ve tested this, my own little challenge. It has really served me to work out after I eat because it just helps to… Or take a walk. And again, I’m not eating anything… It’s always savory too, but it just general just helps. And it’s not a major shift or difference, but it’s a little bit of a shift. And so I don’t know if you guys have looked at any of that as well of when to work out.

Dr. Casey Means (00:33:51):

Yeah. There are different ways to look at this question. And the answer is there’s benefits to both. And I would actually probably recommend some combination of the two on different days. So the benefit of working out in a fasted state. So this would be like maybe first thing in the morning before you have breakfast. The beauty of this is that it helps with metabolic flexibility in a way that working out after meals doesn’t. And the reason it aids and metabolic flexibility is because overnight, so in our bodies, we have different banks of energy. Our circulating glucose is our quickest form of energy. It’s in the bloodstream, we can just pull it out really quickly. Then we have our liver, which stores about a few hours of glucose for use. It’s basically like our debit account, it’s like a short-term checking account to pull money out. And that is like two or three hours of cardio training or more like if you’re just resting overnight, you’ll deplete that stored glucose, which is called glycogen.

Dr. Casey Means (00:34:57):

And then we have this energy in the body that’s stored as fat, that has to be basically broken down by the mitochondria, and that’s our like long-term savings. And that based on how much body fat you have, you might have anywhere between two weeks and a year worth of stored fat. And actually there are people who have fasted for 387 days, which I’m not recommending to anyone, but that’s how much energy that some people have stored in fat in the body.

Dr. Casey Means (00:35:24):

And so what’s happening with a fasted workout is that we are depleting that liver glycogen overnight. And then let’s say we have a little bit left over in the morning, we might burn through some of that when we start working out and then our body has to go to fat for energy. So we are flipping the switch from glucose burning to fat burning intentionally, and we’re pushing our body to use its long-term storage and we’re mobilizing fat. And that is metabolic flexibility. Being able to switch between glucose burning and fat burning really at will based on different conditions.

Dr. Casey Means (00:35:59):

And the average American is rarely ever burning fat because we’ve been told to eat six small meals a day. We’ve been told that we should get six to 11 servings of grains and carbohydrates. It’s the base of the food… It was the base of the food pyramid. 65% or more of the average American diet comes from ultra refined grains and sugars. You are constantly giving your body a glucose source. So why would you ever have to, I mean, it would be very hard to deplete that and then move into fat burning. So we’re not metabolically flexible and that’s a huge root cause of our chronic disease epidemic, our metabolic epidemic. The fact that 88% of Americans have at least one biomarker of metabolic dysfunction. We want to be metabolically flexible.

Dr. Casey Means (00:36:40):

So when I’m working out in the morning, let’s just take a day, an example, let’s say you stop eating at 6:00 PM and you’ve had a bit of a savory fairly low carb dinner. So you’re not even overloading your body with glucose. So your liver is pretty full, but not overly. It’s not filled with the glucose that you had for dinner and dessert. You burn through that throughout the night, you’re burning through your stored glycogen. You’re getting that tank low overnight. Then you do your 45 minute Peloton workout in the morning, you deplete it. You’ve started going into fat burning. And then let’s say you wait another hour or two to have breakfast.

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

What you could do at that point is check your ketone levels. So first thing you can do is look at your continuous glucose monitor. And one of the reasons I like wearing a continuous glucose monitor when I’m doing fasted workouts, is that it shows me that my glucose is actually fine and I’m not going hypoglycemic. And the reason is because the body, even if it uses its stored glucose in the liver, the body makes glucose from other things like protein in the body, in a process called gluconeogenesis to keep your blood sugar essentially in an okay range. If it goes too low, that’s a problem, but your body knows how to compensate to basically keep it at a safe level. So I’m looking at my continuous glucose monitor and saying, “Okay, I’m not going super low. I’m okay. I can do this workout.” It’s reassuring in a sense. And then I check my ketones, which you can either do through breath or through blood and that’s the byproduct of fat burning.

Dr. Casey Means (00:38:08):

And what I find is that when I fast overnight, do my fasted workout and then check my ketones, my ketones go up. And that to me is proof that I have done something that is metabolically flexible.

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

So that’s why you would do the fasted workout. And I just caveat out want to say, certainly ease into it. You don’t want to go from never having done a workout without a snack, to all of a sudden running five miles without having a snack beforehand, because if you’re not metabolically flexible and your cells, aren’t adapted to burning fat, it’s going to feel like crap. So I would just ease into it. Maybe start with lower carb snacks before your workouts, see how that feels then ease into a much smaller snack. Then maybe just a handful of nuts before a workout and then start seeing how it feels to really actually do it first in the morning with no snack. And of course, talk to your doctor before doing anything like that. So that’s the purpose of the fasted workouts.

Dr. Casey Means (00:39:03):

And then the post meal is more about just reducing glycemic variability. So we do not want huge ups and downs swings on our glucose throughout the day. That’s bad for health. It creates inflammation, oxidative stress, glycation, promotes insulin release. We don’t want any of that. We want to keep our glucose more flat and stable throughout the day. And that’s where walking after a meal or even maybe dancing around the kitchen after dinner, whatever you want to do to just move your muscles, that’s what that’s really helping with, is the glycemic variability.

Dr. Mariza (00:39:36):

I so appreciate you explaining this. For a long time I was definitely recommending women to create more of that metabolic flexibility, especially in their 30s and 40s, because I feel like if we’re not able to make that switch, especially with our inability to focus to have great brain function and women are telling me their memory issues. But then I know that a lot of women are still working on stabilizing that blood glucose. And I was like, “Oh, my gosh, if I’ve been misleading women by saying, “Always work out fasted so you can deplete those reserves and move into fat burning mode.”” And then maybe they were seeing a spike after breakfast. So now having that, choosing maybe a couple of days, you are working on the metabolic flexibility and the other days working on stabilizing that blood glucose as well. So I love that, having flexibility within the two as well, they’re both equally as important.

Dr. Casey Means (00:40:28):

Yeah. And they both do different things. So I guess on my absolute ideal day, it would be trying and get out for a walk or do a workout in the morning before eating and then take two to three minute walks every half an hour throughout the day. Literally just get up from my desk and walk around the house for one to two minutes and then maybe take a 10 minute walk after dinner. That to me is pretty much at this point, just knowing what I know about glucose, that would be be an optimal day. So it’s nothing crazy. And it’s nothing out of control. It’s just timing things in a way that’s going to optimize all aspects of my blood sugar, but isn’t taking maybe more than cumulatively an hour during the day.

Dr. Mariza (00:41:15):

Love that. And I think the idea of one, and there’s so many other side benefits to this, there are the benefits of de-stressing, just getting out in nature, just throughout the day just. Because I so often, I think we are under the impression that we have to do these big time workouts, but really in terms of stabilizing blood sugar levels, I think what the big thing is, is that we’re able to take those little mini breaks throughout the day and get those walks in, that’s what’s going to help stabilize us more than doing that big, big workout in the morning or in the evening, whenever that is.

Dr. Casey Means (00:41:49):

Absolutely. Yeah.

Dr. Mariza (00:41:50):

All right, Casey. That was amazing. I just love breaking down the ideal of what works and it just feels so much more doable than what we’ve been told in the past. And so what I want to do is I would love to segue into a little bit of some of your findings around how blood sugar levels and stabilizing our blood sugar and how that impacts our hormones as a whole. And one of the conversations we were having is one of the things that I see a lot from my ladies from my community is that it’s really, our metabolism is one of the major contributors to why we don’t always feel so great. Why we’re struggling with exhaustion, why we’re dealing with brain fog, why we’re dealing with that stubborn weight gain, especially that belly fat. And in our modern medicals system, you show up with those symptomology and it’s like, oh, maybe you need estrogen or maybe you need this. And we’re not really looking at the metabolic piece. It’s like put over here of let’s just wait and see if you head into prediabetes. We’re not connecting the dots there.

Dr. Casey Means (00:42:50):

Absolutely. One thing I’m so excited about with continuous glucose monitoring and more broadly, the advent of being able to take our metabolic health into our own hands through personal data is that women uniquely need to be on top of their blood sugar, in different ways than men. And in a sense, almost more than men. Because blood sugar of dysregulation affects women at essentially all parts of their life cycle in ways that it will never affect men because of our unique female hormones.

Dr. Casey Means (00:43:24):

So what I mean by this is in our 20s and 30s, it’s affecting our fertility. As you’ve talked about on your podcast. I know your audience knows this already, but PCOS, polycystic ovarian syndrome, leading cause of infertility in our country. A disorder of insulin resistance and really fundamentally has roots in metabolic health and is interlinked with it and can be improved by stabilizing our blood sugar. Menstrual irregularities and how we feel during our cycle blood sugar changes throughout the menstrual cycle and knowing how it changes in the follicular phase and the luteal phase can help us eat in a way that makes us feel better during that time.

Dr. Casey Means (00:44:03):

And then of course, going into menopause, we know that hot flashes are related to blood sugar spikes and potentially hot flashes may cause blood sugar spikes or blood sugar spikes may cause hot flashes. And it looks like there’s a bidirectional relationship that hasn’t fully been elucidated yet, but we know that people of better metabolic health have fewer menopausal symptoms.

Dr. Casey Means (00:44:23):

Then we get into post-menopause. And we see what happens with women, which is that our rates of diabetes and overweight and obesity start going up and surpassing men after menopause because we lose the protective effect of estrogen on our metabolic health. And then we get into later life and women have twice the rates of Alzheimer’s dementia as men. And Alzheimer’s dementia is being called type 3 diabetes, and we know is deeply related to our overall metabolic health.

Dr. Casey Means (00:44:51):

So there’s really no point in the women’s life cycle that it’s not important to make sure we’re managing our blood sugars to make us feel better and cognitively be at our best. So that’s one area where the advancing technology I think, is going to uniquely help women in a way I’m really excited about. And also just women, I mean, it’s not like managing your glucose is going to be the cure all for all of this. We’re still going to go through menopause. It’s still going to have challenges. There’s still going to be infertility in cases of PCOS that can’t be solved by getting blood sugar under control. We still may have PMS, but a lot of these things, I think we can feel like it’s totally out of our control or we have to go towards hormones or whatever it is to manage these things. And to at least know that there is something, a knob that we can turn, a lever that we can pull to at least in some way impact these things. I think that’s pretty empowering in its own right.

Dr. Mariza (00:45:48):

I think it’s extremely empowering. I think that again, so often we’re just told, “Oh, go take these hormone replacements or go take the Xanax or go get on birth control.” And a lot of it, there’s a root cause with our metabolic health or dysfunction, one or the other. And we’re not looking enough at that. And so I think as we start to be able to manage our own metabolic health, our own blood sugar, I think we’re going to be able to identify at least one of the root causes and be able to get that under control.

Dr. Mariza (00:46:18):

I just did an episode on fatty liver disease and that the biggest growing population for fatty liver disease are women in menopause and not men. A lot of us, the assumption is it’s men, it’s got to be men. But it’s not. Again, I think there’s even just more sensitivity there, but once we lose estrogen, we just become more insulin resistant and that leads to a fatty liver and that we have the highest propensity for fatty liver disease in that particular population.

Dr. Mariza (00:46:48):

And so besides Alzheimer’s, there’s other concerns that we got to be looking at. And the more that we know in terms of what’s going on with our body on a daily basis, the better that we can make real time actionable decisions about our bodies. And so I just wanted to bring that to light, because as you mentioned, as young girls, we’re starting to see this as well. We’re talking about in their teenage years, we start to see PMS symptoms and we see symptoms of PCOS. We just start way earlier than we think. And we’re not looking at the food component at all for these girls.

Dr. Casey Means (00:47:22):

Absolutely. And I did not know that about fatty liver. It’s not surprising given that that is when women start, what I call going off this metabolic cliff after menopause and that we can absolutely intervene upon by being more in control of our metabolic health before menopause and during menopause. Use it, not as something that’s scary, but as this opportunity to really get on top of it. And unfortunately the average doctor is not going to be bringing this up with a patient. They’re not going to be saying in these appointments about maybe menopause symptoms, “Hey, something we really have to dial in right now is focusing on metabolic health because you are at higher risk starting now for these things.”

Dr. Casey Means (00:47:59):

And so if you’re not going to hear it from your doctor, you can hear it from both of us today, this is something to focus on. And for people who don’t necessarily have access to a continuous glucose monitor or they’re not using one, that’s fine. I mean, there are so many, just like listening to podcasts like yours and others who are talking about ways to manage metabolic health with or without the monitoring is important. I mean, if you’re not using a CGM, you could just use a fingerprint glutometer as well, and just see where you’re fasting glucose, make sure it’s creeping up into that pre-diabetes range or that high normal range. And if it is, maybe it’s time to dial in a little bit more on diet.

Dr. Casey Means (00:48:37):

And one of my favorite studies about diet and women’s health and metabolic health was one about a PCOS intervention, that’s applicable to everyone, I think. I think it was from 2019, and it was an interventional study looking at a group of women who had PCOS. They checked all their hormones, all their metabolic markers and they put them on a 12 week intervention, which was a Mediterranean ketogenic diet. And so this is a low carb diet, but what I loved about this study was it was a really healthy, healthful diet. It wasn’t just about what you’re taking out of the diet, low carb, it was actually really focused on nutrient density.

Dr. Casey Means (00:49:17):

So it was actually mostly plant based and it was Mediterranean in the sense that it was tons of antioxidant rich, low carb, green, leafy vegetables, and colorful vegetables. It was nuts, seeds, olive oil. And then actually just a moderate amount of animal protein in the form of poultry grass-fed meats and fish. Of course, Omega-3, anti-inflammatory rich fish. So it was quite a healthful dietary pattern, not just eat low carb at all costs, even if that’s all processed low carb bars and shakes and stuff. It wasn’t that, it was actually a new nutrient dense diet. And in 12 weeks, the women in this study transformed. Their hormone levels completely, for many of them normalized. Their metabolic markers greatly improved. Several of them lost up to 20 pounds. It was very significant.

Dr. Casey Means (00:50:10):

And so they didn’t use a CGM, they didn’t use a continuous glucose monitor. It was really just focusing on these dietary patterns that really minimize the refined carbohydrates, the fructose in the form of high fructose corn syrup, the refined sugars, the excess of grains, and really gets down to the basics of everything you’ve been talking about, which is the vegetables, the lean, the protein, healthy fats, things like that.

Dr. Casey Means (00:50:38):

So maybe we can link that article, and I think it’s just a good starting point for a lot of people of that’s the type of dietary pattern that’s going to be good for lots of different people at different… And it doesn’t necessarily have to be ketogenic in the sense of five to 10% of calories as carbohydrates, which is very, very low, but it’s a good direction to lean in, if we’re going to be thinking about our macro nutrient ratios.

Dr. Mariza (00:51:05):

I agree. I have a 14 day women’s hormone… A detox that I run men and women through, mostly women. We’ve done over 5,000 women or people now, and we’re getting ready for the fall. Because I always want to set people up for success in the holidays. Because it just can go crazy. It can just get out of control if we don’t have those really beautiful habits in place or even identifying sugar. Some of us just can’t even tell. Don’t know. Even my mom and my sister can have the same thing, I’m like, “Oh, my God, there’s so much sugar in that.” And they’re like, “Really?” They’re just like, “No, there’s not.” I’m like, “Yes, there is.”

Dr. Mariza (00:51:39):

And so even in 14 days, we’ve seen labs come back where hemoglobin A1C has dropped under pre-diabetic. From a seven to like a 5.5 and we’ve seen such incredible things. And it’s literally the diet you described to a T. It’s all tons of plants, lots of green leafy vegetables, color with the rainbow, healthy fats and lean proteins like fish and poultry. And I think we even take red meat out of it in this particular one. Because it’s just, sometimes it’s worth giving the body a little bit of a reset. But it’s amazing, 12 weeks is a transformational amount of time. 90 days, are you kidding me? You’re talking about a totally different person. But even 14 days, 21 days or 30 days, you’re just identifying when you change that diet.

Dr. Mariza (00:52:24):

It’s really fascinating to me though, Casey, how many people it’s a hell no. They’re like, “14 days, and you want me to what? You want me to give up sugar and corn and processed foods? And it’s grains entirely? And for 14…” It can feel so hard to make that shift. But those who decide to do it for 21 or thirty or even 14 days, it’s a game changer. And I can’t speak into nutrient dense food with or without the CGM. Although girl, I am keeping that CGM on to run the full 14 days because I did the last seven the last time, but I want the full thing. I want to see the full program on the CGM, but I had seen other people’s labs. I had seen all of that, but I wanted to see it for my self and I was in optimal range the entire time. Because it’s what it’s designed to do.

Dr. Mariza (00:53:15):

But yeah, I mean nutrient dense diets with or without a CGM, oh, my God. It’ll literally transform your life. And it’s just a matter of being willing to do it is what it is. I reversed my Hashimoto’s doing that.

Dr. Casey Means (00:53:28):

Ugh. It’s so amazing.

Dr. Mariza (00:53:30):

I just wanted to speak into just seeing those results myself in people in less time than 90 days.

Dr. Casey Means (00:53:38):

Oh, yeah, absolutely. I mean, I’m with you. I have had several patients who have in 30 dropped their triglycerides 100 points. I mean, because when you were… Triglycerides are really that marker on that cholesterol panel, what’s the refined grains and sugars? It’s to me, this proxy metric of what’s going on with the carbohydrates and the sugar and the body? And so when you eliminate everything you just said, the sugar and the refined grains and the corn and the starchy vegetables for even a short period of time, it plummets. And that is so motivating. Because you’re like, “Wow, this lab test just transformed.” And we know triglycerides is very related to development of diabetes down the road, heart disease, et cetera.

Dr. Casey Means (00:54:22):

And so it’s fun to see these things shift and I think what you speak to with your program, like the power of community and doing this with support can make a huge difference. And also just figuring out the foods that are alternatives to what you love that are not necessarily have the things that are going to be landmines. And so one thing I love that we’re publishing a lot on the Levels blog is essentially swaps. You don’t have to give up everything you love or what’s culturally resonant for you, but there’s ways to modulate it, to just make it so much better. And I’m sure a lot of people would roll their eyes when they hear this, because it’s like it’s not the same, but delicious mashed cauliflower versus mashed potatoes, you can make that really good. I have had really bad mashed cauliflower. I’ve also had Vitamixed cauliflower that’s whipped with cashews and nutritional yeast and freshly roasted garlic that literally is better than any mashed potato I’ve ever had in my life. So it’s like, yes, I understand it can be gross, but it can also be really good.

Dr. Casey Means (00:55:27):

So learning how to make some of that comfort food with alternative ingredients, eat flax crackers instead of regular crackers. I make flax tortillas instead of regular tortillas and dialing in a few of those favorite recipes that you’re not reaching for that thing that is your comfort food, I think there’s a lot to be said for that too. Simple swaps, I mean, it almost seems too simple, but if you can get a few of those recipes dialed in, I think it can really help stay consistent. And so we try and put a lot of that on the Levels blog, just as a practical way of helping people make that step because giving up this stuff is hard, especially when it feels like you’re giving it up forever and it’s something you really love.

Dr. Mariza (00:56:11):

Yeah. And it takes time. Where I was at 25 to 30, from 35 to 40, there’s foods I would never, ever consider today that were maybe considerable a decade ago. And then you have to realize it over time as you make these swaps, someone would say to us, someone listening to this, it’s like, how dare they even compare mashed potatoes to mashed cauliflower. But we are just like, but that’s the only option for me. You know what I’m saying? And it’s my favorite. And I love it because it’s what I’ve been doing for so long now. You know what I’m saying? And so you make those swaps over time and all of a sudden, that becomes where you’re at in terms of how you eat.

Dr. Casey Means (00:56:53):

And you end up craving it.

Dr. Mariza (00:56:55):

Yeah, exactly. Oh, I’m like, “I can’t wait for Vitamix,” I swear I love Vitamix cauliflower just whipped up and adding all the goodies, especially adding rosemary to it. I can go on, we do all kinds of fun things with it, and it can take a little minute, but just those little steps moving in that right direction, then it ultimately becomes a thing that that’s what you do.

Dr. Casey Means (00:57:16):

Absolutely. It takes time. It takes time and I’m a big fan of certain direct to consumer food companies out there that help you on this journey. One that I’ve used and recommended to a lot of my patients before is a brand called Daily Harvest, which is this, they ship you these things called Harvest Bowls and they’re basically everything we’re talking about. It’s grain free vegetable forward comfort foods. There’s a mac and cheese, but instead of macaroni, it’s broccoli and cauliflower. Again, people and instead of cheese, it’s a butter nut squash sauce with a lot of nuts.

Dr. Casey Means (00:57:48):

And I think if people are like, “I don’t even know where to start. I don’t cook. I get most of my food out. And these swaps sound gross,” consider investing for just a short period of time in one of these types of services. Daily Harvest is the best one that I know of. There’s also Daily Dose that does a ketogenic plant forward, direct to consumer thing. Even if for two weeks or a month, as an investment, it can sometimes spark ideas and, “Okay, this actually tastes really, really good. I can get around to this.” As opposed to having to start by what? Going to the grocery store, buying all new foods, figuring out how to cook them, it can be really intimidating. So that’s one tip that I’ve given several patients that has helped them get over that initial hump of getting into some of these habits.

Dr. Mariza (00:58:35):

Yeah, that makes so much sense just to get a sense of how it works. Yeah, absolutely.

Dr. Casey Means (00:58:38):

And that it tastes good.

Dr. Mariza (00:58:40):

Yeah. Well, my audience, my ladies want to know where they can get a Levels CGM. And so there’s potentially an opportunity for me to share a cut the line because I’ve been telling my people for a long time that Levels is still in beta mode, there’s a lot of awesome things that they’re working out. But I know that there are some influencers that get a skip the line code and I believe I’m going to get one for this episode. I’m super excited.

Dr. Casey Means (00:59:07):

Yes. Yes. So we will figure out what the… It’ll be levels.link/ probably essentially you or Dr. Snyder, something like that, but we can link it in the show notes and your audience can skip the wait list. Because we are still in a closed beta program for Levels. But yeah, for people who are interested in trying CGM, basically the Levels program is a one month program where it makes it really easy to get access to a continuous glucose monitor and then interpret the data. So we pair you with a physician who evaluates you for this monitor because they still are prescription only in the United States. They’re over-the-counter everywhere else in the world, but in the US they’re prescription only. So a brief telemedicine consultation. They’ll be shipped from a pharmacy to your home and then the Levels software, which helps you interpret your data. And then of course the whole ecosystem of helping you figure out better options and everything we’ve been talking about today. So we’ll link that.

Dr. Mariza (00:59:58):

Yay. And I just want to let you know my mama has one and we are comparing, right now, she and I, we’re about 20 years apart. We’re going to do an episode together the two of us, about both of our findings. And-

Dr. Casey Means (01:00:10):

Oh, cool.

Dr. Mariza (01:00:10):

… just as a mother daughter. Because I am literally her genetics. You know what I’m saying? I look like… And so it’s been so fun. She texts me, she sends me screenshots of her day. And so we’re scheduling that in the next couple of weeks after she’s got a full month of data so that we can do a little comparable, the two of us.

Dr. Casey Means (01:00:26):

That is amazing. And we just released a new feature in the app called Community Glucose View, where you can actually see each other’s data in the app if you want to. So we’ll have to make sure you’re hooked up with that new feature.

Dr. Mariza (01:00:38):

Yeah, absolutely. Well, hey Casey, honey, thank you so much again for coming on, girl. This episode was delicious. I had such a good time. I know people are going to walk away with so many major takeaways. Thank you so much.

Dr. Casey Means (01:00:50):

Thank you so much for having me on and thank you for everything you’re putting out into the world. It is just so wonderful. And I love knowing you.

Dr. Mariza (01:00:56):

Ditto. What a powerful conversation on one of the biggest epidemics facing over 130 million people in the US. Now, I have a feeling that you know at least one person in your life who is suffering from metabolic issues and you may find yourself wondering if you should focus more on creating more resilience for your metabolism. I know it’s always at the top of my mind for my health and the health of my family, especially my baby, Kingston.

Dr. Mariza (01:01:24):

So one of the things that she mentioned today on the show that I felt was super powerful is how our metabolism and our metabolic function impacts pretty much everything inside of the body. It’s literally considered one of the biggest root causes for disease. Now, if you are interested in trying the CGM and the Levels technology, I have a wonderful surprise for you. Although Levels is still in beta mode and there are like 200,000 people on the waiting list at the moment, occasionally Casey and her team give out an early access pass so that you can get your hands on the CGM and the Levels technology. And guess what? Today is that day.

Dr. Mariza (01:02:04):

So I have your backstage pass right here. I’ve got the promo code to skip the wait list line to join Levels, and the link is going to be levels.link/drmariza. Now you may not get all that. So I’m going to have the link in the show notes for this episode, for Episode 320. And let me tell you, it is one of the most game changing devices that I have ever used to understanding my health. I used it for almost six months in a row, just finished using it last month in October. And I’ll tell you what, it changed so much about how I see what I eat, what that nutrition is doing for my body. And then a lot of red flags that I would not have ever known that I thought were super healthy for me, that just weren’t healthy for me.

Dr. Mariza (01:02:49):

So if you can make an investment on your health, I think this is so worthwhile, especially as we ramp into the holiday season. It would give you a really great sense of what is going on with your body. So go and grab it. The link will be in the show notes, as I mentioned earlier.

Dr. Mariza (01:03:05):

And I just want to say thank you so much for listening into the Essentially You Podcast today. This show, as you know, is about providing tools to rock your hormones and feel amazing in your body. This episode was no exception. Now, if there’s someone in your life that needs to hear all of the amazing nuggets that we dropped today, take a screenshot, send it on over to them or share it on social media. And if you share it, definitely tag me up and hashtag hormone literacy or hormone CEO.

Dr. Mariza (01:03:33):

Now coming up next is going to be an interview with one of my dearest friends and a woman who really had such a big impact on my life, Dr. Debi Silber, we’re going to be talking about how unhealed betrayal impacts our health, work and relationships. Ooh, this is a really powerful conversation and I cannot wait for you to hear it. Until then, have an amazing day.