Trick or Treat: How Diet and Lifestyle Support Whole Body Health with Dr. Casey Means

In this episode of the Superwomen podcast, host Rebecca Minkoff chats with Levels Chief Medical Officer and Co-Founder Casey Means. Casey shares insight on the current crisis of metabolic dysfunction in the United States, and what the average person can do to take control of their health.

02:11 – The monumental crisis in the United States

The major health crisis going on in the United States at this moment is the metabolic disease epidemic.

The metabolic health epidemic affects almost every American, 88% of Americans have at least one biomarker of metabolic dysfunction. And this shows up as pretty much most of the common killers that we see in United States. So, from diabetes, heart disease, stroke, Alzheimer’s dementia, chronic liver disease, chronic kidney disease, but also impaired metabolism affects a lot of other things in our lives that we don’t really necessarily realize that aren’t quite as obvious. So, things like depression, anxiety, infertility, the leading cause of infertility in the United States, polycystic ovarian syndrome is a metabolic condition, erectile dysfunction, gout. So, it’s just really interesting this observation that I was having as I was in my surgical career of like, “Okay, there’s something more systemic and bigger going on in the body of almost everyone that we’re not really talking about.” And that is really fundamentally related to our diet and lifestyle. And most of which is preventable. This whole epidemic and trend has really only reared its head over the past 100 years. And yet, is now contributing to the chronic disease epidemic that we’re seeing that is leading to 90% of our $4 trillion healthcare costs, goes to chronic disease.

07:01 – Understanding metabolism

At the cellular level, mitochondria are responsible for generating energy in our body.

So, the way to really frame metabolism from a high level is, it is all the cellular reactions in the body that help us produce energy from food. We have 37 trillion cells in the body. 37 trillion human cells. We probably have around 40 trillion bacterial cells in our body too. But we have a ton of cells and every single one to work properly needs energy to function, to power every single thing in the cell. And that happens in this little place in the cell called the mitochondria, where we generate energy. And when that process isn’t working well, and the cell isn’t able to make the energy it needs to do all the things it needs to do to function, essentially, you get cellular dysfunction. And that when that happens in a lot of cells, you get tissue dysfunction, organ dysfunction. Ultimately, that’s what symptoms are, is when the little basic units of our body, the cell, aren’t working properly. And metabolism is core to all of that. So, it’s in every single cell. And like I was mentioning before this, the way we’re live right now, which is very unnatural compared to the rest of human history, in the sense that we’re eating food chemicals that really haven’t existed before in the forms they have, we’re putting these things into the body that the body’s really never seen before throughout evolution, in quantities that are kind of unfathomable.

09:57 – A process called glycation

Glycation is caused by the presence of excess glucose in skin fibers. This excess triggers an internal reaction with our sugar molecules.

Sugar, high sugar also sticks to things in the body, a process called glycation. And that can cause dysfunction in our proteins and various parts of our body. But the big thing that it does is it stimulates an insulin release from the pancreas. Your body needs to take up all that blood sugar into the cells from the bloodstream. And it does that by stimulating this hormone called insulin, which helps you shuttle that glucose into the cells to either be used or to be stored. And because there’s so much glucose going into our body, because of the foods we’re eating today, you end up getting these big insulin releases frequently. And what happens is the body becomes numb to insulin, because it’s like, “Oh my God, there’s so much around and we’re trying to shuttle all this glucose into the cells and the cells can’t process all of it. The mitochondria can’t process all of it. Oh my gosh, there’s so much of this.” So, the cells, as sort of a protective mechanism, become insulin resistant.

10:47 – Insulin resistance leads to metabolic dysfunction

There’s evidence that insulin resistance and metabolic dysfunction is happening in 88% of the country.

A lot of people may have heard that term, insulin resistance. It’s essentially the process by which we start to move towards having blood sugar dysregulation. So, it’s that continuous spike of the blood sugar by eating all the time, eating high carbohydrate refined foods that is causing this. So, your body’s becoming insulin resistant. And over time, it ends up releasing more insulin to try and actually drive the blood sugar into the cells. So, your insulin levels are rising throughout time. And eventually the body just can’t actually push the glucose into the cells. So, blood sugar just starts rising at baseline, and that’s when you start seeing fasting glucose go up, your doctor might say, “Oh, your fasting glucose is going up. It’s going to the pre-diabetic range, whatnot.” And that’s a real problem, because that’s really showing that our cells have essentially, in some ways, become really dysfunctional. They’re not moving glucose, which is our energy substrate, into the cell properly. They’re not processing energy properly in the mitochondria. We’re not creating the energy we need. And that’s when the downstream symptoms that can happen, again, anywhere in the body and look like almost anything, start showing up. And there’s evidence that this process, insulin resistance, metabolic dysfunction is happening in 88% of the country. So, one in 12 Americans are optimally metabolically healthy, which is kind of amazing. It’s just astounding. And it can look like anything. And the fundamental thing we need to do is improve our insulin sensitivity, improve our cells’ ability to process glucose and move it to the mitochondria.

14:47 – Testing the blood

Dr. Means shares that testing of the blood can help us understand what’s happening in the body and provide clues for how to shape our diet.

This is where testing can really help us get on top of this process that’s happening in the blood, that downstream leads to the metabolic dysfunction that we’ve been talking about and give us the ability to really shape our own diet that works for us. And I think for many of us who have felt stuck with various diets, it can help accelerate us past that sense of frustration or plateau that many people deal with on their food, or nutrition, or weight-loss journey.

19:54 – Metabolic dysfunction and women

Women are particularly susceptible to the downstream consequences of long-term metabolic dysfunction.

I think the same is happening for women all over the world. Like I’ve mentioned about infertility, polycystic ovarian syndrome is ultimately insulin resistance of the ovaries, high insulin in the body stimulates the ovaries to make too much testosterone. And that leads to the menstrual irregularities and the infertility that we see in PCOS, which is the leading cause of infertility in the country. And maybe affecting up to 25% of women worldwide now. And is growing because of the trends in insulin resistance in our country.

26:26 – Find the root cause

Dr. Means thinks that every doctor should be asking questions and thinking bigger about these things.

I think a lot of it comes down to the fact that we need to have a more root cause approach to our health. We need to be thinking not just about the symptoms we have, but what’s causing those symptoms and start treating at that level. And something that Dr. Robert Lustig, again, who wrote Metabolical, which is a fantastic book about the systemic factors that go into our healthcare crisis, and the different industry influences that are involved. These core pathways that lead to disease, there’s very few drugs that can actually affect them. It’s not like a pill can fix the complex physiology that leads to metabolic disease. There’s too much going on. But food can. And so, he sums it up by saying, “These conditions are foodable. They’re not druggable.” And we need to really wake up and realize that and figure out how to build evidence-based nutrition, personalized nutrition, and empowerment of people to make better decisions about diet and lifestyle into our clinical practice of medicine, or else we’re really never going to get on top of these chronic illnesses.

29:20 – Be focused with your mission

Every person has a mission in life, whether it’s related to health goals or other things. It’s important to remain focused on what you want.

And I think when you truly, truly believe in what you’re doing, the naysayers, you can listen a little bit about what they’re saying and see if you can learn anything from it, but at the end it’s like, you’re on your mission and you know what you’re doing. And it’s a lot easier to let that stuff slide, I think, when you’re so committed to where you’re going and what you’re trying to achieve. So, that’s been nice to evolve into that and realize like, I care a lot less about what people are saying if I really am so laser focused on my mission.

Rebecca Minkoff (00:05):

Hey, everyone. It’s Rebecca. I just want to let you know, the podcast you are about to hear is all about your health and how to take control of it. I had the opportunity to speak with Dr. Casey Means about something you might not even think is wrong with your body, but that could be. This is not a sponsored podcast. It’s just, as you know, I love and care about health. So, when I get opportunities to talk to doctors like Casey, I think it’s important to share those findings with you. So, I hope you enjoy it. She’s not going to share her stories of failure or vulnerability here, but you’re going to come away with a lot more insight on what you can do to take control of your health. And that’s just because I care about you. Enjoy the episode.

Rebecca Minkoff (00:47):

Hey, everyone. Welcome to Superwomen. Today’s guest is Dr. Casey Means, the Stanford-trained physician, chief medical officer and co-founder of the company Levels. What is Levels? Well, we’re going to to get into that. But first and foremost, welcome, Casey.

Dr. Casey Means (01:05):

Thank you so much, Rebecca. I’m so thrilled to be here.

Rebecca Minkoff (01:07):

So, I think my listeners know by now that I’m very much into health, they’ve heard me talk about the proliferation of vitamins and supplements and health-related things I like to tout on the podcast and in my life. So, I was really happy when you reached out to talk today, because I think that what you’re doing is really beneficial, and for people that are already healthy, I think what you’re doing is an incredible way to remain healthy. So, would you explain a little bit about your background and what Levels is and how you got to the company?

Dr. Casey Means (01:41):

Sure, absolutely. So, I am trained as a medical doctor and I actually started my career in head and neck surgery, ear, nose, and throat. And was doing that for about five years. And during that time, was really kind of seeing this tension between the work I was doing, which was focused on a really specific part of the body, just the ear, nose, and throat, and what was a much bigger monumental health crisis going on in the United States, which was the metabolic disease epidemic.

Dr. Casey Means (02:11):

The metabolic health epidemic affects almost every American, 88% of Americans have at least one biomarker of metabolic dysfunction. And this shows up as pretty much most of the common killers that we see in United States. So, from diabetes, heart disease, stroke, Alzheimer’s dementia, chronic liver disease, chronic kidney disease, but also impaired metabolism affects a lot of other things in our lives that we don’t really necessarily realize that aren’t quite as obvious. So, things like depression, anxiety, infertility, the leading cause of infertility in the United States, polycystic ovarian syndrome is a metabolic condition, erectile dysfunction, gout.

Dr. Casey Means (02:45):

So, it’s just really interesting this observation that I was having as I was in my surgical career of like, “Okay, there’s something more systemic and bigger going on in the body of almost everyone that we’re not really talking about.” And that is really fundamentally related to our diet and lifestyle. And most of which is preventable. This whole epidemic and trend has really only reared its head over the past 100 years. And yet, is now contributing to the chronic disease epidemic that we’re seeing that is leading to 90% of our $4 trillion healthcare costs, goes to chronic disease.

Dr. Casey Means (03:18):

So, it just got me waking up and saying like, “Hey, I’m spending all my days prescribing antibiotics and steroids for sinusitis and busting holes and sinuses in the operating room.” But this isn’t really actually getting at what the root cause of what the biggest issue that we’re dealing with in healthcare is that we’re not really talking about. And the reason we’re not really talking about it is because we’re such a specialized system, everyone’s focusing on their little part of the body and not looking at the big picture. And that big picture really dials back to food and lifestyle and how we’re living. And unfortunately, the Western diet, the Western world has the way we’re living and the way we’re eating with the majority of our calories coming from refined, ultra-processed foods that are high in refined carbohydrates and sugars, tons of fructose, it’s hijacking our cellular biology and it’s hijacking these core pathways of metabolism that are fundamental for every single cell in the body to work.

Dr. Casey Means (04:11):

And that’s why the symptoms downstream of metabolic dysfunction are showing up in all parts of the body. It’s not like it’s a brain thing or a heart thing, or a pancreas thing, it can show up anywhere. And that’s why it’s sort of has so many faces. But also why we’re kind of ignoring it, because we’re such a subspecialized healthcare system.

Dr. Casey Means (04:28):

So, long story short, really had this reckoning where I was like, “I don’t really want to operate and cut more people until I really figure out how I can contribute positively to what is, I think, a lot of preventable issues in the United States. A lot of things that could keep out of operating room.” And for me, that really came down to helping empower people, understand how diet and lifestyle are affecting their health. So, they can have more agency in their lives to make decisions that hopefully keep them in better health, improve longevity, and just allow them to cut through a lot of the marketing out there about food and health claims that may be keeping them stuck.

Dr. Casey Means (05:08):

So, that led me towards actually, over time, leaving the surgical world and starting a health tech company called Levels, which really, for the first time ever, helps people know exactly how what they’re eating is affecting their body in real time. We do this through a wearable called a continuous glucose monitor that gives you this constant feedback about every bite that you’re putting in your mouth, exactly what it’s doing to your metabolism pretty much instantly. So that you can really create that one-to-one relationship and say like, “Hey, I know this is marketed as healthy, but this is actually not good for my body and isn’t helping me with my goals or my metabolism.”

Dr. Casey Means (05:42):

So, that was kind of my journey and I’m just thrilled to be able to be working with a team and on a product that I think could really have a lot of impact on giving people that sense of understanding of their body and ability to make decisions that can keep them healthy and not have to wait for their doctor to raise the red flag when it may be really, really far down the line.

Rebecca Minkoff (06:06):

So, I think that most people don’t realize how damaging glucose or if your glucose levels remain unchanged can be. I know, in the beginning, you said metabolic disorders, but can you break that down? What does that mean? Because I was saying before we started recording, my parents wear a continuous glucose monitor. They’re extraordinarily healthy, in shape, athletes. I joke that they’ve preserved their bodies with all the supplements they take. But then my dad will eat beans, which you would think would be fine, and his numbers go through the roof.

Rebecca Minkoff (06:38):

So, can you explain what metabolic disorder is and how different body types might… You might, again, like you said, think that things are healthy or you’re eating an apple, or I used to have blueberries in my smoothie every morning, but it would spike my levels. So, can you talk a little bit how that could be dangerous or not dangerous, but not healthy you for the long term?

Dr. Casey Means (06:59):

Yes, absolutely. So, the way to really frame metabolism from a high level is, it is all the cellular reactions in the body that help us produce energy from food. We have 37 trillion cells in the body. 37 trillion human cells. We probably have around 40 trillion bacterial cells in our body too. But we have a ton of cells and every single one to work properly needs energy to function, to power every single thing in the cell.

Dr. Casey Means (07:26):

And that happens in this little place in the cell called the mitochondria, where we generate energy. And when that process isn’t working well, and the cell isn’t able to make the energy it needs to do all the things it needs to do to function, essentially, you get cellular dysfunction. And that when that happens in a lot of cells, you get tissue dysfunction, organ dysfunction. Ultimately, that’s what symptoms are, is when the little basic units of our body, the cell, aren’t working properly.

Dr. Casey Means (07:51):

And metabolism is core to all of that. So, it’s in every single cell. And like I was mentioning before this, the way we’re live right now, which is very unnatural compared to the rest of human history, in the sense that we’re eating food chemicals that really haven’t existed before in the forms they have, we’re putting these things into the body that the body’s really never seen before throughout evolution, in quantities that are kind of unfathomable.

Dr. Casey Means (08:17):

It’s totally changing the way that process of energy production works in a bad way, in a way that is essentially maladaptive. So, we’re essentially in this energy deficit in the body, even though we’ve got way more energy substrate that we’re giving the body, because we have an abundance of food now, but it’s taking over.

Dr. Casey Means (08:35):

So, what happens to kind of make this a little bit more concrete, if this is affecting the heart, it could look like high blood pressure, it could like look like heart disease, it could look like stroke. If it’s affecting the little blood vessels in the body, it could look like diabetic retinopathy. So, the blood vessels in the eye clogging up and causing eye disease. It could look like erectile dysfunction, which is the little vessels of the penis getting narrowed and causing problems. If it’s happening to ovaries, insulin resistance in the ovaries can look like, I mentioned, infertility. So, it can really show up anywhere.

Dr. Casey Means (09:11):

And the relationship with glucose is that when we eat glucose, essentially sugar, what carbohydrates are broken down into, and we digest the carbohydrates and they turn into glucose in the bloodstream, it sends the body on this cascade that leads to metabolic dysfunction.

Dr. Casey Means (09:26):

And the way this happens is that the glucose rises after a meal. And if it’s a high carbohydrate meal and especially something with high carbohydrates, refined carbohydrates or sugars, you’re going to have this big blood sugar spike, essentially, after a meal. And that can lead to several things. So, the first thing it does is it can lead to inflammation. The body’s like, “Okay, there’s a lot of sugar in the body. This is different. It generates inflammation.” It also generates oxidative stress, which is a stress on the body where there’s too many, what are called free radicals, reactive molecules in the body. And that could be damaging.

Dr. Casey Means (09:57):

Sugar, high sugar also sticks to things in the body, a process called glycation. And that can cause dysfunction in our proteins and various parts of our body. But the big thing that it does is it stimulates an insulin release from the pancreas. Your body needs to take up all that blood sugar into the cells from the bloodstream. And it does that by stimulating this hormone called insulin, which helps you shuttle that glucose into the cells to either be used or to be stored.

Dr. Casey Means (10:23):

And because there’s so much glucose going into our body, because of the foods we’re eating today, you end up getting these big insulin releases frequently. And what happens is the body becomes numb to insulin, because it’s like, “Oh my God, there’s so much around and we’re trying to shuttle all this glucose into the cells and the cells can’t process all of it. The mitochondria can’t process all of it. Oh my gosh, there’s so much of this.” So, the cells, as sort of a protective mechanism, become insulin resistant.

Dr. Casey Means (10:47):

And a lot of people may have heard that term, insulin resistance, it’s essentially the process by which we start to move towards having blood sugar dysregulation. So, it’s that continuous spike of the blood sugar by eating all the time, eating high carbohydrate refined foods that is causing this. So, your body’s becoming insulin resistant. And over time, it ends up releasing more insulin to try and actually drive the blood sugar into the cells.

Dr. Casey Means (11:12):

So, your insulin levels are rising throughout time. And eventually the body just can’t actually push the glucose into the cells. So, blood sugar just starts rising at baseline, and that’s when you start seeing fasting glucose go up, your doctor might say, “Oh, your fasting glucose is going up. It’s going to the pre-diabetic range, whatnot.” And that’s a real problem, because that’s really showing that our cells have essentially, in some ways, become really dysfunctional. They’re not moving glucose, which is our energy substrate, into the cell properly. They’re not processing energy properly in the mitochondria. We’re not creating the energy we need.

Dr. Casey Means (11:44):

And that’s when the downstream symptoms that can happen, again, anywhere in the body and look like almost anything, start showing up. And there’s evidence that this process, insulin resistance, metabolic dysfunction is happening in 88% of the country. So, one in 12 Americans are optimally metabolically healthy, which is kind of amazing. It’s just astounding. And it can look like anything. And the fundamental thing we need to do is improve our insulin sensitivity, improve our cells’ ability to process glucose and move it to the mitochondria.

Dr. Casey Means (12:20):

And a lot of this has to do with keeping those blood sugar spikes down over time, like making sure we’re not persistently stimulating the system. So, something that, like you mentioned with your parents, that continuous glucose monitors can do is give you insight into what’s happening when you eat something. The thing is, we just don’t know how a food or a combination of foods is going to affect our blood sugar, unless we test it.

Dr. Casey Means (12:45):

Some people might say, “Well, oh, there’s glycemic index charts where you can look and see, okay, like a piece of white bread is going to have this impact on my blood sugar, and broccoli’s going to have this impact.” And that’s a good, rough guide. But research actually, over the last five years, there’s a lot of research that’s been done, especially out of a group in Israel called the Weitzman Institute, has put these continuous glucose monitors that monitor your blood sugar 24 hours a day, like what your parents are wearing, has put them on large populations, like 800 people of individuals without diabetes and given them standardized meals, so they’re all getting the exact same meal.

Dr. Casey Means (13:19):

And showed that people have totally variable responses to the same meal from like no glucose spike to a gigantic glucose spike. So, for one person, it’s initiating that whole cascade of high glucose, insulin, on that spectrum of pushing them towards insulin resistance. And for others, it’s not doing anything. You might ask, “Why? If it’s the same amount of carbohydrates in each meal, why would it be different?” But one of the biggest factors they found that differentiates between who spikes and who doesn’t is their microbiome composition. And they actually found over 100 factors in the person’s body of why they would respond differently, how they would, person A might have a huge spike to a banana and person B might have no spike. But a big one was microbiome.

Dr. Casey Means (13:58):

So, it does seem like there’s a lot of individual variability and like your dad spikes with beans, I’m someone who doesn’t spike with beans and we see across our population that it’s variable across people. It’s also variable based on what you eat it with. High carbohydrate foods, when paired with proteins, fats and fiber tend to have a much lower glucose spike than if they’re eating alone. Similarly, if you eat a lot of greens or roughage before a carbohydrate meal. So like a big salad before pasta tends to have a much lower glycemic response, glucose response than if that pasta’s eaten first in the meal, if it’s sequenced differently. Even eating the same carbohydrate in the morning versus eating it at night can often have a very different glucose response. Because we tend to be a little bit more insulin resistant at night. So, a bowl of oatmeal at 8:00 AM versus 10:00 PM could look very, very different.

Dr. Casey Means (14:47):

So, this is where testing can really help us get on top of this process that’s happening in the blood, that downstream leads to the metabolic dysfunction that we’ve been talking about and give us the ability to really shape our own diet that works for us. And I think for many of us who have felt stuck with various diets, [inaudible 00:15:08] can help accelerate us past that sense of frustration or plateau that many people deal with on their food, or nutrition, or weight-loss journey.

Rebecca Minkoff (15:18):

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Rebecca Minkoff (16:10):

So, I feel like we’re in a location where people just want to take a pill for everything. And I meet too many people or, like you said, either cut it out or take a pill for it. So, in what you’re doing, you’re going against a lot of vested interests that have a lot of money to be made by giving people pills and/or changing the mindset of people that they can take health into literally their own hands or arms, wherever you place the monitor.

Rebecca Minkoff (16:41):

And do you feel that you’ve faced criticism or pressure and what do you do in the face of that? Because I feel like there’s so many incredible health proponents and because they’re going up against people that just want to give you the prescription for the pill that hides your… I had gestational diabetes, all I was told was, “Take the insulin, take the insulin, take the insulin, or we won’t let you have a natural birth.” And I’m no doctor, nor am I prescribing this, but my dad found an article from 1977 that said sometimes low levels of this B vitamin called P5P can lead to what looks to be gestational diabetes.

Rebecca Minkoff (17:20):

So, I went from having it in both pregnancies to not having it at all in my third, because I took this supplement. So, how do you go up against the people that are like, “Wait, we don’t want people to control their health, then they’ll be healthy.”

Dr. Casey Means (17:34):

Oh my gosh, it’s a great question. And I think, your example about gestational diabetes is kind the perfect example. I mean, this is one where, for many people with gestational diabetes, this coming out in pregnancy is sort of uncovering maybe an underlying baseline insulin resistance that’s been there. And this is an opportunity for doctors to really educate patients about how to get on top of this, about understanding [inaudible 00:18:02] glucose levels and setting themselves up for success after pregnancy, because people with gestational diabetes have a much higher rate of developing diabetes later in life, unless they mitigate their risks. And that’s not something that’s often talked about. It’s a huge opportunity. And I think often a missed opportunity to help women move in the right direction.

Dr. Casey Means (18:21):

I was actually just talking with my brother about something recently. My mom, I was an 11-pound, nine-ounce baby, and my brother was almost 12 pounds.

Rebecca Minkoff (18:30):

Oh my God.

Dr. Casey Means (18:31):

Yeah, we were huge. And in the hospital, people joke that this is just like an amusing outlier statistic. It’s like, “Oh my God, biggest baby that we’ve had this year. This is so funny.” But what people don’t realize is that that’s actually a condition called fetal macrosomia, where babies are born above a healthy weight, which is typically considered around eight pounds, 13 ounces. And fetal macrosomia literally means big body. And it’s very well-known that it leads to increased risk of many complications in the baby, like childhood obesity, metabolic syndrome.

Dr. Casey Means (19:05):

And also means the mom’s more at risk for future metabolic problems. And it’s basically a sign of insulin resistance in the mom, because high insulin drives cell growth essentially, and so drives a bigger baby. And it’s really unfortunate, because my mom ultimately developed blood sugar problems and ultimately died from cancer related to her blood sugar. She died of pancreatic cancer, which the risk factor is type II diabetes.

Dr. Casey Means (19:30):

And just thinking back, almost 35 years ago, the doctors could have used that example as a way to talk to her about, “You had a really large baby. This probably means you’re insulin resistant. You should probably get on top of that. Your kids are at higher risk for X, Y, Z.” And no one of course talked about it. It was just amusing outlier statistic, laugh of about how big the baby is, move on. That is just such a missed opportunity.

Dr. Casey Means (19:54):

And I think the same is happening for women all over the world. Like I’ve mentioned about infertility, polycystic ovarian syndrome is ultimately insulin resistance of the ovaries, high insulin in the body stimulates the ovaries to make too much testosterone. And that leads to the menstrual irregularities and the infertility that we see in PCOS, which is the leading cause of infertility in the country. And maybe affecting up to 25% of women worldwide now. And is growing because of the trends in insulin resistance in our country.

Dr. Casey Means (20:23):

This is a huge opportunity to talk to women about the underlying physiology and help protect them from the downstream consequences of having long-term metabolic dysfunction. And we just totally let it pass. We say, “Oh, here’s a birth control pill to regulate your periods.” And often give people a pill called Metformin, which is actually an… It’s a diabetes medication, it’s an insulin-sensitizing medication.

Dr. Casey Means (20:49):

But don’t talk about the fact that this is insulin resistance and there’s a lot you can do about it. And there’s several studies showing that low carbohydrate or ketogenic diets can actually reverse a lot of PCOS. So, just like what you’re saying with gestational diabetes, there’s just so much more we can be doing. And I think this gets to the heart of your question, which is like, what is the pushback?

Dr. Casey Means (21:07):

And I would say the pushback, right now, I think, because this is an emerging type of technology, using continuous glucose monitors to help people understand their diets is still quite emerging. It’s not something that’s totally on the full mainstream yet. So, we haven’t seen the food into industry come after us yet, or the healthcare industry in a big way.

Dr. Casey Means (21:31):

But I mean, I’m absolutely just holding my breath for when that’s going to happen, because it’s unquestionable that it will. I mean, when you start giving people the information to say, “Hey, your bar that you sell in the grocery store says low glycemic and heart healthy, but it caused a 90-point glucose spike in me.” Which is huge, that’s like, we never want to go up 90 points. That’s going to start… When that happens with lots and lots of people, it’s going to be unavoidable that the food companies are going to have to address the fact that the claim on the box or what they’re saying about their food is not actually accurate in the bodies of the people who are consuming it.

Dr. Casey Means (22:10):

And we’ve had about 13,000 people go through our beta program. And we see this all the time. Bars that are marketed as keto, or low carb, or health drinks, or things that people perceive are healthy are actually causing massive glucose spikes. And one of the ones that surprises a lot of people and often happen into people’s first week of using continuous glucose monitoring is they eat their morning oatmeal. Because their doctor said that oatmeal is really, really healthy. And for some people, it doesn’t cause a glucose spike. But in, I would say, the majority of our members, it causes a huge glucose spike. For me, it causes an 80-point glucose spike.

Dr. Casey Means (22:46):

And for reference, I generally don’t want to go above 20 to 30 ever after a meal. So, 80 is really, really high and leads to a big crash for me afterwards. So, when you go up really high with your glucose, your body releases all that insulin and you come crashing down and that can lead to that post-meal slump, that post-meal energy crash that a lot of people feel. Whereas having a more glucose-stabilizing breakfast will just totally avoid that.

Dr. Casey Means (23:09):

So, even just one packet of plain instant oatmeal can send me on that 80-point roller coaster. And then, of course, when you see it advertised on the website for Quaker Oats, they also have orange juice and fruit and brown sugar and toast. It’s like, I can’t even imagine what that would do to me. And then they also market it as heart healthy. And since we know that glucose variability, these big swings in glucose, directly relates to cardiovascular disease, there’s no question that that’s not heart healthy for someone like me and for the majority of our members.

Dr. Casey Means (23:39):

So, I think that’s going to lead to a big shift in the food industry, whereas opposed to a lot of just… I mean, right now there’s nothing objective that holds anyone accountable for what is being said about food. And when a lot of people are testing this in themselves, I think that aggregate data is going to really change the way we think about food. And I hope is going to nudge the food industry to do a little bit better in terms of what they’re putting in their products.

Dr. Casey Means (24:04):

But no question. I mean, people who have, I think, higher profile who are talking about things like blood sugar in the food industry and how the healthcare industry is really focusing on downstream symptoms and not root causes, things like this, they get a lot of flack. I mean, people like Robert Lustig, who wrote Metabolical and Fat Chance. People like Mark Hyman, Dr. Mark Hyman, who wrote The Blood Sugar Solution. These people get a lot of crap from the food industry and also from the healthcare industry and anyone who goes against what’s called standard practice or essentially “evidence-based medicine,” which is essentially the guidelines that doctors are given for treating different things.

Dr. Casey Means (24:43):

If you step outside of that at all, like recommending someone take a more preventative approach to blood sugar disorders by using something like a continuous glucose monitor, you are kind of considered a pariah or iconoclast, or doing something wrong and-

Rebecca Minkoff (24:57):

Or censored completely.

Dr. Casey Means (24:59):

… or censored. Exactly, exactly. And that’s a problem, because you have to be thinking bigger about these issues, because things are getting worse and worse every year in our country in terms of health. When you just step back and look at things, our healthcare costs are going up every single year. We’re now spending over 17% of our GDP on healthcare, $4 trillion on healthcare. And yet, life expectancy is going down in our country. It’s been going down for a couple years consistently, even though we spend more than any other country in the world by a huge margin on healthcare.

Dr. Casey Means (25:35):

And we are getting progressively sicker, progressively fatter and progressively more depressed as a country. So, depression, anxiety, suicide, obesity and sickness are all increasing, life expectancy is going down, costs are going up. So, if you’re a doctor and you’re working in this system and looking at what’s happening, which is essentially like a sinking ship, it’s not working, the things we’re doing are not working, and not scratching your head and saying, “Why? How could we be doing this differently? Where are we sort of philosophically going wrong here?” That is what every doctor I think should be asking and just thinking bigger about these things.

Dr. Casey Means (26:14):

And fundamentally, I think a lot of it comes down to the fact that we need to have a more root cause approach to our health. We need to be thinking not just about the symptoms we have, but what’s causing those symptoms and start treating at that level. And something that Dr. Robert Lustig, again, who wrote Metabolical, which is a fantastic book about the systemic factors that go into our healthcare crisis, and the different industry influences that are involved. These core pathways that lead to disease, there’s very few drugs that can actually affect them.

Dr. Casey Means (26:43):

It’s not like a pill can fix the complex physiology that leads to metabolic disease. There’s too much going on. But food can. And so, he sums it up by saying, “These conditions are foodable. They’re not druggable.” And we need to really wake up and realize that and figure out how to build evidence-based nutrition, personalized nutrition, and empowerment of people to make better decisions about diet and lifestyle into our clinical practice of medicine, or else we’re really never going to get on top of these chronic illnesses.

Rebecca Minkoff (27:16):

Well, I have to say, normally my podcast is usually about the women, her journey, her struggles, but I think that the information you’re providing is going to help so many women with a struggle they might not even been aware of or thought there was an answer to. So, I appreciate your knowledge, your insight. My husband says, I take joy in going against the man or sticking it to the man wherever I can, and you’re sticking it to the man in a big way. So, I love that you’re trying to get to the root cause of health.

Rebecca Minkoff (27:46):

And just with seeing the influx of obesity in children, that number growing, or the fact that the majority of the United States is above a size 12. And that’s trying to be normalized, when it’s a solution that’s in our hands and not to say anything is wrong with you if you’re above a size 12, but if you don’t want to be, or you want to take control of your health, I think what you’re offering is an incredible way to start peeling under the hood of what’s so different and individual about all of us.

Dr. Casey Means (28:16):

Yes. Well, thank you. I think I’m with you. It’s like waking up every day and asking, how can we be doing better? And often leads to being a bit of a contrarian, but I would have to say, in terms of just personal fulfillment, the ability to feel like my work is really aligning with my values and my vision for what I want to see our country move towards, which is a healthier, people thriving, people feeling better mentally, physically, getting up every morning and knowing that my work really is leading towards that. I mean, it’s night and day in terms of my own personal satisfaction and day-to-day contentness.

Dr. Casey Means (28:56):

It’s hard to even describe how different it is from when I was more in the surgical world, which is… I mean, kudos to surgeons, that we need surgeons, it’s important, but it didn’t align with the vision that I have for healthcare and what I wanted to be as a doctor. So, sometimes that does mean getting out there and being a contrarian and really asking people to think deeper. But I think it’s kind of the most fulfilling journey that you can go on.

Dr. Casey Means (29:20):

And I think when you truly, truly believe in what you’re doing, the naysayers, you can take a little bit of… Listen a little bit about what they’re saying and see if you can learn anything from it, but at the end it’s like, you’re on your mission and you know what you’re doing. And it’s a lot easier to let that stuff slide, I think, when you’re so committed to where you’re going and what you’re trying to achieve. So, that’s been nice to evolve into that and realize like, I care a lot less about what people are saying if I really am so laser focused on my mission.

Rebecca Minkoff (29:56):

Yes. I think we have to be, no matter what our mission is, health related or not, I think when you’re that laser focused and certain, that all just becomes noise. So, where can people find this? How do they get one? So that people can start taking control of their health and not taking a pill.

Dr. Casey Means (30:15):

You can find out more about blood sugar and a lot of the things we talked about in more detail at the blog that I basically help manage and work on with my team, it’s called levelshealth.com/blog. It’s really, I would say, that is the place to go if any of this was interesting to people in terms of wanting to learn more about metabolic health or specific conditions or symptoms they might be dealing with. We’re really bringing in the world experts on metabolism, and a proactive preventive approach to it, to write for the blog. So, definitely go there to learn more.

Dr. Casey Means (30:49):

Also, on Instagram and Twitter, we’re @levels. And that’s kind of fun to follow, because we’re posting a lot about what our beta members are learning from checking their glucose. So, even if you don’t have a continuous glucose monitor, you can see the types of experiments people are doing to learn what works with their bodies.

Dr. Casey Means (31:05):

So, for instance, like what happens when they eat an apple alone or an apple with chia pudding, which has a lot of fiber and protein, and some almond butter, and see the different glucose responses. So, there’s a lot that can be learned just by observing what other people are experimenting with. What happens, a lot of people are posting, “Oh, I got a poor night of sleep. And my glucose is a lot higher,” which is sort of a well-known thing that can happen. But seeing the actual data really brings that home.

Dr. Casey Means (31:32):

So, @levels on Instagram and Twitter. And then, I’m @drcaseyskitchen, D-Rcaseyskitchen on Instagram, and I’m primarily plant-based. So, I post a lot about plant-based metabolic health and really how to refine any individual type of dietary philosophy that you subscribe to, whether it’s like paleo or keto or vegan or whatever, and use data to tailor it to make it the most rewarding for your body.

Dr. Casey Means (31:57):

So, get the best out of the diet without necessarily having the glucose spikes and the collateral damage that you don’t want. So, refining a vegan diet has really been a big journey for me over the last two years to figure out how to do that without having any really major glucose spikes. So, I talk about a lot on my Instagram.

Dr. Casey Means (32:15):

And if you want to sign up to get a continuous glucose monitor through Levels, we’re still in a closed beta program, but on levelshealth.com, you can sign up for the wait list. And then, as spots open up, we will contact people and bring them into the program. So, that’s the best way to reach us.

Rebecca Minkoff (32:32):

Awesome. Well, thank you for doing what you do and providing such great insights into health. So, if you’re listening, take note, we can take control of our health by just simply knowing what spikes our glucose levels, that leads to so much. And we didn’t even touch on it, but I love on your site, you talk about mental health and so many people, again, just think it’s some nerves in their brain that lost the coding that leads to their depression. And I always talk about gut health and how that has everything to do with depression. Now, you’re talking about how glucose can impact that. So, dive in, everybody.

Dr. Casey Means (33:11):

Yeah, absolutely. And we have actually a lot of articles on our site about how those two exact things are totally connected, the microbiome and glucose. And just, yeah, getting down to that deeper level, I think, can be really empowering for people, especially with mental health. And I would certainly never claim that controlling your glucose spikes is going to fix all mental health struggles, but it’s certainly a way to manage one of the factors that we know is related to it.

Dr. Casey Means (33:35):

For me, personally, in my own life, that’s been incredibly empowering and not just imagining that something’s happening just to me and there’s nothing I can do about it, but what are the areas, what are the knobs that I can turn and the levers I can pull to really have as much health as I can in terms of my mental and physical wellbeing? So, I love that point about mental health and absolutely.

Rebecca Minkoff (33:55):

Awesome. Thanks again.

Dr. Casey Means (33:57):

Thank you.

Rebecca Minkoff (34:00):

I just wanted to thank you guys for listening to today’s episode. I also want to ask you to rate and review the show wherever you listen to podcasts. I know it’s a pain in the butt, but it actually helps with search and algorithm. So, if you love this podcast, it is an easy way to get it more visible and out there. I also want you to follow me and Instagram, @rebeccaminkoff, @rmsuperwomen, and be sure to check out my book, Fearless: The New Rules for Unlocking Creativity, Courage, and Success. Thank you again. And you will hear from me next week.