What Do Healthy Glucose Levels Look Like? With Dr. Casey Means Co. Founder of Levels Health

Dr. Casey Means is on a mission to bring metabolic health to the masses. As a co-founder of Levels Health, this isn’t just a dream – it’s becoming a reality. Thanks to wearable technology in the form of continuous glucose monitors, we are one step closer to getting the current metabolic health crisis under control. From this interview with Connie Nightingale on The Fit Farming Food Mom, get the skinny on why sugar is making 88% of Americans unhealthy and how you can optimize your diet and lifestyle choices to feel your best everyday.

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out The Fit Farming Food Mom
• Connect with Connie Nightingale Instagram or YouTube

7:01 – The first wearable for nutrition

Monitoring diet and blood glucose is vital for health. That’s why Dr. Means’ team at Levels has created the first wearable for nutrition so people can optimize their choices.

“A lot of us have wearables that we use, like WHOOPs, and Ouras and Fitbits to keep us on track, but those are all great for sleep and our heart rate and our steps and activity, but we don’t really have anything like that for nutrition. We don’t have a wearable and some sort of app on our phone that says like, Oh, you just ate this, it wasn’t a great choice, it was a good choice. It wasn’t like that’s ever really existed. The best we have is you can step on a scale the next day and kind of see what happened in your previous day. Or you might get your cholesterol or blood sugar checked six months down the road and get some feedback on that. But I was super fixated on how can we give someone this sort of Fitbit, Oura Ring, WHOOP-like experience, but for nutrition. And that’s why I started this company Levels, which really fills that void for the first time ever.”

9:40 – Getting to the root of why 88% of Americans are unhealthy

The reason the majority of Americans have poor metabolic health is directly related to poor blood sugar regulation.

“Actually only 12% of people are metabolically healthy. So there was a study out of UNC two years ago that was looking at basically five different biomarkers of metabolic health or dysfunction. It was different types of cholesterol, waist circumference and blood sugar. If you had all five of these factors in the healthy range, you were considered metabolically healthy and only 12% of the people I studied fit into that category. So 88% of the country has at least one biomarker of metabolic dysfunction, which is just, it’s crazy to think about it, but it’s not that surprising because we have 128 million Americans with diagnosed pre-diabetes or diabetes. That’s almost a third of the country. We have 74% of Americans that are overweight and obese. So this is really, really pervasive. ”

15:07 – A doctor can’t be on your shoulder 24 hours a day

The healthcare system is not set up to provide constant coaching and support. Levels bridges the gap between physician and daily life to give the answers you need in real time.

“I think a lot of doctors are feeling very squeezed to do the best they can with the resources in the time that they have. And you know, prescribing a pill sometimes is the most efficient way to take an action with a patient with a chronic condition. I think certainly that if we had more time to counsel effectively, it would be wonderful for outcomes, but our system unfortunately is not designed that way right now. And this is actually one of the things that really inspired me to start a company based on a digital product. So an app and a wearable that was going to actually do a lot of this sort of coaching for people on their own. A doctor can’t be on your shoulder 24 hours a day telling you, Oh, this is a good food option, you should exercise now because your glucose was high, Oh, you need to go to bed earlier tonight because your glucose has been high throughout the day and a good night of sleep could really help that.”

20:01 – Closing the gap between action and reaction

A continuous glucose monitor shows how food is affecting you now. You don’t have to wait days, months, or even decades to find out what is right for your body.

“It’s always been an open loop system where you eat dinner or you eat something, a snack, and you have really no indication of what that’s actually doing to your body. Is that contributing to weight gain, is that making you sleep poorly? There’s so many other variables. So the more that you can tighten that feedback loop and have some sort of objective response to a food, I think the more you can move people to making better decisions. So much of nutrition is trial and error and we spend years, if not decades, trying to actually just narrow down what the right diet is. There’s, I think, people many decades into life who can’t say this is the right diet for me, but we’re actually at a time now where we can start to do that. We have the tools and I think now things like continuous glucose monitoring. I think now it’s really about how to get that more mainstream and expand the amount of people who are aware of this and who are able to get access to it.”

23:01 – Aim for a rolling curve, not a spiky surge

The lower the blood glucose range, the lower the risk of disease later down the line.

“If you look at the research, you actually find that people who are in the lower range of normal have much better health than people in the higher range of normal. So what they’ve basically studied as if that, if you are between more like 70 and 85, you have less risk of developing diabetes down the road. You have less risk of cardiovascular disease in the future or cardiovascular mortality, and you’re generally healthier. And so I would personally recommend that people shoot for that lower half of the normal range, like 70 to 85, for their fasting glucose… After meals, I would say you probably don’t want to see much more than about a 15 milligram per deciliter rise from your baseline before the meals. So let’s say you start off and before you eat lunch, you’re at 85 milligrams per deciliter, really not going above a hundred after about a 15 point rise is probably just a very safe and healthy sort of bump after a meal. It’s not completely flat, you’re getting kind of a natural glucose elevation, but you’re not getting like a huge spiky surge that is going to be associated with a big insulin release and a lot of exposure to insulin in the body and then potentially crashing back down after that meal.”

29:38 – The higher you rise, the further you fall

The blood sugar crash felt after a big meal is the body releasing insulin to soak up the excess glucose. Too much insulin causes too much glucose to be absorbed leading to the crash in energy physically and mentally.

“We want to avoid these sharp spikes up to 140, 150, 160 after meals, because what’s happening in the body is that you’ve got that big glucose surge and the body has to respond to it by releasing insulin and insulin is going to generally be proportional to the amount of glucose that is in the blood. So if you’ve got a big spike, you’re gonna have a big insulin spike and that insulin is telling the cells to take up the glucose. You’re trying to get it out of the bloodstream, soak it up into the cells so that it can either be used for energy or alternatively stored as glucose or stored as fat. So that big insulin surge because you’ve got that big influx, it’s telling the cells to soak up all this glucose. You can sometimes overshoot and sort of soak up so much glucose that you actually dip or have sort of a plummeting and that reactive hypoglycemia has been associated with fatigue, anxiety, really low energy. You don’t want to have that dip.”

32:09 – Feel unlimited with stable energy

When your glucose is stable, energy feels stable. A CGM takes away the guesswork, so you can know exactly how to keep energy balanced.

“So what’s interesting is that glucose stability tends to also mirror energy stability and sort of mood stability, and kind of just really helps you uplevel your day, because you’re not dealing with some of these swings. And what I think is so cool about tracking it is that I think a lot of us deal with little swings throughout the day. Sometimes, normally like you have a post-meal energy slot where you want to take an afternoon nap, or maybe you feel a little bit irritable if you’re hungry or something like that and it’s like, Oh, this is just part of part of life. But then when you start seeing why this is happening and what’s triggering it, you can just so quickly make really slight easy modifications to start smoothing that all out.”

35:10 – Check your personal responses with the juice test

Everybody will respond differently to foods. However, everyone will notice the difference between an apple and apple juice.

“Have an apple. Have a normal sized, organic, nice apple, and then have an eight ounce glass of apple juice and just see what happens. I think it’s just so profound. I think for most people you’re going to see a massively higher spike with the juice. Just for all the reasons you just said, it doesn’t have the fiber, it doesn’t have the bulk, you’re drinking it so much more quickly and it’s in liquid form so it actually travels to your small intestine faster. Just so many factors. But the other interesting thing is that it really highlights not only how different forms of food can affect you differently, but let’s say you’re doing this experiment, you can also see what is happening to other people. If you have another friend who’s doing this with you and see if the response is similar or different. Everyone is going to respond differently to the same types of experiments like that.”

38:40 – If you want to lose weight, keep your glucose in check

Too much glucose tells the body to keep storing fat rather than use it for energy. Keep glucose low and the body will switch onto fat for fuel.

“You can either use fat or glucose to make energy in the body. And if there’s tons of glucose around, your body doesn’t think it needs to use fat, so it won’t burn it for energy. So when you’ve got that insulin around, it’s a signal to the body: we’ve got lots of energy from glucose available, we don’t need to burn the fat. So if your insulin is high, it is unlikely that you are effectively burning fat, whether that’s for energy or for weight loss. And so I just think one of the lowest hanging fruits in a weight loss journey is to see what your glucose is, which can be a metric or a proxy metric for what’s going on with your glucose and start getting those glucose spikes down. Because it’s sort of like we go to the gym everyday to lift weights and do our reps to get stronger, but it’s no different with our metabolic health and our metabolic fitness each day that we keep those spikes low.”

41:28 – Learn what works for your body

Dr. Means shares her own journey and how experimenting with small changes helped to stabilize glucose levels.

“Food pairing, food timing, stress management, exercise, and sleep are really the key fundamentals of metabolic health. And so now after doing this for a while, you kind of just build that intuition of exactly what works for your own personal body and physiology to keep things really flat and stable. But even now I’ll have a surprise every once in a while, I’ll go to a restaurant and eat a meal that’s not balanced properly, see a huge spike 150, 160, feel terrible, feel maybe sometimes shaky or really tired or moody or something like that. And so I’m still learning. But it’s cool in the early stages of figuring it out to say, let’s say you have a meal, you do just eat a couple pieces of fruit and you see a big spike, to say, okay well how am I going to modify this the next time around to just maybe get a little bit flat or like take a walk, just simply take a walk after eating it or add some peanut butter to it, you know? And then you just can experiment and learn those little tricks.”

44:40 – There’s not a metabolic lightswitch

With consistent action, the body can adapt. But it takes time to reprogram the cells.

“The beauty is that you can always move in the right direction, no matter where you’re at on the spectrum. It’s very fluid and as you log those days of just keeping the glucose as more stable and keeping that insulin lower your cells perk up again and they say, hey I need more insulin around or they become less insulin resistant, more insulin sensitive, and you need less insulin to get that same amount of glucose in the cell. So your baseline insulin is just going to come down and that unlocks this whole pathway of metabolism that we’re really putting the brakes on in our modern society with the way we’re eating and living, essentially not being able to burn fat effectively. And those are biochemical pathways in the body that you have to work over and over again for them to be efficient. It’s not like one day your insulin is low and you’re automatically a perfect fat burner, this takes time and that’s why we do call it metabolic fitness because it’s not a metabolic light switch. It’s metabolic fitness.”

48:26 – Your very own superpower – using fat for fuel

Traditional wisdom says that to perform at your peak, you need sugar. Athletes are finding that keeping glucose stable means they can use fat for fuel instead.

“We’re seeing more and more athletes just so interested in metabolism and glucose monitoring, because it is like unlocking a super power when you can fat oxidize. When you get to the place where your insulin is stable and you’re able to when you have run out of your quick glucose stores in the body, instead of having to slam that goo you just flip it on to doing more fat oxidation. Even a lean person has likely weeks worth of fat to burn through, we just have naturally in the human body enough fat to fuel us for quite a long period of time. But for most of us, it’s totally inaccessible. You think about some of the dietary conventional wisdom that’s been said in the past, like you need to eat breakfast first thing in the morning, you need to snack every two hours to keep the metabolism up. We’ve been having these low fat, high carbs snack bars because fat is bad. And so you can imagine in that scenario, eat every two hours, eat these high carb, low fat snack foods and then of course, standard American diet, tons of processed, refined grains and sugars. You can imagine there’s a lot of people out there who never are really giving their bodies a break from insulin.”

56:54 – It’s within our power to change our health

The body is adaptable and everyone is capable of making changes.

“The beauty of the body is that it’s resilient and that nothing is fixed. We may be far down the road of feeling like we’re not in good health, or we have a lot of problems there, on our plates are tons of symptoms and it’s just the list is long. And it can feel almost like how do I possibly dig myself out of this or move in the right direction? And it can also seem like there’s so many things we’re asked to do to move in the right direction. But you know, I’ve been in this field for 10 years and I would say one of the lowest hanging fruits is think about metabolic health, think about glucose and you can make a lot of small wins and start moving in the right direction on this health spectrum by just getting this one thing under control.”

Connie Nightingale: [00:00:00] Hello there, and welcome to my podcast. I’m Connie. I’m a certified nutritionist, personal trainer, busy mom, and I live on a small hobby farm. I’m a former bodybuilder, and I currently found a love for endurance sports, but I’m not your typical athlete. I believe there are many more contributors to athletic performance and overall health.

And that we, as a population might be doing it wrong. You won’t see me pounding goos or chicken and rice, but you will see me in the pursuit to fuel not only athletic performance, but also balance it with optimal health. This is not just a podcast for athletes. Many people that fall into the health scene get there for a reason. I found myself in sub optimal states at multiple times in my life, and it has really sparked my passion for metabolic and systemic health. I am constantly a student of what I love, and now I hope to help others by bringing quality guests to the show, to share their opinions and resources, to hopefully help you formulate strategies to help you crack your health code.

Everybody to season number two of The Fit Farming Food Mom podcast. This will be our first episode with a guest in season two, and we are bringing it in hot with Dr. Casey Means. She is a Stanford trained physician, chief medical officer, and co-founder of metabolic health company, Levels. I’m currently wearing one of their sensors right now and getting so much feedback on how well my blood sugar is regulated. It is awesome. I cannot wait to do a full episode on that alone. She is also the associate editor of the International Journal Of Disease Reversal  And Prevention. Her mission is to maximize human potential, and reverse the epidemic of preventable chronic disease by empowering individuals with tech enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices.

Dr. Means’ perspective has been featured in many magazines, including Forbes, Entrepreneur, Endocrine Today, and many, many more. So you guys, she has so much information to give to us today. And I’m so excited to have her on. We’re going to talk about what healthy glucose levels look like, and what you should be aiming for when you are checking your blood sugar and all of that.

So you guys, I’m excited. At the end of the podcast, stay tuned in, I’m going to give you a discount code in case you’re interested in using their services at Levels Health. This can give you amazing feedback guys. And it already taught me so much, and I am so freaking excited. I’m not stabbing my finger every couple of hours, like I used to, in order to see where I’m at, pre and post meals.

So this is a big deal. It’s also really great, because you can see how your exercise affects your blood sugar. All of these things, you guys. So anyway, stay tuned, at the end of the podcast, I’m going to give you a code so you can skip the waiting line for their services, and jump right in there and get going to learn about your metabolic health.

Well, without further ado here is Dr. Casey Means.

Dr. Casey Means, welcome to the podcast. I’m so excited.

Dr. Casey Means: [00:04:00] So happy to be here, Connie. Thanks for having me.

Connie Nightingale: [00:04:04] So before we get going too crazy here, first of all, if you could tell my listeners who you are, what you do, what got you going down the avenue that you’re going down.

Dr. Casey Means: [00:04:14] Yeah, absolutely. So I’m Casey Means. I am a medical doctor.

I focus on functional medicine and longevity medicine, and I am the co-founder and chief medical officer of the metabolic health company, Levels. And you had my co-founder Josh Clemente on, about a month and a half ago, I think. And so I’m so excited to follow up. But yeah, so in terms of kind of what got me going on this.

So I trained as a surgeon, so my history as the head and neck surgeon, ear and nose and throat doctor. And when I was practicing surgery, something that was interesting to me about my patient population is that so many of the conditions I was treating were fundamentally disorders of chronic inflammation.

So it was like, chronic sinusitis, chronic inflammatory ear diseases, Hashimoto’s thyroiditis. You know, these are all itises, things that, and itis usually means inflammation. So in all of these conditions, I was treating with antibiotics and steroids and surgery. There was something going on in the body that was saying, you know, I’m in threat mode and I need to activate this immune system response against some external threat.

And that was really interesting to me because when you think about it that way, that this is, these are conditions where the immune system is revved up, it kind of seems a little odd to like approach them with a surgical intervention. It kind of made me step back and say, Well, why don’t we think a little bit more deeply about what’s actually causing the inflammation?

What are the exposures that people’s bodies are encountering that are making their immune systems be revved up, so to speak. So that kind of sent me on this journey to really understand the root causes of chronic inflammation. And, you know, when you really step back and look at it, a lot of those are rooted in our sort of everyday choices that we make every single day about what we eat, and how much sleep we get, and the toxins we’re being exposed to in the air and the water and in our food, you know, how much we’re stressing, how much sedentary behavior we have, you know, all of these things can translate into the body into inflammation.

And so really a lot of it comes down to those sort of like day in and day out choices. And another thing that’s really rooted with inflammation is our blood sugar. So whether our blood sugar is elevated, how much it’s spiking throughout the day, you know. A lot of spikiness with our blood sugar can tell our body that there’s kind of a problem, and that can generate an immune response.

So it was looking at all these root causes. And it kinda got me really inspired to work with patients in a different way. So as opposed to being, you know, just the surgeon, who’s at the end of the line, you know, when diseases have really gone really far down the road of pathology, what could we do for patients like upfront to help them really manage their diet and lifestyle and their blood sugar in a personalized way, to kind of get on top of inflammation on the front end, and more of a preventative way.

So I opened up a private practice where I was really helping with that, really getting people metabolically optimize, their blood sugar would be stable. Really examining what they were putting into their bodies, what they were exposing themselves to, and getting those things on track. And in my practice, you know, it really, like I said, came down to changing behavior in a positive way and changing our choices.

And that got me really thinking about what, how can we leverage tools, and tools that we have with us all the time, like our phones and our tech to help motivate us to make some of these decisions. And you know, a lot of us have wearables that we use, like Whoops, and Ouras and Fitbits to kind of keep us on track. But those are all great for sleep and, you know, our heart rate and our steps and activity, but we don’t really have anything like that for nutrition.

We don’t have like a wearable and some sort of app on our phone that says like, Oh, you just ate this, it wasn’t a great choice. It was a good choice. It wasn’t. Like that’s never really existed. The best we have is like, you can step on a scale the next day and kind of see what happened in your previous day.

Or you might get your cholesterol or blood sugar checked six months down the road, and get some feedback on that. But I was super fixated on like, how can we give someone this sort of like, Fitbit, Oura Ring, Whoop like experience, but for nutrition. And that’s why I started this company Levels, which really fills that void. For the first time ever, we have a wearable that is monitoring an internal biomarker related to your nutritional choices, and giving you instant feedback on how your choices are affecting your health and your metabolism. And so that was sort of my attempt as a physician to sort of think bigger and sort of scale solutions to how we can get people’s bodies, you know, into a better state at baseline, and how we can sort of minimize this chronic inflammation, stabilize people’s blood sugar.

And from, you know, this past history of being as a surgeon, like really big picture thinking like, how do we keep people out of the operating room by helping guide their daily choices. So that’s kind of my history and why I started this company. And yeah, and I know you’ve been checking your blood sugar for years now. So I’m preaching to the choir.

Connie Nightingale: [00:09:06] Yeah. Agree.

Dr. Casey Means: [00:09:07] But yeah, it’s exciting to see how people you know, unlock these interesting insights by checking, by using continuous glucose monitoring and starting to really see firsthand how things are affecting them.

Connie Nightingale: [00:09:23] Yeah. And it’s a, it’s a such an amazing direction that all this is going, as far as people looking into their metabolic health, because what is the number exactly, I’m not sure. I think it’s only like 20% of people in the United States are actually metabolically healthy. And that’s kind of a crazy number to think about. And you see it, like if you start to get tuned into things, you can almost see it when you’re walking down the street. Or me, I work in the medical profession myself for my second job. I should say it was my first, but now I feel it’s becoming my second.

And I’m still there. And I have these patients come in and they have these huge medical history lists and all this stuff. And I see all these things that hold hands with dysregulated blood sugar. And there are so many practitioners out there that just continue to add to the list of these medications.

When I feel like if they got to the root cause of it, it would be a non-existent factor with these people. People would be so much more healthy.

Dr. Casey Means: [00:10:21] I think it’s such a good point. I love the way you just said that. Like, what are these conditions that hold hands with blood sugar dysregulation? I think that’s such a cool way to put it.

So just circling back, you said that something around 20% of people are metabolically healthy. And the number that you know, people are really talking about now is that actually only 12% of people are metabolically healthy. So there was a study out of UNC two years ago that was looking at basically five different biomarkers of metabolic health or dysfunction.

And it was different types of cholesterol, waist circumference and blood sugar. And if you had all five of these factors in the healthy range, you were considered metabolically healthy. And only 12% of the people I studied fit into that category. So 88% of the country has at least one biomarker of metabolic dysfunction, which is just, it’s crazy to think about it. But it’s not that surprising because we have 128 million Americans with diagnosed pre-diabetes or diabetes.

That’s almost a third of the country. We have 74% of Americans that are overweight and obese. So this is really, really pervasive. And like you mentioned, like it’s holding hands with so many other conditions. And I think that’s something that’s under-recognized, is that the faces of metabolic dysfunction and the faces of blood sugar dysregulation are so varied that we kind of think of them as isolated silos.

We think about them as separate conditions. And so in medicine we’re playing whack-a-mole. We’re just trying to sort of symptomatically treat all these seemingly different conditions, when actually we need to just pull out the roots, which is blood sugar, dysregulation and metabolic dysfunction. So some of those conditions that are the different faces of blood sugar dysregulation, you know, it might look like fatty liver disease, nonalcoholic, fatty liver disease.

It might look like chronic kidney disease. It might look like retinopathy and premature blindness. It might look like infertility, polycystic ovarian syndrome is the most common cause of infertility and it’s basically metabolic dysfunction showing up in the ovaries. It could be erectile dysfunction, it could be high blood pressure.

It could be Alzheimer’s dementia. It could be, you know, pain in your legs when you’re walking, peripheral vascular disease. All of these things are fundamentally rooted in the fact that our bodies are being exposed to too much blood sugar, and too much results in insulin, and the effects of those things on all these different parts of the body. And where that’s kind of showing up in each person can be different, but at their core, a lot of them are really related on the physiologic level.

And certainly it’s not a one-to-one relationship, like every single person with, you know, PCOS is directly related to blood sugar, but certainly we know that that blood sugar is strongly linked to, and a mitigating factor of all of these different conditions I mentioned. And so, so many more as well.

So yeah, it’s great that this has been identified, but now it’s really about moving this into how we take care of patients, and how we treat patients. You know, do we keep throwing individual medications on each of these conditions, you know, a blood pressure medication for hypertension and, you know, birth control pills or oral contraceptives for you know, polycystic ovarian syndrome and you know, other things for other conditions. Or do we actually really get to that root and see, you know, ideally if you clean that, that part up, you can start to see a lot of these symptoms and conditions kind of just really improve in one fell swoop. So yeah.

Connie Nightingale: [00:13:53] And you know, I’m not sure where we went wrong as a, you know, as a country or any of this. Like, I try to think about this. I’m always, my brain is always really just ridiculous. I wish I could shut it off, but I think about it and I’m like, okay. I mean, there’s a lot of theories out there.

There’s the big pharma theory where they talk about that. There’s the other side of it, which is the big food, then there’s political, you know, things. But coming from a medical standpoint, and maybe as a doctor, you have some input on this, but I feel like maybe some doctors know in their heart, that a change in food and a change of lifestyle has to happen, but they feel that most people are not willing or disciplined to do that.

So that’s where they’re just like, Hey, here have a pill for this. I mean, we’re kind of raised in that pill mindset as it is, right? When you’re young, you have a tummy ache, you take this. You have a headache, you take that. And you never really wonder why do I have this headache, or why do I have this stomach ache?

And so patient compliance, I think could also be another big piece to why we’re not able to start making a shift in how we’re helping people. Does that make sense?

Dr. Casey Means: [00:15:07] Yeah, it absolutely does. You know, I do think there are physicians who, you know, may think like, Oh, having this conversation might be a few times because it’s just so difficult to enact. But, you know, I think it’s really. I don’t necessarily think it’s rooted in necessarily distrust or like anything like that.

I think it actually much more is like a systems issue. You know, the way that healthcare is financed and has been historically financed, has really squeezed providers to have to really deliver care in a very, very quick amount of time. And so a lot of doctors are only spending 15 minutes with patients who have multiple chronic conditions, many of which are rooted in diet and lifestyle.

And that unfortunately, is borderline unavoidable in this day and age in an insurance-based practice. And so you’re just, you know. I think a lot of doctors are feeling very squeezed to do the best they can with the resources in the time that they have. And you know, prescribing a pill sometimes is the most efficient way to, you know, take an action with a patient with a chronic condition.

I think certainly that if we had more time to counsel effectively, it would be wonderful for outcomes, but our system unfortunately, is not designed that way right now. And this is actually one of the things that really inspired me to start a company based on a digital product. So an app and a wearable that was going to actually do a lot of this sort of coaching for people on their own, you know. A doctor can’t be on your shoulder 24 hours a day, telling you like, Oh, this is a good food option, you should exercise now because your glucose was high. Oh, you need to go to bed earlier tonight because your glucose has been high throughout the day. And a good night of sleep could really help that. Like, we can’t do that. Even with a coach, it would be tough for this to happen. And I think having, being able to leverage like digital health tools to kind of be an extension of what the doctor is doing, and make it sort of this real-time continuous feedback, that is where I really think healthcare is going to be moving.

And sort of this partnership with the doctor is because, yeah, the time restrictions just make it very, very difficult for doctors to be true agents of behavior change for their patients. So that’s where I think biofeedback can be really, really useful. And, you know, I think you mentioned a lot of the other factors that are certainly at play. Tou know, there are interests with the food system, you know, that are strong financial interest to keep food sort of the way it is. And there’s farm bills that you know, fund and actually subsidized foods that are disease promoting, you know, corn and soy and wheat, things that are by and large turned into ultra processed versions of these foods, and that contribute to chronic disease.

You know, and you’ve got, of course, you know, pharmaceutical interest, and you’ve also just got the medical school, education. And the way that that plays out, which is that there is not a big focus on diet and lifestyle. And many medical students are actually receiving less than 10 hours of nutrition training in their entire medical school curriculum.

So on many, many levels, it’s just, we’re facing a lot of uphill battles. And so I think that the intentions of most doctors are very pure, and they really do want to help people as best they can, but the system is very, very tough. And I think anything we can do to empower individuals with their own personal health information, and make that understandable and actionable is a step in the right direction. Within this, you know, the confines and barriers of our current system and the fact that digital. You know, our phones are with us all the time. And so how can we leverage them for good and for health, you know?

Connie Nightingale: [00:18:50] And that brings up another thought in my head, and we’ll get into the main body of this podcast soon, but this has kind of gone down a rabbit hole is, I think insurance companies are paying a lot for medications and procedures and testing for a lot of people that suffer from metabolic problems or things that are linked to that. I feel like they oftentimes fight the continuous glucose monitor route when it comes to helping people or even diabetics, things like that. But I feel like if that was the main tool they started using for a lot of these people, with some of these mainstream diagnosis, and these insurance companies would pay for that tool, they would save themselves so much money down the road for all these medications and stuff. Because people do so well when they see real time feedback, when they get that Apple watch and they’re like, Oh, I haven’t met my activity goal for the day, I better do that. Like, it actually sparks something in people that a lot of people didn’t know they had just because they have something telling them that. So I feel like it would actually be in the insurance company’s best interest to move towards something like this, the medical profession, everything, because it’s going to help everybody.

Dr. Casey Means: [00:20:01] Yeah, I couldn’t agree more. And I think really just the outcomes data and the cost efficacy data needs to be done, to really encourage payers to move in that direction. So there’s a lot of movement with people working on that exact topic right now. And I think it’s great. And I think you bring up an amazing point about the importance of closed loop biofeedback. For behavior change, this sort of ability to see like really quick results, and to really limit the time between an action that you’re taking, and then the reaction that you’re seeing, the more you can narrow that, I think the more you can engender sustaining behavior change. And I think with nutrition, that’s been very nebulous in the past because we have, it’s always been an open loop system where you eat dinner or you eat something, you know, a snack, and you have really no indication of what that’s actually doing to your body. Is that contributing to weight gain, is that making you sleep poorly? There’s so many other variables. So the more that you can tighten that feedback loop and have some sort of, you know, objective response to a food, I think the more you can move people to making better decisions than so much if nutrition is trial and error.

And we spend years, if not decades, trying to actually just like narrow down what the right diet is. And there’s, I think people many decades in their life who can’t say like, this is the right diet for me. But we’re actually at a time now where we can start to do that. Like we have the tools, and I think now, things like continuous glucose monitoring.

And I think now it’s really about how to get that more mainstream, and expand the amount of people who are aware of this and who are able to get access to it. So.

Connie Nightingale: [00:21:45] I love it. I love it. So I guess we went down a rabbit hole there, but let’s get to the main part of today’s podcast, which is, I get asked by so many people, what should my blood sugar look like?

And I’m like, Well, it kind of depends because there’s so many factors, like how much sleep you had, what type. Like one gal, she messaged me and she was like, Well, I’m, I don’t know why, but my blood sugar was almost a hundred after I got done with my body pump class. And I’m like, What’s going on here.

I was exercising. This should be under control. And I was like, well, there’s a physiological response that your body has to exercise. Sometimes if it needs to bring sugar up, it will for you to fuel your workout, you know, naturally. I said, that’s a normal response for your blood sugar to rise sometimes post exercise or D-ring.

And she was like, Oh. I said, so there’s so many variables. And rather than me try to figure it out for somebody, I have no medical knowledge. I just studied the heck out of stuff. So I was like, let’s get a professional on here. Let’s talk about this. What is a normal glucose response? Like what, where should our levels be? Let’s kind of jump into this.

Dr. Casey Means: [00:23:00] Absolutely. Well I think maybe the first thing to say is like, what are the widely accepted norms for blood sugar? Because there’s sort of like what is considered normal, and then what is actually optimal. Like what should we probably be shooting for? So in terms of normal, so the way that blood sugar is traditionally tested is by testing a fasting glucose level.

So that’s like pricking, having a doctor or doing it yourself, pricking your finger, first thing in the morning after consuming no calories for the prior eight hours. And so there’s really three ranges that you can fall into. It’s considered normal, pre-diabetic or diabetic. So normal is under a glucose level of 100 milligrams per deciliter, pre-diabetic would be between a hundred and 125, and then diabetic would be above 126 milligrams per deciliter, first thing in the morning, having not eaten anything. Then there’s also tests that are done in the doctor’s office to dynamically test how you respond to glucose, and that’s called the oral glucose tolerance test. And so with the oral glucose tolerance test, you’re given a 75 gram, like basically drink of glucose that you’re supposed to just chug.

It’s called Glucola. And it’s really yucky. I don’t know. Have you ever had to take it?

Connie Nightingale: [00:24:16] Oh yeah. For when I was pregnant, I had to do two of them, like all the time and I was just like, No, not this stuff that makes me want to puke. It’s so bad. And you feel crummy afterwards.

Dr. Casey Means: [00:24:25] I’ve never actually done it. And I am scared too, because, yeah, I mean, I imagine it’s going to just, you’re going to spike and crash. But basically what they do is they take your glucose at 30 minutes, an hour and two hours, usually after that, after you drink that drink and see what happens to your glucose. And if after two hours you are below 140 milligrams per deciliter, you’re considered normal. And if you’re above 200, you’re considered diabetic. And if you’re in between, that’s a pre-diabetic range. So less than 140, two hours after this huge glucose drink is considered normal.

So that’s sort of like some of the criteria that we talk about in standard clinical practice. But, you know, unfortunately because people who don’t have diabetes, hadn’t really been checking their blood glucose that much, you know, we don’t have a big, there’s not a lot of guidance for like, what should we be shooting for after a meal?

So a lot of people say, Hey, if you’re below 140 within two hours after a meal, that’s normal because that’s what the oral glucose tolerance test looks like, basically you know, calls normal. But that doesn’t actually tell us whether that’s like optimal for our health. So then you have to dig in deeper and really look in the literature, and see if we can discern anything more from that.

And when you do that, you actually will find there’s a number of studies that have been done, where they put a continuous glucose monitor on non-diabetic individuals, and just watch what happens as they’re sort of like free living. So that gives us a little bit more information. These are people with no diagnosed metabolic conditions, totally healthy, what happens to their glucose? And what these studies found was that for the average healthy person wearing a CGM, their blood glucose is going to stay between 70 and 120 milligrams per deciliter for about 90% of the day. So in a 24 hour period, essentially most of the time, it should be staying between 70 and 120.

And if you look at some other studies, you’ll see more like between 70 and 140. But in a generally, just healthy young population, 70 to 120. So that gives us a little bit of a tighter range to shoot for like, Okay, I should probably be staying somewhere between 70 and 120. And so that’s kind of one thing now.

In the Levels app, we basically tell people like this is the golden range to be in. You want to just sort of for like about 90% of the day stick within that. Well, then we had to get into some nuances, like where do you want to be after meals? And what do you want your fasting glucose to be for optimal health?

So let’s talk about fasting glucose first. So right now, like I mentioned, under a hundred is considered normal. But again, it doesn’t really tell us where optimal is. Well, if you look at the research, you actually find that people who are in the lower range of normal have much better health than people in the higher range of normal.

So what they’ve basically studied is if you are between more like 70 and 85, you have less risk of developing diabetes down the road. You have less risk of cardiovascular disease in the future or cardiovascular mortality, and you’re generally healthier. And so we, I would personally recommend that people shoot for that lower half of the normal range, like 70 to 85 about, for their fasting glucose.

85 to a 100 is considered normal, but we see this sort of linear increase in the risk of actually developing future diabetes or future heart disease, if you’re in that high range of normal. So why not shoot for that lowest risk profile? So, yeah, so, you know, shooting for under 85 is probably a smart choice for your morning fasting glucose. And then after meals, I would say you probably don’t want to see much more than about a 15 milligram per deciliter rise from your baseline before the meals.

So let’s say you start off and, you know, before you eat lunch, you’re at 85 milligrams per deciliter. Really, you know, not going above a hundred after, about a 15 point rise, is probably just a very safe and healthy sort of bump after a meal. It’s not completely flat, you’re getting kind of a natural glucose elevation, but you’re not getting like a huge spiky surge that is going to be associated with, you know, a big insulin release, and a lot of exposure to insulin in the body, and the potentially crashing back down after that meal. You want to just keep these like very slight gentle, rolling hills as opposed to the peaks and valleys. So kind of to sum it all up, I would say fasting glucose, probably shooting between 70 and 85 is a really healthy level. Through the vast majority of the day, staying between about 70 and 120, having a post-meal glucose that’s about 15 points from your pre-meal baseline, ideally again, below that sort of  20 range and, you know, keeping your sort of mean glucose somewhere around 90 to a hundred. Again, if you look at these healthy populations and you look at average glucose, it generally ranges between about a hundred and 105.

So I would say around that hundred range for average glucose is probably a safe place. So much more sort of specific and nuanced than just the general, like under 140 after meals. But that’s really where I shoot for.

Connie Nightingale: [00:29:38] That’s awesome. And that’s very good to know, because so many people you see, they’ll get up to like 160 or higher.

And I feel like the higher it gets, the bigger the crashes. I think I’ve kind of noticed this pattern that happens with that. So I know back before I had my blood sugar regulated, I would have crazy peaks and crashes, and then I would be hungry and I’d be thirsty. And, it was just crazy, the things that were happening.

And so I started to like, I’m a real data shark. So I started a graph all this stuff and write it all down, like crazy research nerd. And in the process, that’s when I started to notice is the more extreme the sugar goes up, I feel like the more extreme it crashes afterwards, which then causes a whole another influx of issues.

Dr. Casey Means: [00:30:30] Yeah, exactly. And that phenomenon that you’re talking about has a name, which is called reactive hypoglycemia. And this is one of the reasons we want to avoid these sharp spikes up to 140, 150, 160 after meals. Because what’s happening in the body is that you’ve got that big glucose surge, and the body has to respond to it by releasing insulin. And insulin is going to generally be proportional to the amount of glucose that is in the blood.

So if you’ve got a big spike, you’re gonna have a big insulin spike, and that insulin is telling the cells to take up the glucose. You’re trying to get it out of the bloodstream, soak it up into the cells so that it can either be used for energy, or alternatively stored as glucose or stored as fat. And so that big insulin surge, you know, because you’ve kind of got that big influx.

It’s telling the cells to soak up all this glucose. You can sometimes overshoot, and sort of soak up so much glucose that you actually, like you said, dip, or have like sort of a plummeting. And that reactive hypoglycemia has been associated with fatigue, anxiety, really low energy. You don’t want to have that dip.

And what’s nice about keeping glucose pretty stable after meals, just like a gentle, you know, 10, 15 point rise after meals is that you’re not going to have that huge insulin surge. Your body’s not going to be overcompensating. And so generally, what I’ve seen anecdotally in myself and my patients and Levels customers is that, you know, with that slight increase after a meal, you just come right back down to where you were. You don’t overshoot it, you don’t dip.

And so what what’s interesting is that glucose stability tends to also mirror energy stability and sort of mood stability, and kind of just really helps you, I think, uplevel your day, because you’re not sort of dealing with some of these, you know, these swings. And what I think is so cool about tracking it is that, you know, I think a lot of us deal with little swings throughout the day.

Sometimes, normally like you have a, you know, post-meal energy slump where you’re like, you want to take an afternoon nap. Or maybe you feel a little bit, you know, irritable if you’re hungry or something like that. And it’s like, Oh, this is just part of part of life. But then when you start seeing like why this is happening and what’s triggering it, you can just so quickly make really slight easy modifications to start smoothing that all out.

And what I love to think about is like this trifecta of, you know, you have A, action. Like, okay, I ate oatmeal for breakfast, and then you have a subjective experience like, Oh, okay, I had a late morning energy slum. And maybe in the past, you’ve never related those two things together. But then now you have the data and let’s say you had a huge spike, like up to 180, which we frequently see in people who are eating a bowl of oatmeal.

And so now all of a sudden, you have this trifecta of like objective data, subjective experience and an action. And it’s really liberating to sort of eliminate that mystery and often misattribution that we’re doing in life, where we’re like, Okay, well I’m tired for this reason. Or I’m feeling a slump for like, you know, maybe I had too much coffee.

I didn’t sleep well, maybe I’m just moody. But to be able to actually say like, Oh, I had a massive glucose spike and then I crashed down, and that’s why I’m feeling this way. It’s really liberating. And for me at least, and I think it also makes changing your diet a lot easier because you’re not just like guessing or trial and error.

You’re like, Oh no, this actually caused a problem. I’m going to either eliminate it or I’m going to modify it. So if I want to eat that high carb snack, well, maybe I’m going to pair it with more fat and protein. Maybe I’m going to eat it after a heavy workout. You know, maybe I’m going to only eat that if I’ve had a really good night’s sleep. These are all things that can modify our glucose response.

So kind of just building a better context in the body for those carbs so that you’re not just like so massively spiking. So I think it can be really liberating to gain that type of awareness, you know, that before we’ve kind of just been guessing, so.

Connie Nightingale: [00:34:27] Right. And I find that interesting, like sleep and so many other factors are involved.

And I tell people that all the time. Like I had a lady the other day, she’s like, Well, I’m just having some pineapple juice for breakfast. And I was like, well, that’s horrible for your blood sugar. Like, seriously, just she’s like, Oh, it’s just juice. I’m like, There’s not even any fiber there, anything to buffer that sugar surge that’s going to happen right there.

I mean, if you were to eat an actual apple. They’re like, Well, it’s out of an Apple, but there’s some fiber there or have that Apple with some peanut butter or something that can kind of have fat in it and kind of slows that down even more. There’s so many different ways to pair foods in order to change that glucose response, which is another awesome thing.

Dr. Casey Means: [00:35:10] Yeah, absolutely. Like, I think one of the most “fun” things you can do when you’re checking your glucose, whether it’s through fingersticks or a continuous glucose monitor is like, have an apple. Like have a normal sized, organic, nice apple, and then have an eight ounce glass of apple juice and just like, see what happens.

And I think it’s just so profound. I think for most people you’re going to see a massively higher spike with the juice, just like for all the reasons you just said, you know. It doesn’t have the fiber, it doesn’t have the bulk. You’re drinking it so much more quickly, and it’s in liquid form.

So it actually travels to your small intestine faster, just so many factors. But the other interesting thing is that it really highlights you know, not only how different forms of food can affect you differently, but you know, let’s say you’re doing this experiment. You can also, you know, see what is happening to other people.

Like if you have another friend who’s doing this with you, and see if the response is similar or different. Like everyone is going to respond differently to the same types of experience, experiments like that. And there was this like really fascinating paper, a published research paper about five years ago called Personalized Nutrition By Prediction Of Glycaemic Responses.

And what they did was they gave people like, you know, a cookie and a banana. They gave two people, like you would have a cookie and a banana. And I would have a cookie and banana, and see what their responses were. And people had totally different responses, and sometimes equal and opposite. So I might spike really high with a banana, and have no spike with the cookie.

And you could be the exact opposite. So how our bodies actually processed those carbohydrates into glucose is totally variable based on your body type, your microbiome, how much sleep you got in. And it’s just like really lends itself to some fun, you know, experimentation and some, you know, comparisons and. Yeah.

It’s just, it’s hard to make generalizations because each body seems to be very, very unique in how they process carbohydrates. So, yeah.

Connie Nightingale: [00:37:10] Yeah. And that’s one thing I’ve been solid about throughout my coaching experiences. Everybody is so diverse, and so they need to be coached as such. I don’t think there’s one certain way to coach people, but I’ve gotten a lot of flack in our local community, and some of the people that are around me as far as coaching goes. Because the first thing I’m like, have you checked your blood sugar? Do you know what your blood sugar is after a meal? Because I feel like that is such a huge piece to health and weight loss, and it needs to be monitored. And people think I’m crazy.

Like when I’d say, Hey, have you checked your blood sugar, but it’s so easy. You can get a glucometer right at the dang pharmacy. They’re like $30 and it gives you insurmountable information. It is an amazing thing.

Dr. Casey Means: [00:37:55] Yeah. I think it’s so important, weight loss discussion, and, you know, I just like want to plug a couple books.

Jason Fung, The Obesity Code, and then Ben Bikman’s Why We Get Sick. They both described this so beautifully. And actually Mark Hyman’s The Blood Sugar Solution too. They talk about the relationship between weight and glucose. And it goes back to that exact conversation we were having about insulin and reactive hypoglycemia.

When we have a big insulin surge, which tends to happen after a big glucose surge, what insulin does, other than telling our bodies to take up glucose in the cells ,is that it also tells us to stop burning fat. That is another signal that insulin gives. And the reason makes sense. You can either use fat or glucose to make energy in the body.

And if there’s tons of glucose around, your body doesn’t think it needs to use fat. So it won’t burn it for energy. So when you’ve got that insulin around, it’s a signal to the body, We’ve got lots of energy from glucose available. We don’t need to burn the fat. So if your insulin is high, it is unlikely that you are effectively burning fat, whether that’s for energy or for weight loss.

And so I just think one of the lowest hanging fruits in a weight loss journey is to see what your glucose is, which can be a metric or a proxy metric for sort of what’s going on with your glucose, and start getting those glucose spikes down because the more. It’s sort of like we go to the gym everyday to like, you know, lift weights and, you know, do our reps to kind of like get stronger, but it’s no different with, with our metabolic health and our metabolic fitness. Each day that we keep those spikes low, that’s like doing reps for improving our metabolic fitness and keeping our insulin low, getting our insulin sensitivity up, and therefore being able to unlock that burning. And so, you know, sure you can potentially lose weight from a very low calorie diet, but getting on top of the hormonal side of weight loss is just, I think, such a simpler solution to getting where you want to go.

So yeah, like you said, checking fasting glucose with a finger prick, getting a continuous glucose monitor and seeing all that data is another option. Having your doctor potentially order a fasting insulin test to see where your baseline insulin is. Those are all things that I think are very, very helpful on the weight loss journey.

Connie Nightingale: [00:40:17] Absolutely. And some of these things aren’t cheap, but you have to look at it from a perspective of health. And when it comes to that, there are so many places down the road and things that could cost you so much more if you don’t invest in your health now. So it’s the data that you get from that is insurmountable.

You cannot replace that. It it’s very important. And so at a minimal, just get a regular glucometer. A really great thing though, is what you guys are doing, watching it in real time and being able to train your body based on that feedback. People will probably get there a lot faster than I did sticking my finger all the time, trying to figure out what’s going on because you don’t have real time data.

You don’t know what’s happening when you’re sleeping. You don’t know what’s happening when you’re exercising. Like when I’m on my bike, I’m not like, okay, let’s stop pedaling real quick and check our blood sugar. Make sure we’re not going to bonk out. Make sure everything’s going right. Like, I can’t do that, but now I can have some crazy things going on because it’s like, yeah, I’m seeing this in real time.

This is, you just can’t top it.

Dr. Casey Means: [00:41:28] Yeah, absolutely. There’s just, it’s amazing to move from single time point measurements to continuous measurements, just in terms of giving us feedback. Like, you know it’s like, over the past year of wearing a continuous glucose monitor, I’ve been able to really dial in exactly how to pair foods, when to time foods, especially carbohydrates, you know, what exercise I need to do to keep glucose stable, how much sleep I need to get to keep glucose stable. And how I ended up really engaged in my mind, body and stress management practices to keep glucose stable, because you know, food, pairing food, timing, stress management, exercise, and sleep are really the key fundamentals of metabolic health.

And so now after, you know, doing this for a while, you kind of just build that intuition of exactly what works for your own personal, you know, body and physiology to keep things really flat and stable. But even now, I’ll have a surprise every once in a while. You know, I’ll go to a restaurant and eat a meal that’s not balanced properly, see a huge spike, you know, 150, 160, feel terrible, you know, feel, you know, maybe sometimes shaky or really tired or moody or something like that. And you know, so I’m still learning. But it’s cool to, you know, in that early stages of figuring it out to say, like, let’s say you have a meal, like you do. Just eat like a big, a couple pieces of fruit, and you see a big spike, like to say, Okay, well, how am I going to modify this the next time around, to just maybe get a little bit flat or like take a walk, just simply take a walk after eating it or add some peanut butter to it, you know?

And then you just can experiment and learn those little tricks. And so it’s a lot of fun and. Yeah, like you said, like there’s a lot of tools out there. Some that you can even just get over the counter like a finger stick glucometer. So it’s pretty accessible these days. So

Connie Nightingale: [00:43:19] I have a couple of things to throw on this train here. You said a few things that kind of struck a chord with me. And the first one was metabolic fitness. And just like regular fitness, it doesn’t happen overnight. And I see so many people that give up on trying to get their body right before they’ve ever given it the opportunity to learn, and start reproducing this pattern.

And it takes a lot of time of the same repeated pattern. So after a week of keeping your glucose levels stable, you may not see results. It’s when you do it time and time again, that you start to develop this health. So I’ve noticed with myself that it took me a long time of keeping my blood sugar perfect. I’m talking like eight months before I actually started to be able to eat a substantial carb load, and my body handled it so much better because my insulin sensitivity was better. So there it takes time. And I liked what you said about that. I also liked what you said about going to a restaurant and seeing that spike.

Because I feel like even though you’re saying you’ve got a spike, I feel like back to what I just said, the more you train your body and you keep it at a flat level, the better it handles that load, that it would not have handled before when you were having these huge peaks and valleys.

Dr. Casey Means: [00:44:40] Yeah. I think that’s true. You know, that really gets to this idea of insulin sensitivity that you mentioned, which is that, you know, going back again to insulin. Every time we spike glucose, we get that insulin spike. And when that happens over and over and over and over again, our cells kind of become confused, because they’re seeing all this insulin. And they’re like, Why is there so much insulin around, this is too much. And they actually become numb and resistant to it.

And your body has to produce more insulin to get the same amount of glucose in. So you’re just, your body’s seeing higher insulin all the time. And you can imagine how that affects the weight loss journey, because your insulin is constantly elevated, you’re not going to be oxidizing burning fat effectively.

So you know, when we keep those spikes down, and you said it took, you know, eight months for you to see this real shift. It can happen quicker for some people, maybe longer for other people. But the beauty is that you can, you know, always move in the right direction, no matter where you’re at on the spectrum.

It’s very fluid. And as you log those days of just, like keeping the glucose as more stable, and keeping that insulin lower, your cells perk up again and they say, Hey, oh, I want to become, I need more insulin around. You know, or they become less insulin resistant, more insulin sensitive. And you need less insulin to get that same amount of glucose in the cell.

So your baseline insulin is just going to come down, and that unlocks this whole pathway of metabolism that we’re really putting the brakes on in our modern society with the way we’re eating and living this, like essentially not being able to burn fat effectively. And those are biochemical pathways in the body that you have to work over and over again for them to be efficient.

It’s not like one day your insulin is low, and you’re automatically a perfect fat burner. Like this takes time. And that’s why we call it metabolic fitness, because it’s not a metabolic light switch. It’s metabolic fitness. Then, it’s consistency and it’s time to develop this, and your cells have to change over to becoming more insulin sensitive.

Then they have to change over to being good at fat oxidation. And so, yeah, I think it is worth looking at it that way. That like, you know, the more we can be consistent with these things, the more we’re just going to unlock like the beauty of good metabolism. And with, you know, healthy metabolism and the ability to jump between burning fat and burning glucose, and doing each really efficiently, which is a process called metabolic flexibility.

The more we can do that and give them that state where we’re efficient at both, I think the more energy we feel, the better we can perform in, you know, athletic events. You know, the better our mood is going to be on our general and overall current and future health. So that’s really the direction we want to go in.

But like you said, it does take time. It takes reps. But the body adapts and it does, and that’s exciting. Like none of this metabolic dysfunction is you know, fated or necessarily permanent. It’s a very hopeful area of health, because we can move in the right direction. But we need, you know, information and data about ourselves to do it.

Connie Nightingale: [00:47:45] I love that. Yeah. And you know, it’s funny. I started cycling and the cycling community around here, I started like going to people and they’re like, What are you? You don’t need to eat goos every 15 minutes. And I was just, all I was thinking of is like, Holy blood sugar, goos, what, you know, like that was all I could think of.

And I was like, No because I have put in the reps to make my body metabolically flexible to where it can go between both fuels. So when everyone else is crashing out and they’re pounding goos and they’re trying to keep going, I’m fasted and I’m just going to crank it away. And I’m perfectly fine because my body has been trained to operate that way.

And it took time.

Dr. Casey Means: [00:48:26] That’s so, it’s so impressive. And I think, you know, we’re seeing more and more athletes, just so interested in metabolism and glucose monitoring, because it is like unlocking a super power when you can fat oxidize. When you get to the place where your insulin is stable, and you’re able to just, when you’re sort of have run out of your quick glucose stores in the body, instead of having to slam that goo, you just flip it on to doing more fat oxidation. We have, even a lean person has likely weeks worth of fat to burn through, so we just have naturally in the human body, enough fat to fuel us for quite a long period of time.

But for most of us, it’s totally inaccessible. And you know, you think about some of the dietary conventional wisdom that’s been said in the past, like you need to eat breakfast first thing in the morning, you need to snack every two hours to keep the metabolism up. You know, we’ve been having these low fat, high carbs snack bars because fat is bad.

And so you can imagine in that scenario, we eat every two hours, eat these high carb, low fat snack foods. And then of course, standard American diet you know, tons of processed, refined grains and sugars. You can imagine there’s a lot of people out there who never are really giving their bodies a break from insulin having to be secreted.

So yeah, so it’s just, you know, like we were talking about earlier, the cards are somewhat stacked against us with just sort of the food that’s widely available. But, you know, knowledge is power. And like you said, when you start to get that all under control, you unlock this little superpower of this other energy source that we all have.

But most of us can’t access because of our hormones, which are related to our glucose. And when you get there, all of a sudden, no more goos, you know, it just, it’s kind of amazing. Like, so I would say just anecdotally myself and many, many people on my team. A lot of us have switched over to really trying to do more fasted workouts, you know, getting on the bike or taking a run first thing in the morning, having not eaten.

And I wouldn’t necessarily recommend this to everyone because again, you have to work up to it. The first time you do this, it’s not going to feel good. You’re going to burn through your glucose. We have about two hours of glucose stored in our body at any given time, like in our liver and our muscle cells and in our circulation.

So you know, after, if you’re not able to tap into your fat stores, that first run you do fasted, you’re gonna rattle your glucose in about, you know, two hours, and then you’re going to bonk. And that term we hear in working out, bonking is like, you hit the wall. You just can’t do any more. And I think what you find as you start training more in this way, start unlocking these fat burning pathways, exercising in a low insulin state is that that time to bonk just goes farther and farther and farther out.

And that’s really exciting. So yeah, it’s cool to hear that that’s been your experience as well.

Connie Nightingale: [00:51:19] Yeah, that’s crazy. And then that takes me back to so many things. I get it. It’s funny how we’re always learning and evolving. It’s like I had a client consultation today and I told her, I was like, Well, I don’t really know.

I haven’t tried this, but in theory it should work. I’m honest about it. It’s like, listen, what I know now and then, you know, it’s totally changed. Things have morphed. We learned so much about our body. And so I can’t tell you how many times I’ve heard from a client, Well, I’m hypoglycemic. I have to eat every two hours.

And it’s like, Well, are you really hypoglycemic? Like, is your body telling you something you need to do a little bit of metabolic conditioning, you know? There’s so many things out there. I mean, when I was, I don’t know why, but this is something that I am a huge nerd, energy pathways. So the Krebs cycle, all of that stuff, my, I love it.

Like, it’s really weird and I’m fixated on it. And I remember when I was learning all of this, there was a portion in my personal training. I think it was my personal, when I got my personal training license, I can’t even remember now. But where they said endurance athletes do better fueling on fat. And I was thinking, no, they’re fueling on goos.

Their fuel. Like they need glucose, so they don’t go hypoglycemic. And then all of a sudden, further on down the line here, I am years later, I’m looking at it and I’m going, Duh, fat produces so many more ATP molecules. It’s actually much more efficient as an energy. But we don’t know how to use it and that’s our problem.

Dr. Casey Means: [00:52:52] Yeah. And I think you know, the Krebs cycle thing is really interesting too. Because you know, the Krebs cycle essentially is just for people listening, you know. You take these energy sources, like these basic building blocks like fat, or glucose, and you have to take them into the body, into the cells, in the mitochondria, which are within the cells, and then convert them to energy we can actually use. Like glucose is not a currency our body can use. It has to be converted to ATP, which is like the cash that we can use in the body. And then the Krebs cycle basically takes, you know, these energy substrates and turns them into that ATP. And another really interesting thing that I certainly love to Nirvana nerd out about, is that in that process of that cycle, which is essentially, you know, moving different building blocks throughout this little cycle of enzymes that are converting different building blocks, the next step of the pathway until it makes ATP is the importance of micronutrients as well. Each of those enzymes in that pathway requires quite a few important micronutrients to function properly. And many of these fall into like the B vitamins, carnitine, zinc, manga, magnesium, manganese.

And to me, it also just really shows how metabolism is even more than just all this lifestyle stuff about sleep, stress, exercise, food, food, timing, food pairing, but it’s also how much richness and diversity of our diet are we getting? Are we getting the vitamins and minerals? We need to be co-factors of these enzymes, IE, little protein machines that are actually creating the energy in the body.

So it just, every time I look at the co-factors needed for something like the Krebs cycle and for ATP production, I think, you know, We just can’t just be eating one type of food or just being super restrictive or narrow. We really need these wide vitamins and minerals from whole foods.

Ideally, you know, good amount of plant foods. And just like, you know, making sure that we’re getting quality in our diet and not just, you know, focusing solely on macronutrients, because the micronutrients actually play a key role in metabolic health as well.

Connie Nightingale: [00:54:58] I love that. I actually made a post long ago about that.

I was like, we’re all focused on the macros. Well, where’s the micros. We need those too. They’re very important. So I think a lot of time in the focus of these people, counting their macros, they’re doing whatever they can to fit as much as they can in as little as they can, if that makes sense. And so, in that path, they’re losing a lot of the vitamins and nutrients that they need in order to properly fuel their body.

Dr. Casey Means: [00:55:26] Yeah, absolutely. I absolutely think. I’m hoping the next phase of sort of nuanced nutrition is going to be very micronutrient, focused because it is almost something that we don’t talk about, you know, in nutrition. It’s all about protein, carbs and fat and, you know, are we thinking about manganese?

Are we thinking about iron? Are we thinking about zinc, B1, B2, B3? I mean, these are like lock and key co-factors to make these parts of our body work. And so yeah, we just have to be, I think, thinking about diet quality and where our food is coming from, what the soil our food is being grown in. Is it nutrient rich?

You know, it’s all important. So yeah, certainly. You know, that’s something that’s a little harder to kind of track or identify with, with maybe like glucose monitoring. But it’s part of the big picture of overall metabolic health. So and sometimes with patients in my practice, when I see someone who’s really refractory to dietary interventions, I think, you know, we really need to maybe sometimes test some of these you know, deeper nuanced things like micronutrient status. So.

Connie Nightingale: [00:56:35] I love that. Well, it has been a wonderful, wonderful podcast. I don’t want to keep you too long. However, if you could leave my listeners with one piece of advice that you would want to get out there in the world, and you feel would be good for their journey, what would it be?

Dr. Casey Means: [00:56:54] Ooh, I would say two things if that’s okay. One is just to leave people with a sense of empowerment. You know, the beauty of the body is that it’s resilient and that nothing is fixed. You know, we may be far down the road of feeling like we’re not in good health, or we have a lot of problems on our plate, and there are tons of symptoms and it’s just, the list is long.

And it can feel almost like, How do I possibly dig myself out of this or move in the right direction? And it can also seem like there’s so many things we’re asked to do to move in the right direction. But you know, I’ve been in this field for 10 years. And I would say like one of the lowest hanging fruits is, think about metabolic health, think about glucose.

You can make a lot of small wins and move, start moving in the right direction on this health spectrum by just getting this one thing under control. And you know, this might for you look like getting better sleep, you know, practicing some stress management stuff, you know, trying to reduce refined sugars, eating more whole foods, as opposed to refined foods, getting healthy fats, taking a walk, a 20 minute walk after meals. But you know, you got to find out what works right for you. But the beauty is like, there’s a lot of really low hanging fruit we can do to start moving this in the right direction. And because it’s a root cause physiology of so many health problems, I really do believe that you can move a lot of rocks in your health, in your life by just focusing on this one thing.

So in terms of efficiency and value, I think it’s a high value thing to do to focus on glucose, and it’s an all of our power to do so. I think the second thing I would say just as a I am a plant-based eater. I love plants and I would just say get more fiber. I know that, you know, there’s probably some people who are carnivores listening, and you know, different diets.

But my personal thought is fiber is really good for metabolic health. It’s processed by the microbiome. So for many of us, it doesn’t even register as a carbohydrate. Our microbiome processes it, and turns it into healthy substrates for our body. But I shoot for 50 to 75 grams of fiber a day. And you know, adding beans, flax seeds, chia seeds you know, nuts, legumes.

Those are all easy ways to get to get fiber in the diet. So yeah, the average American gets 12 grams a day. Try to double that next week. Yeah.

Connie Nightingale: [00:59:23] That’s funny you say that. Because that is a big, hot topic right now, too. I feel like I need to have some fiber debate on my podcast because so many people are like, yes, you need it because the stuff that, the organisms that live in your stomach, they eat it.

They create so many things out of it. There’s all these things. And then other people are like, No, you don’t need it. So, that’s, I like hearing that from you. It’s always an interesting one that, you know, I don’t know what to do with myself. I kind of just stay in the middle of it. But yeah.

So thank you so much. And I wanted to just reverse a little bit on the glucose control thing, because so many people think that it’s expensive for a continuous glucose monitor. However, I see so many people investing hundreds of dollars in these online instant weight loss programs and shakes and food meal, prep programs and all of these things.

If they would just invest that towards health data, that can help them make the right choices and learn something that will last for a lifetime. I think that’s extremely important and they will get a much bigger benefit from it.

Dr. Casey Means: [01:00:32] I love it. Yep. And if people want to learn more about how to get access to one, they’re welcome to come to our website, you know, www.LevelsHealth.com.

And, you know, it tells you how you can get access to one, and look at your data. And I certainly hope the price point comes down too. I think as more hardware becomes available and the demand for this goes up, I think we’re only going to see costs coming down. So my goal and intention is to help be part of that process, to get this to be something that every single person can have, if they want. And that ideally down the road, insurance will be paying for.

So we’re certainly pushing that, trying to push that ball forward as well. And I agree with you completely. So I love that.

Connie Nightingale: [01:01:14] Well, Dr. Casey, it’s been a pleasure and I’m so thankful you decided to join me today and I hope you have a wonderful week.

Dr. Casey Means: [01:01:24] You as well. Thank you so much, Connie. And I love the work you’re doing.

Connie Nightingale: [01:01:33] Thank you. You’re welcome. That wraps up my episode with Dr. Means. I’m so thankful she decided to come on the podcast today, and talk about what healthy glucose levels look like. I think this is a super important thing for people to know. And I’m hoping that it’s a place that the medical system is now going. If you liked this podcast, please, please, please, go leave me a review.

It helps me so much. It helps me get great individuals like Dr. Casey coming on my show and talking all about the things that they know and sharing their knowledge. So super important. Also helpful for other people to find this podcast because without reviews, I’m essentially invisible and we don’t want that.

We want to share this information. If you want to jump on the Levels bandwagon, I have a link for you guys, which is so awesome. It’s going to allow you to skip the 38,000 plus person waitlist and join the Levels early access program right now. There is a little bit of processing time, which is a few weeks, but it’s going to get you on that list way sooner and get you going with a continuous glucose monitor.

Like I said, I absolutely love mine. I am addicted. The price for the one month program is $399. It includes the tele-health consultation with a physician in your state, and the two sensors shipped to your door, plus the Levels software. So to jump on board with that, you just go to Levels.Link/FitFarmingFood.

I will put that in the show notes so that you guys have access to that. And thank you so so much for listening. We’ll see you next Monday.