What it Means to be Metabolically Fit with Casey Means

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Dr. Casey Means is a Stanford-trained physician and the co-founder of metabolic health company Levels. As a surgeon, Dr. Means saw how inflammation was the root cause of so many chronic conditions. On the Mindful Movement podcast, Dr. Means explains the root cause of chronic conditions, how lifestyle factors within our control can improve or deteriorate health, and the benefits of understanding how your decisions impact your body.

8:52 – Disease is rooted in lifestyle choices

Many chronic conditions like diabetes and cancer are linked to inflammation in the body. Functional medicine experts studying the root cause of inflammation find lifestyle factors like food, stress, sleep, and exercise all contribute to inflammation in the body.

“Fundamentally, you can’t actually operate on the immune system and so it felt very much like a band-aid to me. Why aren’t we actually addressing the root cause physiology of what is causing inflammation in all these patients? Unfortunately you see patients come back season after season, year after year with some recurrence of these conditions. I started really feeling like maybe this is because we are not actually addressing what the fundamental triggers of inflammation in the body are. And this led me into a real journey diving deep into the functional medicine world and listening to so many of these great authors who are publishing books about root cause medicine. So people like Mark Hyman and Sara Gottfried and Terry Wahls and reading about the gut and the gut brain access and all these things. I became really fixated on how can we keep people out of the operating room. How can we help empower people to change these modifiable, dietary, and lifestyle factors that we know contribute to inflammation, the food we eat, how we stress, how much sleep we’re getting, the amount of movement we’re doing, the toxins we’re exposed to in our food, water, and air. These all drive into wrapping up our immune system and I think really feed into a lot of these chronic conditions I was seeing. We know that outside of ENT, these are feeding into so many of the chronic conditions that we’re seeing today, the development of diabetes, obesity, dementia, heart disease, a lot of the big killers like cancer.”

12:19 – Bringing glucose monitoring to the masses

Levels was founded to help provide instant feedback on what we’re putting in our mouths. When everyone understands the impact of their diet on their health, chronic diseases could be prevented.

“We started this company that gets this incredible technology, continuous glucose monitors, to the mainstream. This is a technology that traditionally was actually FDA approved for the management of diabetes, these overt disorders of blood glucose. But we see this huge potential for getting this into the hands of everyone and anyone who eats food basically could benefit from understanding better how food is impacting their body in real time. We’ve never had that ability to have real time biofeedback on what we’re putting in our mouths. We’ve had biofeedback for sleep, for stress, for exercise, but never for food. So really the way that ties in is how do we give people these tools so that they can day in and day out make choices that ultimately are going to lead to a less inflammatory state in the body better fundamental health and ideally, circling back to surgery, keeping them out of the operating room as best we can.”

15:00 – Sugar culture is damaging the body

In the US, sugar consumption is at an all-time high. The over-consumption of sugar causes dysregulation, metabolic dysfunction, and damage to the cells and functioning of the body.

“Right now we have 128 million Americans with pre-diabetes or diabetes. So that’s almost a third of the country with a diagnosed metabolic blood sugar disorder. Of those, 90 million are pre-diabetic and most of them do not know that they have pre-diabetes and so we’re walking around with these blood sugar problems, many of us, and aren’t really aware of it. So the reason it’s a problem to have dysregulated blood sugar is because a lot of things happen, our body really tries to keep glucose in a very, very narrow range. And when it goes out of that range, we see a lot of different physiology stemming out of that. We see inflammation can occur when blood sugar is quite high. We see oxidative stress. So too many free radicals generated in the body, which are these damaging metabolic byproducts that can hurt the function of tissues in the body. And then we see a process also called glycation, which is where sugar actually just sticks to things in the body and causes dysfunction. So inflammation, oxidative stress, glycation are three problems with high blood sugar levels.”

17:30 – Too much sugar stops fat burning

When eating sugar, insulin increases, so high blood sugar leads to the overproduction of insulin. This tells the body there is enough energy circling around and it doesn’t need to utilize fat stores.

“So high blood sugar, or really any sugar that you consume is going to cause an insulin release in the body…Insulin is a very pro-growth, pro-storage hormone in the body. So it’s going to tell your body to store fat. It’s going to tell your cells to replicate more, which is why it’s implicated in cancers and driving cancers. It’s not good to have those insulin levels creeping up. And then the flip side of insulin is that because it’s a signal to the body that there’s enough energy in the form of glucose in the body, it tells the body, Oh, we’ve got enough of this onboard. We don’t need to use other forms of energy, like fat, which is our other main building block of energy in the body. So it’s a big block on fat burning. So if our insulin is chronically high, we are going to have difficulty losing weight. We are going to have difficulty using fat for energy during workouts. We’re going to wake up super hungry in the morning because our body hasn’t had glucose overnight and it’s not going to be able to do that fat burning. So we’re going to be like, Oh, we have no energy. We’re really, really hungry. Your body’s going to be dependent on glucose when insulin is high. So the state that we want to be in is where we’re getting enough glucose and carbohydrates from our diet to give us a very normal and physiologically relevant amount of energy in the body, but not so much that we’re causing this downstream cascade of insulin resistance and impairing our ability to burn fat.”

21:16 – Metabolic flexibility is being able to choose from different fuel tanks

When you eat sugar, the body either uses that energy or stores it as fat for later. When keeping glucose spikes and insulin spikes low, the body can switch to using that stored energy.

“Let’s say total hypothetical, but you’re a hunter gatherer. You come across this incredible glucose source, like a bunch of berries or something. So you eat and you don’t know the next time you’re getting food necessarily. So you eat all these berries, your glucose goes way up. Your insulin goes way up. You utilize what you can from that for energy in the moment. And then your body actually stores that remaining glucose as either stored glucose in the liver, or it will actually convert it to fat for long term storage. Insulin, like I mentioned, it’s a pro-growth pro-storage signal. It tells us to store fat and not to burn fat. So that situation, that’s great. You’ve used what you’ve needed. You’ve stored the rest for later. Then you can imagine, let’s say you’re not eating for the next three days because you haven’t found any more food. Well, you’re not going to have any glucose spikes during that time because you’re not consuming any food. So your insulin is going to be quite low. And that’s going to take that break off that burning and allow you to burn that fat for energy when you don’t have the glucose around. That’s exactly that metabolic sort of flexibility switch, it’s this kind of on-off switch that lets us have access to different energetic substrates when we have different resources available.”

27:53 – The major killers in the U.S. are all down to blood sugar dysfunction

The inability to regulate blood sugar leads to health conditions which are chronic and even fatal. It also impacts day to day enjoyment of life by causing fluctuating energy and mood.

“So many of the massive conditions that we’re dealing with in our country, actually 7 of the 10 leading causes of death in the U.S. are related to blood sugar dysfunction and metabolic dysfunction. And so it’s not that it’s just about diabetes or obesity, the obvious things that we’re thinking about. Blood sugar dysregulation directly leads to heart disease, high blood pressure, heart failure. It contributes to cancer. Obviously non-alcoholic fatty liver disease. Like you mentioned, chronic kidney disease, preventable blindness, even Alzheimer’s, which is now being called type three diabetes because when the brain is insulin resistant and can’t get enough energy you can imagine that could lead to dementia. It’s related to chronic pain, fibromyalgia, chronic fatigue, syndrome, depression, and anxiety, and erectile dysfunction and infertility, even sexual function I think. So that’s sort of the long-term things that you might see amongst many others. And then even in the short term, it can be related to high and up and down blood sugar spikes, can relate to our mood changing throughout the day, or feeling low energy after a meal if we have a big glucose spike and a big drop.”

41:11 – The ideal blood glucose levels for maintaining health

Lower fasting glucose levels and lower spikes are shown to decrease the chance of developing diabetes, obesity, and heart disease. Dr. Means suggests aiming for levels slightly lower than most healthcare professionals state for achieving optimal health.

“I try and stay between 70 and 110 milligrams per deciliter, pretty much for the entire day. So that’s, to me, sort of my healthy range. Sometimes I’ll go up to like 120. If I get totally bamboozled by something like ketchup, sometimes it will go up a little bit higher, but I mean, I really try and stick on days when I’m cooking and I’m in control, 70 to 110 So if you just went to the doctor and they asked what is a normal glucose range, they’d say under 100 for fasting glucose, first thing in the morning, haven’t eaten for eight hours if you’re under a hundred you’re okay. But if you actually look at the research, people who are between more like 70 and 85 tend to do much better long-term than people who are in the higher range of normal for fasting glucose. So as your glucose goes from the lower end of normal to the higher end of normal, from 70 up towards 100 on your fasting glucose, your risk for developing diabetes, obesity, heart disease all goes up. So from my standpoint, I’d like to stay in that lower risk range and the lower end of what’s normal for fasting glucose… And then sitting in the high seventies, low eighties throughout the day when I’m not eating. And when I eat, I try and go up maybe 15-20 points at the most. But then I’d like to see it go up in the maybe 45 minutes and then come down totally to normal within about an hour and a half to two hours. That shows like a healthy insulin response. You digest the food, it went in, it came down. And what you’ll often see eating normal American foods, all the processed foods so things like crackers, chips, breads, tortillas, desserts, sodas, et cetera, is that you might often see a glucose response that’s like 70, 80, 90, 100 points with just a single snack or drink.”

43:00 – The cause of the dreaded sugar crash

When blood glucose spikes too high, the huge insulin release causes the energy to be soaked up into the cells. This drops blood sugar below what is normal and leads to the energy decrease, fatigue, and anxiety we all know and dread.

“I like to not go up to 50, more than 15 to 20 after meals, it would be if you’re not trying or focusing on this, it would be very easy to go up like 60 to 100 points. And what happens then is that you do get that huge insulin release and then what you’ll often find is that after those meals, you crash down cause that insulin caused all that glucose to be soaked up in the cells. You had this exaggerated insulin response, and then you crash to below your pre-meal levels and that’s a process called reactive hypoglycemia and we’re basically overshot. That state, that reactive hypoglycemia is associated with anxiety. It’s dizzy with fatigue. That’s sort of that post-meal slump that you might be feeling where you get your energy zapped.”

45:36 – Getting the good glucose high

High intensity exercise gives the body a good glucose high, as it is releasing stored glucose from the liver to fuel the muscles.

“So this is a super interesting phenomenon that we see where people’s glucose when they are exercising at high intensity, generally high intensity only, you actually might see a glucose spike during the workout, even if you haven’t eaten anything before the workout. And this is a totally different mechanism that’s happening, which is exactly what you just mentioned. Your body is utilizing the stored glucose it has to fuel your workout, basically. So when you start a high intensity workout, something like a big bike ride or a run or a powerlifting type thing, it’s going to release a stress hormone in your body. That’s a stressor and so your body’s going to release cortisol and catecholamine hormones like adrenaline and that’s actually going to tell your liver, which is the place in the body, the liver and the muscles both store some glucose. You’re going to dump that glucose from the liver into the bloodstream to fuel your muscles. You can actually think about it almost like you’re clearing you’re clearing the tank. It’s not a bad thing. It’s not like food coming in from the outside. The muscles are quite brilliant in that they can actually take up glucose through an insulin independent mechanism. So just the contractility of muscles actually allows them to take up glucose without needing that insulin signal.”

50:20 – Flex your metabolic muscles every day

By keeping blood glucose low, you are training metabolic fitness. Everyone needs a different regime based on their body, so tracking is the best way to know.

“For building muscles, the reps are lifting weights day after day, month after month. You don’t immediately have a big muscle after your first workout. You adapt to having big muscles when you put in the reps and for metabolism. And to be able to get into that metabolically flexible state, the reps are keeping your glucose lower day after day. And how could we possibly do that if we’re not testing it? I mean, we could follow a general low carbohydrate diet, but there’s actually a few problems with that. One is that, and you’ve alluded to this earlier, is that each body is different. Each body actually responds to food differently. So you and I could both eat a banana and my glucose could go up 70 points and yours could go up 5 points based on our body types, our microbiome, how much sleep we got last night, how much stress we’re under today. For you that might be a good metabolic choice, for me it’s a bad one. So it’s actually really individualized. So just following a blanket and low carb diet can be challenging sometimes to really be precise, but having a tracking tool can accelerate that and move past just the constant trial and error that we’re often doing with our nutrition regimens. So I think absolutely, we need to think of this as a continuum, a spectrum. This is something we can train, but we do have to actually do the reps so that our cells can change and adapt to become these more metabolically flexible machines. A lot of that is tied in with insulin.”

52:23 – Text messages and cars honking could be damaging your health

Stress creates a hormonal response in the body keeping blood sugar high. All those stressful messages, commutes, and media scrolling could be leading to metabolic disorders.

“So food, stress management, sleep, and exercise are kind of the four pillars that all feed into our glucose response. The stress thing is interesting because when we stress, we release cortisol and that’s going to keep our blood sugar essentially elevated. So we want to really think about mindfulness…We’re exposed to more of these chronic stressors these days than I think we may have been historically where there were acute, severe threats, but now a lot of our threats are more psychological in nature. You know, we’re getting stressful text messages, having stressful conversations, there’s honking, there’s our digital world, there’s the sensationalist media, there’s all this stuff happening. So it’s this constant low grade stress and I think that’s massively affecting our metabolic health as a country.”

53:52 – Just one hour less sleep could make you pre-diabetic

Studies have shown that even the smallest sleep deprivation can lead to insulin resistance the next day. Over time this builds to a metabolic disorder.

“We’re sleeping less than we have historically on average and sleep deprivation, even getting one hour less sleep per night than your body actually needs, can make you significantly more insulin resistant the next day…There was an interesting study that showed that if you took someone from seven and a half hours of sleep. These numbers might be just a tiny bit off, but it was like seven and a half hours of sleep to having them get six and a half hours of sleep. When they then did a test the next day for insulin sensitivity, which is called an oral glucose tolerance test, it’s basically where you take a drink that has 75 grams of glucose and then you see how the glucose responds over the course of two hours. So the people who were sleep deprived by an hour, and those who had a normal amount of sleep, they had the exact same glucose curve for the oral glucose tolerance test. But the sleep deprived people had to produce 50% more insulin to get that same curve. So it basically made them transiently insulin resistant.”

55:30 – Keep on moving all day long

Walking for 2 minutes every 30 minutes activates big muscle groups in the body which soak up glucose and stabilize blood sugar.

“A key part of physical activity is that while exercising for 30 minutes or an hour each day is great, what might be even better for metabolic health is actually just staying active throughout the day. It seems like long periods of muscle inactivity like sitting at a desk for eight hours is very, very bad for insulin sensitivity and even standing up and walking around for two minutes every half hour has been shown in quite a few research studies to improve insulin sensitivity in 24 hour glucose levels. So it’s not that hard, just set a timer for every 30 minutes and then walk for two minutes. It activates these massive muscle groups, even when you’re walking, your quads, your hamstrings, your glutes, they have to contract when you’re walking. And like you said, it’s this glucose repository, it’s a glucose sink, and so it can really keep things stable, even with just a little bit of light walking throughout the day.”

61:04 – Tech is closing the loop between action and reaction

With real-time feedback from the body, we can now gain more awareness of how our body is impacted by our everyday decisions.

“I think there’s huge potential for tech in this type of case to really bring us back to our body and our sense of body awareness. I think especially with nutrition, because we’ve never had closed loop biofeedback, we’ve never been able to. It’s really an open loop system where you do something, you do a set of actions, like have a meal that’s very, very complex, a lot of different component and then maybe the next day you weigh more, or maybe you’re a little tired that night, or maybe six months later, your cholesterol is higher. But there’s no actual feedback loop between the food you’re eating and what’s actually happening to your body. So we end up, it’s very difficult to optimize because we don’t have a one-to-one relationship between an action and a reaction. And fundamentally, I think behavior change is most effective when we close the loop between an action and a reaction, and you have more of that one-to-one relationship between what you’re doing and what the outcome is. So it really accelerates behavior change in a unique way because it kind of takes some of the emotionality and the questioning and the misattribution out of things.”

Les Raymond: [00:00:00] Hello, and welcome to the Mindful Movement podcast. I’m your host, Les Raymond. And I want to thank you for joining me today for another episode. Today’s episode I have Casey Means on. Casey Means is the co-founder of Levels Health, which is a technology company that has designed a product that it allows users to monitor in real time what their blood sugar levels are.

Now, I’ve been kind of a health enthusiast for quite some time, and I feel like blood sugar has become quite underrated as I learned more. And it’s been brought to my attention that our blood sugar levels are at the core of so many of the components of our health, especially when you’re looking at trying to avoid the common disease processes that seem to take so many lives every year. So when designing a lifestyle with a long-term approach, accounting for these mechanisms in our body, that kind of go awry when we have too much sugar too often in our bloodstream, I think is really paramount. So as someone that feels compelled to help people take more power over their own sense of wellbeing, being able to have real time data that tells you how your body is responding to the foods you eat is really important and how your body’s responding to environmental conditions also. So before, these products were really expensive and not really, you know, available to most people in the public. And oftentimes, people just think of them as a tool for people that suffer from diabetes to help manage that disease. But really everybody could benefit from the information that we get so that you could adjust your lifestyle choices to help you improve the probability of, you know, just a terrific lifespan and health span.

So now that these technologies are available, it’s like at our fingertips and it’s very interesting. It’s been a really eye-opening experience. I wore one of these devices for the last few weeks, and I wore it past the time of the recording this interview. And so I’ll talk in the interview about some things that I noticed and some benefits, but I wanted to touch on one that wasn’t covered in the interview. And it was kind of a surprise for me. And that was really the relationship of my blood sugar levels to my mood. And I would say they’re inversely related in a way. So like if my blood sugar was, let’s say healthy, stable, and low, my mood seemed to be more positive and relaxed and calm, which I really like feeling that way.

So I love that barometer, to see how my choices, if they serve me well or not. And then of course, inversely, if I noticed my mood was off, I felt agitated or maybe had a higher than average experience of anxiety, I was able to correlate that to the times where my sugar levels were high. And sometimes my sugar levels are high because part of the idea of this mechanism is not to wear forever, but to just wear for a little while, to gain some information that you could use, then you could apply.

Now, some people really love it, and they might use it as a long-term strategy. But I think for most, you could benefit a lot from just a try. And it’s interesting to see the information and notice how it’s reflected in the way you feel. And I think that’s just a great opportunity for us to be able to access this information that before, wasn’t really. Now this product isn’t really out to the public yet.

I think it’s a few months away. Right now, there’s a wait list of about 55,000 people waiting for this product. And I’m really happy to announce that Casey was nice enough to offer our listeners a way to kind of bypass that wait list and get into the beta program that I just took part in. You know, you could do this, I’m mentioning it now because we didn’t cover it in the interview.

But if you go to Levels.link/Mindful, you will have an invitation to do a trial of the product. And I assure you, you won’t regret it. It is really cool. And I think the benefits, the longterm benefits from this short term trial, are just so potentially profound. And, you know, I just think, I’m just really excited that this is available to people.

Now, I strongly believe that you should compose your lifestyle around the basics, meaning getting clean air, sunshine, clean water, healthy food, prioritizing your sleep, managing your stress, building strong relationships with not just yourself, but your environment and loved ones and friends. But there’s times where technology can offer just an outs, just a huge opportunity.

And they’re great. And some of them are really expensive and they never truly offset the benefits of sticking to the basics, even though they can absolutely enhance your lifestyle and your health. But this one is really cool because it’s really reasonably priced, I think. And the value you get out of it is just so much greater than that cost.

So I’m excited for people to be able to try this, see how the observation of what’s going on in their body and that feedback loop they get, changes their behavior. And I’m really looking forward to the feedback to the community of what this product does for you. If you do take advantage, if you have no interest in taking advantage of it, there’s still a lot to learn in this interview.

Casey has a nice overview of really what blood sugar levels are, what they mean and what disease processes can manifest if the system that we have internally to regulate this, kind of goes awry. So I thank you for listening to this long-winded intro. And of course, I’m grateful for your listening today.

I hope you enjoy the episode.

Hello and welcome to the Mindful Movement podcast. I’m your host, Les Raymond. And I want to thank you for joining me today for another episode. I’m super excited. I have Casey Means on the podcast today. Casey Means is a Stanford trained physician. She’s the chief medical officer and the co-founder of the metabolic health company Levels.

She’s an associate editor of the International Journal Of Disease Reversal And Prevention. And I’m super stoked. I have tons of questions for Casey. Casey, please say hello to the Mindful Movement.

Dr. Casey Means: [00:07:31] Hello, Mindful Movement audience. Les, thank you so much for having me today. So glad to be here.

Les Raymond: [00:07:36] I’m very grateful that you came on, and I’m really grateful for the work that you’re doing.

For those that are watching this on YouTube, you can see I’m wearing this real strange sticker on the back of my arm. And this is coming to existence because of some of Casey’s work. It is a continuous glucose monitor that I find has been really helpful for me when I’m trying to, I guess, figure out what are the foods that agree with me most, and also how other lifestyle things affect our blood sugar level, which has been really eyeopening that hopefully we’ll take a little dive onto today. But first Casey, maybe you could tell the audience kind of where you came from and how you got to where you are putting out this tech to kind of help the population become healthier.

Dr. Casey Means: [00:08:27] Sure. Absolutely. So I am a metabolic health enthusiast at this point. Really, my core focus of my entrepreneurial work and my practice right now is metabolic optimization, and helping people get their glucose under control and get their glucose to be as flat and stable as possible. And so, you know, it was kind of a circuitous route to getting here.

I actually started my medical career as a ear nose and throat, head and neck surgeon. So I was at Stanford for my undergrad and medical school. And then I came up to Oregon for my residency and in ear, nose and throat. And in that field, it was quite interesting, because after, you know, four and a half years or so, I’m sort of, you know, day in and day out in the operating room.

And I’m kind of reflecting on the types of things that I’m doing. And I realized that almost all of the conditions I was treating were fundamentally inflammatory in nature. So it was like sinusitis, laryngitis, thyroiditis, all these itises, which are, you know, it’s the suffix in healthcare that means inflammation, itis.

And, you know, I was kind of slinging steroids left and right, these immune suppressant type medications, nasal steroids, topical steroids, inhaled steroids, IV steroids. It’s a lot of medication that really tamps down the immune system. And when those don’t work, we take people to the operating room, and

we bust holes in things like the sinus, and we suck pus out. And I kind of came to this realization, like I’m prescribing a lot of medication to turn down the immune response, and I’m sucking a lot of puss out of sinuses and ears and all these places, but you fundamentally, you can’t actually operate on the immune system.

And so it felt very much like a band-aid to me. Like why aren’t we actually addressing the root cause physiology of what is causing inflammation in all these patients. And unfortunately you see patients come back, you know, season after season, year after year with some recurrence of these conditions.

And I started really feeling like maybe this is because we are not actually addressing what the fundamental triggers of inflammation in the body are. And this led me into a real journey, diving deep into the functional medicine world, and listening to so many of these great authors who are publishing books about root cause medicine.

So people like Mark Hyman and Sara Gottfried and Terry Walls, and reading about the gut and the gut brain access and all these things. And became really fixated on how can we keep people out of operating room? How can we help empower people to change these modifiable, dietary, and lifestyle factors that we know contribute to inflammation; the food we eat, how we stress, how much sleep we’re getting, the amount of movement we’re doing, the toxins we’re exposed to in our food, water, and air.

These all drive into revving up our immune system, and I think, really feed into a lot of these chronic conditions I was seeing. And we know that outside of ENT, these are feeding into so many of the chronic conditions that we’re seeing today, the development of diabetes, obesity, dementia, heart disease, a lot of the big killers, cancer.

So I kind of moved away from the operating room, started focusing on really root cause health, opened my own functional medicine private practice, got trained at the Institute For Functional Medicine. And did that for a couple of years and really started. I mean, I was just, it was an incredible transition, because I was so grateful to be able to be helping people really deeply dive into their all aspects of their life and their health behaviors, and really empower people to take ownership over some of these health behaviors, to turn their health around, to create conditions of the body that were going to be healthy.

And then I became really focused on, Okay, I’m doing this for like 15, 20 patients a week. I’m spending two hours with each patient,, but how do we scale this? How do we make this bigger? How do we empower people to make these decisions that are going to be ultimately great for foundational fundamental health. And something I really landed on was I wanted to help people figure out how to control their blood sugar better. Blood sugar, high blood sugar is a huge driver of inflammation in the body.

And it’s actually really quite simple to keep our blood sugar stable. And as the average American eating the standard American diet, our blood sugar is just all over the place. And that is just, I think really underlying, so many of the health conditions we’re seeing today. So I teamed up with my co-founders at  Levels,

and we started this company that gets this incredible technology, continuous glucose monitors to the mainstream. This is a technology that traditionally was actually FDA approved for the management of diabetes, these overt disorders of blood glucose. But we see this huge potential for getting this into the hands of everyone.

And anyone who eats food basically, could benefit from understanding better how food is impacting their body in real time. And we’ve never had that ability to have real time biofeedback on what we’re putting in our mouths. We’ve had biofeedback for sleep, for stress, for exercise, but never for food. So really the way that ties in is like, how do we give people these tools so that they can, day in and day out, make choices that ultimately are going to lead to a less inflammatory state in the body, better fundamental health and, you know, ideally kind of circling back to surgery, keeping them out of the operating room as best we can.

Les Raymond: [00:13:38] Yeah. That’s great. Thanks for that summary. Yeah. I mean, with food, it’s like, there’s so much information, it’s hard to know what’s right for you. And I like that this technology seems to take a lot of the guesswork out, because you just can’t lie. I mean, you can’t fudge it. Like you eat something and the device is going to tell you how your body’s responding to that.

And I’m sure, just because the vast spectrum of like genetics and environments that people have throughout the world and different upbringings, like everybody’s different. So what’s good for you might be very different for someone else. And you know, if you don’t have some type of feedback, you’re really just guessing what is it about blood sugar?

I mean, I’ve heard this explained a little bit. I’m not an expert on the topic by any means, but I know that in the environment that I work with clients over the years, we’re always talking about health-related things. And one thing is obvious is people don’t know, like people don’t know what it means to really maintain a proper, low level of blood sugar and the costs in not doing so, like what happens when we eat to our blood sugar?

Like, what is it supposed to be? And what happens when it goes awry? Like how does that mechanism take place?

Dr. Casey Means: [00:15:00] Yeah, so we can kind of jump into some of the science a little bit, because I think it’s helpful to understand sort of what’s happening when you eat, and then to realize how that’s feeding into a lot of the problems we’re facing today.

So, first thing I’ll say is that we’re not doing a good job of managing our blood sugar in the United States. We are exposed to astronomical amounts of carbohydrates and sugar in our culture. And it’s estimated that the average American is eating, average Americans eat between 150 to 200 pounds of sugar refined sugar per year.

And we were probably eating about one pound of refined sugar per year, around a hundred years ago. So that’s a lot for our body to process, like this has to be processed by all our cells. And when you think about that, just monumental burden, you can imagine how we could be leading to some problems. So many problems by that astronomical load.

Right now, we have 128 million Americans with pre-diabetes or diabetes. So that’s almost a third of the country with a diagnosed metabolic blood sugar disorder. And of those 90 million are pre-diabetic, and most of them do not know that they have prediabetes. And so it’s just something that we’re really it’s, we’re walking around with these blood sugar problems, many of us, and aren’t really aware of it.

So the reason it’s sort of a problem to have dysregulated blood sugar is because a lot of things happen. Our body really tries to keep glucose in a very, very narrow range. And when it goes out of that range, we see a lot of different physiology stemming out of that. We see, like I mentioned, inflammation can occur when blood sugar is quite high.

We see oxidative stress. So too many free radicals generated in the body, which are these damaging metabolic byproducts that can hurt the function of tissues in the body. And then we see a process also called glycation, which is where sugar actually just sticks to things in the body and causes dysfunction.

So inflammation, oxidative stress, glycation, three problems with high blood sugar levels. And then the second part of this is, is not just the sugar, but what it’s doing to our hormones. So high blood sugar, or really any blood sugar, any sugar that you consume is going to cause an insulin release in the body.

That’s the hormone from the pancreas that tells our cells to take glucose out of the bloodstream so that it can be used for energy. Glucose is this core energetic building block in the body, we take it into our cells, and then it’s converted into a form of energy that we can actually use. So it has to be converted by the mitochondria in the cells to ATP, which we can actually use for energy. And insulin is the gatekeeper that allows that glucose to be taken out of the cell, out of the bloodstream

into the cells. But when we spike our glucose over and over and over again, day after day, multiple times per day, with lots of snacks and refined sugar and carbohydrates, our body is taxed with having to produce lots and lots and lots of insulin. And ultimately the body can become what’s called insulin resistant.

It basically has just seen too much of this around and it sort of puts up a block to hearing this signal. And so to get the same amount of glucose out of the bloodstream, into the cells, the body has to actually produce more insulin to overcome that resistance. And over time, you just get these higher and higher levels of insulin, what’s called hyperinsulinemia.

And that’s a problem for a number of reasons. Insulin is a very pro growth, pro storage hormone in the body. So it’s going to tell your body to store fat. It’s going to tell your cells to replicate more, which is why it’s implicated in cancers and driving cancers. It’s not good to have those insulin levels creeping up.

And then the flip side of insulin is that, because it’s a signal to the body that there’s enough energy in the form of glucose in the body. It tells the body, Oh, we’ve got enough of this onboard. We don’t need to use other forms of energy, like fat, which is our other main sort of building block of energy in the body.

So it’s a big block on fat burning. So if our insulin is sort of chronically high, we are going to have difficulty losing weight. We are going to have difficulty losing, using fat for energy, like during workouts. We’re going to wake up super hungry in the morning because our body, it hasn’t had glucose over night, and it’s not going to be able to do that fat burning.

And so we’re going to be like, Oh, we have no energy. We’re really, really hungry. Your body’s going to be dependent on glucose when insulin is high. So the state that we want to be in is where, you know, we’re getting enough glucose and carbohydrates from our diet to kind of give us a very normal and physiologically relevant amount of energy in the body, but not so much that we’re causing this downstream cascade of insulin resistance and impairing our ability to burn fat.

We want to be able to burn glucose when it’s around, and burn fat when we don’t have enough glucose around. And right now, we’re kind of thwarting that ability by having these higher insulin states in the body, and sort of blocking that ability to bounce back and forth between glucose and fat burning, which is a state called metabolic flexibility, which is what we want.

So for all these reasons, the best thing we can do is shape our diet so that we’re not causing these big glucose elevations with our meals and our food choices, and kind of keep things a little bit more gentle, rolling hills of glucose, keep that insulin under control and, you know, and just really be able to kind of move into that state of metabolic flexibility and just really controlled glucose levels.

Les Raymond: [00:20:27] Gotcha. Well, thank you for that summary. Um, there was a lot of information there, the way that I understand, I’ve heard it is that like this relationship with glucose and insulin is something that used to probably serve us very well when there was more like uncertainty and not randomness, but we’re fluctuation in the availability of food and the body’s ability to say, Hey, fat is a really good long-term energy storage system.

So insulin kind of helped us put fat away so that we could last longer without food, but it’s that systems kind of hijacked and backfires because of this availability that we have due to our current, our culture and our habits. It. Am I understanding that right? Or.

Dr. Casey Means: [00:21:16] That’s exactly right. You can imagine in times of scarcity or food insecurity, this could be really helpful.

Let’s say, you know, total hypothetical, but you’re a hunter gatherer. You come across this incredible, you know, glucose source, like a bunch of berries or something. So you eat and you don’t know the next time you’re getting food necessarily. So you eat all these berries, your insulin go, your glucose goes way up.

Your insulin goes way up. You utilize what you can from that for energy in the moment. And then your body actually stores that remaining glucose as either stored glucose in the liver, or it will actually convert it to fat for longterm storage. Insulin, like I mentioned, it’s a pro growth, pro storage signal.

It tells us to store fat and not to burn fat. So in that situation, that’s great. You’ve used what you’ve needed. You’ve stored the rest for later. Then you can imagine, let’s say you’re not eating for the next three days because you haven’t found any more food. Well, you’re not going to have any glucose spikes during that time, because you’re not consuming any food.

So your insulin is going to be quite low. And that’s going to take that break off that burning, and allow you to burn that fat for energy when you don’t have the glucose around. And that’s exactly that metabolic sort of flexibility switch. It’s this kind of on-off switch that lets us have access to different energetic substrates when we have different resources available.

And because we are such a high carb sort of Western standard American diet, now we’re just overloading the body with that glucose carbs signal. And we are, you know, the insulin is still telling the body, Cool, we’ve got all this glucose, store it, store it, store it, store it. And that’s all, you know, turning into fat, and we’re never actually getting the opportunity to burn through that.

So as of right now, 72% of the country is overweight or obese. And this is very much, I think, related to a very hijacked insulin system.

Les Raymond: [00:23:10] And then the resistance is basically your body just getting worse over time. Because you’re kind of, you’re taking advantage of the system. You’re overdoing it and then it becomes

less, um, like strong of a, say, like less effective of a signal. So it doesn’t open. It’s not, it’s no longer a good gatekeeper. It doesn’t open up the, the flood gates of the cell. From what I understand it, um, I guess there’s a signaling molecule, I guess, in the middle of the cell or in the lysosomes. And it moves out to the cell membrane to open the doors and say, come on in, like get nutrients in here.

So that whole process just gets dumbed down.

Dr. Casey Means: [00:23:50] I think dumbed down is the perfect word. So you have insulin receptors on your cell membranes, and those are going to bind with this hormone insulin. And then what happens is this, inside the cell, a whole cascade of events that causes glucose channels to go to the cell called glute channels.

And that’s going to allow that glucose to come in. That whole process is impaired in the process of insulin resistance. And part of it is that a lot of the glucose that we’re eating and consuming when it’s stored as fat, and we’re also pairing these high carb diets with also a lot of fat in our diets.

What happens is that inside the cell, you can actually get really gunked up with a number of different, basically stored forms of glucose and fat. And that actually, from the inside of the cell, blocks the insulin receptor from working properly. And that’s really the root of insulin resistance. So, not to get too much into the weeds, but it’s very much this sort of process of almost like a protective mechanism for the cell. Like we are too full. It is full,, like stop shoving glucose in this cell, there is no space. We can’t deal with it. And so it kind of blocks. So the nice thing is that as you then take a cell like that, that’s insulin resistant and sort of like stopping that influx, putting that, you know, dumbing it down, putting the break on that through insulin resistance,

if you then, you know, really optimize conditions in the body, go into a more like lower glucose state, you know, optimize your diet so that you’re not getting these glucose spikes or do some intermittent fasting. What you’re going to do is you’re going to create these conditions in the body where your insulin is actually lower when you’re not eating a lot of glucose or carbohydrates or fasting, your insulin is going to come down because you don’t need it.

There’s not exogenous glucose coming in. And over time, the cell will perk up again, that it will start listening to that insulin signal a little bit sharper because it’s becoming insulin sensitive again. So you can very much move back and forth on this spectrum of insulin resistance based on how you’re eating.

And our goal is to help people with  Levels, is to help people understand their diet better, as they understand the glycemic impact of the food they’re eating, and then can hopefully work towards, you know, improving that insulin sensitivity over time, by not overloading the body with this huge constant, you know, glucose signal.

Les Raymond: [00:26:11] Gotcha. Yeah. One of the doctors, I listened to a doc, I don’t know if you’ve heard of him, Dr. Peter Attia. Okay. So I’ve been listening to Dr. Attia for a while now, and I get a lot of my, I guess, education about some of these things, because I guess he’s somewhat obsessed with this stuff. And if you haven’t checked out, he’s got an outstanding podcast for the listeners out there.

I highly recommend, but he put something in perspective once that I guess, was startling to me. Where he said all the blood in your body could only hold like about a teaspoon of sugar. It’s like nothing. And that sounded crazy. And the liver could hold, I guess, based on how big you are of a person, you know, maybe 80, 90, maybe a hundred grams, but then like, there’s no, there’s nowhere else to go.

And then you have muscle. So like, there’s, first of all, that’s a good point that there’s value in building muscle, because it’s kind of like extra storage space for sugar. So, um, you know, it’s like a glucose disposal system, which is really, you know, helpful when you like to eat, you can handle more, but it was startling to hear like how little we can hold.

So. Am I right in thinking or on track that if you ingest more than those amounts, you’re essentially triggering some inflammatory process that’s basically triggering inflammatory pathways when there’s more sugar than your body has places to put it, or is it just kind of effecting that insulin sensitivity and then there’s all kinds of potential disease pathways that are born out of that.

Dr. Casey Means: [00:27:53] Yeah, it’s both. So there’s the glucose specific physiology that can happen like I mentioned, like triggering inflammation. There’s the glycation that can happen, which can, you know, the sticking of glucose to things which can hurt your blood vessels and cause problems like that.

And then there’s the whole hormonal cascade that can happen, which is very problematic as well. And so both of those can contribute to a whole host of health conditions that we’re seeing. And, you know, it’s interesting because what I think people don’t quite recognize is that, and even the medical community doesn’t fully recognize that so many of the massive conditions that we’re dealing with in our country, actually seven of the 10 leading causes of death in the U S are related to blood sugar dysfunction and metabolic dysfunction. And so it’s not that it’s just about diabetes or obesity, the obvious things that we’re thinking about, you know, blood sugar dysregulation directly leads to heart disease, high blood pressure, heart failure.

It contributes to cancer, obviously non-alcoholic fatty liver disease. Like you mentioned, chronic kidney disease, preventable blindness, even Alzheimer’s, which is now being called type three diabetes, because when the brain is insulin resistant and can’t get enough energy, you can imagine that could lead to dementia.

It’s related to chronic pain, fibromyalgia, chronic fatigue syndrome, depression and anxiety, and erectile dysfunction and infertility, even sexual function. And I think, so that’s sort of the long-term things that you might see amongst many others. And then even in the short term, it can be related to high. You know, up and down blood sugar spikes is related to our mood, sort of changing throughout the day, or sort of feeling low energy after a meal.

If we have a big glucose spike and a big drop. And.

Les Raymond: [00:29:44] Yeah, everybody’s probably experienced that at some time. You have that huge, I mean, we’ll experience it tomorrow. We’re recording this the day before Thanksgiving where, you know, you feel like you’re in a food coma after you, you know, how much food can I eat in one day, in one sitting?

Dr. Casey Means: [00:29:59] Yeah, I think, you know, and I would encourage people for the holidays to think about their meals through the lens of glucose, to enjoy the meal, but maybe, you know, do some swaps that prevent some of the collateral damage of the meals. But, you know, I think it kind of makes sense with how many of these conditions and symptoms are related to glucose, because we think about this metabolism, this processing of glucose for energy.

This is like a core fundamental pathway in the body that affects every single cell. Every single cell in the body needs to process glucose efficiently, which means that an efficient insulin sensitivity in order to convert glucose or fat, to actual energy we can use. When cells don’t get energy, they don’t function.

And we see some disease emerging. So you can imagine if this core fundamental pathway is screwed up, it could show its face in so many different ways. But depending on what cell type or tissue we’re talking about, if it’s the ovaries, it might look like infertility. If it’s the brain, it might look like depression, anxiety, Alzheimer’s, chronic pain or fatigue.

If it’s the liver, it could be non-alcoholic fatty liver disease. But it’s really this insulin resistance. And this out of control blood sugar is like the trunk of the tree with all these different branches that sort of seem different, but actually at their core, a lot of them have a very similar issue, which has all these things we’re talking about.

And it comes down to the fact that cells need energy to function. They need to get it in an efficient way. And when we start messing with that process, which largely happens because we are overloading the body with glucose and creating this insulin resistance, making it difficult for cells to kind of actually even get glucose in, because they’re insulin resistant.

You can imagine, that could just create such a wide amount of clinical results. And so while they seem different in a lot of ways, they’re actually rooted in the same fundamental core physiology.

Les Raymond: [00:31:56] Which is to me like the exciting opportunity, because you have all these things. I mean, you say seven out of the, I guess, top 10 killers or something.

So to me, that’s great news in a way, because it’s like, Oh, I could just focus on fewer things. And I guess based on genetics or other factors, that problem could manifest down any one of those branches you mentioned. But to be able to just focus on the trunk and say, Let me just attack all of these potential source at, you know, a causal component is empowering. And, you know, you don’t necessarily need technology to do that, but there’s times where a little tech help from technology is like so useful, and you could eliminate so much guesswork. So I’ve been where, I’ll fill the listeners in on my experience with this.

So I’ve been wearing one of these. And I remember hearing about these, I think listening to Dr. Attia for years and, you know, they sounded really expensive and you needed a prescription. And, I remember even thinking about contacting my doctor and seeing if I could get one, but I wasn’t like diagnosed diabetes.

I didn’t see that happening. I just looked at it as an opportunity to optimize health. And when I heard about Levels, I was really excited. Because I was like, Oh, this is very, you know, obtainable. This is well-priced, it’s easy and you can get it. You don’t need to go see your doctor first. So, you guys sent me the pack.

I put it on, it’s a really robust software that comes with it that, I wouldn’t say it like, maybe it kind of like gamifies it a little bit. It kind of makes it exciting. You have something to play with and you know, you’re getting information from the inside of your body, and then your phone is teaching you about it, and it’s telling. And you know, you could log.

So every time you have a meal, you could add a note, take a picture of the meal, you could write a description. And then over the next few hours, you’ll see your response to that. And you could learn like, does this serve me? And there was some eye-opening moments for me where. I generally eat pretty well, but because of this was on, I looked at it as opportunity to kind of test some things. And I think that’s part of the idea, like challenge. I think you guys call it, you give even ideas of how to challenge your system to see, you know, something that you would normally cheat with or, and it was kind of alarming. And, like I had this thought in my mind that white rice, I already kind of knew it wasn’t good for me, because it never satisfied me.

I could eat it an insane amount of it. And then usually afterwards I feel like I’m in like pancreatic shock or something. So sure enough, like I have, what otherwise would be a pretty healthy meal. Like it was a seafood broth with fresh seafood, and a little bit of vegetables, but then there was a big bunch of white rice in it. And it was like a disaster on my score. And it’s cool because you get, you know, daily emails of this is how your day did, and then it shows you like this, you know, rakes your meal. Basically, it puts a quantitative number to like, is that meal good for you? Or is it not? So like, if you have a nine it’s like, Oh, I ate this and I got a nine out of 10.

Like I could eat this. I mean, this probably is not going to lead to all these seven, you know, killer diseases. But then you like, you get this red flag and it’s like a five and it’s like, Oh, there’s a lesson here, but this is a gift because I could be guessing. And you know, you don’t think much of it, but let’s say I’d already eaten rice two or three times a week.

Well, what does that look like over 20 or 30 years? There’s thousands of thousands of like bombarding my signaling mechanism of insulin that it’s a disaster over time. But now that I know it’s like, it doesn’t mean I’ll never have it, but I won’t eat it often and I won’t need a lot of it when I do.

And it’s, it’s empowering to know, like I have that control. Let’s see. But, you know, overall, it was funny. I was excited because I hooked it up, and my levels look pretty good. And I’m like, yeah, my blood sugar is good. And then it was humbling. Like I had the rice dish. One day, I had like some peanut butter jelly, like no bread.

I just had a little peanut butter jelly. And again, it was a disaster. And I’m like, Okay. And afterwards I’m like, of course it is, it’s peanut. Like it’s two tablespoons of straight fructose and sugar. Like of course it’s going to be a problem. But I would justify that all the time because of, you know, maybe I live an active lifestyle and I feel like I got room for that, it’s no big deal. But maybe it is a big deal. But then I was pleasantly surprised on some dishes where I would have large amounts of food, food that I like, and I would respond really well to. And it’s like reassuring, like, yeah, you’re on the right track. You could eat these things. So it’s really cool.

I love the software. I love the way that you guys display the information, so you could quickly learn and there’s all kinds of articles you link to it to learn more and take deeper dives on topics. I think it’s a terrific tool. I’m really grateful that it’s in existence, and I’m looking forward to seeing where it goes.

I have another a week and a half or so with the one that I’m wearing now. But I see myself coming back to this as a tool periodically, maybe every six to 12 months. And just one, to see if anything changes. I think it would be interesting to see, because I bet there’s foods that even though they don’t agree with you at one point, maybe as your health changes, maybe you could handle more or maybe you just need a bigger sample size where you change maybe the amount. One thing I haven’t played with is, well, I know that if I eat, you know, an entire large sweet potato, it’s not great for me, but that doesn’t mean that a half a sweet potato is not. And sometimes I have control issues around quantities. So I have like, there’s a lot of work you could do to like, you know, dive into the nuance of really fine tuning your routines.

Dr. Casey Means: [00:38:30] Absolutely. This is so fun to hear about, you know, your experience and what you learned. And I think that something that you really highlighted is that there are foods that you sometimes eat like rice or peanut butter and jelly. And this allowed you to see how foods that you like and that you eat intermittently are affecting you. And so it helps you make smarter more personalized choices. I think there’s this whole other category of things that I know for me has been really interesting, which is like foods where you actually think they’re totally okay. But then you get surprised by what you see. So an example for me would be ketchup.

So, you know, I would put ketchup on things here and there, you know, if I’m making like a black bean burger or something. And I would eat a meal where I’m like, Oh, this is going to have no glucose response at all. And then I’d see like a 50 point rise in my glucose, which is really, really high. And I’d get, you know, a terrible score.

And then I’d be digging through the ingredients of what I ate and realized that, Oh, that ketchup I ate, which maybe I ate like four tablespoons has, you know, six grams of added sugar per tablespoon. Like this is insane. So it was actually just like, it thwarted me unknowingly. So some of those surprises. Salad dressings will often do that.

Les Raymond: [00:39:48] Did you try again with like a lower sugar ketchup to see, or.

Dr. Casey Means: [00:39:51] Oh yeah. I immediately bought, you know, primal kitchen, no sugar ketchup on Amazon. And I would never, never go back. And of course it was fine. It has no sugar and it’s just such a different. And actually I went to Whole Foods first because I was looking to see if there were any ketchups that I could find.

And there was, they were actually out of primal kitchen that day. Not a single other ketchup in Whole Foods that had not had added refined sugar. And so I was just shocked. But it’s, you know, you see this for a lots of different things. It’s like, it’s soda, obviously it has sugar, but now it’s in things like you wouldn’t even expect, just like marinades and stuff.

Les Raymond: [00:40:33] It doesn’t take much, like you said, six grams. I mean, people don’t realize how little sugar the body is really meant to handle at a time. What’s the deal level. So when I was logging, when I was setting up the app, it basically asked me to set the parameters, and I wasn’t really sure. So what’s an ideal fasting blood sugar level, and then post meal.

I know that, you know, you want to monitor it after time. So like, you know, at 30 minutes, maybe 60 minutes, two hours. What should it look like?

Dr. Casey Means: [00:41:11] Yeah. So what’s interesting is that we haven’t had a lot of guidance on this throughout in the past, because continuous glucose monitors weren’t a thing. And certainly not a thing for people who are just, who are non-diabetic, who were actually just trying to optimize their diet.

So there’s not a ton of guidance from the medical community on what healthy glucose ranges are. So really where I come from and  Levels as well, is actually just digging really deep into the research literature and trying to figure out clues to like, what is the optimal glucose levels for people to basically stay out of trouble. And really where it’s kind of landed for me is that, I try and stay between 70 and 110 milligrams per deciliter, pretty much for the entire day. So that’s, to me, sort of my healthy range. Sometimes I’ll go up to like 120 if I get totally bamboozled by something, you know.

Les Raymond: [00:42:00] Like ketchup.

Casey Means : [00:42:02] Like ketchup. Sometimes it will go up a little bit higher, but I mean, I really try and stick on days when I’m cooking and I’m in control, 70 to 110, a healthy fasting glucose range.

So if you just went to the doctor and they asked what is a normal glucose range, they’d say under a hundred for fasting glucose, first thing in the morning, haven’t eaten for eight hours, if you’re under a hundred, you’re okay. But if you actually look at the research, people who are between more like 70 and 85 tend to do much better longterm than people who are in the higher range of normal for fasting glucose.

So as your glucose goes from the lower end of normal to the higher end of normal, like from 70 up towards 100 on your fasting glucose, your risk for developing diabetes, obesity, heart disease, all goes up. So from my standpoint, I’d like to stay in that lower risk range and the lower end of what’s normal for fasting glucose.

So 70s to 110 for sort of my optimal 24 hour range, 72 to 85 for my fasting glucose. And then kind of sitting in the high seventies, low eighties, like throughout the day when I’m not eating. And when I eat, I try and go up, you know, maybe 15, 20 points at the most. But, and then I’d like to see it go up in the, you know, maybe 45 minutes, and then come down totally to normal within about an hour and a half to two hours. That shows like a healthy insulin response.

You digest the food, it went in, it came down. And what you’ll often see, eating sort of like normal. American foods, all the processed foods, so things like crackers, chips, breads, tortillas, desserts, sodas, etc, is that you might often see a glucose response that’s like 70, 80, 90, a hundred points with just like a single snack or drink.

So I said, I like to not go up to more than 15 to 20 after meals. If you’re not trying or focusing on this, it would be very easy to go up, like I said, like 60 to a hundred points. And what happens then is that you do get that huge insulin release. And then what you’ll often find is that after those meals, you crash down, because that insulin caused all that glucose to be sort of soaked up in the cells.

You had this exaggerated insulin response, and then you crash to below your pre-meal levels. And that’s a process called reactive hypoglycemia, and we’re basically overshot. And that state, that reactive hypoglycemia is associated with anxiety. It’s associated with fatigue. That’s sort of that post-meal slump that you might be feeling where you get your energies zapped.

Les Raymond: [00:44:37] So I’ve seen that on the app a little bit, and I’ve seen that really sharp spike and then come down. And I definitely can associate fatigue with it. That’s like when I feel like I want a nap or something, and at a time where you shouldn’t, you know, stay time, shouldn’t be tired necessarily. I saw some other things that popped out of me.

I wanted to ask you about like other, I guess environmental things that alter blood sugar. Two things that stood out to me. One is exercise. So I exercise almost every day to some degree. And I definitely see a spike from exercise. One, is that normal? And is it because your body’s just shuttling nutrients?

So like the bloodstream is filled with essentially substrate it needs to make energy, like sugar. Does that happen intentionally because you need it?

Dr. Casey Means: [00:45:36] Yeah. So this is a super interesting phenomenon that we see where people’s glucose when they are exercising at high intensity, generally high intensities only. You actually might see a glucose spike during the workout, even if you haven’t eaten anything before the workout. And this is a totally different mechanism that’s happening, which is exactly what you just mentioned. Your body is utilizing the stored glucose it has to fuel your workout basically.

So when you start a high-intensity workout, so something like a big bike ride or a run or a power lifting type thing, it’s going to release a stress hormone in your body, that’s a stressor. And so your body’s going to release cortisol and catecholamine hormones like adrenaline. And that’s actually going to tell your liver, which is the place in the body. The liver and the muscles, both store some glucose.

And you’re going to dump that, like glucose from the liver into the bloodstream to fuel your muscles. And so you can actually think about it almost like you’re clearing you’re clearing the tank. not a bad thing. It’s not like food coming in from the outside. And the muscles are quite brilliant in that they can actually take up glucose through an insulin independent mechanism.

So just the contractility of muscles actually allows them to take up glucose without needing that insulin signal. So it’s a totally different pathway.

Les Raymond: [00:46:54] Interesting. So it doesn’t contribute to insulin resistance because you’re not whaling away on that mechanism. The muscle could just grab glucose into the cells, into skeletal muscle cells without insulin opening up the door?

Dr. Casey Means: [00:47:11] That’s correct. Yeah. So there’s that muscle insulin independent mechanism, that’s going to soak it up. And actually almost all forms of that. All forms of exercise improve insulin sensitivity over time. So whether it’s resistance training or aerobic training, or even agility, flexibility type training, all like yoga, all of these improve insulin sensitivity over time.

So at this point, you know, with the employees at our company, we are all, you know, into fitness and athletics. And we almost use the magnitude of those glucose spikes as a marker of how intense the workout is. Because it’s like, the bigger that spike it needs your body like was under that, you know, potentially good stress and told your body, Okay, you’re working hard. You need glucose. We’re going to dump it from the liver.

Les Raymond: [00:48:03] Do you have like office competitions who can get the highest blood sugar spike from working out.

Dr. Casey Means: [00:48:08] I wouldn’t say. We haven’t gotten that far, but we do. You know, if you follow us on Instagram or Twitter @Levels, you’ll see tons and tons of people posting athletic spikes, because it’s very interesting for people to see that. And actually our head of customer success, Mike DiDonato was an incredible athlete. And he over time has gotten himself to be so metabolically flexible, meaning his diet is so refined to be sort of low and stable glucose that he’s, his insulin is likely very low.

He’s a very good fat oxidizer at this point, he can burn fat effectively. That he’s now actually running marathons multiple times per quarter, just on the weekend himself, totally fasted, zero food. And I do not recommend that other people try this. But he’s running 26.2 miles totally fasted. And what you’ll see is that on his, you know, in the beginning, his glucose will go up maybe 30, 40 points.

That’s his body clearing out the stored glucose for the beginning of his run. And then he’s likely just going into just really high, fat burning for the rest of the run, not using any gels or gooze or anything like. And so again, I do not recommend this at home, but it’s interesting to see that type of physiology. The average person who just took a run fasted, would struggle with that because their body’s so used to needing glucose for energy, but.

Les Raymond: [00:49:27] But you bring up a good point that that’s trainable. Like the cool thing about this, I think that’s very empowering to people, especially if you’re solving, let’s say, you know, most people carry around some amount of excess weight, excess in form of fat.

And like, this is something that you can get better at. Like you could train. And I used to be pretty heavy. I was about 80 pounds heavier than I am now, back in the day. And, I didn’t know any of this stuff back then, but now I’ve learned that like, you can absolutely train this ability to switch.

So if you feel like your fat’s kind of stubborn and you’re not good at switching fuel sources, as you practice, just like anything, you get stronger. Like you adapt to that adaptation essentially, and you get good at switching gears or switching substrate.

Dr. Casey Means: [00:50:20] That’s exactly right. And that’s why we’re actually calling this improving metabolic fitness. We really are focused on this term fitness for metabolism, because it’s exactly what you said.

It’s just like adaptations. And for building muscles, the reps are, you know, lifting weights day after day, month after month. You don’t immediately have a big muscle after your first workout. You adapt to having big muscles when you put in the reps. And for metabolism, and to be able to get into that metabolically flexible state, the reps are, keeping your glucose lower day after day.

And how could we possibly do that if we’re not testing it? I mean, we could follow a general, low carbohydrate diet, but there’s actually a few problems with that. One is that, and you’ve alluded to this earlier, is that each body is different. Each body actually responds to food differently. So you and I could both eat a banana, and my glucose could go up 70 points, and yours could go up five points based on our body types, our microbiome, how much sleep we got last night, how much stress we’re under today. For you, that might be a good metabolic choice, for me it’s a bad one. So it’s actually really individualized. So just following like a blanketed low carb diet can be challenging sometimes, to really like be precise. But having a tracking tool can accelerate that, and move past just the constant trial and error that we’re often doing with our nutrition regimens.

So. Yeah. I think it’s absolutely, we need to think of this as a continuum, a spectrum. This is something we can train, but we do have to actually do the reps so that our cells can change and adapt to become these, you know, more metabolically, flexible machines. And a lot of that is tied in with insulin.

And, you know, I think it’s also worth mentioning, you know, you mentioned the exercise. But there’s other things other than just food and exercise that impact our glucose levels and our insulin sensitivity. The other, you know, two really big ones that we have control over, I think day in and day out are stress and sleep.

So, so food, stress management, sleep and exercise are kind of the four pillars that all feed into our glucose response. And, you know, it’s just, it’s the stress thing is interesting because, you know, when we stress, we release cortisol, and that’s going to keep our blood sugar essentially elevated. So we want to really think about mindfulness.

Les Raymond: [00:52:37] And why is that? So when cortisol, is that because like your body’s in the I’m fighting the tiger and I need nutrients at my extremities.

Dr. Casey Means: [00:52:46] Precisely. Yeah. So, that, you know, and we’re exposed to more of these chronic stressors these days than I think we may have been historically, where there were like acute, severe threats that. But now a lot of our threats are more psychological in nature.

You know, we’re getting stressful text messages, having stressful conversations. There’s honking. There’s our digital world. There’s the sensationalist media, there’s all this stuff happening. So it’s this constant low grade stress. And I think that’s massively affecting our metabolic health as a country.

And then we’re sleeping less than we have historically on average. And sleep deprivation, even getting one hour less sleep per night than your body actually needs, can make you significantly more insulin resistant the next day. And so sleep is just one of those.

Les Raymond: [00:53:38] That’s interesting.

That’s quick. And then how long, like is there any understanding out there about like how long it takes to regroup from that? I mean, it is just a few days later or.

Dr. Casey Means: [00:53:52] Yeah, there is actually research on that. So one of these great studies looked at a group of, I think it was like 11 young, healthy men. And they made them sleep four hours per night for about a week.

And within that, just so sleeping. And that’s a lot of sleep deprivation, but four hours a night for a week. They all went from being basically non-diabetic to pre-diabetic in that time. Then they flipped them and put them in, they could sleep as much as they wanted. So like unlimited sleep the next week.

And they all, you know, bounced back and came back. But, you know, imagine like a college student who might be getting five and a half, six hours and a half of sleep per night for years, like what that could be doing to their body. And there was another interesting study that showed that if you took someone from seven and a half hours of sleep. These numbers might be just a tiny bit off, but it was like seven and a half hours of sleep to just having them get six and a half hours of sleep. When they then did a test, the next day of insulin sensitivity, which is called an oral glucose tolerance test, it’s basically where you take a drink that has 75 grams of glucose.

And then you see how the glucose responds over the course of two hours. So the people who were sleep deprived by an hour, and those who had a normal amount of sleep, they had the exact same glucose curve for the oral glucose tolerance test. But the sleep deprived people had to produce 50% more insulin to get that same curve.

So it basically made them transiently insulin resistance. So, yeah, so it’s just like, it just gets down to the basics, you know. It’s a diet that’s thoughtfully, you know, selected. It’s getting the sleep every night. It’s taking the deep breaths when we get a stressful email, and managing our cortisol, you know, the stress management. And then making sure we’re being physically active.

And a key part of the physical activity is that while exercising for, you know, 30 minutes or an hour each day is great. What might be even better for metabolic health is actually just, also just staying active throughout the day. It seems like long periods of muscle inactivity like sitting at a desk for eight hours is very, very bad for insulin sensitivity. And even standing up and walking around for two minutes every half hour has been shown in quite a few research studies to improve insulin sensitivity in 24 hour glucose levels. So it’s not that hard, like just set a timer for every 30 minutes, and then walk for two minutes, and it activates these massive muscle groups, even when you’re walking, your quads, your hamstrings, your glutes, they have to contract when you’re walking.

And like you said, it’s this glucose repository, it’s a glucose sink. And so it can really keep things stable, even with just a little bit of light walking throughout the day.

Les Raymond: [00:56:30] Yeah. I’m glad you mentioned that. And that’s something I’ve noticed on my app. So I guess, one of the real blessings that have arisen in my life during these last, you know, eight, nine months or whatever we’re going through now, is I’ve started walking more.

So I walk with my daughter after dinner every night. And it’s not long, it’s, you know, the end of the neighborhood back, it’s probably 20 minutes round trip. But it definitely makes a difference. If I miss a walk, I notice that I have a bigger spike. And I think I’ve heard someone else once that was using a CGM, a continuous glucose monitor.

They said that right before meal, that they would like knock out a big set of squats, or something in their kitchen when they’re cooking, just to get the muscles hungry so that, you know, you have extra storage space essentially in the moment when the glucose is coming in. So again, you know, it doesn’t take a lot of time.

I actually have a habit of, I cook almost every night. And where like, I’ll do these moves later, like body weight exercises in my kitchen while I’m like waiting for the water to boil or. I get, kind of silly about it. My family already thinks I’m crazy though. So it’s, you know, it’s, it’s kind of just part of the scenery around my house, around, you know, dinnertime. The other environmental thing that stuck out to me.

Another part of, I guess, like my daily practices, I usually have some kind of heat exposure, usually in the form of sauna, like infrared sauna, or I take Epsom salt baths. And that definitely spikes it. Is that like acting as exercise or is that a different mechanism. What’s causing that spike there?

Dr. Casey Means: [00:58:24] Yeah, there could be two things there that are worth mentioning.

So one is that a heat stressor can generate that whole stress cascade of, you know, cortisol and getting the liver to release glucose into the bloodstream. But that also may be related to sensor error. So the sensors are quite sensitive to heat. And so we have found that just heat exposure alone can create some, you know, perturbations in the glucose response. The same thing with cold baths and things like that, you can see a little bit of error. So it very well could be a mix of both of those things.

Les Raymond: [00:58:58] But that’s not a problem. Like that’s not taking advantage of our like insulin signaling mechanism or, or is it?

Dr. Casey Means: [00:59:08] Yeah, the consensus. And there haven’t been great human studies in heat and cold exposure for metabolic health.

But generally, it’s thought that these things are actually good for our mitochondrial function. They are stimulating the mitochondria to be more efficient. That’s the part of the cell that converts glucose to energy we can use like ATP. So, the consensus is really generally, that these things are positive for our overall metabolic health.

The cold exposure is getting really popular now with like cold baths and cold plunges and cold showers and things like this. And they’re thought of as a hormetic stressor. So this sort of like low grade stress, that’s going to ultimately make us adapt better in the future. And lots of studies actually done in mice where they put mice under intense cold exposure.

And what they’ve found in mice is that they actually, cold exposure, even for short periods of time, Increases the amount of mitochondria in each cell, mitochondrial biogenesis. And you actually see what’s called an increase in Brown fat. We have white fat, which is the main type of fat that we see in our bodies as an adult.

But actually babies have a lot of this stuff called Brown fat, which is brown because it’s filled with mitochondria. So it generates tons of heat from all this metabolic activity. And it seems like cold exposure as an adult can potentially generate more of this Brown fat, and make us, increase our sort of metabolic churn and activity.

So I can’t wait to see more studies happen about that type of stuff in humans. But you do see this in, in rats when you.

Les Raymond: [01:00:42] I’ve heard that term. So the Brown fat basically means it has more mitochondria per area.

Casey Means : [01:00:50] Yeah. Okay. Exactly.

Les Raymond: [01:00:53] And mitochondria is where the magic happens. So that’s where we’re taking like food or let’s maybe like chemical energy, turning it into electrical energy, and then mechanical energy. It’s like through the movement of electrons, essentially the release of the electron of ATP is what’s creating all the things that happen in our body. Right?

Dr. Casey Means: [01:01:17] Yeah. So you can imagine you’ve got this, you know, sphere that is your cell. You’ve got the insulin receptor, the glucose receptor, the glucose is going to come into the cell.

It’s going to travel inside the cells, the mitochondria, where a number of biochemical processes are going to happen. That takes that glucose, and basically uses its energy in the form of electrons and cellular bonds and whatnot, to eventually drive this electron channel that creates, like you said, electrical energy essentially. And that’s going to generate adenosine triphosphate, ATP.

That’s going to generate the ATP molecules themselves. And then those go around and donate phosphate groups, the P in the ATP, to other proteins and such in the cell that actually, they can dump energy then to other parts of the cell to basically, it’s currency that could be used in the cell for energy.

Les Raymond: [01:02:11] I dropped out of school a little early, so I like getting those little tidbits of education.

Dr. Casey Means: [01:02:16] You got it. I mean. It’s basically it is this miraculous, crazy complicated turbine, essentially that is generating new forms of energy. And it’s pretty beautiful.

There’s amazing YouTube videos online showing 3D renderings of this type of process in the mitochondria. So I’ll follow up with some, but they’re really fun to watch.

Les Raymond: [01:02:43] Cool. Well, before we wrap it up, there was something you alluded to before we hit record, that was interesting. And I guess it was in regards to relationship with food, relationship with eating.

And I think that’s something that most people could benefit to some degree. I know I’ve played around my food, just trying to find what works best for a long time. I’ve done a lot of fasting protocols, a lot of intermittent fasting. And one thing that I get out of it is just altering the relationship.

And I think some people, you alluded to the idea that some people could look at tech as, I don’t know, like cluttering that relationship and having a negative effect. And I really look at this tool as an opportunity to build more self-awareness, and alter your relationship with your body and your food, and take a more mindful approach where you know, it’s very positive. And, you know, I think a lot of people could benefit with like, learning, like, Oh, I see this, and I feel this, I’m learning about myself. And I mean, yeah, you could maybe get carried away and get a little OCD with that, you know. But for most people, I think that’s a great opportunity to learn really important lessons about yourself and how you’re thinking about your food and.

What are your thoughts on that?

Dr. Casey Means: [01:04:13] Yeah, I think that’s exactly right. I think there’s huge potential for, for tech in this type of case to really bring us back to our body and our sense of body awareness, I think, especially with nutrition. Because we’ve never had closed loop biofeedback. We’ve never been able to just, you know, it’s really an open loop system where you do something, you do a set of actions, like have a meal that’s very, very complex, a lot of different components.

And then maybe the next day, you weigh more, or maybe you’re a little tired that night, or maybe six months later, your cholesterol is higher, you know. But there’s no actual feedback loop between the food you’re eating and what’s actually happening to your body. And so we end up, it’s very difficult to optimize because we don’t have a one-to-one relationship between inaction and a reaction.

And fundamentally, I think behavior change is most effective when we close the loop between an action and a reaction, and you have more of that one-to-one relationship between what you’re doing and what the outcome is. So, you know, it really accelerates behavior change in a unique way, because it kind of takes some of the emotionality and the questioning and the misattribution out of things that can be very, very stressful. So we have an emotional relationship with food. There’s no question to that. It’s not just a form of sustenance, but it’s also very much part of our community and our, you know, for many people, coping and enjoyment and pleasure. But I kind of think of glucose tracking as like food poisoning.

It’s like, if you eat a bunch of clams and then the next that night, you’re throwing up, like over and over and over again, like it’s you’re just never eating clams again. Your body is just like, I don’t want these. This is not good for me. And, you’re not like sad to part with that food.

You just have a negative association with it from then on out. And it’s kind of that way with seeing a glucose spike after eating a food that you might love. It’s like, you know, I was eating oatmeal for years for breakfast, thinking that it was like a super heart-healthy food and there’s all this marketing about it.

But when I saw that it spiked my glucose to 200, I just never wanted to eat it again. It wasn’t emotional. It was just like, Well, this is not a good choice. And you know, eating something else for breakfast is going to be like a half an avocado with some tahini and chia seeds and, you know, just something different.

Like if it’s going to cause no glucose spike, total game changer, but it wasn’t emotional. And so I think there’s a lot of opportunity to help people move past what is often like a real struggle of trial and error to figure out what works for their body, and let it be a lot more efficient. You know, people might say, Oh, having this is going to make you obsess about food, but I think it’s the opposite. I think it actually makes it much more efficient to figure out what works for your body. And we’ve got a lot of customers who in the course of a month, doing a lot of experimentation and learning about how their foods are affecting them, have been able to just like move forward after that month and, and, you know, have a whole new set of foods that they know are the right parts of their diet.

And so, so I think that really, you know, helps people understand themselves and their choices better, and can make it really efficient. And then the second thing that I think is positive for people is that it’s not necessarily all about elimination or getting rid of things. You mentioned the sweet potato example, like yes, a cup of sweet potato might spike your glucose, but you know, there’s so many things we can do to foods to actually make them more glycemically friendly for us.

We have this whole toolbox of things. We can obviously eat a smaller portion, but we could, we could add fat or protein or fiber. All of those three things are been shown to lower a glucose response when you pair it with carbohydrates. We could sequence our meals differently. When we eat our fat and protein first and our carbs second, we tend to have less of a glucose response. We could eat it earlier in the day, when we tend to be more insulin sensitive. We could walk afterwards, we could make sure we’re eating those carbs when we’ve gotten lots of sleep. There’s all these things that we can do to build a context in the body that actually processes glucose more effectively.

So I think, to me it feels, I just, you know, I think people would be fearful that like, Oh, this is going to make my diet no fun, because I can’t eat the things that I love. But in a lot of ways, I think we can actually just learn to see ourselves as this complex multi-dimensional system, where a lot of these different choices we’re making interplay with each other, and just create the best possible context in the body for healthy eating, and to have the least collateral damage possible with the foods we’re choosing to eat.

Les Raymond: [01:08:57] Gotcha. Yeah, that’s great. Yeah. I haven’t found anything negative personally, about me using it. I don’t, and I am one to get a little obsessive about some things, and I don’t sense that I’m having like negative relationships emerge with food. It’s more like, it’s a little gamified, so kind of exciting, but it does make it like more matter of fact, Like, Oh, if you see a 200 just like, Oh, that decision’s easy. You know, it makes it very clean, like very like efficient. I have one other question about the levels itself, like the blood sugar levels. And then I want to learn more about and help the audience learn how they could try this if they want. Like if you were trying to tell what’s more important, let’s say you eat a meal and your blood sugar spikes really high, but it comes down pretty quickly.

Is that inherently better or worse than it doesn’t go as high, but it goes too high still, but then it stays there longer. Like, is it the area under the curve, the total area that matters? Or is it how quick we get back down?

Dr. Casey Means: [01:10:11] Yeah. So the answer to that question is it’s not fully known. They’re going to basically tell us different things.

I would say the huge spike is more indicative of a poor choice. You know, if it goes straight up and straight down, that means you probably ate something with tons of carbs, but your insulin response was strong and good. And you were able to soak it up into the cells, and it was, you know, you were able to clear it from the bloodstream. Going up a bit, and then staying elevated for a while can be more indicative potentially of insulin resistance. So you’re making, you have that insulin, but it’s not actually getting that glucose into the cells out of the bloodstream. So, you know, someone could eat something that’s maybe not so spiky. It’s not such a big glucose load, but they did eat some carbohydrates, and then it just kind of stayed high for a while, because you’re not clearing it well. So those things are going to kind of tell us different things about what’s happening. But area under the curve, like you mentioned, which is essentially you can imagine a curve of a glucose spike, for people listening, that shaded area underneath, the bigger the number for area under the curve, that is more associated with metabolic problems.

So we want to keep area under the curve as low as possible. So the idea would be a little teeny, you know, 10 points up after a meal, and then it comes immediately back down. And then, you know, that same person could also go up a hundred points if they drank a soda, but it might still come straight back down.

That’s still be a fairly low end of the curve, than someone who’s a little bit more on the metabolic dysfunction spectrum, a little bit more insulin resistant, might eat a moderate meal and go up, you know, 50 points and then stay elevated for two hours. That’s not ideal. That means there’s trouble clearing glucose from the blood stream.

Les Raymond: [01:11:58] At what point should it hit its peak, even if it’s a little bump. Should that be within a half hour?

Dr. Casey Means: [01:12:05] Yeah. In studies it’s generally between 45 minutes to an hour for a healthy person.

Les Raymond: [01:12:11] Right. Gotcha. So, you guys sent me one of these. It’s been awesome. I really thank you all for the gift. This, I got, I didn’t, wasn’t sure if this was like a beta version, is this out rolled out officially for people to try.

Dr. Casey Means: [01:12:24] We are still in a closed beta program. So we do have a wait list. So the best thing to do would be for people to sign up for our wait list at LevelsHealth.com. And we’ll keep you posted and up to date on our ability to get you into the program. And, we hope for a full launch in early 2021, where we can really start servicing more customers.

So yeah. Check us out at LevelsHealth.com, @Levels on Instagram and Twitter. And we have a lot of great metabolic health information on our blog at LevelsHealth.com/blog. So highly recommend that for people who are interested in learning more.

Les Raymond: [01:12:58] Okay. So for the listeners now, check out the blog, learn more, get ready.

This will be available soon. It’s really an outstanding tool and it’s priced really reasonably. I really thank you for rolling it out the way you did. And I’m excited to dive a little bit deeper and finish my trial. And I appreciate all, and not to mention the support you guys have provided. I’ve gone back and forth with some questions about this thing and.

You know, getting email responses within minutes, and it’s been really helpful. And I really love what I’m learning. I might take. I might not look at it tomorrow. I’m not gonna, you know, try to be smart on Thanksgiving. I’ll use that as an opportunity to go off track. I’ll maybe, I’ll still check it out, but I really thank you, Casey.

Is there anything else you’d like to share for the audience in regards to your, the work you’re doing or what they should be looking out for?

Dr. Casey Means: [01:13:54] I would just say, you know, none of this is a one-way street with health. We can always move in the right direction. And, you know, I think there’s a lot of wonderful health leaders out there.

A lot of people you’re having on your podcast who are helping, you know, share the word about how to kind of move in the right direction. And so certainly, nothing but hope to be feeling I think in health right now. And definitely not a one-way street. We can all improve. And a lot of people here to support that process.

Les Raymond: [01:14:24] Well, that’s a great message. And this is definitely a, I think I don’t know overlooked, but you know, a lot of people are just, it’s not on their radar, you know, how important blood sugar is. So it’s awesome that, you know, we have access to a tool, or soon we’ll have an access that we could, you know, improve our life and take a little bit more control. At this channel, empowering people to play a bigger role in their wellbeing is really important.

And this just speaks to that perfectly. So I want to thank you again for taking the time to have this discussion and educating us. And really I’m grateful for the work that you guys are doing. I’m really excited to see how this could really move the needle from like, a population, you know, basis of health.

I feel like that we’re kind of trying to turn around a cruise ship on a societal level. So I’m really excited that this is going to be introduced into the population and, over time, I think it’ll have a tremendous impact. So I thank you for that. And for the listeners out there, I’m really grateful that you guys tuned in today. If you have any questions about this, shoot us our way, check out more at LevelsHealth.com. Send us a comment if you have any questions and I hope you guys stay tuned for more episodes. Everybody out there have a great day. Once again. Thank you for listening. I really appreciate you tuning in. I hope you got some value out of that conversation. I definitely did. I really enjoyed this one. Casey is just so pleasant and just such a good communicator on this topic. And I’m really grateful for the work that her and her team are doing to bring this to market. And I’m really grateful that they offered me a chance to try it.

I found it just tremendously useful. I look forward to using it again sometime in the future. I’m thinking I’ll probably revisit the tool, maybe every six to 12 months, just to check in, to see if there’s any adjustments I can make in my lifestyle. So thanks again. Again, if you are enjoying these podcasts, please let us know by just leaving a positive review on your podcast player.

And of course, if you think, you know, someone that would enjoy this or get value out of this episode, I ask you to please share it. Thanks again. I hope everybody out there has a terrific day.

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