Why You NEED to Know About Your Blood Sugar with Dr. Casey Means of Levels

Episode Introduction

Do you know your glucose levels? If your answer is no, you’re not alone. In a past life as a surgeon, Dr. Casey Means recognized that many of the conditions she was operating on and prescribing medicines for as a surgeon could be largely preventative through a better understanding of our bodies’ glucose levels. Together with her co-founders, Dr. Means started health and wellness company Levels, whose continuous glucose monitors (CGMs) provide real-time data points to users, helping them find what diet and lifestyle changes help them reach their peak performance. On the Optimal Performance Podcast with Sean McCormick, Dr. Means discusses the role of CGMs, an explainer on the impacts of glucose levels and the success users have found using Levels.

Show Links

• Check out Levels
• Follow Levels on LinkedIn or Twitter
• Connect with Dr. Casey Means on LinkedIn or Twitter
• Check out the Optimal Performance Podcast
• Connect with Sean McCormick on Twitter and Instagram

13:36 — The journey from reactionary to proactive medicine

After becoming inundated with biology as a student at Stanford. Dr. Means was enthralled by the idea that environmental inputs — like what we eat, what toxins we expose ourselves to, and other behaviors — affect our genetic blueprint. When Dr. Means attended medical school a few years later, though, that idea wasn’t widely practiced.

“And then flash forward four or five years, and I’m in medical school and I’m going to Stanford for medical school. And it was a completely different ethos because modern clinical practice is, sort of by design and by necessity just for efficiency, not so much about personalization, it is much more about pattern recognition and it’s much more about algorithms. And so the last nice way to say that would be sort of cookbook medicine or reactionary medicine. But that’s kind of the way that medicine has been set up is you visit with a patient and you collect a history and you do labs and you do a physical exam, and together those form symptoms and signs that you then look at and put together. And if that collection meets some criteria, then you label it with a diagnosis. And once you have that diagnosis, you can turn around and say, ‘OK, what’s my toolbox of pill, or invasive interventions like surgery procedures to then treat this condition, this label. And so that, to me, it was so different than what I had sort of been brought up in, in the biomedical sciences of thinking of people as these really unique and dynamic systems that are in constant conversation with the environment.”

23:24 — What is ‘metabolic health’?

In order to understand Levels’ continuous glucose monitoring (CGM) devices, you first have to understand metabolic health and what factors lead to the rise and decline of those levels.

“Metabolism and metabolic health is essentially the set of cellular mechanisms that produce energy from our food and environment. So, we eat things and we put them through our digestion and they go into our bloodstream and then they interact with our body and we produce cellular energy from those energetic substrates. So cellular energy is like ATP [adenosine triphosphate] that our cells can then use to function every cell in the body. But to actually make that you need these substrates, and one of those key substrates is glucose and glucose comes largely from carbohydrates that we break down and it enters into our bloodstream and gets taken up into our cells, our mitochondria, these little powerhouses of ourselves converted to ATP. And when that process is running really smoothly and we’re able to take that glucose and convert it into ATP — without generating metabolic lead, damaging byproducts, like lots of free radicals and things like that and not had excess glucose in the bloodstream, which can cause inflammation and oxidative stress and glycation processes — when that’s happening really smoothly, that’s metabolic health.”

25:03 — What is ‘metabolic flexibility’?

Striking the balance between using fat and glucose for energy is called “metabolic flexibility,” and it’s something that we’ve been less able to do since the introduction of refined sugars.

“But when that insulin is around, it’s telling the cells that they should not burn fat because there’s another fuel source — there’s glucose. And so that’s a really interesting balance because we want the body to be able to process glucose effectively, but we also want the body to have at times where there’s not a lot of glucose around and there’s not a lot of insulin around so the body can still have the opportunity to convert fat to energy as well. And that ability to be able to be very flexible and kind of bounce back and forth between processing glucose — when there’s good glucose around — and process fat — when there’s not a lot of glucose around — that’s called metabolic flexibility. And that is widely associated with good health and reduces risks of chronic disease.”

26:04 — What is metabolic fitness?

Finding that sweet spot between managing the optimal amounts of glucose in the body? Dr. Means calls that “metabolic fitness.”

“So we’ve kind of like a lot of us have lost the ability to really ever burn fat because we always have insulin on board. And so that’s kind of hard to talk about glucose without, talking about fat and insulin. And so, when this balance is optimized and we have like the right level of glucose in the body, we’re processing it, we’re storing it in the right ways — not too much, not too little, when these processes are all running smoothly — I call this metabolic fitness and that’s because it’s kind of constantly flexing up and down on these different pathways. I like to think of it in that fitness mindset because it is something that our metabolism gets better when we manage it properly, you have to be treating it right. And having repetitions of good glucose control every single day to be able to achieve good metabolism. And that’s something that is very much something you can achieve and, unfortunately, because we’re exposed to so much carbohydrate load and glucose in our diets, it’s hard to ever really get there.”

29:29 — What it means to be ‘insulin resistant’

Because people have introduced an excess amount of glucose into their bodies in recent history, and insulin has to keep up to keep an optimal balance, insulin resistance has become a new norm for many individuals who either are obese, diabetic or both.

“When that’s happening day in and day out, you’re constantly getting these insulin surges. Your pancreas is saying, ’OK, all this glucose has got to get into the cell, so I’m going to release some insulin, so you can take it up.’ But when that happens, day in and day out, the cells are like, ‘Whoa, uh, that’s too much. We cannot store all of this in ourselves. We can’t process all of this stop putting it in.’ So you’ve got what’s called ‘insulin resistance, and that’s essentially the cells becoming numb to the signal of insulin. And, over time, what you can imagine happens is you have to produce more insulin to drive that glucose into the cell. So now you’re getting to this state where high insulin levels circulating and the cells aren’t taking up the glucose so then glucose levels start to rise. So that’s the process that’s happening and we’re really seeing the downstream effects of that now just epidemiologically. There are so many overt signs of this where it’s very clear that these are metabolic disorders like obesity. You know, 74% of the U.S. is now overweight or obese. This is fundamentally a metabolic issue.”

33:30 — Maintaining optimal glucose levels can affect everything

If we can manage our glucose levels, we may have the power to prevent downstream health sickness and disease.

“So it’s kind of got its finger on everything. And I think it makes a lot of sense because if you think about metabolism and glucose control as a core pathway of producing cellular energy, if that core pathway is screwed up — which it is in so many people — then every cell in the body will suffer. And so if it shows up in the brain, this might look like Alzheimer’s disease, which is being called Type 3 diabetes. If it shows up in the kidney, it’s chronic kidney disease. If it shows up in the penis, it’s erectile dysfunction. If it shows up in the ovaries it’s PCOM [polycystic ovarian morphology]. If it shows up in the brain, it could also look like fatigue, anxiety or depression. It could look like brain fog. And so it makes sense because this is a core fundamental pathway that every cell needs. So these symptoms are essentially showing up in different cell types, but it also creates a beautiful opportunity where if we can attack a core pathway and not think of all these diseases, isolated silos that we have to treat like separately in different doctor’s offices. If we think of it really more on this metabolic spectrum, it makes it so much more efficient to sort of treat these things. And when you reverse metabolic dysfunction, a lot of these symptoms melt away.”

37:18 — You don’t just wake up sick — it’s a progression

You don’t become diabetic overnight. It’s a progression of decisions and factors made over the course of several years, an idea that goes against the “on-off” switch of the healthcare system.

“When you’re stepping back and thinking in the way that we’re talking about, which is that health is a spectrum and it’s not like one day you wake up and you have type two diabetes. This is a process. This is a march that’s been happening probably for 10, 20, 30, 40 years and, these days, probably from like six months of age with the foods that we’re giving kids of just the constant insulin stimulation, insulin resistance until yes, one day, one year, you walk into the doctor’s office and you get your yearly finger prick and they say, ‘Oh, you’re diabetic.’ And so it kind of feels like, in our system, it feels like it’s an on-off switch, but in the body, it’s actually a long, long march. And then the second piece of it is that we think of this as a one-way journey, right? Like you’re, you’re diabetic and then you get put on Metformin and then, you know, things might get worse and you get at, some other diabetes medication and then ultimately you might be on insulin and that’s it that’s life. But the reality is that we’re not — we know now that.”

43:14 — Measuring your glucose metabolism relies on many factors

It’s not just the types of foods that you eat that affect your glucose metabolism. Factors like time of day, sleep and stress can all contribute to your levels.

“There are so many things that affect how food affects you, so many variables involved in that. So glucose as carbohydrates, as we know, are not a one-to-one relationship between carbs and glucose elevation in the blood. And the other things are what I like to call kind of your metabolic toolbox. And so you’ve got so many factors that impact glucose. You’ve got the time of day that things are eaten, so things generally eaten earlier in the day are going to have less of a glucose surge in your blood than the exact same meal eat at night time. And some of that likely has to do with melatonin. Melatonin is the hormone that’s released from the pineal gland. When the sun goes down, part of our circadian rhythms that helps get us to be sleepy, but it also makes you kind of insulin resistant at night. And so that is something great to know if you’re going to eat your high carb stuff — eat it earlier in the day. We know that exercise can acutely improve insulin sensitivity, almost any exercise. You do resistance training, low-grade cardio, aerobic activity, even walking for two minutes can improve insulin sensitivity. High-intensity interval training can and yoga can. So it is basically like any movement is going to be good for your glucose control stress management, we know is helpful for glucose.”

48:42 — Getting started with Levels

When a user signs up for Levels, they’re walked through a process that judges whether or not they’re a good candidate for the CGM. Then, patches (the CGM) are delivered to a user, who applies it to their body and tracks its function with a companion app.

“So, what a customer would experience if they come to Levels is you’d purchase the product, which is a 28-day metabolic awareness journey. You would go through a telemedicine consultation with our partner physician network that we’ve established that will evaluate you to basically see if you’re a good candidate for a CGM. So there’s an off-label prescription. This is for people who do not necessarily have Type 1 and Type 2 diabetes and might go to their primary care doctor and ask for one, they want it to have better visibility into their metabolism…we fulfill that prescription through our partner pharmacy and two sensors, which each last for 14 days, get shipped to your home. They come and you wear one for 14 days, and then switch out for the second one. You get this really cool waterproof patch, called Levels Performance Cover, that makes it waterproof so it doesn’t fall off. Then you have access to the app. We are just completely laser-focused on how to make this app as absolutely actionable as possible. So our goal is to reverse metabolic dysfunction at scale like this should not exist. And for the most part, it’s a different story for people with Type 1 diabetes. Absolutely. But the majority of metabolic dysfunction can be prevented or reversed or improved.”

53:18 — The impact Levels has had on its users

By being able to pair subjective experiences with data, Levels allows users to isolate parts of their lifestyle to determine what makes them feel better (and, perhaps more importantly, worse).

“So we’re trying to narrow the time between action and reaction to essentially minutes so that you can isolate the variables that are causing both metabolic problems but also subjective problems in your life. And what’s really cool about this from a behavior change standpoint is that visualizing this and making these connections takes the emotion so much out of the behavior change piece of thing. It’s almost like food poisoning. Like you eat some bad clams and have terrible diarrhea, and it’s not like you feel sad about giving up clams. Like you’re just not going to eat clams anymore. You’re done. And your body just knows. And when you see those spikes and the getting a score of two on the app and feel that that was directly related to this big pain point in your life, like post-meal energy slumps, you’re kind of just like done. You’re like, I don’t want this. This is the problem.”

01:03:44 — A Levels success story

Dr. Means recalled how a keto user used Levels to confirm what she had already known: that her diet was keeping glucose levels low. But the user quickly found out she was able to add in foods she previously thought were off-limits.

“One of our really early customers, Allison Cruck, she’s a keto girl on Instagram and she’s been keto for like three years and she lost like a ton of weight. And now she’s like super fit and has this incredible inspiring Instagram account. And she lifts a lot and she’s been following strict keto and it was hugely beneficial to her life. So she comes to us kind of curious to see what CGM will tell her about her glucose, and she used it as a tool to essentially experiment with some foods that she’s been eliminating for the past three years and see what happens and kind of just to prove like how the keto diet is very effective at keeping glucose low. But what she found was that some of these foods that were off-limits for keto actually did nothing to her glucose and did not bump her out of ketogenesis. So she had literally been going to restaurants for three years, ordering salads and picking every single carrot out of the salad and putting it on the side and not eating it. She found out that carrots when mixed with like a big salad absolutely did not touch her glucose. And it was emotional for her. She was able to liberalize her diet.”

01:09:22 — Defining optimal glucose levels with CGM data

The optimal range for glucose ranges from 70 to 140. But at Levels, since they have such a large dataset of non-diabetic blood glucose values, they’re looking to provide users with steps on how to fit within the metabolic healthy range.

“So the vast majority of the day, we are between 70 and 120 and that’s before or after meals. Some other studies have a little bit more liberal range, and often these involve older populations. Like a young, young, healthy population, 70 to 120 for 91% of the day. Some bigger population studies show that between 70 and 140 about 90% of the day. So that’s kind of the range that non-diabetics will be in, but that still doesn’t tell us what is the optimal range to be in. What should you shoot for if you’re trying to be superhuman and be part of that 12% that’s metabolically healthy? And that is something that we, as a company, are really trying to define.”

Sean McCormick: [00:00] Welcome everyone to the Optimal Performance Podcast. My name is Sean McCormick. I’m a life coach, performance coach, wellness entrepreneur, and it’s my pleasure to bring to you every single week the world’s leaders in the field of performance, so that you can live your life at its most optimal level, plus cutting edge ideas so that you can stay ahead of the curve in an ever-changing world. Let’s dig right in.

Oh, hey, there. Welcome back to another episode of the Optimal Performance Podcast. Hey, will you do me a favor? Go follow me on Instagram, RealSeanMccormick and OptimalPerformancePodcast. Go follow me on Instagram. If you’re on Instagram, even if it’s like once a week or whatever, just go follow me. And I want you to DM me. Take a minute, take just less than a minute, take 30 seconds. And DM me the types of topics that you’re most interested in. I want to hear the guests that you want. I want to hear the topics that you’re interested in. Are you done hearing about COVID? Do you not want to hear about it anymore? Let me know. Do you want to focus more on mentality? Do you want me to focus more on nutrition, sleep? Because I have whole bunches of people that email me every single week saying, “Hey, I want to be on the podcast” or, “Hey, I’ve worked, my client X wants to be on the podcast.” And I think I’m doing a good job of bringing you a varied content that’s useful and helpful for your life, but I really want your input because there are thousands and thousands and thousands of you that don’t miss an episode. And you’re likely that person listening right now. I would love to hear from you for real. I just want to, send me a DM on Instagram, RealSeanMccormick. You know, I want to make this as easy as possible to give you the best content. So if you’ve got a really great idea, I’d love to hear it. I want this to be more interactive, and it’s so hard to do, because the podcasts that I listen to, they try to do this. They try to find ways to connect with listeners like myself. And I make it a point of sending DMs and sending emails to the podcast hosts that I listen to and saying, “Hey, this was really great.” “Hey, I really enjoyed this episode.” “Hey, have you thought about this person?” So I’m asking the same thing from you. If you would, please give me your input because I want to give you the stuff that you want that is useful in your life.

Speaking of things that are useful in your life, this episode is going to be a two-parter. We are looking at continuous glucose monitoring. Now I am not as scientific as say Ben Greenfield or Dave Asprey, and you know that by now, but I do pay attention to bio-hacking tools that work consistently. And what Levels Health is, is a continuous glucose monitoring device that you put on your skin that sends a signal to your cell phone to track your glucose in real time. Like every 15 minutes, it sends a ping to your phone that tracks your glucose. Now, why does that matter? Why is that interesting? Well, Dr. Casey Means from Levels who is the co-founder, she explains to me how basically metabolic health is a massive and likely the most important indicator for your health, right? So if you have metabolic inflexibility, if you are insulin resistant, you’re going to have problems with your health. And this is, a lot of people have problems with their health. 88% of the country’s considered to be metabolically dysfunctional. That’s a massive amount of us, right? And the majority of metabolic dysfunctions can be prevented, reversed or improved. And what this will make available, Levels, if you go to levelshealth.com, you can read tons more of these and just expands. Their blog is insane, expands on the conversation that we’re having. But if you know what different types of foods are doing to your metabolism, what they’re doing to your glucose when you eat them, then you will know exactly what sort of foods you should and shouldn’t eat. There’s a 25,000 person waitlist to get one of these  continuous glucose monitors, and there’s a good reason for that is because not only for high-performers, but anybody that just wants to be able to feel better and have more energy and have metabolic flexibility so that they can just have the lifestyle that they want. This is going to be a blockbuster product. It already is this, this is like a Meta  device. This is like cutting edge biohacking. And when you eat a banana, you can see what your blood glucose does. When you have that glass of wine at night, it will tell you exactly what that’s doing to your glucose levels. And when you know different foods are doing to your glucose levels, then you can adjust your diet effectively so that you can just be healthier and happier. Of course, I allow, I sort of guide Dr. Casey into some fairly scientific areas during this conversation, but it’s also really accessible to you. You know, in this episode, we talk about the fact that most doctors get four hours of nutrition education in med school. So it’s really up to you to figure out what you need to do to eat for you. We talk about what exactly a continuous glucose monitor does. We talk about the fact that sleep, exercise, stress, food, and food timing immediately affect your metabolism. And we talk about what is the sort of optimal level for blood glucose. You know, normal is somewhere around, you know, conventionalism says a hundred, but really like optimal is 72 to 85.

This is just packed with tons of fascinating information and in part number two, we’re going to have the other co-founder of Levels come back after I’ve been able to use Levels for a while to figure out what it’s doing to my blood glucose, so that I can know what’s going on in my metabolism, so that I can be healthier. And I’m just sort of a normal guy, right? Just slowly biohacking my way into the body that I want, into the brain that I want, into the lifestyle that I want. You’re going to get so much out of this episode. I know you’re going to love it. This is the type of episode that you’re going to want to share with people in your family and people in your life. You know, like this sort of blows the roof off of a, we’ll just clarify as a metabolic and flexibility what that means. And I know there’s people in my life that need to hear this, and I know that there’s people in your life that need to hear this very important information so that we can be our best. Like this is, I think 10 years from now, everybody’s going to have these, and for good reason. So that we know what our body needs nutritionally. I’m going to save the ads for the middle and the back of this podcast. And we’re going to jump right in. So ladies and gentlemen, without further ado, Dr. Casey Means.

And we’re here with Dr. Casey Means, the co-founder and chief medical officer at Levels. Casey, welcome to the Optimal Performance Podcast.

Casey Means : [06:57] Thank you so much for having me, Sean. I’m so glad to be here.

Sean McCormick: [07:01] I think I want to start with the first question, which is not going to be what you expect. So it might immediately catch you off guard.

Casey Means : [07:08] I love it.

Sean McCormick: {00:07:09] As an expert in metabolic health, and this is the, don’t feel isolated or like you’re alone in this because this is the first question that I ask almost all of my guests when it comes to nutrition and fitness. But what time is it where you are right now and what have you put in your body today?

Case Means: [07:28] Hmm, love this question. It is 2:39 PM. I am in Portland, Oregon. And so far today I have had a cup of coffee with unsweetened walnut and pumpkin seed milk that I made myself. I actually made it this morning. I then did not eat any actual food until about noon. And I had what I usually have each day, which is a gigantic salad. And that salad had in it about five cups of chopped rainbow chard that I microwave for about 20 seconds just to wilt a little bit, three quarters cup of kidney beans, a half a cup or so of firm tofu, chia seeds, peanut butter, tomato paste, tamari, beet, sauerkraut, and let’s see… Oh, chopped red onions, and then kind of mixed it all up into this sort of salad melange. But that’s basically, I  have this gigantic, probably 800 calorie, salad for lunch. That’s usually my first meal of the day and really trying to just hit all of my functional nutrition boxes with that and get at least five to eight servings of vegetables in there in one fell swoop. And it gives me 30 or 40 grams of fiber from the beans. It gives me about 30 to 40 grams of protein from the tofu beans. Chia seeds, peanut butter gives me healthy whole food fats, from the chia seeds and the peanut butter it gives me Omega-3, alpha linoleic acid from the chia seeds around 1500 milligrams, and yeah, tons of phytonutrients and antioxidants from the red onions, the chard, the tomato paste, lycopene, all that stuff. So it’s just like a big, huge, heavy hitting salad. And then I usually don’t eat again until dinner.

Sean McCormick: [09:26] I imagine that people are listening to that and going, “She put peanut butter. She put peanut butter. Who is this woman? She put peanut butter in her salad, but.” You know. I mean, you know, when you’re, when you know as much as you do, when you know exactly what you need to eat for your body and where you’re at in your life, kitchen sink approach, with all of the things that you need to do, you know, hitting your servings, that sounds, I would, that sounds really good to me. I would love to try that, but Holy cow, that is a very eclectic salad. That’s awesome. I’m so glad I asked that question.

Casey Means : [10:16] I make it in about a 10 cup Tupperware container so that I can just stir it around aggressively until it’s homogeneous. And I’ve had a person I used to work with who called it my trough, which was super kind. They’re like, “What’s in your trough today?” But it’s actually a salad that I’ve sort of, the framework for that, I’ve sort of optimized over the past couple years, as I’ve really dove deep into functional nutrition. And one thing I’ve really optimized for is that it doesn’t do anything to my glucose levels. So, this shows my glucose levels for the entire day so far, and it did not even bump at five points. So it’s probably got, I don’t know, 60 to 70 grams of carbohydrates in there. Probably very much fewer net carbs than the fiber, but it’s just like totally optimized meal with the fat, protein, fiber, carbs to just actually do nothing to my glucose levels, which is why I choose- If I eat any of those in isolation, it’s much more likely that they would kind of go up. But it’s, yeah, it’s really, really fun. And I, yeah, I torture my family by sending them photos of the salad and they think I’m a monster because it’s, but I think it’s delicious. So I crave it now.

Sean McCormick: [11:36] That is so cool. We are going to get into the app. We’re going to get into the system. We’re going to get into the tech, we’re going to talk all about continuous glucose monitoring. But I would love to hear your story. How do you go from head and neck surgeon to a doctor specializing in metabolic health? Like, what was that moment where you decided, “You know, I’m not doing the right thing that I want to do. I’m going to totally switch gears.”

Casey Means : [12:07] Oh, That’s a great question. And it’s really like a 15 year journey that I will condense into like two minutes hopefully. I say two minutes will probably be like four minutes, but it really started back in college. So when I was like 17, 18, so I went, I was really lucky to go to Stanford right after the human genome project finished, and 23andMe was coming online and all this consumer genetic stuff and like Silicon Valley, it was just so hot with like personalized medicine and personalized genomics. So I get to Sanford, I’m really interested in biology. And that was sort of that whole world was the framework through which I came to the study of human biology. And the study of biomedical sciences was that it’s very personalized, it’s very unique biochemical individuality, and that we are a fundamentally this genetic blueprint, but really the key to health is the differential expression of that blueprint. So what then defines the difference of expression is environmental inputs. And our primary environmental inputs are things like what we eat, what we put into our bodies, what toxins we expose ourselves to, and then different behaviors that translate to biochemical reality through things like hormones and our nervous system. So that’s like exercise, sleep and stress. So these are the things that actually pull the levers on our genetics. And so, that was just very much alive and in the water during that time. And I worked at 23andMe when I was in college, and I was a teaching assistant for pharmacogenomics classes and things like that, and it was just really fun. And then, flash forward four or five years, and I’m in medical school. And I’m also at Stanford for medical school. And it was a completely different ethos because modern clinical practice is sort of by design and by necessity, just for efficiency, not so much about personalization. It is much more about pattern recognition and it’s much more about algorithms. And so the less nice way to say that would be sort of cookbook medicine, or reactionary medicine. But that’s kind of the way that medicine has been set up, is you visit with a patient and you collect a history and you do labs and you do a physical exam, and together those form symptoms and signs that you then look at and put together. And if they match a certain, if that collection meets some criteria, then you label it with a diagnosis. And once you have that diagnosis, you can turn around and say, “Okay, what’s my toolbox of pills, or, you know, invasive interventions like surgery procedures to then treat this condition, this label.” And so that, to me, it was so different than what I had sort of been brought up in, in the biomedical sciences of thinking of people as these really unique and dynamic systems that are in constant conversation with the environment. So, that was sort of what was alive in medical school. It’s also interesting to me because in medical school we get, you know, the average medical student, I think it’s four hours of nutrition in medical school. And one big passion of mine in college was nutrigenomics. And so nutrigenomics is the study of how food compounds. So things like isothiocyanate compounds from cruciferous vegetables, how these molecular pieces of information inside food go into the cells, go into the nucleus and actually change gene expression. And so that was like, I was like, “Oh, this is huge.” This is of course key for health, but we don’t, we do not learn clinical nutrition in medical school. And so that was not a part of the conversation, coupled with the fact that we know that most Americans by late life have a chronic condition. Most chronic conditions are related to diet and lifestyle. And so it felt disheartening that we weren’t really being equipped with the information to incorporate that type of stuff in our clinical practice in a rigorous way. So moving forward, I finished medical school, went to surgery and I decided to do head and neck surgery. It was a fascinating field. It’s a field that has, to me, to my eyes, it was compelling because I was like, “Oh, surgery is very cool because I can go in and visit with a patient and I can go in and fix something.” You know, they have a lump in their neck, I’ll take it out. Their sinus is filled with pus, I’ll punch a hole in it with my tool and suck out the pus. Their ear, their middle ear is filled with pus, I’ll make a little hole in it, put an ear tube in, suck the pus out. We’re done. Like I fixed people, I’ve helped people, and that felt really good. And as a doctor, when things are so complex and so busy, people actually feel like you’re ending your day, fixing something is a great feeling. And I think it draws a lot of people to surgery. And surgery is a beautiful art. So flash forward, I’m five years into my surgery career, head and neck, and I’m realizing, you know, I’m looking at all my cases and what I’m doing every day. And I’m like, “Every single thing I’m doing is treating an inflammatory disorder.” So like sinusitis, inflammation of the sinuses. You know, ear infection is inflammation of the eustachian tube that drains the nose and the ear, that’s that when that tissue is inflamed, it gets blocked, you get pus build-up. Hashimoto’s thyroiditis, a disease that’s rising in incidents, is inflammation of the thyroid. Vocal cord granulomas is inflammation, inflammatory masses of the vocal cords. These are all rooted in chronic inflammation. And I’m stepping back and I’m like, this feels illogical that I’m treating an inflammatory disorder with a surgical treatment, because surgery does nothing to actually impact inflammation. It’s sort of like changes the plumbing so that things can drain, but it doesn’t fundamentally affect those inflammatory pathways. And this was like a big eye opening experience for me because I’m prescribing, I am like slinging steroid prescriptions left and right. I’m like,  “Prednisone for you,” you know, “Medrol Dosepak for you.” “Here’s antibiotics,” you know, “Let’s do surgery if those don’t work.” And fundamentally, it was just like, “Wait. I know that chronic inflammation is at least in some part triggered by diet and lifestyle and exposures and the way we live and other comorbid conditions. You know, obesity is an inflammatory condition, you know? And so why are we not talking about this? Why is this, why is the Venn diagram here in our practice totally separate? There’s no overlap.” So that, anyways, that was the journey. A couple of years of figuring out that, like, I didn’t fundamentally want to be treating these conditions with surgery when I felt like really the lowest hanging fruit was helping people get fundamentally healthy, and at least impact their chronic inflammation in some capacity through these more holistic aims, and ultimately transitioned into functional medicine and opened, split from surgery pretty much, completely decided that there’s enough surgeons out there, but there’s not enough, I think, physicians really thinking about root cause fundamental health and how to reverse our chronic disease epidemics at scale. And so I really wanted to devote my life to that and that then, you know, that study of inflammation, that study, that practicing functional medicine longevity really at the heart of that is metabolic function, because metabolic dysfunction is a huge driver of chronic inflammation. When your blood sugar and your metabolism, and the way you’re processing energy in the body is off the rails, your body responds by saying, “Oh, this is not good. This is a threat. Like we need to, we need to rev up our inflammation. TNF alpha, aisle six.” I, you know, like, and so, because, you know, metabolic dysfunction is so rooted in diet, it’s so easy to turn around if you know what to do. I was like, “This is where I want to focus my energy. I want to be.” And I became a, basically a metabolic evangelist. That’s the root. Yeah. That’s what happened.

Sean McCormick : [19:26] That’s so cool. Well, I mean, the couple of things that stand out for me is, you know, you wanted to, you didn’t want to be sticking up your thumb in the hole in the dike to prevent catastrophe. You want it to be able to swim upstream and figure out what was going on, rather than preventative or reactionary. I think that’s super, super admirable. And obviously, your credentials and talent for what you do, the fact that you just, that you wanted to go to the root cause, that you want to look at the systemic issues that people are having to make sure that they were having a better opportunity to live a higher quality life without having to get a hole punched in their nose or, you know, have drainage from inflammation. Super cool. And then the other thing that stood out for me too is, and I’ve heard this before, and I think that I’ve said out loud, you know, I think that doctors get something like one day of nutrition in their education. And you just said four hours. And to me, it just, it boggles my brain. And of course you and I are in a universe that’s, you know, biometrics and biohacking and performance optimization and you know, metabolic issue. And so, for you and I it’s like, it’s so sad and it’s scary because rarely, I mean, everyone listening here today is like, “I’ve never been asked by my doctor what my diet is. I’ve never been asked by my doctor how my sleep is.” It’s like, “What are the symptoms? What can we prescribe?” And it’s sad to me. And what drives me on to have guests like you to like, “Let’s blow the lid off this thing,” because what you have done, what you have created, what you have devoted time and money and attention to is to create something that people can use, that’s direct to consumer, that’s usable and easy and trackable that will like seriously empower them to live a better quality of life. So hats off to you.

Casey Means: [21:32] Hmm. Thank you. I mean, yeah. I just, and this is why I am, part of if, I’m just so inspired by this health podcast sort of movement that I think we’re in right now, because you know, this message is not necessarily coming down from on high in academic medicine and it’s, you know, I think it’s- But the voices, there’s a strong community and that community is connecting. And I think it’s a really exciting time. And I think that the real message amongst this whole health seeking community is empowering people to make good decisions. And that is just really exciting to me, to move from a 10 years of clinical medicine where I was kind of just telling people what to do, and then letting them go and not really seeing anything happen, to now really seeing this movement where people are seeking out their own information. They’re listening to podcasts, they’re seeking out providers, thinking about things a different way, a more root cause way. It’s very exciting. And I like that ethos of people, you know, really taking ownership of health and, yeah I think we’re entering a really great era.

Sean McCormick: [22:40] It’s really meaningful, and you are, obviously you, so, I don’t want to beat around it. Let’s go right to it. What we’re talking about is a device that’s been around for a very long time, and yet not many people really know what it is or how it can affect their life. But I would love for you to explain what a continuous-  First of all, what’s glucose? What is a continuous glucose monitor?

Casey Means : [23:12] Yeah, absolutely. So I think that the best place to start here is to probably just, yeah talk about glucose metabolism. So basically kind of even backing up from glucose, like fundamentally metabolism is the thing we’re talking about here. So, metabolism and metabolic health is essentially the set of cellular mechanisms that produce energy from our food and environment. So, you know, we eat things and we put them through our digestion and then go into our bloodstream and then they interact with our body and we produce cellular energy from those energetic substrates. So cellular energy is like ATP that our cells can then use to function every cell in the body, but to actually make that, you need these substrates. And one of those key substrates is glucose. And glucose comes largely from carbohydrates that we break down, and it enters into our bloodstream and gets taken up into our cells, our mitochondria, these little powerhouses of our cells converted to ATP. And when that process is running really smoothly and we’re able to take that glucose and converted into ATP without generating metabolically damaging byproducts, like lots of free radicals and things like that, and not have excess glucose in the bloodstream, which can cause inflammation and oxidative stress and glycation processes, when that’s happening really smoothly, that’s metabolic health. And then there’s other things that we can actually convert into energy in the body like fat, and is another big one. And there’s a really, there’s a balance between basically using fat and glucose for energy. And what’s really interesting is that when glucose comes into the body, to get it into our cells, we need insulin to be secreted. So insulin is like this little lock in key, obviously is as you know that binds the cell membrane to the insulin receptor and lets the glucose be taken up so that it can be processed by the mitochondria. But when that insulin is around, it’s telling the cells that they should not burn fat because there’s another fuel source, there’s glucose. And so that’s a really interesting balance because we want the body to be able to process glucose effectively, but we also want the body to have, at times where there’s not a lot of glucose around and there’s not a lot of insulin around, so the body can still have the opportunity to convert fat to energy as well. And that ability to be able to be very flexible and kind of bounce back and forth between processing glucose, when there’s good glucose around, and process fat when there’s not a lot of glucose around, that’s called metabolic flexibility. And that is widely associated with good health and reduce risk of chronic disease. But because of the way we’re sort of eating and living these days, and our exposure to all these sort of food substances that have just such a high concentration of refined glucose and such a huge load of it, like amounts that our bodies have never throughout human history seen, we don’t often get into a state where we get into a low glucose, low insulin state. So we’ve kind of, like a lot of us have lost the ability to really ever burn fat because we always have insulin on board. And so. So that’s kind of hard to talk about glucose without talking about fat as well a little bit, and insulin. And so, but when this balance is optimized and we have the right level of glucose in the body, we’re processing it, we’re storing it in the right ways. It’s not too much, not too little. This is sort of, when these processes are all running smoothly, we call these, I call this metabolic fitness. And that’s kind of, because  it’s kind of constantly flexing up and down on these different pathways, I like to think of it in that fitness mindset, because it is something that our metabolism gets better when we manage it properly. You have to be treating it right, and having repetitions of good glucose control every single day to be able to achieve good metabolism. And that’s something that is very much, something you can achieve. And you know, unfortunately, because we’re exposed to so much carbohydrate load and glucose in our diets, it’s hard to ever really get there. And we’re, you know, one fun stat, there’s an (? EMD 00:27:11) study from a couple of years ago, 80 to 88% of the country is considered to be metabolically dysfunctional in some way. Only 12% of the country is metabolically healthy.

Sean McCormick: [27:22] Wow.

Casey Means : [27:22] So. And they basically were looking at five biomarkers of metabolic health. So, waist circumference, HDL, LDL levels, fasting glucose, triglycerides. And basically if you had one of those that was off, you were part of that 88%. So people with perfect, you know, all five, only 12% of the country. So we’re metabolically dysfunctional and in a major way.

Sean McCormick: [27:48] And that can be pointed back to old-school food pyramids that put carbs at the very bottom of that you know, “You should be consuming.” I mean, I grew up consuming just massive amounts of white bread and flour because that’s what my folks thought nutrition was. And we follow those nutritional guidelines. And now, fast forward to 2020,  there’s a lot of shenanigans in how food is branded and how it’s positioned. And now it’s like, “Oh, if it’s organic, then it’s probably okay for my metabolism because it’s organic.” Like my folks don’t listen to the podcast so I can speak freely, but they believe that if it’s organic, it means that it’s okay for them. It’s not going to disrupt their metabolism. And this disconnect between the way foods are labeled, there’s just so much confusion around, “What is this going to do to my metabolism when I eat this?” You know, if it’s just because it’s branded in a certain way, or just because like, “I heard that this is good for you,” doesn’t necessarily mean that it’s good for you and there’s, and we have to have data, right? To support that.

Casey Means: [29:08]   Absolutely. Yeah. You know, I think it’s so interesting. So yeah, obviously the food pyramid set us back quite a bit. I think implying that we needed to eat six to 11 servings of grains and refined grains were okay. And yeah, we, I mean, our bodies just were bombarded for decades with refined carbohydrates and now we’re seeing the consequences of that. And the consequences are showing up. And just to kind of recapitulate that process, like when that’s happening day in and day out, you’re constantly getting these insulin surges. Your pancreas is saying, “Okay, all this glucose got to get into the cell. So I’m going to release some insulin, so you can take it up.” But when that happens, day in and day out, the cells are like, kind of like, “Whoa, that’s too much. We cannot store all of this in our cells. We can’t process all of this. Stop putting it in.” So you’ve got what’s called insulin resistance and that’s essentially the cells becoming numb to the signal of insulin. And over time, what you can imagine happens is insulin levels- You have to produce more insulin to drive that glucose into the cell. So now you’re getting to this state where high insulin levels circulating and the cells aren’t taking up the glucose. So then glucose levels start to rise. So that’s kind of the process that’s happening and we’re really seeing the downstream effects of that now, just epidemiologically. So, you know, there are so many overt signs of this where it’s very clear that these are metabolic disorders. So that would be like obesity. You know, 74% of the US is now overweight or obese. This is fundamentally a metabolic issue because it’s- Essentially what is being overweight? It means that you’re storing things that’s fat and not using it. And so that’s an energetic mismatch. And a lot of that fat we now know is really actually sugar that’s been converted to triglycerides and fat and stored in our fat cells, not a overconsumption of fat issue, overconsumption largely of sugar issue. And we also know that when that sugar is in the body, the insulin goes up that blocks fat oxidation on a molecular level. So you get into this vicious cycle where you just can’t burn through it, unless that insulin gets lower. So you’ve got that, you’ve got the overwhelming rates of diabetes. We’ve got 128 million Americans with pre-diabetes or diabetes. And that number is growing, it’s growing in children. And of that, about 90 million of those are prediabetics. And about 38 million are diabetics, and of that 90 million who are pre-diabetic, 90% don’t know it. So you’ve got a lot, it’s huge, huge. So it’s, breaking down the numbers there, I guess we’re looking at maybe 80 million people walking around with pre-diabetes who have no idea, which is just heartbreaking. And then you’ve got other really overt things. You’ve got non-alcoholic fatty liver disease, which is if the liver is storing too much sugar as fat. And you’re starting to see this rise in kids rampantly. A lot of functional pediatricians are starting to talk about that. This is an epidemic we need to be thinking about. You’ve got metabolic associated conditions that we know are related to blood sugar, like stroke and heart disease- leading cause of death in the US. You know, the mortality of these and the incidents of these go up virtually exponentially as blood sugar goes up. And then, so those are kind of like all the overt things, but then you’ve also just got all this subtle stuff that people don’t necessarily realize are actually fundamentally metabolic conditions. And so, you know, most of the pain points that the average person deals with is probably has its toe in the metabolic spectrum. So things like infertility. You know the leading cause of infertility in the US is polycystic ovarian syndrome. This is a metabolic condition. This is, you know, some people call it insulin resistance of the ovaries. And so as insulin rises, it actually tells the ovaries to produce more testosterone and that causes menstrual irregularities and infertility. Something like erectile dysfunction is on the metabolic disease spectrum. Small vessel disease in the penis is erectile  dysfunction, small vessel disease is caused by sugar and endothelial dysfunction clogging up the system. So, you know, those things, sexual health is even related. And then you’ve got things like fatigue, decreased exercise endurance. You’ve got anxiety, depression, chronic pain, chronic fatigue, these things all, we know from the research, are worsened by people who have basically blood sugar dysregulation. So it’s kind of got its finger on everything. And I think it makes a lot of sense because if you think about metabolism and glucose control as a core pathway of producing cellular energy, if that core pathway is screwed up, which it is in so many people, then every cell in the body will suffer. And so, you know, if it shows up in the brain, this might look like Alzheimer’s disease, which is being called type three diabetes. If it shows up in the kidney, it’s chronic kidney disease. If it shows up in the penis, it’s erectile dysfunction. If it shows up in the ovaries, it’s PCOS. If it shows up in the brain, it could also look like fatigue, anxiety, or depression. It could look like brain fog. And so, but it makes sense because this is a core fundamental pathway that every cell needs. So these symptoms are essentially, it showing up in different cell types. But that’s also, it creates a beautiful opportunity where, if we can attack a core pathway and not think of all these diseases as isolated silos that we have to treat separately in different doctor’s offices. If we think of it really more on this metabolic spectrum, it makes it so much more efficient to sort of treat these things. And when you reverse metabolic dysfunction, a lot of these symptoms melt away.

Sean McCormick: [34:36] Yeah.

Casey Means : [34:36] So, you know, so it’s kind of, I like to think about things as systems. And this is the premise of the whole field of systems biology and network biology, which is, “What are the links between diseases that make a web?” And, you know, proteomics and high throughput sequencing has allowed us to understand the landscape of how diseases are connected versus the conventional model, which is silo, silo, silo, silo treat separately. So, inefficient. But, yeah.

Sean McCormick: [35:02] What’s the biggest thing that we can possibly solve?  What’s the biggest thing that we can change for people that will have the greatest good, the biggest effect on all of the different things? Right? I mean, that’s the whole point of this.

Casey Means : [35:15] Exactly.

Sean McCormick: [35:15] Right. So, so then, I want to get eventually to, okay, so we, biometrics are useful, right? Understanding, you know, wearing an Oura ring to track heart rate beat variability, or to track sleep and REM cycles like, “Oh, that stuff’s really well and good.” And then I really want to get to, “How does this get to a behavior change?” That’s the most important thing for me, because as a performance coach and a life coach, it’s like, “Cool. So you know you’re fucked up, but now what? So now, what is the next thing you’ll do now, now that you know that there’s these issues, what will you do to change?” And so I want to go there, but obviously, but before we go there, I want to talk about like, you know, continuous glucose monitors. And I think everybody, when we say that, they can kind of picture like that thing, like a little patch. It looks like a little patch on there, usually on your arm. And that has, you know, they’ve been around for a long, long time, but only really available for either prediabetics, or is it just diabetics?

Casey Means : [36:22] Just diabetics.

Sean McCormick: [36:24] Just diabetics.

Casey Means : [36:25] Yeah. These are these little quarter size devices that you stick on your arm and they’d stick on with adhesive and they have this tiny, hairlike sensor that goes under the skin. Totally painless, that’s sampling glucose 24 hours a day, usually at 15 minute intervals and then delivering that information to your phone. And this amazing technology have changed the game for people with type one and type two diabetes. And it’s primarily used as an FDA approved device for treatment and management. So it helps people see what’s going on with their glucose and then be able to dose their insulin accordingly, dose their medications accordingly. So as opposed to the normal paradigm, which is pricking your finger four or five times a day, and so you have these individual data points, you can manage your medications that way. This is like a significantly more granular data. So it’s been very great for that population. But when you’re stepping back and thinking in the way that we’re talking about, which is that, you know, health is a spectrum and you know, it’s not like one day you wake up and you have type two diabetes. Like this is a process. This is a mjarch that’s been happening probably for 10, 20, 30, 40 years. These days, probably from like six months of age with the foods that we’re giving kids of just the constant insulin stimulation, insulin resistance until yes, one day, one year you walk into the doctor’s office and you get your yearly finger prick and they say, “Oh, you’re diabetic.” You know? And so it kind of feels like, in our system, it feels like it’s on off switch, but in the body, it’s actually a long, long march. And then the second piece of it is that we think of this as a one-way journey, right? Like you’re diabetic and then you get put on Metformin and then, you know, things might get worse and you get at some other diabetes medication and then ultimately you might be on insulin and that’s it. That’s life. But the reality is that we know now that, actually even overt diabetes is reversible and Roberta Health and Sarah Hallberg and has really shown in some really cool published data that you can essentially reverse diabetes, take people down to a normal hemoglobin A1C with as little as 10 weeks of a dietary intervention, and coaching, and that these are sustained effects. And so it is reversible even when it’s in its most overt, sort of, fulminant manifestation. But along that earlier spectrum, like pre-diabetes and just, you know, normal range where you maybe was starting to show some elements of poor glucose control. There, you know, the beauty of this is that like it’s very much actionable to move things in the other direction,  to improve your metabolic fitness, to move backwards on that spectrum. So there’s, you know the body is so adaptable and resilient when the conditions are right. You know? And so that’s really what this is all about, is helping people figure out, “What are the right conditions for me and for my body?”

Sean McCormick: [39:20] Yeah.

Casey Means : [39:20] And like you alluded to earlier, it’s different for everyone. We had for a long time this big, you know, there was this, the glycemic index scale was very much talked about, and it’s still talked about hugely and that you should just eat a low-glycemic diet or, you know, now it’s kind of, “Eat a keto diet and just eat really low carb.” But actually, what we’ve kind of been learning is that two people can respond to the exact same carb load completely differently.

Sean McCormick: [39:51] Right.

Casey Means : [39:51] And the research that showed this was like five years ago, it was published in a huge medical journal cell out of the people, the group from the Weisman Institute. And their paper was called Personalized Nutrition by Prediction of Glycaemic Responses. And they basically slapped CGMs on a bunch of healthy people and gave them standardized meals and watched what happened. And they found that you would give to people, me and you a banana, and you might have no glucose response to it. And I might go up 60 points. So I probably shouldn’t be eating bananas in it, at least in this particular context. And they’re probably okay for you. And then they looked at predictive factors of what would determine that. And it was really interesting things. Microbiome was a statistically significant factor in that, recent sleep, exercise, anthropomorphic features like how much visceral adiposity did someone have, which is kind of a marker of insulin resistance. Like how much of that they had. Like there were factors that could kind of determine whether you and I would react differently. So the reality is that, you know, there’s what you were saying earlier, something might be healthy, but not healthy for you. And that’s really like nutrition 2.0 and where the, yeah.

Sean McCormick: [40:59] Two very quick things before we continue in on this conversation. Number one, we need tools to manage our emotions. We’re all stressed out. We’re all tired. We’re all scared. We’re all freaked out. And we need a tool. The tool, the most effective tool that I have ever experienced in all of my coaching and in being a coach and being coached is the stop method. Go to stopmethod.com and watch the demonstration of how the stop method works to help you get rid of negative emotions forever. It is massively incredibly effective. And if you want to take it further, you want to book me for a coaching call so we can talk through some of this stuff. You know, I have a ton of wisdom I want to share. And you guys that listen every single week, you listener, you, whoever you are, whatever you’re doing, you are the center of my bulls. I want to give you as much value as I can. Book me for a free coaching session at thestopmethod.com or you can go to seanmccormick.com, but go check out the stop method and learn how to get rid of your negative emotions forever. This is not voodoo. This works. It’s neuro-linguistic programming and it’s FA nominal. Don’t wait on it, go check it out. Just while you’re listening to this. Just go to stop method.com and follow through. And if you want to take it further, book me for a coaching session. Okay. Back to the episode.

And it’s not, and it goes even further than that right? It’s not just what might be nutritious for me might not be nutritious for you, or it might affect our glucose differently, but also like what time of the day. Right? And like, whether or not you slept very well last night. You know, a you a year ago, banana doesn’t do anything, but you today, because of stress or because of sleep, or because exercise, you know, has fallen off or whatever, it may affect you drastically different this year than it did last year. And so that, when you think about that, like when you’re really talking about, like, in this moment, during this time and where you’re at with all of these different biomarkers, with all these different features that you have stress levels or whatever, like this is not a good idea. You have, “Banana is not a smart idea for you, Sean. Don’t do it, man.” And if you really got to have the banana, if you really want it, you should eat it in the morning instead of the evening. Right? That’s where this goes. Right?

Casey Means : [43:14] Exactly. And this is the beauty, is like you know, it is actually very liberating to think about metabolism holistically, like this way, because really it’s like, there are so many things that affect how food affects you. So many variables involved in that. So glucose is not, carbohydrates, as we know, are not a one-to-one relationship between carbs and glucose elevation in the blood. And the other things are what I like to call kind of your metabolic toolbox. And so you’ve got so many factors that impact glucose. You’ve got, like you said, time of day that things are eaten. So things generally eaten earlier in the day are going to have a less of a glucose surge in your blood than the exact same meal eaten at night time. And some of that likely has to do with melatonin. Melatonin is a part of our, you know, the hormone that’s released from the pineal gland when the sun goes down, part of our circadian rhythms that helps get us to be sleepy, but it also makes you kind of insulin resistant at night. And so it’s like, that is something great to know. If you’re going to eat your high carb stuff, you know, eat it earlier in the day. You know, we know that exercise can acutely improve insulin sensitivity, almost any exercise you do. Resistance training,, low grade cardio, aerobic activity, even walking for two minutes can improve insulin sensitivity. High intensity interval training can and yoga can. So it basically like any movement is going to be good for your glucose control stress management, we know is helpful for glucose. You probably shouldn’t be eating a piece of cake when you’re super stressed, because you’re just going to worsen the response because you’re also going to have all these catecholamine stress hormones on board while you’re loading your body with glucose. So the catecholamines are telling your liver to dump glucose. The cake is telling you that you’ve got glucose and it’s just going to compound things. And then sleep. As you know, sleep is such a big driver in metabolic health. And even getting, they’ve done some studies where they basically took healthy people, made them have only four hours of sleep for like five or six nights in a row, and then looked at all their metabolic health markers. And like, they essentially looked pre-diabetic after that. Like they acutely worsened their metabolic health. So you got all that stuff, sleep, exercise, stress, food, food timing. And then you’ve also got things like more long-term factors like microbiome. Like if you can get your microbiome diversity on track over time, you might just see generally better glucose control. There’s some really cool companies doing evidence-based research in the probiotic space, Pendulum Therapeutics, Colleen Cutcliffe, the CEO of that company. And they have actually clinical research showing that they can reduce hemoglobin A1C in diabetics with changing the gut microbiome. But you know, for the sort of typical person who’s healthy and doesn’t have diabetes, I would just recommend improving the microbiome through sort of your tried and true methods, like increasing fiber in the diet, increasing probiotics, foods in the diet and avoiding antibiotics when you don’t need them.

Sean McCormick: [46:06] Right.

Casey Means : [46:06] You’ve got, you’ve just got so many levers to pull. So it’s not like, “I can’t have a banana,” but it’s like, “I have to think about the context with which I am consuming this banana,” and using.

Sean McCormick: [46:18] Yeah.

Casey Means : [46:18] Yeah. And that’s the metabolic toolbox. That’s what I like to call building metabolic awareness or metabolic intuition. And I’ve been wearing a continuous glucose monitor now for almost a year. And you know, I’m obviously a huge fan of it. I started a company around this as a dietary and lifestyle biofeedback tool for non-diabetic individuals and building software to help make all of this super simple for people. But I’ve been wearing it for a year now. And I would say, my, this metabolic intuition now is just so dialed in. Like I don’t have to think about it as much anymore because, it’s just, I’ve tried every experiment, I’ve tried every permutation, every combination. And the app has told me, you know, “This is what works for you.” And I changed it.

Sean McCormick: [47:00] The app specifically said, “You know, girl, you got to put some peanut butter in that salad with those red onions.”

Casey Means : [47:05] Yep.

Sean McCormick: [47:06] And that’s what your body wants. I love it. So let’s talk about how it works. I mean, what you are, what you got out was saying like, you have to think about when is the right time to eat that banana. Bananas are good for you unless the XYZ. But you can learn the types of foods and the times of days to eat the types of foods. So let’s talk a little bit about how the app works and how it can actually help people. You know, I was just going to share it, you know, you can go on the website, you can read, the blogs are phenomenal. So, I mean, they’re really great because it really does explain a lot of really key ideas and also peripheral ideas around sort of metabolic health. So I found that to be really good. And then the stories like the testimonials of people. You know, “I had pasta and then I went for a walk and as soon as I went for a walk, like my numbers went down.” And so it’s, I just love it’s so sleek. The design is beautiful, but please let’s, walk us through how it works from start to finish.

Casey Means : [48:26] Yeah, absolutely. So essentially we are just a full service operation for getting these devices in the hands of health seeking individuals who may not have a metabolic diagnosis, and then pairing it with software, that fundamentally is a behavior change software. So, what a customer would experience if they come to levels is you’d purchase the product, which is, the journey, which is a 28 day metabolic awareness journey. You would be, you’d go through a telemedicine consultation with our partner physician network that we’ve established that will evaluate you to basically see if you’re a good candidate for a CGM. So there’s an off label prescription. And so, you know, this is for people who do not have necessarily type one and type two diabetes, and might go to their primary care doctor and ask for one, they want it to have better visibility into their metabolism. And their doctor just may not understand the value of this at this point. So, we kind of get through that by partnering you directly with the telemedicine network that we’ve established. And then if the physician thinks it’s a safe intervention for you, they’ll write a prescription. And then we fulfill that prescription through our partner pharmacy, and two sensors, which each last for 14 days, get shipped to your home. And they come, and so you put one on, you wear it for 14 days, and you switch it out for the second one. And you get this really cool waterproof patch called Levels Performance Cover, that makes it waterproof, and so it doesn’t fall off. And then you have access to the app. And so the app is every, we are just completely laser focused on how to make this app as absolutely actionable as possible. So our goal is to reverse metabolic dysfunction at scale. Like this should not exist, and, for the most part. You know, there’s certainly, it’s a different story for people with type one diabetes. Absolutely. But the majority of metabolic dysfunction can be prevented or reversed or improved. So, fundamentally, we want to empower people to make that happen. So this, our software is showing you your glucose 24 hours a day. We use that data to make it really simple for people. We score your meals, but the proprietary algorithm basically looks at different metrics associated with your glucose response and kind of converts that into very simple language. Like, was this a good option for you, was this not a good option for you? People can also log their exercise, obviously log their food intake and we’re, we can get other, we have other data inputs from Apple Healthkit, Google Fit, which pull in other biomarkers. So you can start to build a relationship between what’s happening between these different levers involved in metabolic health, like stress, sleep, activity, food, and what’s happening, and ultimately serve up on a silver platter like, “This is what’s happening to you when this happens,” and start to build that metabolic awareness. And, you know, people like, I’d say like the first week, the first couple of weeks is just so interesting for people because they have some of these like really “Wow” moments where they can start to put together subjective experiences they’ve been having in their lives, maybe for their whole life, and like actually identify a real cause for that. So a lot of people say, like, “Oh, you know, I’ve been having oatmeal every day for breakfast for the past five years.”

Sean McCormick: [51:43] Yeah.

Casey Means : [51:43] I mean, they noticed that, like, then, you know, they get a late morning, like a real big energy slump. And they’re like, “Well, that’s just, you know, whatever, my coffee hasn’t kicked in or whatever.” And now you can be like, “Oh, I spiked to 170 and then crashed down and had a huge dip after the insulin surge came out and soaked up all that glucose. And that’s what the fatigue was. It was a glucose spike.” And then they can, you know, think about changing that food, adding fat, you know, having a smaller portion, adding more fiber to it with, you know, chia seeds or something or inulin, and just experiment with it and figure it out. Or eliminate it completely. And, you know, it’s just very, very quick. And so what we’re fundamentally doing is closing the loop on nutrition. And you mentioned things like Oura and Fitbit, and there’s a lot of devices now that are closing the loop on like heart rate activity, stress, there’s heart rate variability, but there is nothing to close the loop on diet and what it’s actually doing to your body. There’s nothing, this is notoriously an open loop system where you eat 20 things in a full 24 hour period. And then you may have some symptoms a couple of days from now bloating, or your weight goes up a little bit or you didn’t sleep well, but how in the hell would you possibly know what from the day before caused that? You just don’t. It’s open loop. And that’s even if you’re like monitoring your symptoms. For some people who may not be even making these connections between food, the only loop end of that is that you go into the doctor once a year and get a finger prick and they say, “Oh, you’re still normal.” And that’s like a massively open loop. So we’re trying to narrow the time between action and reaction to essentially minutes so that you can isolate the variables that are causing both metabolic problems, but also subjective problems in your life. And what’s really cool about this from a behavior changed standpoint is that, it kind of, visualizing this and making these connections takes the emotion so much out of the behavior change piece of thing. It’s almost like food poisoning. Like you eat some bad clams and have terrible diarrhea, and it’s not like you feel sad about giving up clams. Like you’re just not eating clams anymore.

Sean McCormick: [53:52] Yeah.

Casey Means : [53:52] You’re done. And your body just knows. And when you see those spikes and getting a score of two on the app and feel that that was directly related to this big pain point in your life, post-meal energy slumps, like you’re kind of just done. You’re like, “I don’t want this.” Like, it’s not, this is the problem. And so we’ve gotten that feedback time and again, so I think this concept that we’re really like seeing happen in our customers, I think, can be summed up by people are developing somatic awareness, body awareness. And this other term that I love that’s called interoception, which is essentially this new found sense of what is happening inside of their bodies, because they’re pairing it with data. So even though it’s like a digital tech, you know, this sexy app solution, really, I think fundamentally it’s helping you become more in touch with actually what’s happening in your body. And these very bulls that are causing certain experiences. And that we know that people have better somatic awareness, interoception do better overall mental health. They do better with long-term health. When you can sense the internal workings of your body, things are, you’re usually, it’s easier to kind of be consistent with your health. So.

Sean McCormick: [55:13] It’s everything, it’s everything. I mean, it really is everything. And that term interoception is such an important concept for people to understand, because if you get to a point where you can use, you can develop your sense of interoception to say, like, “Okay, I feel sluggish. Okay. I feel sluggish. Okay, I’m recognizing that I feel sluggish,” or, you know, using another example, like choosing the emotions that you have on a given day. You know I’m big on neuro linguistic programming and meditation and  self-talk and affirmation and EFT and tapping and so forth. So like I’m huge into this stuff. And for people who intuitively know throughout the day, “like I’m starting to get pissed off. Okay. What can I do? What can I do to like slow this train down so that I don’t become an asshole to my family? Like, what can I do? I’m sorry. I’m beginning to get pissed off. What do I need to do? Do I need to go for a walk? Do I need to do some breath work? Do I need to pray or just sit?” The the same thing applies in so many different areas and so many different systems in our body. And for people like you and I, and for people in like the performance and biohacking world, we’ve become canaries to ourselves, You know, the canary in the coal mine where you know like, “I know that I just can’t eat donuts.” I love donuts, my family donuts. I just can’t do it. I’d be like, it makes me crazy. It makes my neck stiff, I get aggressive, you know. I know intuitively now, like I can’t, I just shouldn’t do it. I don’t feel like I want it, the same thing that you said, like the clams, the clams thing, like the food poisoning thing. Once you get to a point where you can sort of intuitively feel from the inside out, “Is this going to be a good decision for me? I don’t feel good right now. What can I do to regulate that? What can I do to actually have biological sovereignty, emotional sovereignty, autonomy, agency over my life?” That is everything, because then you don’t have to rely on,  super, I don’t know. It just simplifies your entire process and it’s this, it really is this like massive switch of transformation from the inside out that just makes your life better. And so, I love it. I love it.

Casey Means : [57:56] Yes. I mean, mind blown emoji. I’m with you. Like that is just like\, you summed it up so beautifully. And I think it gets to a bigger point that I see in my practice, you see in your practice, I think, which is that when you start building this somatic awareness and this sense of autonomy and agency with things like food, stress management, sleep, and start building consistent habits around those things,  that then pervades into all aspects of life. Like I think it changes people’s relationship with everything. And one, a couple, you know, a couple things I think are important with the food aspect is that, I mean right now, we have, we’re up against two big fights, I think with being healthy from a nutrition standpoint. One is that we’re eating a lot of processed foods that, you know, food is molecular information. So food is molecular information that comes into your body and tells your cells exactly what to do. That’s what it is. It’s wonderful, it’s enjoyable, it’s pleasurable, but fundamentally it is a, both a building block and it’s molecular information. And so when you process that and you start putting in molecular information in the body, that body doesn’t really know how to process like ultra refined white flour, or like hydrogenated oils, or like, you know, refined vegetable oils. Like, it’s like putting information into the system that doesn’t know how to process. And I think that’s where we really see a lot of diseases. So you’ve got, you start losing, and your body hormonally doesn’t respond to it the way it was supposed to. So our hunger cues are screwed up. Our satiety cue is like, our digestion is off. And so somatic awareness? Like that is difficult when you don’t even have the cues hormonally that necessarily, if you were eating real whole food, you would have. That’s one. We also are living in this hyperstimulating digital world, which has a lot of wonderful benefits, but it does, I think, take us away from an inward focus on our body. It’s very externally focused. And I think that, I love that tech is now being used, flipping the mirror back to help people get back in touch with that. But I think with TV and with video games and with a lot of this stuff, it does kind of take you out of your body. And I think after, you know, a Netflix binge, you wake up and you’re like, I haven’t thought about my body or anything. Like, you just kind of feel like you woke up in a dream, you know?

Sean McCormick: [01:00:21] Yeah. I mean, yeah. And I’m really glad you said that because it does detach you from, you know, not only are you sitting in a weird position with your neck kinked and your hips twisted, your arm sideways, watching TV for three hours a night, not only is that bad for your sort of physiology and your posture, but you’re right. You don’t think about the fact that, that you’re actually not hungry. So you don’t really want a bowl of ice cream, you know. Like I’m feeling tired. Okay. Well, it’s 11:30, of course you’re feeling tired, but the TV is still on, so you don’t have that somatic experience from the inside out that listens to your body and gets the signals that say like, Hey, dumb dumb, like it’s 11:30, you should go to bed because you’re tired. But you’re blasting your face with blue and green light that’s, you know, suppressing melatonin release. All of those different things. The ability to like be in in body, be in your body, understand your body, listen to your body, and to have a really effective tool that’s elegant and accurate, and real time. I mean, it’s, I think it said it’s every 15 minutes, right, it sends a signal to update. I mean, like, I cannot wait. I’m really excited to try mine, because I’m really curious about what my nine o’clock glass of organic red wine does. Like, I’m really curious about what, you know, the 24 ounce ribeye steak does that I eat three nights a week at 5:30. I’m really curious because there’s some foods that I’ve been demonizing for a long, long time, because I’ve been keto and paleo and carnivore and OMAD, and tried all of these different things and tinkered around. Like there are some foods that I really have demonized, you know, certain, certain grains and seeds and stuff that are, have high caloric values that I just don’t want. I also take a lot of supplements, right. So I take a lot of vitamin C. I take a lot of amino acids. I take a lot of collagen because I’m trying to put on lean mass. I’m super curious about what 20 grams of collagen powder is going to do, how my body’s going to respond to that. Should I be doing it first thing in the morning or should I continue fasting? Like I’ve been intermittent fasting, eating in a window for like two and a half years. And it’s because I got there by listening to my body and understanding, like I can just skip breakfast and it feels better. I just prefer that, but maybe, you know, maybe some oatmeal or chia seeds every once in a while and a bunch of butter and some menuca honey is a good idea for me sometimes. I’m just really excited. I’d love to hear like, if you could share like a story of someone that just like their mind got blown where they’re like, Oh my God, I cannot believe this one food. Like, Oh no, I can’t anymore. Or you, personally.

Casey Means: [01:03:32] Yeah. Well, I mean, honestly with our beta program with six months of this. I have like a hundred, I want to share. But one of my favorite, oatmeal, that one is almost universal. People are like, Oh, this has been effing me up. So, but I think the most specific example that I love is, one of our really early customers, Alison Cruck, she’s a keto girl on Instagram. And she’s been keto for like three years, and she lost like a ton of weight. And now she’s like super fat and this incredible inspiring Instagram account. And she lifts a lot and she’s, yeah, she’s been following strict keto. And it was hugely beneficial to her life. So she comes to us kind of curious to see what CGM will tell her about, you know, her glucose. And she used it as a tool to essentially experiment with some foods that she’s been eliminating for the past three years and see what happens, and was totally expecting like them to spike her and, you know, but kind of just to prove like how the keto diet, you know, is very effective at keeping glucose low. But what she found was that some of these foods that were off limits for keto, actually did nothing to her glucose, and did not bump her out of ketogenesis. So she had literally been going to restaurants for three years, ordering salad, and picking every single carrot out of the salad, and putting it on the side and not eating it. She found out that carrots when mixed with like a big salad did absolutely did not touch her glucose. And it was like a very, it was like emotional for her. She was able to liberalize her diet. She found freedom and flexibility in a keto diet with a tool that you could imagine would actually restrict you. But it actually has, for so many people, liberated especially for people who learn, you know, this food’s not good for me, but 30 minute walk after dinner completely blunts my spike, like that’s liberalizing. So she is just amazing.

Sean McCormick: [01:05:35] And I’m sorry to interrupt, but she probably, you know, maybe two or three years ago when she was a lot heavier and had metabolic inflexibility, maybe carrots would have messed with her. Maybe that wasn’t so good for her, because they’re high in natural sugar or whatever. But now that she’s gotten back to a better place where she’s more metabolically flexible and not so sensitive, like then yeah, have the carrots on the salad. It’s a nice addition. Sorry. Keep going.

Casey Means: [01:06:01] No, and that’s exactly what she did. And so she was able to do that for a bunch of foods. And yeah, I mean, it’s a dynamic system. So I think very likely if she’d done this three years ago or six months ago, things might’ve been different. Things are different day to day. So tracking is really great. And you can imagine, like she’s been tracking ketones, and even that is much more of an open loop system than continuous glucose tracking. Because you know, you’re not going to see necessarily ketone change, 30 minutes after eating a meal. It’s going to probably be more like hours to like the next morning that you’ll see a big change. And, you know, maybe you go from 1.5 to 1.3. But it’s very hard I think to still know with checking ketones, what was the exact food that was the problem or not the problem. So, I think ketone checking and continuous glucose monitoring together is like super powerful. And I check my ketones frequently and. Oh yeah.

Sean McCormick: [01:06:53] Do you do blood or urine.

Casey Means: [01:06:56] I do blood. I use keto mojo. But for me, so again, and I’m whole foods plant-based, and I’m not in like a super dogmatic way. But like I just, going back to nutrigenomics, like, I am obsessed with how food compounds affect genes. And like, for me, like plant compounds and the way they interact with like epigenetics and transcription factors and stuff, like absolutely blows my mind. And so I’m just like, it’s an intellectual fun experience for me to like, pack my diet, to think of like how I’m changing gene expression day-to-day. Like, Oh, I’m eating curcumin from tumeric. I’m dangling on a Kappa B. Like, Oh, I’m eating sulforaphane. I’m upregulating NRF 2, et cetera. So like it’s, so I’m not like super dogmatic about it, but I am plant-based, and a lot of people are like, Well, that’s gonna be a problem for your metabolic health. And what’s been fun for me as a vegan is to, over the last year, totally, totally transformed my diet to essentially a high carb, also high fat, vegan diet that my glucose never basically goes up. So like my triglycerides are like 47, my average 24 hour glucose is in the seventies, not my fasting. My fasting is like low seventies. My average is like mid seventies, sometimes low eighties, but these are like very, very low numbers.

Sean McCormick: [01:08:10] Can you clarify those ranges for me really quick, because I think for a lot of people that’s sort of out of context, like glucose levels.

Casey Means: [01:08:16] Yeah, absolutely. So there’s two sort of levels that we can talk about. So there’s like, ADA criteria, American Diabetic Association criteria, which is like the diagnostic threshold for metabolic dysfunction or normal. So those thresholds are, if you have a fasting glucose, meaning your glucose level in the blood, first thing in the morning after fasting for eight hours, no calories, if it’s under a hundred you’re normal. If it’s between 100 and 125 you’re pre-diabetic, and if it’s 126 or above you’re diabetic. So that’s one way of diagnosing diabetes or pre-diabetes. There’s a couple other ways of diagnosing it too, but that’s fasting blood glucose. That doesn’t tell us a lot about like, what’s best. This is a really like this threshold based diagnosis that doesn’t actually tell you, like in the normal range, whether you’re doing great or not doing great, how far along that spectrum towards pre-diabetes are you? And we know that a third of the country is in that pre-diabetic range. Probably a lot more are in the high end of normal moving into that. So, it doesn’t tell you a lot about that. So when you actually look at healthy people wearing continuous glucose monitors, which there’s six or seven studies that have done that, what you see is that for people wearing a continuous glucose monitor for either a few days or weeks, their glucose will be between 70 and 120 for about 91% of the day. So like the vast majority of the day, we are between 70 and 120, that’s before or after meals. Some other studies have a little bit more liberal range. So like, some studies will show, and often these involve older populations, like a young, young, healthy population, 70 to 120 for 91% of the day. Some bigger population studies show between 70 and 140, about 90% of the day. So that’s kind of the range that non-diabetics will be in. But that still doesn’t tell us what is the optimal range to be it? What should you shoot for if you’re trying to be superhuman, and like, be part of that 12% that’s metabolically healthy. And that is something that we, as a company are really trying to define. And, you know, even now in our early stages of our company, we are pretty confident that we have the first or second largest dataset of non-diabetic blood glucose values paired with food of anywhere in the world. Because with just, you know, lots of people wearing CGMs for a month, it’s a lot of data points. Millions, if not more of data points. So, a lot of my work with the company as a chief medical officer has been really like scouring every research paper on Pub Med about trying to find insights into what we should be shooting for. And I will say that even though normal fasting glucose is considered to be under a hundred by standard criteria, the research that I can find best suggests that actually shooting for between 72 and 85 is going to be much better for your health. And there’s some really interesting studies. So like New England Journal Of Medicine, a major medical journal looked at a bunch of young, healthy men and followed them over time. And they basically took normal people and separated them into core tiles. So if you’re like between 70 and 78, 78 and 85, 85 and 92, 92 to a hundred, what are your risk of long-term health outcomes? And it was just a linear increase between, I think this was a study on, it was either a cardiovascular mortality or stroke, and development of. Oh, sorry. This paper was development of type two diabetes. And basically what they showed was like, as you go up in fasting glucose, you have a significantly higher chance of developing type two diabetes. So why would we be shooting for a 92 to a hundred for a fasting glucose, if that has an odds ratio of four for becoming diabetic? Why wouldn’t you shoot for 70 to 78, which has essentially no increased risk. Then there’s other studies that show for heart disease and stroke outcomes, that even in the nondiabetic range, these curve starts to become exponential for increased risk far before a hundred, of fasting glucose. So looking at a lot of these studies together, my sense is that if you want to avoid all this stuff, shoot for much lower in the healthy range. There’s a lot there. Actually, I wrote a very large blog post on this that was months of work of research that I would highly recommend it. It’s called, The ultimate guide to normal and optimal blood glucose levels. I’ll link. I can send you the link to that.

Sean McCormick: [01:12:50] Yeah, we’ll put that in the show notes.

Casey Means: [01:12:54] And then we suggest some ranges for like how, what you should limit yourself to, in terms of a post-meal spike. And from my perspective, no one really should ever be going over 120 after a meal, and you don’t really want to go more than 30 points above your baseline from a meal. Because as you spike really high, you’re activating that insulin. You’re activating inflammation. You’re activating oxidative stress, you’re activating glycation processes, which is where glucose sticks to proteins and fats in the body and causes problems. You don’t want that. So, anyways, long answer to your question. Sorry.

Sean McCormick: [01:13:27] No, it’s perfect because I think, you know, a lot of people listening are going like, Yeah, that’s great. Thank you for that clarification. I knew that. And other people are going, Oh my gosh, thank you. It’s out of context. So far so good for the company, right? I mean, Levels is, has. Tell me about the waitlist, how many?

Casey Means: [01:13:51] 25,000 people on our wait list.

Sean McCormick: [01:13:53] Oh my God. It’s gone up by 5,000 in the last, like two weeks. Oh, people are itching for it.

Casey Means: [01:14:01] Yeah, it’s exciting. I mean, and it’s all pretty much organic traction. Like we haven’t really done really any paid marketing. So it’s, this is exciting to me, because our North Star is to reverse metabolic dysfunction, and people care. So we’re like, This is good. But it’s been really great. We’ve had some really awesome supporters and early evangelists who have been taken to the, you know, Twitter and showing their results. And I think the social nature of this also, you know, from a behavior change standpoint, because I know you care about that. The fact that this data is fun to look at and it’s exciting and it’s like self hacking, people love sharing it. And so that’s, I think very motivating too, from a behavior change standpoint. So we’ve been seeing a lot of excitement from that standpoint.

Sean McCormick: [01:14:46] It’s so exciting. I think it’s so cool. I mean, we started off, you know, really talking about the real impact that this could have. You mean like this could be a preventative measure, some preventative early corrections for people’s lifestyle and diet that changes everything, that makes their life like so much better. And that’s something that I get excited for. And if it’s just a matter of like putting something on your arm, and then putting the stuff you’re eating into an app, and then learning about what it does to you, that’s a killer. I’m really, really excited. Well, before I ask the last question, just so people know. So, I’m gonna get one, I’m waiting, nananana, booboo. You’re going to have to get in line at, 25,000, 26,000 for a wait list. I’m going to get mine and I’ll be talking about it. I’ll be posting about it. And then, we’ll have your co-founder on, to talk a lot more about the tech and so forth down the road. But where can people learn more? Where can they find out? Where can they get on the wait list? Like, please give me your vitals before I ask the last question.

Casey Means: [01:16:08] Awesome. So you can find us at www.LevelsHealth.com. You can read like so much more about what we’ve talked about today at www.LevelsHealth.com/blog. And that has been really fun for us to create. We’re trying to spread, you know, new information from the research, and giving this research to people in a way that’s really digestible so they can understand these things better. And so, yeah, check that out. You can find us on Twitter and Instagram @UnlockLevels. So that’s the company. So, check it out and you can start to see some experiments that people are doing. And then for me personally, my Instagram and Twitter is, Dr. Casey’s Kitchen. And, I post a lot about plant-based nutrition and metabolic health. So, yeah, trying to kind of really talk about that a high carb diet and not necessarily a high glucose diet in the body, and ways to think about shaping a diet so that your healthy diet, you know, isn’t damaging you through, you know, just through not knowing. And so that’s kind of what I try and share and, yeah. Awesome. Check them out.

Sean McCormick: [01:17:18] Awesome. Check them out. So, this last question is a fill in the blank question. So hopefully again, catches you off guard again. I like to catch people off guard in the, in the very beginning. And then like to catch them off guard again at the very end. And this can be based on full life philosophy, everything that you know. I mean, it can be specific to metabolic health. You know, this is really meant to be a sort of big idea, but please fill in the blank and then, elaborate as much as you wish. Everyone would benefit from knowing.

Casey Means: [01:17:53] Hmm. This is a great question. Everyone would benefit from knowing that. I’m going to go super weird on this question. So, I mean, I think I’ve said enough about metabolic health, like everyone better knowing that metabolic health is, you know, something we should work on. That, you know, fundamentally we are these incredible complex atomic machines existing in this incredible world. And, we are in constant, every second, we are in constant conversation with the outside world in the environment. And you know, exchanging material energy with the world through what we eat, what we put into our bodies, what we put on our bodies. And, even like what we choose to look at, like the light we choose to look at, the people we choose to talk to. All of this environmental input gets transformed into literal signals in our body, through hormones, nervous system, et cetera. And so, you know, I think it’s just important to remember that we are just these energetic beings in this bigger atomic, energetic hive, constantly in conversation. And why that is important to me is, because it just makes me feel like we have so much autonomy and agency to kind of change our environment, change the conditions that we expose ourselves to, what we put in and on our body. And that is the difference between health and disease. And so, I don’t know, it’s just, it’s very cool to me to look at the body as this just like beautiful complex, you know, machine. And, just think about all the levers that we can pull through our choices to express the absolute best version of ourselves. And, you know, there are a lot of forces at play that are not helping us in that regard. The food industry, processed food, media, you know, like even recommendations we might be getting from on high of what to eat. And so, you know, it’s really about coming back to the basics, understanding our bodies, focusing on the core fundamentals, relationships, sleep, stress, exercise, movement, our relationship with the earth and, yeah just creating conditions that let our bodies express their highest form. So I did all over the place, but you know what I’m trying to say.

Sean McCormick: [01:20:30] You went big. I love that. You went big. I totally agree. I totally agree. We should be looking at ourselves in wonder. It’s okay to be excited for this human experience. Dr. Casey Means, thank you so much for joining me today on the Optimal Performance podcast.

Casey Means: [01:20:51] It was so great to chat with you, Sean. And I’m just so excited to have had this conversation. Thank you.

Sean McCormick: [01:21:02] End scene. That was great.