Dhru Purohit Show - The 3 Ways Metabolic Health Impacts Sexual Health with Dr. Casey Means

Episode Date: July 7, 2022

This episode is brought to you by ButcherBox and Pendulum. When we talk about metabolic health, people often associate it with maintaining a healthy weight and having good energy levels.  But did you know our metabolic health affects our sexual function and fertility, too? Our hormones hang in a delicate balance, and when blood sugar goes on a wild ride so does everything else. That means not only are we at risk of weight gain, mood swings, and energy crashes, but it increases the chances of erectile dysfunction, infertility, difficulty finding sexual pleasure, and so much more.  Today on The Dhru Purohit Podcast, Dhru sits down with our friend Dr. Casey Means to talk about the three main ways metabolic health can impact sexual function. Dr. Casey Means is a Stanford-trained physician, Chief Medical Officer and Cofounder of the metabolic health company Levels, an associate editor of the International Journal of Disease Reversal and Prevention, and a lecturer at Stanford University.  In this episode, we dive into:  -The connection between sexual health and optimal health (2:06) -The three main ways metabolic dysfunction and sexual health are connected (14:05) -How metabolic health affects fertility (24:06) -Four things men can do to increase testosterone (26:32) -Why you need to ask your doctor for a fasting insulin test (32:35) -How mood and motivation are related to sexual health (58:46) -The optimal breakfast for metabolic health (1:16:36) -Five reasons we should care about blood sugar spikes, especially first thing in the morning (1:19:59)  -What Dr. Casey eats for breakfast (1:27:32) -Why you shouldn’t drink oat milk (1:30:49)  -How drinking vinegar before carb-rich meals can minimize a glucose spike (1:37:38) Also mentioned in this episode: -3 Ways metabolic health affects sexual function -Fertility and metabolism: the link affecting men and women For more on Dr. Casey Means, follow her on Instagram @drcaseyskitchen, Twitter @drcaseyskitchen, and through her website, levelshealth.com. To learn more about joining Levels and trying a continuous glucose monitor yourself, go to levels.link/dhru. This episode is brought to you by ButcherBox and Pendulum. Right now, ButcherBox is offering new members a great deal. You’ll receive two ribeye steaks for FREE in your first box. Sign up at ButcherBox.com/dhru. Pendulum is the first company to figure out how to harness the amazing benefits of Akkermansia in a probiotic capsule. To receive 20% off your first purchase of Pendulum’s Akkermansia probiotic supplement, go to Pendulumlife.com and use code DHRU20. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

If you care about sexual function, fertility, and even sexual pleasure, then you really need to be thinking about metabolic health and metabolic optimization. Welcome to the Drew Proet podcast. Each week, we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. Casey means. And if you care about your long-term health, you're going to want to pay attention to this conversation, which is about your sexual health. A little bit about this conversation in this interview, Dr. Casey Means helps us understand how the strength of our sexual health on a physical mental level can be a leading indicator of our metabolic health for good or for worse.

We're also going to cover how our blood flow to our sex organs, both as men and women, is critical, hypercritical, how certain foods and lifestyle factors can either help or hurt. that blood flow. Dr. Means will also break down the role of hormones in sexual health and their deep connection to our metabolic health. And lastly, we'll be touching on infertility and how so much of what's driving it today comes back to metabolic dysfunction. Even if you don't necessarily think you're interested in the topic of sexual health, this is a fascinating conversation that anyone can walk away with actionable tips to improve their overall health. A little bit about Dr. Casey Means, today's guest, she's a Stanford trained physician, chief medical officer and co-founder

of metabolic health company levels, which I'm an investor in, an associate editor of the International Journal of Disease, Reversal, and Prevention, and a lecturer at Stanford University. Dr. Casey Means has been on this podcast in the past, and it's always been fantastic. The audience, which is you, has told me that you love her and I love her too. With that being said, let's jump into today's episode. Dr. Casey Means, welcome back to the podcast. It's a pleasure to have you here. I want to jump into something that I read that you shared, which is going to be the inspiration for today's interview. And you had shared that if you care about your long-term health, if you care about your being in your

optimal health, you want to pay attention to your sexual health. Let's talk about that. I think we got a lot of people who perked up all of a sudden. They're very interested in this topic. What do you mean by paying attention to our sexual health and how that's connected to our optimal health. This is a fascinating link that I've been discovering as I've dived deep into the metabolic health world. And what we've really come to realize is that if you care about sexual function, fertility, and even sexual pleasure, then you really need to be thinking about metabolic health and metabolic optimization. The link now is extremely clear, and we don't really talk about it. And it makes sense because metabolism is

fundamentally how we produce energy in every cell of our body. And sexual function and fertility are incredibly complex, very well- orchestrated events in the body that involve so many things. They involve neurologic factors, vascular factors, psychological factors, and hormonal factories, just to get things right when you're thinking about sex or fertility. And all of those elements of the body, all of those cell types that are involved, they all require the cells to make energy properly, which is metabolism. As you know, we are dealing with a metabolic disease epidemic in this country. You've talked about it so many times on your podcast, but 88% of American adults are metabolically dysfunctional. This is unbelievable. This means that 88% of American bodies are not producing

energy properly in their cells. And we cannot have any health without having our cells having their basic functions met with energy. And so this really is paralleling issues that we're seeing with sexual dysfunction in this country, which are actually becoming quite rampant. The statistics are harrowing and sobering. So if you look at women, about 40% of all women have issues with sexual dysfunction. And this means arousal or interest or orgasm. When you get to menopausal age, that number goes up to 85%. Wow. The vast majority of women having issues with sexual function and sexual pleasure, which

is an incredibly important part of life and well-being. So those numbers are way too high, in my opinion. When you look at men, you see that about 50% of men are dealing with issues with sexual function and this largely manifests in erectile dysfunction. And even under the age of 40, a quarter of men are dealing with erectile dysfunction. This number should probably be closer to zero. And again, when we think about erectile dysfunction, we're thinking about a complex orchestra of physiologic events, all of which require good metabolism to work. So that's kind of the landscape of what we're talking about when we need to think about the relationship between metabolic health and sexual

function and happy to dive into all of that more. I think it's a super important topic to go into. And I think it's also part of how we make metabolic health be sexy is to actually talk about the direct link that it has to our sex drive in our life. That's actually one of the openings that you had in one of the articles that you wrote on this topic, which we have a link to in the show notes over here. And because sometimes, you know, if you're trying to talk to young people especially in the rates of diabetes and metabolic health for young people are also crazy.

Every year younger and younger, you're seeing kids with diabetes and other indicators of poor metabolic health. And I think if we're going to reach the younger audience, we have to also help them understand that, number one, first and foremost, it's crazy to have to say this in this day and age. But actually, the drive for sex is a good thing, right? Of course, we want to have good and proper sexual education for people that's available to them. And we shouldn't be ashamed the fact that people have a sex drive. men and women who historically, you know, women got the short end of the stick saying that we shouldn't, you know, women shouldn't have a sex drive.

So I think all those things are important to talk about, but if we're going to get them excited, it's like, hey, actually eating healthier, living healthier is important to how you not only perform, but your interest in wanting sex in the first place. This episode is brought to you by Butcher Box. You know, when I made the leap from being a vegetarian to including meat and animal protein into my diet, one of my biggest focuses was quality. I got to say, looking back on young herbivore Drew, I wish I had Butcher Box in my repertoire because they make it so easy to access high-quality meat and seafood. The quality of meat and seafood we eat is absolutely no joke. And it's one of the things that I'm always careful about, especially when I'm planning a special get-together. With Butcher Box, I know I'm serving the people that I love, the highest-quality clean protein,

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for 20% off your first purchase. I really think we need to reorient to realize that our sexual function and even something like our libido and our interest in sex is actually a barometer for our underlying fundamental health. I mean, that is such a key thing that we need to focus on. If you're having issues in those domain, which, as we just talked about, those statistics, many or most Americans are, it may be a... a big red warning sign. There are things happening under the hood in terms of our metabolic health

and metabolic dysfunction that will lead to very serious issues down the road, like all the diseases we understand are related to metabolic dysfunction. And we know this by looking at certain statistics like in men with erectile dysfunction, they have a 1.5 to 2.6 times higher chance of developing cardiovascular disease. There are these direct epidemiologic links between this non-lethal pain point in our life and the risk of future metabolic issues. Because when we look from that root cause perspective of what is the actual physiology that's going wrong when we have some of these issues, we see that there are clear links between these diseases. And I think you're absolutely right. I mean, metabolic health is sexy. And I think the reason it's sexy to me and endlessly

fascinating is that as we've talked about on other podcasts, metabolic health is this core link that that's connecting so many of the diseases and symptoms that we're facing today in the American Western industrialized world. These metabolic associated diseases and symptoms are making up 90% of our $4 trillion health care costs. And the beauty is, and why it's sexy, is because we can do something about it. This is something where we can lean into dietary and lifestyle behaviors in our own lives to actually have a positive impact on these factors and have multifarious benefits. in terms of our health and things like our sexual function and pleasure and interest. So it's exciting.

Let's talk a little bit about how you were maybe taught to look at the problem in your training as a physician from a conventional standpoint, right? How are you taught to look at what are the drivers for, let's talk about specifically sexual health, interest, or even just, you know, again, it's so complicated. and there's a lot of different layers here. Like therapy can play a role in couples. There's a lot of different factors. But we're specifically talking about the sort of physiological side, which actually also, I think this is going to be a big insight for people as they listen today. It actually influences the mental side too.

That actually might be worth touching on for a second because there's some people that are paying attention today and saying that, hey, listen, like what does metabolism have to do with some of the mental aspects of the pursuit or the enjoyment of sexual health? Yeah. So to answer your first question, which is how are you? conventionally trained to think about these things. I can sum it up in about one sentence. What are your symptoms? Oh, I have low sex drive and I have trouble having an erection. Cool. Here's some Viagra. It's symptom and then diagnosis and then medication. It's just so

algorithmic and it's so unfortunate because when you give that medication, something like Viagra or Cialis or whatever it is, you are missing an incredible. opportunity to help this person understand their fundamental health so much better and make the choices that are ultimately going to positively impact that specific issue, but so many other areas of their life. And that leads into the question of what's really going on here with some of the physiology, including the psychological component. So there are really three main ways that metabolic health and sexual function are linked. The first is blood flow. The second is hormones. And the third is psychology and mood.

So when we think about blood flow, this gets at the Viagra conversation. So what does Viagra do? It allows you to produce more of a chemical in the blood called nitric oxide, which is a vasodilator. It allows blood vessels to dilate. And when you do that, you can get engorgement of erectile tissues, and that's part of arousal and sexual function. Interestingly, in both men and women, really for any sexual function, you need dilation of blood flows and blood flow to go to the erectile tissue. In the women, this is going to be all the areas of the clitoris and around the clitoris. And in men, of course, it's going to be the penis.

And Dr. Sarah Gottfried, who's written extensively on hormones and sexual function, she says that erectile dysfunction in a man under 40 is atherosclerosis of the penile artery until proven otherwise. It is blockage of this artery to the penis unless proven otherwise. And so we really have to focus on blood flow. And of course, metabolic health is one of the biggest determining factors in how our blood vessels are working. So insulin resistance actually affects all aspects of nitric oxide production. So it actually, insulin resistance in the brain can block some of the central factors

and central mechanisms that set off the cascade of events that leads to nitric oxide stimulation. This may be because of the pro-inflammatory cytokines that are upregulated in the brain, in the setting of insulin resistance. It's not totally clear what the reason is, but we know that with insulin resistance, it affects the central aspects that ultimately set off the cascade of releasing this chemical nitric oxide that dilates blood vessels. So that's a problem. It's also a problem not just for the engorgement of erectile tissues in men and women, but also for things like lubrication and vaginal wall dilation and sort of relaxation. And so there's so many aspects of this whole process that are ultimately related to nitric oxide and blood flow.

But bottom line, if you want good sexual function, performance, and pleasure, you need blood flow to these organs. And that is very much dictated by metabolic health and nitric oxide. Now, before we get to the other couple ones, let's just start off a little bit with what are some of the things that restrict that blood flow in the body? Like, what are some of the things that the lifestyle factors? So we know that it's through the mechanism of poor metabolic health. But what are some of the things that people are doing every day that are contributors to having plaque build up and restricting the blood flow with which ends up negatively impacting your sexual drive? Yeah. So the big lifestyle factors that we think about is really anything that causes blood sugar spikes and anything that

leads to insulin resistance. So there's a lot of different things that contribute to insulin resistance in the body. But of course, a key one is going to be, are we eating diets that are spiking our glucose over and over and over throughout the day and causing this glycemic variability, this roller coaster of ups and downswings in glucose? One of the reasons that's problematic is that not only does it contribute to insulin resistance and makes the body essentially numb to this insulin signal, but it also induces oxidative stress. So the production of advanced glycation end products and excess reactive oxygen species. So these are metabolic byproducts that can cause damage to our cells and bodies. And what we know that reactive oxygen

species and in excess of them being oxidative stress can do is lead to narrowing of blood vessels. It can cause thickening of the capillary and arterial walls and cause that narrowing constriction. Another thing that happens when you have those big blood sugar spikes over and over, and ultimately when this leads towards things like pre-diabetes and diabetes, is it affects the nerves that actually impact the elasticity and dilation of arteries, and then, of course, also the nerves of things like the penis and clitoris and whatnot. So it's really, it's multifactorial. It's nitric oxide, it's reactive oxygen species, it's impact on nerves, but one of the key things you can do is keep the blood sugar down. So eating in a way that allows your blood sugar to be more balanced,

which we've talked about on many of our podcasts together, things like eating a whole foods, unrefined diet where you're really avoiding the refined sugars, refined carbohydrates, you know, making sure that you're pairing your carbohydrate sources with fat, protein, and fiber, not just eating naked carbohydrates that are going to get into the bloodstream quickly and spike the glucose. that's all really important. But there are several other factors, of course, for eating a metabolically healthy diet as well. We want to make sure that we're eating probiotic and prebiotic rich foods, which are going to support our microbiome, which directly feeds into our metabolic health. We want to be eating lots of antioxidants and micronutrients to support the metabolic

machinery in the body that lets us make energy properly in ourselves. And we want to be focusing on clean organic food because we know that some of the pesticides that are covering so much of our food today are actually toxins that hurt our metabolic machinery. And they even have a new class of names for these types of chemicals called Obesogens because they directly lead to obesity. So a really micronutrient antioxidant, probiotic, prebiotic, rich diet that's ideally cleanly and sustainably sourced and doesn't spike glucose is the name of the game when it comes to having a more metabolically healthy diet. So I know that sounds pretty complex, but it's basically like eat real whole foods as much as you can. Yeah, a lot of things sound complex when you're

getting started, but the more that you listen to people who are good at breaking them down, and you are great at breaking it down. And also, I love your newsletter, which also has, like, great recipes inside of there. We'll link that up. If anybody wants, like, fantastic recipes on a weekly basis, your newsletter's, Dr. Casey's Kitchen is what it's called, right? Yeah. Is a fantastic one. You know, I was really blown away to see one stat that you had referenced in your article, it said twice as many women with type 2 diabetes experience sexual dysfunction compared to women without.

That's mind-blowing. Yeah. It's mind-blowing. And then another one that is on the side of the statistics with men, you talked about ED a little bit. We often think about ED as erectile dysfunction as being something that affects older men. But one thing that I pulled from yours was ED also affects up to a quarter of gentlemen under the age of 40. When you hear those statistics and you look at this world and you also see

you know, like population decline and all this other stuff, like, does this idea of this? Like, were you, when do you see statistics like this? Absolutely. Because we are dealing with somewhat of a fertility crisis right now. 20% of women of childbearing age who have not had a prior pregnancy are not able to conceive after one year of trying. That's a lot. That's one fifth of women. And there's evidence that this rate is going up. One study that's a global study looks at that this might be increasing by about 0.37% per year. And when you step back and think about what's really happening, it's quite shocking. You know, what is more evolutionarily vital than our ability to reproduce? And right now, it seems that that is partially under siege by this fundamental issue we're having

with our metabolism, which of course is also leading to nine of the ten leading causes of death in the U.S. So it's a metabolic crisis that we're dealing with, and one of the offshoot of that is a fertility and sexual function crisis. And unfortunately, the way the conventional medical system approaches this as very, very simplistic and very unenpowering. And I think when you are dealing with issues as sensitive as this and issues where we have very poor education in our upbringing and our school, the system, unfortunately, you know, people are very desperate to get on top of these things and we'll kind of do whatever, you know. And so we have all of this push towards simplistic pharmaceutical interventions and virtually no push towards thinking about this network

of diseases, this system of diseases that's happening and how fertility and sexual function fit into it. So it's really, unfortunately, kind of up to us right now to learn about these things and to take control of them in our own lives. But yeah, you know, and I think it's just interesting. I think sexuality, it's such a complex and nuanced thing. It's not something I'll be able to sum up simply, of course, in a podcast. But I think it's, you know, aside from being evolutionarily vital for us to like propagate our species, it's also very much linked to, I think, drive and creativity and sort of our ability to feel like we're truly deeply engaged in sort of like the core, you know, generative aspects of our lives. And I think when you, when you, when you pull that away and when lifestyle factors are subtly undermining that that really just sort of, you know, primal, creative force within us, it's very problematic for society. And you are seeing issues with, you know, rates of desire, libido, et cetera, that I think are worth having a bigger conversation about. Yeah, I think one thing that's interesting on the fertility side,

as people wait to have children at a later age, I think one argument that's there is that, great, there might be a lot of different factors, and it's a multifactoral thing. We've got to focus on the economy and jobs and child care. There's a lot of different things that play into it. But if your metabolic health is better, that also means that your egg quality is going to be better. And in the case of men, your sperm quality is going to be better. Can you chime in on that? Definitely. So fascinating statistics about sperm recently. So research suggests that sperm count is down about 50% over the last 40 years. This should make every man's ears perk up. I mean, this is pretty astounding. And there are several proposed reasons why this

might be happening, many of which are related to things we've already talked about. But metabolism seems to be a core link. And one of the pieces of research that really gets at this was a study out of Harvard, that looked at, as you go from normal weight to overweight to obesity, sperm count goes down. So if you are an obese man, you have about an 80% higher likelihood of having no sperm in your semen compared to a man of normal weight. And overweight men, it's in between there around 40%. And so that's pretty astounding that the... these metabolic issues are leading to downstream physiology that's essentially stopping our body from making sperm. I mean, that's incredible to me. And one of the reasons this might be is because

fat tissue actually has this fascinating hormonal effect of converting testosterone to estrogen. And so many people don't think of fat as an endocrine organ, but it absolutely is. It's, as Ben Bickman often says, fat tissue acts like an ovary in men. And so we're seeing lower levels of testosterone in men as their weight goes up. And we know that weight loss can be very effective in getting testosterone levels back up. There's actually, you know, four great things that men can do very simply to get their testosterone levels in a better place. Aerobic exercise, resistance training, stress management, sleep, and a slightly more difficult

one is weight loss. But you do those things, testosterone will generally go up. And so this is a big part of why I think we're seeing decline in sperm count. sperm quality as well. Some of the research that I'm citing, the conclusions of the paper is actually that sperm count and quality should be considered a barometer for overall health of the man. And this, of course, makes sense. This is a type of cell that is being produced constitutively, you know, week after week throughout a man's entire lifetime. So if there's problems with foundational health, you're going to see problems in this cell type. And so,

So that's definitely very real. In terms of egg quality, that's an area that I don't actually know if there's been as much research about, like how insulin resistance and foundational health affects the quality of the egg. The eggs and sperm are a bit different in the sense that the eggs are all in the woman's body when she's born in her ovaries. And we, of course, release them each month during our reproductive age, whereas sperm is just being created, you know, all the time. throughout a man's lifetime. And so that's one I don't know exactly. I have to assume if the body in which these eggs are living is being exposed to more oxidative stress, you know, dysfunctional levels or unbalanced levels of sex hormones, higher inflammation, that it's going to have an impact. But one thing that we do know is that in pregnancy, even if a woman is able to get pregnant,

people with metabolic dysfunction, pre-diabetes, type 2 diabetes, have higher rates of miscarriage. And so we know that blood sugar and insulin resistance both have an impact on placental function. And so even if we get through all the steps required to actually have, you know, proper ovulation, sperm production, fertilization, implantation, then we get to actual caring. of the baby, and even at that level, having issues with blood sugar and insulin resistance can create a higher risk environment for the placenta and for carrying the baby to term. You mentioned those three areas that are related to the sexual health. We covered blood flow, which had a few different components to it. The other one that you mentioned was hormones.

Let's dive into hormones a little bit and how key hormones are to this whole topic. Yeah. So hormones are such a complex topic, but one thing that I think is key to understand is that there's this sequence in the body called the HPG axis, hypothalamic, pituitary gonatal axis. You can think sort of like brain down to sex organs. And this is a cascade of events that happens. It ultimately stimulates us to have the right balance of sex hormones. And insulin resistance and metabolic dysfunction can hurt the HPG axis at basically every level.

If we have insulin resistance in the brain where the hypothalamus is, it's going to cause problems for this central, top level aspect of this coordination that can ultimately result in issues with testosterone and estradiol production. And so HPG axis basically, if there's issues with metabolism, you're going to have issues with that. you know, more moving into sort of the specific hormones themselves, testosterone, like I mentioned, is we're having issues with testosterone given the fact that many men are overweight or obese, have excess fat tissue, and are therefore going to be converting their testosterone to estrogen and disrupting that very delicate balance of hormones that's required for sexual function and optimal fertility in sperm production. So that's really the key things, I think, to know about the hormone aspect is that insulin resistance is going to affect the brain.

It's going to affect testosterone production and conversion to estrogen. And it's going to also impact our ovaries. You know, our ovaries are what make a lot of our female sex hormones. And one thing that's quite interesting is that when women have higher levels of insulin in the setting of insulin resistance, that insulin actually can stimulate the ovaries to make more testosterone. And so this is actually the root of the leading cause of infertility in the U.S. for women, which is called polycystic ovarian syndrome. And essentially, when insulin levels are high, in the setting of insulin resistance, the faecal cells of the ovary, which have insulin receptors,

are stimulated in excess, and they produce more male hormones or androgens like testosterone. And when a woman has too much testosterone circulating in her body, that's going to cause things like menstrual regularity, potentially lack of ovulation, excess hair growth, acne, or hercetism, and issues with excess weight storage. And so these are all symptoms that we see in polycystic ovarian syndrome, which are related to the fact that high insulin levels can drive the ovaries to make excess testosterone. And in women, throw off that, again, delicate balance between testosterone and estrogen. So that's kind of the landscape of hormones.

think long story short, we really want to keep our insulin levels down because it's going to protect our ovaries and women from producing too much testosterone. In men, of course, high insulin levels are going to be associated with excess fat storage, and that's going to be a problem for our testosterone and estrogen levels in men. You know, you were on the podcast once previously, and on the topic of insulin, you were saying like it's actually one of your top most important tests that you recommend. I think it'd be worthwhile to do a little bit of a refresher on fasting insulin. and just even just zoom out insulin. What is it and what is the role that it plays inside of the body?

Why is there so much talk about insulin these days? Yeah, insulin. Oh, it might be my absolute favorite hormone. It is so, so important. And what it does is that it is the hormone that is released from the pancreas. And we have blood sugar spikes in the body. And it helps the body take that sugar out of the bloodstream, bring it into the cells so that can be either used or stored. So you imagine you eat something, you have your blood sugar elevate, insulin is released,

it helps take it out of the bloodstream for use or storage. When we are spiking our glucose levels over and over again throughout the day, like we're often doing in our westernized, industrialized diets that have majority of calories from ultra-refined carbohydrates and sugars, and we're on that glucose roller coaster, that poor insulin is having to be secreted all the time. It's like spike, spike, spike, spike, spike. And what happens is the cells essentially get numb to that signal. They're like, oh, my God, too much insulin around. we are trying to drive too much glucose into the cells. We're having to do too much metabolic activity. Stop. And it puts up a block to that insulin. And that's called insulin resistance. So the pancreas is very smart. And it's like, oh, okay, you're trying to block me. I'm just going to produce way more insulin to drive that blood sugar into the cells to overcompensate. And so that's called hyperinsulinemia. And it's a compensatory response of the body to insulin resistance. So this is now these early stages of metabolic

is a metabolic dysfunction, where your body may be compensating enough that your blood sugar actually looks okay. And if you go into the doctor and get your yearly fasting glucose, blood sugar texts, they're like, oh, it looks fine. But if they're not looking at insulin, then they might not realize that your body's actually pumping out way more insulin to keep that blood sugar at a normal level. And so what research has shown and a really interesting paper in The Lancet from a couple years ago is that that high insulin level and that hyperinsulinemia, which is a sign of early insulin resistance and metabolic dysfunction, can be happening for more than 10 years before we actually kind of break that system and fasting glucose starts to go up.

So we are missing all those people in that early window of metabolic dysfunction because we're not checking fasting insulin. we're only checking fasting glucose. So you and I might both go to the doctor, same day, each have a fasting blood sugar of 80, and the doctor will tell each of us, you're exactly the same, you're totally fine, you're both super healthy from a metabolic perspective. But I might be pumping out an insulin level of 40 to keep my blood sugar at 80, and yours might be two.

So you are significantly more insulin sensitive than I am and are probably going to have less risk of sexual dysfunction, less risk of future heart. disease, diabetes, obesity, stroke, cardiovascular disease, Alzheimer's dementia, chronic liver disease, chronic kidney disease, gout, migraine, infertility, et cetera. All the things that we know are associated with metabolic disease. And yet we will not have any awareness of that. So that's why I want everyone to ask their doctor for a fasting insulin and shoot for a range of about two to six milliase per milliliter, which is a really great signal that your body

is quite insulin sensitive and not having to work too hard to keep that glucose in a healthy range. And you can imagine circling back to the conversation about PCOS, the woman whose insulin is two or three, that's not a ton of insulin stimulating that ovary to make testosterone. But if your insulin is 30, 40, 50, that's such a stronger signal to the thika cells of the ovary to produce testosterone. And so we want to figure out strategies to get the insulin down. a lot of the research in the PCOS literature has looked at healthy, low glycemic diets that are intended to get insulin down and had really promising results in terms of quickly lowering

glucose levels, insulin levels, weight, cholesterol levels, triglystorides, and normalization of sex hormones. So there's a lot of promising literature out there about how getting insulin under control can have a really positive impact on sex hormones. and conditions like PCOS. And why do you think it is that so many doctors, even with all the literature that's out there on how important of a biomarker fasting insulin is, how come it's not more universally included in sort of the standard blood results that are there? What are your thoughts on that? Is it just lack of awareness?

I think it's a couple things. I think the best person to have this conversation is Dr. Rob Lustig, because he can go on about this for an hour and does it so eloquently. But I think it's multifactorial. You know, I think that glucose is an easy biomarker to test. It's quick. It's really cheap, although insulin is actually very cheap to test as well. It's like $10, $15 to do. And so that's not a great reason. We also have medications that can lower glucose levels, like for instance, insulin as a medication, which is interesting. So we can actually very quickly, when we test glucose and let's say it's high and someone's type to diabetes, bring it down. That is not something we can do with insulin. We don't have a medication that can just immediately bring insulin down necessarily. And that's what

we really need to do. And so I think sometimes what tools we have at our disposal drive, what tests we actually want to do. I think we've seen this in the cholesterol area as well because, you know, we have such a big focus on LDL cholesterol being the big, bad, dangerous cholesterol, when in fact, actually the odds ratio for risk of cardiovascular disease with a high LDL is about 1.3. But for triglycerides, another part of the cholesterol panel, which gets way less attention, the odds ratio is 1.8. It's higher. And yet no one's out there talking about. how bad triglycerides are. Well, we haven't had a good medication for lowering triglycerides. We have had statins, which lower LDL cholesterol. So sometimes I think that this feedback loop between what

tools we have and what we actually choose to test gets really, really ingrained, which I think is unfortunate. But the beauty of what you talk about on the podcast and what a lot of, you know, the forward-thinking medical profession is doing is saying, hey, we might not have a medication for those things, but we know exactly what dietary and lifestyle factors can improve these things like triglycerides, like fasting insulin. So let's test them, let's focus on them, and let's get them down. We might not do it through medication, but we can. So could you talk about the connection between our liver and insulin, like specifically like fatty liver? We're hearing about like it's exploding. It's out there. One of my friends actually hit me up just a few weeks ago and said,

I have non-alcoholic fatty liver. What's going on there? The liver is really one. of our key metabolic organs. And I don't think most people realize this. When the liver has problems like non-alcoholic fatty liver disease, which now 20 to 30 percent of American adults have, that number should basically be zero. It means that there's insulin resistance in the liver. So that's, again, I'm going to stimulate the pancreas to have to reduce so much more insulin to overcome this insulin resistance. And something interesting about the liver in regards to the sexual health conversation is that the liver makes a protein called sex hormone binding globulin, which actually is a protein that binds to free testosterone in the bloodstream and kind of

takes that out of commission. And sex hormone binding globulin levels are significantly decreased by liver dysfunction. So that's going to impact that delicate balance of sex hormones. The other interesting thing about the liver and sex hormones is that the liver detoxifies and excretes estrogen. And so when the liver is dysfunctional, there's two phases of estrogen detoxification. The first is in the liver, which is called phase one detoxification. And then you go to the gut, and that's phase two detoxification, where estrogen is actually excreted in our stool.

And so, again, if you have liver problems because of metabolic dysfunction, there are several ways in which that layers upon our sex hormones in the ways that were, you know, you, either increasing or decreasing them in the body. And so much with hormones is around delicate, delicate, finely tuned balances. And so we really need the liver to be functioning properly in order to have optimal sex hormone balances and levels. In terms of what we can do about non-alcoholic fatty liver disease, what we're realizing is that this is a conversation that in large part centers around fructose. So we've been taught, we've talked about glucose, but fructose is also a key form of sugar that seems to uniquely hurt the liver and cause fat deposition

in the liver, which causes insulin resistance in liver and both non-acolic fatty liver disease and insulin resistant. So we want to get rid of the really high fructose sources in our diet that overload the liver. So two key ones here are going to be anything with high fructose corn syrup in a liquid form. So soda is a big one. also juice, which is even though it is sometimes natural, it is concentrating the fructose from fruit in a very intense way. And then another one we want to think about in terms of liquid carbohydrates that really affects the liver is beer. Because beer is a high carbohydrate source liquid that both the alcohol and the carbohydrates in the beer can uniquely generate

fat deposition in the liver. So soda, juice, and beer, I would really recommend we eliminate those if we want to have a liver that has the minimal amount of fat and that's functioning optimally. Fructose, which I know you've gotten into with other people on your podcast, what it does is when it's in this high concentration form, goes into the body really quickly, like in the high fructose corn syrup or juice form, it overwhelms the liver cell's ability to break it down, basically, and process it. And in breaking down fructose and liver cells, you form this byproduct called uric acid, which both David Prometter and Rick Johnson have written books about this year. And that uric acid, interestingly, uniquely damages the mitochondria of the liver

cells, which are, of course, are energy factories, the powerhouse of the cell that process glucose to energy to ATP, and that uric acid overwhelms the mitochondria and essentially damages their ability to process glucose. And so we shunt that excess glucose to fat. And that's why you end up getting fat storage in the liver cells. And this fatty liver, again, is going to promote insulin resistance. And because of that and the hyperinsulinia that results from that is going to feed into this whole sexual health conversation. Because like we talked about earlier, insulin resistance throughout

the body, it's going to impact our ability of our blood cells, our blood vessels to dilate, to get blood flow to our sexual organs and affect our hormonal balance as well. So what's the relationship between insulin resistance? You know, let's say you mentioned earlier, like all those successful things happen, you're able to hopefully, you know, we know that miscarriage rates are up for individuals that have poor metabolic health, but hopefully knock on wood, you're able to go all the way to delivering the baby. What's a relationship between insulin resistance and the birth of a baby? There's a really interesting relationship between insulin resistance and the size of the baby. And so we know that insulin is an anabolic

pro-growth hormone in the body. It stimulates generative processing the body. It also, unfortunately can stimulate things like cancers. And so in some ways, it can be anabolic in a good way, like building muscle. And then, of course, it can be detrimental, like when it's coming to stimulating cancer cell division and growth. And so this also can happen for a fetus. And what can happen is that in women that are insulin resistant and have high insulin levels, while the insulin does not cross the placenta, the high glucose levels in the mom can and can lead to insulin resistance in the baby in utero and stimulate greater growth. And so there's a condition called fetal macrosomia. And macrosomia literally means big body, macro big, somia body. And so this is

defined by babies that are above about 4,000 to 4,500 grams, which translates to about bigger than 8 pounds, 13 ounces. And for babies that have fetal macrosomia of which insulin resistance and high glucose levels in the mom is a risk factor, these babies, it portends metabolic issues for the child. So a large baby is more likely to have metabolic syndrome and childhood obesity. And so if we can go into pregnancy with more insulin sensitivity, lower insulin levels, and more stable glucose levels, it's going to be positive for the baby. We certainly shouldn't think about, like, you know, aggressively going on any restrictive diets during pregnancy or right before pregnancy, but I think a very thoughtful, holistic approach to insulin sensitivity optimization as you're

thinking about preparing for conception and during pregnancy is a really good strategy. And, you know, this one's kind of personal for me because I was actually a very very good strategy. And, you know, this one's kind of personal for me because I was actually a very large baby. I was 11 pounds, nine ounces. And this was in the 80s that I was born. And I think, you know, unfortunately, I don't think we knew as much about these links then because I, it was always celebrated that I was a big baby. It was like, oh, that's so cool. Like, because bigger is better in America, you know, in a lot of ways. It's like, wow, like, congrats mom. Like, you had this, you know, awesome big baby. Yeah, your grandmother told your mom that she was having a two-year-old. Yeah, yeah, yeah. She goes, when my grandma first met me in my first week of life, she goes, she said to my mom, you, you didn't give birth to a newborn. You gave birth to a two-month-old.

Two-month-old. Sorry, not two-year-old. And then the other joke is that people were walking by the newborn little baby nursery and we're looking at, this is actually my brother and said, someone must have left him here because he was so big. We were both really large babies. And, you know, looking back hindsight's 2020. But, but. But my mom, you know, she ended up having blood sugar issues. She had trouble losing the baby weight in her 50s and 60s. She ended up getting some of the classic American issues like high cholesterol and high blood pressure. And what I wish would have happened is that back when she was having those large babies, someone had said to her that you probably have metabolic dysfunction. you probably have insulin resistance, and you should really think about this and get on top of this now.

But of course, no one mentioned that. No one linked all these things together. And over time, she, you know, went down that normal pathway of getting a prescription for this and a prescription for that. And, you know, ultimately, she died of pancreatic cancer, of which the number one, you know, biggest risk factor is metabolic dysfunction, obesity. history of type 2 diabetes, smoking as well. And so it's just, you see things like this unfold all the time in American healthcare where there's these clues and there's these constellations of things

happening where if you don't have the right framework for it, you're going to miss it. And this is why we need to have a metabolic framework for thinking about health. Because otherwise, these seem like disparate issues that are all their own separate. silos. We even might celebrate some of them when in fact they're connected. We can do something about it and it can have a big impact for our future health. So, you know, I definitely would love women, especially at a younger age, to look at things like what's happening during their pregnancies, you know, whether they're getting gestational diabetes, what's happening with their menstrual, you know, cycle and if they have PCOS, how bad their hot flash symptoms are. All these things we know are

hot flash and other menopausal symptoms. We know these things are all in some way related to metabolism. But if we don't have that awareness, we're not going to realize that these could be harbingers of future issues. Now, before you step into your current role as one of the founders, co-founders of levels and we'll chat about that in a minute, you were seeing patients and you had a practice where you would put them up to continuous glucose monitors and you would run all these tests and you'd help them try to get to the you know root of what was going on with them in your experience taking it back to sexual health somebody came in let's start off with you know a young man one of those people that is in that you know 40 50 years old that's suffering from ed or lack of drive

or other things when they started to make the changes that you would recommend they were watching their blood sugar spikes they were maybe paying attention to their fast fasting insulin. They were focused on improving their metabolic health. When they were focused on that, what was your experience about on average, how long it would take them to start noticing a difference? I'd say that in my functional medicine private practice, it took around two to three months for people to see very significant quality of life changes after instituting very consistent dietary and lifestyle changes, which to me was very exciting, you know, two to three months after dealing with these symptoms often for decades. I remember one incredible patient, a gentleman in his late 70s,

he had worked in the airline industry and in a workout studio in his small town in Oregon, And someone, he was talking about a bunch of his symptoms he had. And some young person in the class gave him a book about functional medicine. I think it was actually one of Mark Hyman's books. And this guy had never heard about any of this and read this book and it changed his life. And so he found me and we worked together. He came in with, I believe, 52 symptoms, which is not uncommon. I mean, if you think about it, it's like the average person walking around, they're like,

oh, yeah, I mean, I feel a little anxious sometimes. And yeah, I get migraines every once in a while. And I have low back pain. And yeah, I have some eczom on my seat. skin and sometimes my hands get cold when it's cold outside and I've got these little divots in my nails. My ankle has been hurting for three years and I've got some fungus on my toenails. And yeah, my periods are actually irregular. Like they kind of bounce between 25 and 35 days and I've been trying to get pregnant and it's not going well. But I'm totally healthy. I'm 100.

I mean, that is actually like a normal conversation. That's the type of thing where all these things are happening. And the person is like, yeah, I'm just like the average young, healthy American. And they actually probably believe it because they think of themselves as normal because most of their friends also have that same situation. Exactly. But I mean, that person I just described is just basically most people I've known in my life who have just that constellation. Poppin Advil, you know, got a UTL, take an antibiotic, all this stuff. And that's not normal. But when I say 52 symptoms, it's like pretty, when you start thinking it's like, wow, that actually is pretty easy to rack that up when you think about these types of things, then add on some chronic issues. choose because you're in your 70s, like, oh, yeah, I have hypertension, and my blood sugar is a little elevated, and I've got some brain fog, and my energy's low, and I'm feeling more down than usual. It gets up to 50 really quickly. So, flash forward, you know, we institute a lot of blood sugar

stabilization techniques, very comprehensive dietary lifestyle plan. And of course, in this type of practice, it was very high touch working with him really deeply to figure out what are the barriers to adopting these behaviors in your life and how can we work through that together? And two to three months, he came in and he had four symptoms. And I'm just like, this is my calling. This is what I need to do with my, you know, this is, I want to get this message out there. And he was thrilled. I was thrilled.

It's not magic. It's just, you know, you, what I would do with these patients, and I think this was what most precision medicine, functional medicine, whatever you want to call it, type of providers do, is look at all the symptoms. context. Think about, okay, based on the scientific literature, what do we know are the physiologic root causes of each of these symptoms? For instance, diabetes, physiologic underpinnings, we know insulin resistance, chronic inflammation, oxidative stress are some linkers there, glycation. Migraines, we know that oxidative stress and inflammation, both are drivers of migraines. So you look

at all these different symptoms and conditions. I actually put them all up on. a whiteboard and draw just all the links of what are the physiologic things that are leading to each of these symptoms. And then, again, go back to the research literature and look at what dietary and lifestyle strategies and or supplements or exercise or whatever it is, do we know, feeds into ameliorating and improving these pathways. And when a patient understands that, like, oh, several of my symptoms, osteoporosis, pre-diabetes, migraines, There's dozens of research papers that all show that excess oxy of stress is related to these symptoms, for instance. And I would give them all of the papers, long, long educational documents to show them that this is well established.

Then when I tell them, hey, here are ways to reduce exposure to pro-oxidants in your diet. And this is what an antioxidant does. It literally is a chemical that goes into your body or that your body produces that binds that reactive unpaired electrons. and neutralizes it so it's not damaging your cells. All of a sudden, it clicks for them. Oh, I get why I need to eat colorful fruits and vegetables now. I understand why I want to eat as many as possible because these are my symptoms. This is what they're caused by. It has unpaired electrons. The food helps neutralize that. Boom. They adopt the behavior. But if you're missing all those links, then it's just sort of like, why are you making me eat all this stuff that I don't

actually really want or like? And the beauty is, once people believe, it, they understand the mechanisms, and they start adopting some of these changes, you end up learning, I think, to love a lot of these foods, love the exercise, love getting more sleep, love the stress management, love the therapy, and it becomes beautiful parts of your life that are really self-reinforcing. So a bit of a tangent on functional medicine, but I think it's how we need to be approaching sexual health, just like it's how we need to be approaching all these other symptoms and diseases we're facing today. Is there a difference in terms of, you know, we were talking about the example of a, of a, you know, a man coming in. Is there a difference that you see in terms of

when it comes to category of sexual health for the time it takes to maybe see improvements in key categories for women? Is that too abroad of a statement to sort of ask or a question to ask? You know, it's hard to generalize, I would say. So I can't give a specific number. I will say that when we look at the research, many of the studies in conditions like polycystic ovarian syndrome, for instance, are 12-week interventional studies. And in those 12 weeks, we see vast and highly statistically significant improvements in sex hormone levels and all metabolic biomarkers when you put people on dietary interventions. One of the – my favorite studies was done in 2020.

it was a small study. It was 14 women with polycystic ovarian syndrome and infertility, and they put them on a 12-week Mediterranean ketogenic diet. So what I loved about this paper is that it was a very healthy ketogenic diet. It was not restrictive. So you could eat unlimited green leafy vegetables and non-starchy vegetables. So it wasn't like you could only have a certain amount each day. it was actually very moderate in the animal protein consumption. It was, I forget the exact amount, but like a few servings of healthy, sustainably raised like fish or meat per week. And then some polyphenol supplements. So some like plant chemical additional supplements. And just with that, the women on average lost 20 pounds in 12 weeks. There are insulin levels, glucose levels, triglyceride, HGL, LDL, LGL, and sex hormone levels all improved significantly.

So we're talking about fairly short time frames here. So that's kind of, I think, the best research that we can point to. It's like less than three months. Yeah, exactly. Yeah. Exactly. We touched a little on this, but anything else that you want to say on the topic of mood and motivation and how that's related to sexual health and the desire and the pursuit of it.

Yeah. So this is the third. leg of that stool that we introduced earlier in the episode of the relationship between sexual function and metabolic health. We talked about blood flow being a critical piece. We talked about the hormonal aspect. And then the third piece is psychology and mood, which of course is, you know, you need to be motivated and have this desire to want to engage in sexual activity. And we find that actually insulin resistance and metabolic issues really impairs that. Men who have erectile dysfunction increase their risk of depression by a hundred and ninety-two percent.

Wow. And of course, that's somewhat – this is correlation, not necessarily causation. Of course, having erectile dysfunction might be a bummer and lead to mood issues. But I think it's really starting to be felt that it's actually not just that direction of the mechanism, but it's also that the metabolic dysfunction is leading to the depression and also leading to the erectile dysfunction. So people with type 2 diabetes, for instance, have twice the rates of depression and anxiety because these are conditions that manifest from our brains and our neurologic function. and the brain is an incredibly energy-hungry organ that uses a huge amount of the total energy in our body. And when our cells can't make energy properly, we see brain and neurologic dysfunction, which can manifest in so many different things.

We see it manifesting in depression, anxiety, of course, Alzheimer's dementia, which is now being called type 3 diabetes. Conic pain and fibromyalgia rates are higher in people. people with metabolic dysfunction and migraine. So the brain is very sensitive to problems in metabolism and problems with energy production. And so this, of course, if you've got these issues going on, it's going to affect our mood. And if mood is low, if you're dealing with depression, anxiety, chronic pain, it's going to impact your desire to do things like sexual activity. Additionally, brain-wise, we get back to that HPG axis.

So this higher levels of inflammatory cytokines and insulin resistance of the brain are going to affect that hypothelomic aspect of our sexual function. And then we also have to think about just sort of this concept of like dopamine regulation in the brain and sort of motivation in general. So this one kind of is very interesting to me. So right now in the Western world, we are just sort of on this hamster wheel of dopamine stimulation. And so many people have talked about this in beautiful ways. Andrew Huberman, Anne Lemke at Stanford, who wrote Dopamine Nation, Rob Lustig, who wrote Hacking of the American Mind. I would highly recommend any of those resources. But basically, the way that we're living right now is very very much hijacking our dopamine circuitry. And dopamine is, it's often thought of like the, as the neurochemical of pleasure, but really what it is, it's the neurochemical that dictates our motivation to do things and our anticipation of reward, more so than simply pleasure. And so it's what will get us out of bed to seek the thing that our brain thinks that we want like sex. But right now, we are constantly on this dopamine hamster wheel where we're being

stimulated by social media, Instagram, sugar, caffeine, porn, TV, Netflix. All of these things are just constantly keeping us on this wheel of dopamine stimulation. We want more, more, more, more. And the funny thing about dopamine is that when you stimulate it and it goes up, it often kind of leads to this increase in our set point for dopamine, where we need more and more and more to reach that sense of, okay, we have pleasure because we have met that need. We have gone and gotten the thing that our brain thought that we wanted. So this feeds into sort of the sex conversation, because if we are constantly all day, every day, through food and all our major activities, stimulating an increase in that dopamine sex point.

Sorry, set point. What happens is that let's say we have some visual or physical cues to pull us into sexual activity, like with our partner, our husband, our wife, whatever, our body is basically expecting a much, much, much bigger signal to actually reach that pleasure threshold. So we're almost like really, you know, screwing ourselves over in a way by like creating these thresholds that are so high to have a sense of fulfillment and completion of whatever this motivation was. So I'm really.

And if I could interrupt. I guess a lot of people talk about that in relationship to pornography, which is, of course, a part of the equation. But what I'm, what I feel like I'm also hearing a little bit in what you're saying is that it's kind of like a lot of things in our life that overstimulate that level of dopamine and set that new set point. So even things like processed food and flavorings and other stuff that's included in the products that we have. Is that part of what you're saying? It's exactly right. It's not just the porn. It's all the things that are feeding into this pathway. And it's truly,

I mean, it's literally every second of our day in the modern Western world. I mean, you wake up, you roll over. You look at your phone. everything about the phone is designed by thousands of brilliant engineers to make you want to come back and to use it. So that, I think we have to think about stuff like that and then process food. Again, thousands, if not more, of food scientists who are thinking every day about how to get it to stimulate your dopamine reward circuitry, how to get you to want more to keep coming back, to increase that dopamine set points, so that you have to have more and more and more of that food. we have to think of all these different things as feeding into the same issues that we're dealing

with with porn and how it's changing our set point for what we find pleasurable in the real world. And so really this concept of almost like a dopamine detox is really becoming kind of more popularized. And some people are actually truly taking days of the week where they get rid of all this stuff, you know, screens and processed food and sugar and caffeine and Instagram and porn and letting their brain just honestly. relax and reboot so that they can start the next week, hopefully, with like, a lower set point and actually feel enjoyment in the basic everyday activities of, like, looking at a beautiful tree or having sex with your partner or whatever it is. And so I think about that a lot and this really interesting sort of idea that actually a little bit of controlled deprivation

is actually, in many ways, the key to happiness and the key to contentment. We, by limit a little bit, you know, the amount of sugar that we eat, the amount of social media that we use, porn intake, other stimulants of, even, you know, Andrew Heerman talks about this, but like some of our favorite really pleasurable music, you know, for me, it's like EDM gets my brain just like totally tingling. But if I always listen to EDM when I work out, I'm almost like increasing the the amount of stimulation I need to feel good during a workout. So what does it look like to kind of bring that down a little bit and use it much more intentionally so that we keep our set points for what pleasure feels like to much lower and we can actually enjoy every day a lot more

without having to be on this like teat of dopamine stimulation constantly because that is loss of power. When you have become dependent on all this artificial stimulation to reach your dopamine threshold and feel pleasure, you're essentially trapped. And I don't want to live that way. So I think some controlled deprivation is actually very much part of how we can maintain happiness and pleasure at the simple joys of life. And it feeds into the mindfulness conversation, too, because I think so much of mindfulness is about stopping and taking a deep breath and looking around you and feeling grateful and just like actually seeing what's in the room and just actually experiencing what's around you.

Our modern world is trying to take that away from us. It's like get distracted, look at your screen, eat the food, you know, don't look around. And so I think mindfulness can be another great tool in this conversation to get us focused on what's real and what's around. us and kind of wake up from that slumber of thinking that happiness comes in these dopamine stimulating events and actually happiness comes much more from contentment, which is very much more of a serotonin-driven pathway, which is going to be less active if we're constantly on that dopamine-hansder-wheel.

I think a major takeaway for a lot of people here is that it's all connected and it all being on all the time, always, is going to be one of those things. but maybe somebody doesn't struggle with pornography, but maybe they struggle with overeating or they have a lack of sex drive in their relationship with their partner. And again, that's multifactorial. We all know. We've talked a lot about different factors that are there.

But how you show up in maybe one area, the overstimulation could even be impacting the other. So mindful, targeted opportunities. Doesn't have to be here turning into a monk or a nun going living in a monastery somewhere in the Himalayas, but even taking, you know, maybe if you're not taking, any breaks right now, maybe you start off with like a half day, right? A Saturday morning where you're

not looking at your phone, you're not getting alerted by all the notifications or whatever other things are your versions of that dopamine kind of spiking you. It could be, you know, binge watching on TV. So you start off with like a little bit of a half day and then you work your way up to maybe like a day and see in one week's time. There's actually a really beautiful thread. We'll link to it in the show notes. There is a very seasoned investor and business. business operator. His name is Andrew Wilkinson. Have you heard of him? Yes, yes. Yeah. He had a great Twitter thread that he posted last year that I think it was last August. He started to notice and he buys and sells companies and he's involved in a lot of health stuff as well too. And

he started to notice that his just drive for a lot of things in life has just gone down. Like, he just wasn't passionate about things anymore. The deals, the whole reason that he started this was to work on his own terms with the people that he wanted to work with and not have to work with people that he didn't care about working with, a lot of that drive was going away. And then I think he heard one of Andrew Huberman's podcast on dopamine and was like, you know what, I really feel motivated to do a dopamine fast. And obviously, he may be in a different boat than a lot of other people, but he was able to take about a month off and actually moved to a little cottage with like his family and got

rid of his phone and did a lot of the things that you mentioned earlier and just doubled down on the simple pleasures. And one of the key takeaways that he had from this thread, again, you know, if you want to read it, you can click on the show notes, is that a lot of things that he just took for granted that would happen in his day. When he took a break from them through this intentional dopamine fast, he started to step back into the joys that came. So even like, you know, a little bit of, I'm making this up, because I don't know if he did this, but he did some version of this. He had something with food that maybe he had X amount of cups of coffee a day and then he didn't have any coffee during this break. Now all of a sudden he's including coffee in

and that little sip of coffee just tastes so much richer, so much more beautiful. And of course, he's slowing down and stepping away from the trappings and the email alerts and the social media alerts to actually be able to enjoy it in the first place. And I thought that's a really inspirational thing. Again, most of us probably can't take a month off, but can you start off with a morning? Can you start off with a half day and stack it? Stack it with other behaviors. If you're fasting every so often, stack it with that. If you're taking a caffeine break, which I do every so often, stack it with that and see what you notice in your, see what you notice in your body, but also in your mind. I think those are such fabulous takeaways and really sum it up so beautifully. And I think,

and even like the first, first initial step is really just awareness to this cycle that we're in. I think a lot of people don't realize that we're kind of trapped in this cycle. And even the mere recognition that pleasure is different than happiness. And by pursuing pleasure and peak experiences all the time, you may actually be subverting true happiness. I think that is an unlock that can help make some of the investments in dietary and lifestyle changes, which can feel like sacrifices, actually feel much more like investments. And so that's something that I just, that mindset shift of like, me not eating this sugar isn't just because I, oh, I'm doing it for my metabolic health. You know, what does that mean? It's like, I'm doing this to.

change the set point for which I can feel really good and happy in my day. And that type of investment, I think it makes it easier to do some of these things. I know it does for me. You know, you used the word sacrifice. We had Reverend Michael Beckwith, who lives here in Los Angeles. He came on the podcast a few months ago. And you said, you know, the term sacrifice, what it really means is to make something sacred. And so you want to ask yourself, what do you want to make sacred in your life? What are you willing to put up boundaries around so that you can protect it? So when you're starting, off your morning, which we're going to talk about here in a second. And let's say you're used to starting off your morning with like a large Starbucks Frappuccino or something very sugary or

whatever it might be in the pursuit of saying, okay, I understand the medical science from Casey. Thank you, Casey, of why this may not be the best way to improve my health, both my short-term sexual health, my long-term optimal health too. Okay, I understand the science of that. I'm willing to give it a shot. But it's also, okay, it's a ritual. and maybe you have your Starbucks you like going to and there's all these things and you know there's it's a whole thing for people right in terms of the foods that they have in their diet

but it's also okay by me giving up this drink and making something else that also tastes like fantastic there's a ton of recipes out there of how you can enjoy coffee that doesn't have to be some crazy sugary drink or any other sugary drinks that are out there I'm actually making sacred my energy levels so I can give love and attention to this special project that I care about right now

so you have to ask yourself in your life what is it that you're making sacred so you're willing to actually put in the sacrifice to protect that thing? That is so beautiful. I have not heard that particular way of thinking about sacrifice before. And I think it's really motivating. And maybe the thing that someone wants to make sacred in their life is their sexual life with their partner and their sexual relation with their partner. And maybe and hopefully after listening to this and other episodes about this type of thing, that connection can be made between, you know, by investing in my metabolic health, which means maybe eating healthier, exercising more, sleeping more regularly, managing my stress,

et cetera, that I'm actually making sacred this part of my life that is really, really important to me. So, you know, by understanding this link between metabolic disease and sexual health, function, pleasure, and fertility, we actually open up this whole world of opportunity for how we can actually intervene that benefits our life in so many different ways. Because anything that helps metabolism, which of course, like we've talked about is food, sleep, exercise, stress management, optimize our microbiome, getting enough micronutrients, avoiding environmental toxins, and getting the right light exposure during the day, all those things can feed into this area of our life that we may have thought we had no control over. So let's talk about some of those areas

kind of like walking through the day a little bit and teasing them out because I know that for a lot of people who want to make changes, it's truly, you know, a little pat on the back saying, hey, look, your labs look okay, which we're learning, of course, from you and the work that levels is doing is that that's not always the case. You know, you go to your doctor, they pat you on the back and they say, your labs look okay, but, you know, exercise and lose a little weight. And then I'll see you next year. That doesn't really lead to any change. And it also actually might not be addressing the root issue in the first place. So people need examples. So breakfast is something that a lot of people struggle with. I'd love to hear your

thoughts, especially from putting together these incredible newsletters and these recipes you put together. And just the feedback that you've had from millions of data points from levels over the last, has it been over a year now that levels has been out, the product? Three years. Three years. Three years. Yeah. Time flies. Two and a half since we had a real product out there, but it's been a while. Okay. So what do you find are one of the best ways to start our day off if we're trying to make those practical changes that will, again, not only improve our long-term health, but improve our sexual health in the same time as well. Yeah. So, yeah, this data set has been really fun to work through

because we now have 2.6 million food logs paired with 200 million glucose data points. Really one of, if not the largest data set of its kind in the world of glucose responses paired with food in a non-diabetic population. And one of the key things we've seen is that breakfast can either make your day or it can totally tank your day in terms of glucose and metabolic health. Some of the absolute worst foods in our entire data set are breakfast foods, a majority of them, I would say. And we're looking at basically cereals, pastries, bagels, toast, things like this, basically all the refined grain-based breakfasts that we are essentially indoctrinated to think are inappropriate breakfast for the human body. They're not. Can I pause you there for one second?

Do you know about the history of the Kellogg Company at all? A little bit, but yeah, please tell the listeners. I just know about at high level, but, you know, the founder of the Kellogg's, you know, company initially when it was quite small, I think he was some sort of practitioner, right? He was like some sort of, I don't know if he was a doctor or something, but he was some sort of practitioner who also was very religious and one of his thoughts was how do I actually squash desire? So on the topic of sexual health, one of his goals was how do we have desire lowered in individuals and one of the things that he was experiencing with, experimenting with was putting people on essentially these refined carbohydrate cereals. Now, whether they were successful or not,

there's a whole documentary on it and everything. People can look it up. I'm sure we can to link to an article, but that's kind of crazy that there was somebody actually trying to leverage starting the day off the wrong way as a way to actually squash desire because they don't believe that, they believe that desire is some form of sin. You know, that's just kind of funny a little bit. It's incredible. And fits actually so well into this entire conversation about, yeah. And then, of course, probably through some some nice relationships at the highest levels, got that to be part of our food pyramid, essentially, that now there are literally cereal boxes, grains. you know, on some historical versions of the food pyramid, which is shocking.

So you mentioned that breakfast in particular, right, can be some of the most highest spiking foods. And again, just for a little refresher for people, when we're talking about spiking, we're talking about glucose. And again, why are we paying attention to that? And why would we want to look at that biomarker using something like a continuous glucose monitor? Yeah. Yeah. So when we're talking about spike, we're talking about blood sugar spikes. And there are five main reasons why we really want to care about blood sugar spike. especially at the start of the day, and I'll run through them very quickly. The first is that big blood sugar spikes where you've got this large elevation,

you know, we're thinking 50, 60, 70 milligram stress leader above your baseline that you started before the meal. That can lead to inflammation, oxidative stress, glycation, which is where sugar sticks to things in the body and causes problems. It can, of course, lead to insulin release, which over time can lead to insulin resistance. And the fifth thing, which is the thing that's probably most important in the breakfast conversation, is that it can lead to reactive hypoglycemia. And that's where you have this big blood sugar spike.

The body releases all this insulin. The insulin soaks all that or takes up all that glucose out of the bloodstream and actually overshoots and you end up dipping to levels, glucose levels below your premeal baseline. And in that moment of that dip, which is called reactive hypoglycemia, which will probably be about two hours after you eat that high carbohydrate breakfast or juice or whatever it is, that's when you're going to feel fatigue, potentially some mood liability, like some anxiety, that feeling that you might need another cup of coffee and want to have sort of like a mid-morning

nap and when you're going to have more cravings. So reactive hypoglycemia and cravings are very directly linked. So you obviously don't want those things in your mid-morning. You're just trying to get your day started, this totally tanks things. There's actually some research that shows that big acute glucose spikes can lead to brain fog. And in the particular paper, I'm thinking about it's essentially acute issues with fact recall. So you have a big spike, you crash, and your brain's basically not working as properly. And so we want to avoid all of that in the morning. And so the best way you can do that is to have a breakfast that stabilize your blood sugar. So this is going to be things that have a nice balance of fat, protein, fiber, and carbohydrates. And some of the best things we see in our

data set are things like eggs and avocado, eggs and greens. Chia pudding does really well. Chia as an alternative to oatmeal or cereal is great because you're still, it's quick, easy, and you can eat out of a bowl with a spoon. So it's kind of got a similar vibe to cereal or oatmeal, but so much more protein, healthy omega-3 fats, fiber will keep you satiated for longer, won't spike glucose. We have a lot of grain-free granola recipes on our blog, so things that are made more with instead of oats or like rice puffs, things like nuts and seeds and coconut flakes. And then we actually see one really well-scoring item that a lot of our members log is the Fab Four smoothie, which is this amazing smoothie recipe popularized by celebrity nutritionist Kelly Levec,

which is essentially a smoothie that's very balanced. So it's got healthy fat source, lots of fiber, greens, low glycemic sugar, and people have less than a 20 milligram per deciliter spike on average with that. We also see frittata as one of our low spikers. So, you know, we're thinking about these savory breakfast that do not include refined carbohydrates and that have a balance of fat, protein, fiber, and carbohydrates. And that would be the optimal breakfast. And then the alternative to all of that is fast for breakfast. So might be an unpopular opinion, but, you know, we don't need to be eating three meals a day necessarily every single day. And if you're not hungry in the morning and you want to get a little bit more time under your belt for a circadian fast, just skip

breakfast and wait until noon to eat lunch. And that will, of course, also stabilize blood sugar as well. Yeah, that's great. A couple of thoughts on that is that I'm definitely one of those people that does better, especially when I have like an interview like today where there's a lot of prep, and there's a lot of things to cover. If I eat in the morning, I'm better functioning, and I prefer to, like, fast for lunch. And so I think that it's also great that people know that you can do that. You know, if breakfast doesn't work,

if breakfast does work for you and you do better with breakfast because you have, you know, a lot of cognitive task or whatever, or just who knows all the different reasons why people have different physiology that are there, or just even your own personal preference that's there. So it's nice to know that you can not skip breakfast and you can skip another meal. You can even skip dinner sometimes if people want.

want to if you're going to try to practice with that. And then of course, there's variation. We've done a lot of episodes about maybe fasting might be different for women, how you can try on different hats. You can link to some of those in the show notes. And I think the other thing that's there is when you were talking about breakfast options, I'm always amazed. And I used to have this feeling too when I first got involved in this industry and started to learn about functional medicine and started to change my diet, I'd often think about, what do I eat for breakfast? You know, I would make it a big thing because we have a vision of what breakfast should look like. But it's almost like, well, what did you eat for dinner last night?

Okay. If that was healthy, can you eat that same thing for breakfast in a way? Now, I get it. Certain foods have a little bit more of a slant of feeling like breakfast foods or people want to recreate their favorites. And I'm thankful for all the options. But sometimes I think it's as simple for people of like, okay, did you have healthy leftovers from last night that are actually good? Well, can you just eat that for breakfast? Yeah, I agree completely.

I'm laughing because whenever I've talked about this, I get slammed in comments from people say, this sounds crazy. But it's like, what about eating a salad for breakfast? What about eating salmon and asparagus? This is actually what people do in Japan and many other countries, like a very savory breakfast. And it's like, why do we think that's so crazy to have like a really balanced vegetable-rich? meal for breakfast. We need to flip that on its head, I think. But we're really tied to these cultural norms around breakfast, which we think we forget. We're largely created by industry and are very, very modern, the idea that we need these refined carbohydrate rich breakfast with a side

of juice for breakfast. Because going back to this term that used earlier, in a way, that's the meal that we were most likely to eat naked carbs. where we just have carbohydrates by themselves. And that's going to lead to the biggest spikes that we're going to see in long term that's going to impact our fasting insulin for the worse and create poor metabolic health, which increases our risk for all the things that you mentioned previously. So it's almost like breakfast needs a little bit of special attention. I also feel like the morning has power to it.

And how you start the morning usually sets the tone for the day. It's why you often hear when people have enough micro-stress. in the morning and they're kind of in a bad mood, they're kind of in a bad mood for the rest of the day. And there's something powerful about sleep and kind of like detoxifying the mind through sleep and resetting and your memory and all the things that happen in sleep where you wake up the next morning feeling fresh. You're more open. You're more open to possibility. And if you start off the morning in the right way, you're more likely to see good and feel good energy and want to keep those habits up. So it goes both ways. So I think, you know, the morning time needs special

attention, not just from food, but just the inputs, the dopamine that goes into our brain from the various sources. Like, it's a time that we should protect our, we should, we should make sacred, right? It's a time that we should make sacred so that we can perform the best for the rest of the day. Absolutely. Anything's for you that you find work well. For instance, like, do you find yourself often fasting in the morning? Do you like to eat? You know, do those demands change based on your activities in the day? They do. I tend to fast in the morning until about 11 or 12. I also get up probably a little later than most people. I get up usually around 8 or so in the morning, sometimes 8.30 because I'm a bit of a night owl where I just do my best work late at night. So I'm already starting a little bit later. You know, love remote work, of course, with levels because that's totally possible. You can start your day whenever you want and work when you're most productive. So I typically get up around 8.8. 30, do my morning routine. And then don't eat till about 11 or 12 sometimes later. I'll have some

decaf coffee with some unsweetened non-dairy milk in the morning. But that's the only thing I'll have. And then usually my first meal is I'll often eat like dinner leftovers like you talked about. But typically probably three or four days a week, I'm eating a daily harvest, a harvest bowl. So these are these awesome, like organic, grain-free, plant-based meals that are shipped to your house. And I have no relationship with the company. I just absolutely love their product. But, you know, like a cauliflower rice pesto bowl that's totally plant-based and spinach and basil and sundryed tomato and cauliflower rice and all these nutritional yeast. And then I'll usually put maybe some tofu, beans, chickpeas or sardines or canned salmon on top of it for some protein. and then put a ton of sourcrow or kimchi on top of it.

So to me, that's like one of my perfect metabolic meals, in my opinion, because what I'm getting from that, I'll also dump some chia seeds or basil seeds on top as well. Because what I'm looking for pretty much in every meal is I'm looking for the prebiotics and the probiotics. So I'm getting the prebiotics with the fiber from the beans, chickpeas, chia seeds, basil seeds, and cauliflower. I'm getting the probiotics from the kimshed. or the sourcrow. I'm looking for omega-3 source because omega-3s are really important for

anti-inflammatory status of the body and cell membrane integrity, getting that for me, the sardines, the salmon, the basil seeds of the chia seeds. I'm looking for antioxidants and micronutrients, which basically everything in there is going to have a lot of antioxidants and micronutrients. And of course, the cauliflower is filled with sulfurophane, which activates our genetic pathway, NRF2, which upregulates our antioxidant defense system in the body. So you're not only getting antioxidants from the food, but also upregulating antioxidant pathways in the body. It's all organic. So I'm avoiding the pesticides and the obesogens. And I'm getting healthy fat and proteins. So that's basically like those are the components that I'm looking for

in every single meal for optimal metabolic health. And I think that's something I've landed on that's really simple, essentially the base of that bowl, plus adding a few extra things to get each of those components that I know feed into optimal cell signaling, microbiome function, and overall physiology for metabolic health. Any other interesting insights that you want to just share while we're here on the data set that you guys have collected and just parsing through that? Any things that you think that are just interesting takeaways for our audience? Yes. A few, for sure. I mean, one that's really. relevant to breakfast is basically like don't drink oat milk. So that's, I mean, I don't want to tell

anyone what to do or not to do, but our data set shows that oat milk does a lot worse than other non-dairy milks. And this is interesting because sometimes it will, the bottle will still say no sugar added, but because of the way the oats are processed, it's not that there's actually sugar added, but they are essentially releasing, I think, a lot of their carbohydrate to make it more accessible, essentially. And it does make the milk sweeter tasting. But it can be tricky to understand from the label how much it's going to affect your blood sugar. But we see this. You know, if you follow the level of social media, you see we repost all the time, people being like, oh, my God, this oatmeal latte is that me the roof. I'm so disappointed. It said it only had two grams of sugar. And so

that's something we're seeing. So I tend to stick with, I mean, my favorite, favorite non-dairy milk brands are malk and three trees because they both only have like two to three ingredients. It's like water and the nut and salt. No fillers, no gums, organic, et cetera. And then I just basically make most of my nut milk myself. I love making my own nut milk because you can basically pick any nut or seed and whatever micronutrient profile you want and in three minutes make a huge amount of nut milk. So you basically just blend it in the Vitamix, strain it through a nut milk. bag and you have a sugar-free, no-gums, organic, not milk. So that's one thing we've learned from our data set is, unfortunately, that oat milk

doesn't do great. O milk also, I learned from the glyphosate-free foundation that they're a group that basically certifies products as glyphosate-free. They do independent testing. They send it to laboratories. There's a lot of glyphosate runoff. so even if foods that don't really have glyphosate can end up with contamination. And one of the things that they shared with us is that oats have one of the highest amounts

of glyphosate contamination. And they've been working in partnership. I don't know if I should put this out there, but you didn't hear for me. They've been working in partnership with one company that uses oats. And they've just been having a hard time to consistently get batches of this end product, which I won't name, to be tested as glyphosate-free because of just the natural contamination that ends up happening. I don't know why. Maybe it's because it's a relationship to wheat and for wheat.

Often glyphosate is used it as a desiccant in the drying process and oats are kind of stored in very similar facilities and transported. So, yeah, that's a little tidbit that I found out through that. Man, it's rough because a lot of people are trying to do this right. They're like, oh, this is a better option. And then we're just getting inadvertently still bamboozled a little bit by some of this stuff. So it's great, I think, for people to be aware of that. Yeah, and it's good to be aware.

But I would say that one thing that definitely levels and using your guys' service for continuous glucose monitor and then also all the, like you can get fasting insulin done through the app. You can get all your metabolic markers done through the app as well, which I did. One thing is that there's people that I know. well-intentioned who gets so focused, and it doesn't have to be either or, but they're so focused on chemicals and additives in the environment or natural flavors or whatever it might be, that they can, if they're not as well-educated on metabolism and metabolic health, they're missing that whole boat. So the truth is, you know, again, because we want health to be accessible, if you can stick to a whole foods diet, pay attention to things like your fasting insulin number,

which is a very cheap test. You just got to do a little bit of arm twisting with your doctor. you're going to be in much better shape. And yes, they'll still be stuff that's there, right? There's EMFs in this office. There's other things. But that largely is such an incredible foundation. So nobody should be discouraged if there's only a few things you can do, which of course, there's a whole thing that EWG, the environmental working group has, which is like eating healthy on a budget. And there's a lot of creative ways, especially if you're willing to cook at home, that you can still eat healthy without having all the trappings that are out there. Yeah. Yeah. I think.

one framework I have in my head, which is empowered by this understanding of metabolic health and all the different levers that go into it is that, you know, perfection, we're not shooting for perfection because we are never going to get all elements perfect every single day. But the beauty of the body is the biological machine that's incredibly resilient and regenerative. And so I think about every day as like I sort of have this certain mountain of stressors that I can put on the body each day. And when you, when that, that mountain of stressors is bigger than the body's capacity to essentially process it, work through it, adapt from it, regenerate from whatever, you know, stressor that is, you're going to have dysfunction. You're going to go down a path

of symptom and disease. But, you know, you want to, you want to just minimize it as much as you can, but there's always going to be something. It's going to be the sleep quality or that you got woken up that night by your baby or that you went out to a restaurant that probably didn't have organic food, or that you were really stressed because of something at work, or that you got too much blue light exposure at night and didn't get your morning sunlight, or, you know, that you were traveling and were exposed to more gluten, whatever it is. But each day, there's going to be this different shifting amount of those stressors. And as long as I think we can just try and minimize it as much as possible, that's great. But shooting for perfection and also

the stress that's associated with trying to make it all perfect. It can be damaging in and of itself. I love something that Max Lugavari posted. I think it was like yesterday where he was out getting a salad and talked about all the components he had in like a healthy, metabolically healthy salad. And he reposted a comment. Someone's like, but is it organic? And he's like, we're missing the forest for the trees here. Like this salad has so many protective, helpful things in it. And me eating that is ultimately in his belief, and I agree, the better option than trying to eat the maybe organic food that isn't quite as nutrient dense. So it's just this constant balance and juggling, but we're all just doing our best here. So, yeah. Well, how we got on that subject

is that you were sharing about oat milk. Give us, you have one more thing that you want to share from the dataset if you feel like it? Yeah. I mean, there's two more that I think are kind of fun. One is that we have seen in our levels challenges, which are challenges we do with our community. that people who do incorporate vinegar before their meals tend to have a lower glucose response to that carb-rich meal. So the way this challenge works is we tell people, eat a carb-rich-meal by itself, and then on a different day, eat the same meal, but drink some vinegar right before the meal. So about an ounce of apple cider vinegar or white vinegar or even balsamic vinegar, as long as it has no sugar in it, which many balsamic vinegars do. Got to read the

labels, but apple cider vinegar is a great choice. And for the people that did complete that challenge and had something like pizza after the vinegar, they had a pretty significantly lower glucose response than the people who had no vinegar before the meal. So this is something that is not a big surprise because research has shown that vinegar, for several reasons, can help with our glucose response to our carbure meal. But it was neat to see it playing out in in a population of levels members. And just to recap on some of the reasons why it's thought that that happens, the first is that vinegar and acetic acid may slow the rate of emptying from the

stomach of food. So you're actually getting that food into the digestive tract slower. So you're absorbing the glucose slower. So you're not going to have as much of that quick, big spike. vinegar might also help some of the satiety hormones like GLP1 and others, sort of our metabolic hormones function properly and be balanced, and it may actually help with insulin secretion from the pancreas. And the third reason is that they may impact these enzymes in the gut called dysaccharidesis, which break down complex sugars to simple sugars.

And by potentially blocking some of those enzymes, you may actually not digest all the complex carbohydrates that are coming into the gut. So the research is mixed. It's not incredibly, incredibly strong. Like there's no slam dunk review that's like, we should eat vinegar before every meal. But there's some hints in the research and some in our population data that may be taking, you know, an ounce of apple cider vinegar in a glass of water, 15 minutes before a carburet meal may have some benefits in terms of glucose spike. And then the third thing that

we've seen in some of our challenges is that this concept of resistant starches. And it's this interesting concept where if you take a carbohydrate and cook it like a sweet potato or rice and then you cool that food, it actually changes the molecular structure of the starch such that it may become more resistant to digestion. So this is called resistant starch. You, of course, want foods with more resistant starch because you're eating these carbohydrates that are in a form that you may not actually digest and turn into break down into sugar

that goes into the bloodstream. And so in this challenge, we had people eat something like rice, and then on one day see what their glucose response was, then cool it and either get cooled or reheated, where theoretically it should have more resistant starch. in it and see if the glucose response was different. And we also saw that in that population of people who completed that challenge, that there was a mildly lower glucose response when things were cooled and reheated. So that's one other strategy to put in the toolbox of like

if you're going to be eating starchy root vegetables or grains, maybe cook them, cool them, and then eat them the next day as a resistant starch. Yeah, I remember, I think I emailed you about this one time. And I was asking you, is this real? Is this not? Because I've seen mixed things. And, you know, at one point in time, you know, when we have rice just because we're quite busy and we don't have rice frequently, but I'm Indian background and my wife is Persian background, so there's a lot rice in that culture. So sometimes we'll make some dishes that we miss. We'll typically just go to Whole Foods and pick up the rice that's already frozen, right?

Yeah. So there's rice that's already frozen. And I got really excited when we first started doing that on the times we would have rice because I was like, oh, this is great. This would be like a resistant starch. And I would look at like my, you know, glucose response. And I was like, well, it kind of pretty much looks like the same thing. So remember emailing you and saying, is this real?

Is it not real? And what I've gathered from some of the things you guys linked to and also this data set is that there seems to be some bit of a lowering of that response. But at the end of the day, if you're still basing your diet around a lot of starchy items, you know, things like rice, things like white potatoes or even if people cooked and cooled, you know, sweet potato. potatoes, those things still will have, you know, some glucose impact that's there. I guess the other component is, then this is a question that I wanted to ask you since the last time that we talked, if people are getting their fasting insulin done and they're in that optimal range of, let's say, somewhere between two and five, right? And there have things that are regularly in their diet that end up spiking them in their meals, like starchy type vegetables or rice is a good example, right?

How much do they have to pay attention to that or not pay attention to that? I'm curious to hear your thoughts and your response on that. Yeah, I think it's a hard question to answer definitively because we don't know 100% from the research. Like there's a lot of components to this. Eating whole foods, whatever they are, is better than eating refined and processed foods. So for the people who are on a whole foods diet that may skew a little bit of food, bit more towards refined grains, starchy vegetables, fruit, et cetera. That's great that you're eating a Whole Foods diet and you're cooking at home and you're not eating the processed forms of these.

So I would never want to demonize that in any way because that's a positive thing. Because most of the world isn't even really there. No, not at all. Most of the world isn't even really basing their diet around Whole Foods. I mean, I think, what is it? I mean, the stats like with kids, like 60 to 70 percent of their diet is coming from ultra-refined processed foods now. It's like, gosh, if we could get all those kids on just like even if it's higher glycemic foods that are whole foods, like I think that's a plus, right? Whole foods are going to be more nutrient dense, etc. But with that said, excess glycemic variability is not good for health. And as glycemic variability goes up, it's associated with increased insulin resistance, fasting insulin levels,

and fasting glucose. And this may be, it's hard to know exactly what the chicken and egg is with this because people who are more insulin resistant are going to have higher glycemic variability, but also does repeated exposures of a glycemic variability lead to insulin resistance and these issues. I think it's a bit of a cycle, but knowing exactly which came first between the chicken and the egg is hard. With all that said, there's always the factor of this reactive hypoglycemia situation that we

were talking about, which honestly, I try and avoid at all costs because it really does tank that's where you have a really big spike and then you have a big dip afterwards. Exactly. So even if you're eating. Which by the way, when I was eating a more processed vegan diet, that was happening to me on a regular basis only because I was eating more processed food. And even if it wasn't a vegan diet, if it was just a processed food diet, the same thing would have happened to me as well. Yeah. Yeah. So even if you're eating the whole foods like grains, starchy vegetables, lots of higher glycemic fruits, and you're having the spikes, but you're otherwise healthy and your insulin level is too. Can I say definitively that that's a problem?

Not 100%, because of course, those fruit, like things like fruit are going to have a lot of protective chemicals in them too. But it may lead that person to have a big spike in a big crash, which doesn't feel good. And it's actually amazing how even at somewhat moderate levels of blood sugar, it can still have negative physiologic effects. So let's say you get up to blood sugar level of 180 milligrams to deciliter, which is not hard to do. Most of us, you know, we're probably sitting around 75 to 80 right now having not eaten in the last couple hours. And let's say I ate three cups of watermelon or something where I'm thinking of a fruit that spikes grapes or something like that, something that I know spikes my glucose. I might go up to 200.

in 20 minutes. Well, above 180, you can have glucose spilling into your urine, what's called glycosorrhea, where you're literally, your kidneys can't reabsorb glucose fast enough and you're spilling it into your urine. Not a good thing. Also, above 180, it can have impacts on your immune function and actually hurt the ability of immune cells to move and do what they need to do. And so even if you're eating healthy, nutrient-rich whole foods, if they're sending you above 180, 200, that's going to create some issues like potentially reactive hypoglycemia, these other two phenomenon that I just mentioned. And so the way I've really structured my diet is, as you know, I was largely plant-based for several

years. I'm still mostly plant-based, but I eat a little bit of animal protein now, maybe like five to 10 percent of my calories from fish and free range meat. But I totally changed my plant-based diet wearing CGM from what was very grain-based and fruit-based and a lot of starchy vegetables, root vegetables, to much more emphasizing fruits that don't happen to spike my glucose. So if grapes and mangoes and watermelon really spike me, but these 10 fruits don't, I just emphasize those more in my diet. And if millet and sorghum do really well for my blood sugar, but rice and barley don't, then I'm going

to eat the sorghum and the millet. And so just creating, it's not about elimination or fully changing the way the diet looks, but figuring out the items within a particular category that work with my physiology to keep things more stable because I tend to feel better when my glucose is more stable. A lot of people will hear this message and take it and say, oh my gosh, this is anti-fruit, this is anti-whole grain, this is terrible. And, you know, that's, let me be very clear. That's not what I'm saying. But logically, if you have two foods in the same category and you like them both equally, and one is sending you to 180 and one sending you to 110, I'd prefer to have the one that sends me to

110. And as a person who's just subjectively experienced in the world and a physician, I think that's probably the better option. I love it. Let's give a little bit of an overview of, you know, what people get when they sign up for, you know, levels. I'd love to give a little plug. It's why I became an investor and an advocate for it because it's a huge part of my life. I've put so many my family members. I just want to share one anecdote. My dad, over the years when I would talk a little bit about this subject because my business partners, you know, written about it a lot in the past, wrote kind of one of the pivotal books on this topic called the blood sugar solution.

My dad a little bit would feel like, oh, you know, this is kind of, I'm not exactly sure. You know, just he wouldn't say anything. You could just tell a little bit in how he was receiving the information. I said, Dad, would you be open to trying levels, right? This was actually before I got my whole family to kind of, we invested together in levels, which is a really beautiful thing I talked about on your guys' podcast. My dad tried it. And one of the big takeaways that he did is that eating largely an Indian diet,

which has a lot of rice and often starchy, sort of in the modern Indian diet that's there. The big couple things that he did is that before he eats any meal, usually for lunch and dinner, he has what we call like a big fat salad. So a ton of greens, a good diversity of those different greens, They'll throw in herbs and other things like that. He'll add an avocado and really good olive oil and, you know, olives and a whole bunch of stuff like nuts and seeds. And then whatever other things that he might want to have, his rice or other stuff, he typically has about like the quarter of the amount. Dosa is another common one.

I don't know if you're a fan of Dosa or not, but it's kind of like lentil and rice kind of milled together. And they're putting this in this flat bread type thing. And they're often putting in the middle like potatoes and stuff like that. So when he would have those things, which he occasionally did, he just have a smaller amount because one, he's already full. But number two, he saw directly firsthand how much his blood glucose would spike up when he would have those things in their naked version just by themselves. So just that alone, the fact that my dad incorporated that.

And then we ended up doing his labs as well, getting his fasting insulin. And there was a huge improvement after about four months of him being on. this type of way of eating. And so thank you guys for making it a lot more easier and accessible. But yes, what do people get when they sign up for levels? Walk us through that a little bit. So when you become a levels member, you sign up for a yearly membership, which gets you access to continuous glucose monitoring sensors, access to at-home metabolic health labs, a phlebotomist actually coming to your home and drying your blood and getting you access to some of these labs that we've talked about today that like fasting insulin you have to try to convince your doctor

exactly and access to a huge amount of education within the levels ecosystem as well as nutritionists who are incredibly metabolically savvy so that's what the membership gives you access to and then you can really choose your own adventure within levels maybe you want to do a sensor every month for a year a continuous glucose monitoring sensor maybe you just want to do it every six months during that year. Maybe you want to get the lab tests, the at-home phlebotomist lab test done every single month to see how your triglycerides or insulin levels are changing with an intense dietary intervention. Maybe you want to do that twice a year. It's really up to you. So you kind of get those a la carte at a very good price through the membership. So for instance, our metabolic health lab

testing kit where the phlebotomist comes to your home and draws all these labs. And then you get the results in just a couple days is $179. And if you ordered each of those labs a la carte through a lot of other services, it would likely be a lot more expensive. And so, and it's at your your will when you want to do it. And so a Levels member is connected with a telehealth physician. You fill out an online consultation form about your health. The physician in your state reviews those. And if they deem that it's appropriate to prescribe a CGM in these labs, a CGM. A CGM will be shipped from our partner pharmacy directly to your house, a month's worth of sensors for you to wear, and or the phlebotomist is activated to come to your house and draw your

lab. So the key focus here is on helping people have access to their own health information on their terms. They own the data, and they get to choose when and what they're doing with that information. So it's really all about empowerment and learning about how to be aware of our metabolic health, how to optimize it, and how to really take control of this aspect of our health that is fundamental to really everything. Yeah, and bringing back to the start of the conversation, I mean, the key driver of so much dysfunction in the category of sexual health and some of the root issues with infertility is your metabolic health.

The fastest way to improve your metabolic health is all the lifestyle components that are there, including their diet as a big piece of it, but of course sleep and movement too, which the levels out can be a part of and can help you kind of pay attention to those areas. So it's like, why would you not want to be able to first find out that there's an issue earlier, right? Not wait until things have gotten much later down the road where it's a lot harder to intervene and you have to maybe get much more complicated with your care or you're being diagnosed with the chronic disease.

So I'm all about like, let's find out now and then actually let me do something now. Because if I can find out that I'm part of the problem, then that means that I'm also part of the solution. And I love when I get a chance to step into that. And another really cool thing that I just signed up for that you guys launched is that now you have the data for anybody who previously, because I know we have hundreds of people that are part of my community that have already signed up for levels. Now the data is continuously streamed through the app as well. Can you just mention that for a second? Yes. So previously for people who have used levels before, you had to scan the sensor on your arm and then the data went into a app, which then transferred over into the Levels app. And now two things are optimized about that process. One, the sensor Bluetooth streams to the Levels app. So no more scanning. It's just happening all the time. You don't lose any data then, which is great because it used to be that the sensor only held eight hours of data. So if you didn't scan every eight hours, you'd lose some of that. data that's now done. It's going 24 hours a day and sending it directly to your smartphone.

And you'll see it directly show up in the levels app. So it makes the experience just a lot easier. There's a lot of exciting product and community features that make it just really fun and engaging and the ability to learn from others and what other members are learning and about food and lifestyle activities. It's just, yeah, it's a really, it's a really great and fun experience that I think as of this past couple weeks with these new developments, it's going to be even better for members. Casey, close us out with just some final, you know, words about this whole area of not just sexual health, but metabolic health. And what you want people to take away from this conversation? The key thing that I want people to understand is that for us to have good health, to feel our best,

and to be able to achieve all the things we want in terms of our purpose and our relationships and what we're generating in this life, your cells have to work. And for your cells to work, they need to produce energy properly. And right now, for the majority of Americans, that's not happening because of the way our diet and lifestyle is hijacking our energy production pathways, which is our metabolism. You have control over these things by the choices that we're making every day in terms of diet and our lifestyle. And when your cells are making energy properly, the world really unlocks in terms of feeling our best, avoiding chronic disease, and minimizing the non-lethal

pain points that are affecting our lives, so many of our lives. And this includes things like sexual dysfunction, infertility or rectal dysfunction, and lack of motivation. And so I just want to really leave people with that framework that we've got to get our bodies, specifically ourselves, to produce energy properly, and it's actually pretty straightforward. So many good resources out there. So many of your podcast, you mentioned blood sugar solution. I'm like, if there's just, you know, that's one book that people could read if they're interested in this topic or the vegan diet or just so many others.

And just, you know, make the little change as tiny habits. If you're having trouble making some of the changes, so many great habit change frameworks, like atomic habits or tiny habits. These books are super motivating and, you know, little tweaks can make a big difference. So that's what I'd leave you with. Casey, it's always a pleasure to have you on the podcast. Thank you. We have all the links for everything, including your newsletter and your social media.

You post great content inside of the show notes. I super appreciate you being back on the podcast. Great to see you, Drew. Thank you.