the bossbabe podcast - 160. The Biggest Red Flags In Your Current Diet
Episode Date: April 15, 2021Have you ever felt like something just feels “off” in your body, but you don’t know what it is? It can be overwhelming to try to figure out your health on your own. But what if the solution to... some of your most pressing, recurring problems could be solved by paying better attention to the food you eat everyday? Dr. Casey Means is joining us this week to talk about the biggest red flags in your current diet. Plus, she’s sharing what you can do to have better health on a metabolic level - starting now. Links: Backdoor access to Levels: Levels.link/Natalie Levels Blog: https://www.levelshealth.com/blog Use code “BOSSBABE” to save 15% on Organifi: https://www.organifishop.com/ Use code “BOSSBABE20” to save 20% on Soul CBD: https://www.mysoulcbd.com/ Follow: BossBabe: @bossbabe.inc Natalie: @iamnatalie Danielle: @daniellecanty Casey Means: @drcaseyskitchen
Transcript
Discussion (0)
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There is no magic bullet for metabolic health.
Metabolic health is our foundational health and we ultimately just do have to live our days out
to support our body's functioning.
Learn about exercise and all these other things
to really just like build a holistic understanding
about metabolic health.
Learn how specific foods are affecting you
versus other people
and just make smart, informed decisions. Welcome to the Boss Babe podcast, a place where we share with you
the real behind the scenes of building successful businesses, achieving peak performance, and
learning how to balance it all. I'm Danielle Canty, co-founder and president of Boss Babe,
and I am not your host for this episode, but a certain lady is. Do you want to introduce yourself?
I'm Natalie, CEO of Boss Babe and I am your host for this freaking amazing episode.
Okay, full disclosure, I have not listened to this episode yet but I am so freaking excited too because you and Casey dive into everything blood sugar related and I feel this is a really
under-discussed topic. So before we start the
episode, Natalie, just give us a little bit of an overview. What did you discuss? Like who is Casey?
Who is Levels? Tell me all the things. I know you are going to get so much out of this. I'm so
excited for you to listen. So yeah, I interviewed Dr. Casey Means. So she is a Stanford-trained
physician and she's chief medical officer and co-founder of the metabolic
health company Levels that I talk about all the time. And she's also an associate editor of the
International Journal of Disease Reversal and Prevention. So her mission is to maximize human
potential and reverse the epidemic of preventable chronic disease by empowering individuals with
tech-enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. And I'm obsessed because I love any kind of tech
tool that's going to help me to analyze my health. And just full disclosure, I have been using a CGM
for a really long time, and I was finding it really hard to analyze the data. So for anyone
that doesn't know what it means, a continuous blood glucose monitor basically monitors your blood sugar. But for anyone that doesn't really know a lot about
blood sugar and isn't diabetic, it can be really confusing. And so I was getting my data and I was
like, I don't know what this means or what I should actually be doing with it. And I came across this
company called Levels. I begged them to let me on the waitlist. And once I started using it,
I called the founder and I was like, I want to invest in this. I believe in what you're doing
so much. And I've never stopped using it since I discovered it. It's been incredible. So
I was really, really excited to this conversation. I'm glad you let me do it on my own because I got
to ask all the questions I wanted to ask. And particularly, I think the reason that you're
going to love it is there's so much behind hormones in terms of metabolic health and blood sugar. So often we think sex hormones are maybe
the issues behind problems we're having like moodiness or acne or, you know, all the common
things, but a lot of it stems to metabolic health. Well, I'm just really excited to listen. Just
before we even started recording this episode, I was just telling you that my acne has been
really playing up and I actually really haven't spoken about my acne story. And we should probably do another podcast
on that. Because I actually, like you, we both bent on racketing because we were suffering. But
I came off and it has been fine. And now it's playing up again. And I definitely, definitely
now I'm like, hang on a minute, I can't just bandaid this again, I need to find out what's
happening with my blood sugar levels. So from the selfish point of view, I'm really excited to
listen to this episode, because I think I'm going to get one
myself so I can monitor it a little bit more because just from what you were saying and how
much all of these things link up, even from a medical angle, I know roughly, but it still wasn't
something I really dove into. I don't feel like it's actually a big topic of conversation when
it comes to things like acne or it comes to things like polycystic ovaries or it comes just general well-being and health like it's not the first thing a lot of people are talking
about with regards to like the importance of monitoring blood sugar so I think a lot of people
are going to get things out of this episode but also feel empowered then I think that's what's
amazing about this device is it gives a lot of empowerment to you the user to understand your body more and make changes yeah totally and it's
crazy that we both have been diagnosed on some level with polycystic ovarian syndrome we are
among a lot of women that have had hormonal issues so definitely we're going to get you on levels i'm
going to send you the link right after we listen to this episode and then we also need to get you
doing acupuncture because that is such a game changer because the thing is your diet's so clean you exercise you do all the things
that on paper you should be doing but there's so much behind that that it can be really hard to
even know about if you don't know the right things to look at or you don't have the data so we're
gonna get you on that we'll keep everyone updated Yeah, I'll be the next guinea pig now.
Yeah, well, I was just telling Danielle
before this episode started.
So I've been using my CGM for a really long time
and I was used to seeing like lots of spikes
up and down with my blood sugar.
My blood sugar was up and it was down
and it was just very, very spiky.
And I was just telling Danielle,
I am so proud because in the last two weeks,
my blood sugar has been in range
in like the green approved range 100% of the time,
which is massive.
Yeah, because when I started it,
I was probably in range 60% of the time.
And that means my blood sugar was either going too high
or it was going too low.
And it wasn't in the kind of the middle green belt
where it should be.
And so to get that from 60 to 100%,
it's been a long journey. It definitely didn't happen overnight, but that to me is amazing to
see. And I noticed the difference plus doing acupuncture, healing my gut, taking the supplements,
having a great diet. Those things have really, really helped. And it's such a journey because
I still get symptoms like stress is definitely the one
thing that I notice flares things up for me so I'm not perfect by any means and I still get a ton of
things that pop up it feels good to see progress I think that's the main thing right it's like not
perfection it's just progress yeah and I'm just thinking if you really love this episode and
you're really looking to improve your health a good little combo of listening to this episode
and then the Sean Wells one that we did because he gave some good supplement links I know
one of them you've been utilizing as well so Sean Wells was like a couple of weeks ago so you can
dig back and find that in the archive but also before we jump into the episode I just want to
share with everyone guys this is an informative podcast it's not meant to be medical advice for
you guys as individuals so please make
sure you can take it on board but go and consult your own medical practitioner yeah or whoever that
is and get like bespoke advice to you but this is a really good informative one so you'll have
lots of questions to ask but make sure you do seek out professional advice yeah lovely very formal and
one thing i would just say too is when you're listening to this and
you're hearing just how many people suffer from metabolic dysfunction if you listen to it and you
realize oh shit that's me it's not about panicking it's not about oh god like i'm in a really bad
spot it's about oh wait great this is amazing that I'm now putting my awareness towards this. And I know that there's something that I get to focus on
and just be conscious of.
And that alone is a really big step.
Knowledge is everything.
And the big thing that we always want to do with this podcast,
and we did it a lot with birth control,
is just bring awareness to things.
And it's totally up to you how you decide to take it
and whether you decide to action anything.
But I feel like, Danielle, between me and you,
we've been through so many things that we get to share it it's so true and I love you know this episode
is about the real behind the scenes of business and also like you're only going to be successful
in business if you've got good health and wellness and mental health so I really enjoy getting to
talk about these conversations as well and be very open about our struggles with various
pieces of it so it's going to be an amazing episode and like I said I have not listened to
it yet but I'm so so excited so let's make sure we dive in but before we do let's just you know
if anyone loves this and if you get some really key takeaways please make sure you share and tag
us tag at I am Natalie and tag at boss babe.inc because we love to hear your favorite takeaways
and that always helps us form the next podcast and who we get in as well so we love to hear what you love yeah and
then if you are interested in trying levels i'm literally getting danielle on it right now i love
it i never ever would recommend anything that i don't personally stand by and love and i can say
hands down this device has changed my life so i going to put the link in the show notes below. You're going to love it. Okay, Danielle, are you ready? Let's dive in.
Let's go. A boss babe is unapologetically ambitious and paves the way for herself and
other women to rise, keep going and fighting on. She is on a mission to be her best self in all
areas. It's just believing in yourself. Confidently stepping outside her comfort
zone to create her own vision of success.
Welcome to the Boss Babe podcast. Thank you so much, Natalie. I'm thrilled to be here.
I'm so excited to dive into this. I've been looking forward to this all week. I have so many questions for you. And I really want to start at the top and just talk
about like, what is metabolic health? Why is it important? And why are we hearing this term
thrown around? Yes, this is such an important question. So really, metabolic health is our
foundational health. Every single cell in our body, and we have over 30 trillion of them,
requires energy to function properly. For every single one of our cells that make up our body, and we have over 30 trillion of them, requires energy to function properly.
For every single one of our cells that make up our body to work, they need to produce energy.
And that's what metabolism does. Metabolism converts the food we eat into energy our body
can use, a currency that it can use, which is generally called ATP. And when those processes
of converting food to energy are working properly,
our cells can function properly. And when that happens, our organs work properly,
our tissues work properly, and our bodies are functioning well. When our metabolic processes
are not working efficiently or are overloaded or these pathways are in some way perturbed,
we have metabolic dysfunction,
which means we're not producing energy properly. And that essentially leads to cellular dysfunction,
tissue dysfunction, symptoms, and disease. And so really metabolism is a foundational pathway
in our body. Unfortunately, in our modern Western world, the way that we're eating and the way that we're living,
so our diet and our lifestyles, is really hijacking that cellular machinery that allows
us to produce energy in ourselves efficiently.
And it's causing huge problems.
An example of this is just the fact that we're eating on average around 150 pounds of sugar,
refined sugar per person per year.
All of that sugar has to be converted by our cells
to either energy or stored. About 100 years ago, we were eating maybe one pound of refined sugar
per year. So we're doing 150 times what our body used to do under normal circumstances.
So our processed refined foods is just overloading the cellular machinery,
and that can cause a real breakdown in these processes and create problems for us.
And what's so interesting about metabolism and metabolic health is that because it's such a core
fundamental pathway to every cell in the body, when it's not going properly, it can look like
almost anything. And in that sense, it is almost the trunk of the
tree of so, so many health conditions that we are seeing today in the Western world. It's really
like where this metabolic dysfunction is showing up is where we're going to see symptoms. So for
instance, if there is metabolic dysfunction problems with sort of energy production in the
ovaries, it could look like polycystic ovarian syndrome, which is essentially insulin resistance of the ovaries, metabolic
dysfunction of the ovaries. If this is happening in the brain, it could look like Alzheimer's
dementia, or it could look like other brain symptoms like depression, anxiety, chronic
fatigue, chronic pain. These are all things we know that are related to metabolic dysfunction.
If it's happening in the liver, it could look like fatty liver disease. If it's happening in the blood vessels,
it could look like heart disease. It could look like stroke. It could look like small vessel
disease, like retinopathy or even erectile dysfunction, which is a problem with blood
getting to the penis. So it's really like where this is showing up is where symptoms emerge.
So metabolic disease can just look like so, so many things. And actually,
nine of the 10 leading causes of death in the United States are related to problems with our
metabolism, problems with our blood sugar. And it links back really to a lot about nutrition,
because fat and blood sugar, so fat and glucose, glucose is another word for blood sugar. These
are the two main things that are converted by ourselves through our metabolism to cellular
energy.
So these are things that we can really look at and understand what's going on with our
metabolism by tracking things like glucose.
And we know that when we're overloading our body with glucose, with sugar, with refined
carbohydrates that turn to glucose, when we're
putting so much of that into our body, it can cause this dysfunction in metabolism.
So that's the landscape of what metabolism is, why we're having big scale problems right now
with this in our country. We're reaching sort of epidemic level proportions of metabolic
dysfunctions and why that core pathway is related
to so many of these seemingly disparate health conditions that we're seeing when in fact,
a lot of them are very, very related by these core pathways. And just one thing to mention,
just to underline the magnitude of how important this is, is that there was a recent study in 2018 from the University of
North Carolina that suggested that 88% of American adults have evidence of metabolic dysfunction. So
only 12% of American adults are optimally metabolically healthy. And this is almost
entirely preventable. We're not fated to have metabolic dysfunction. This is almost exclusively
because of long-term dietary and lifestyle choices. We also see it in our obesity and overweight rates. We have 72% of Americans
are overweight or obese. And we have 128 million Americans with diagnosed blood sugar problems,
with prediabetes or diabetes. All of this is under that heading of metabolic disease.
And it's really monumental. It is the biggest health epidemic that we're facing globally
right now. And we put a lot of different names on the manifestations of this, like PCOS and
Alzheimer's and heart disease and diabetes and obesity. But fundamentally, it's really all
related to the same dysfunction in core pathways. Wow. Firstly, I've never heard it explained so
succinctly in a way that I fully understand. So I'm so grateful that you just did
that. And my mind is blown. So nine out of 10 leading cause of death are metabolism related.
That is crazy. And I remember my gynecologist telling me, she said, oh, the biggest cause of
miscarriage I see is blood sugar related too. This blows my mind. It is, yeah. The number one cause
of infertility in the United States is polycystic ovarian syndrome. And globally, it's estimated
that up to 26% of women are dealing with polycystic ovarian syndrome, which is amazing because fundamentally, this is a problem with glucose dysregulation in the body.
And what happens when our glucose is dysregulated, and again, going back to what we sort of talked
about in the beginning, when glucose is elevated day after day over and over again because of how
we're eating and how we're living, what that does is that causes actually a hormone in the body to be released called insulin. Insulin is the hormone that's released
in response to glucose and tells the cells to take up that glucose from the bloodstream.
So you eat the food, you digest it, the blood sugar elevates, you release insulin,
it helps you take that glucose out of the bloodstream, the body wants to get back to
normal levels in the blood. And then inside the cells, it's either used to make energy or any excess is stored.
And that's where a lot of problems arise. But when that insulin gets stimulated over and over
and over and over again, like day after day, year after year, like so many of us are doing from
basically like infancy these days, what happens is our cells actually become numb to the signal
of insulin and they
become what's called insulin resistance. They sort of say, oh my gosh, there's so much insulin
around, we're going to block the signal. And the inn is full. We can't take any more glucose in.
And so then what happens is the body overcompensates, makes more insulin to drive
that glucose into the cells. And this is this process of insulin resistance that ultimately
leads to
a lot of this metabolic dysfunction we're talking about, where there's an overabundance of glucose
in the bloodstream, but the cells are less responsive to the insulin and it can't get in.
And then we end up having elevated glucose in the bloodstream. How that relates to infertility
is that that high insulin actually stimulates our ovaries to make testosterone. So our ovaries have cells
called feca cells, which are insulin responsive. And when they are stimulated by elevated insulin,
they actually make male hormones. They make testosterone and androgen hormones,
and they also promote the proliferation of feca cells. The other thing insulin does
is it reduces our level of what's called sex hormone binding globulin, which is a protein that binds testosterone in the bloodstream. So we end up having more free testosterone floating around. And that is what leads to menstrual irregularity, ultimately infertility, and many of the other problematic symptoms of PCOS like acne, excess hair growth, and central abdominal fat and obesity.
And actually, over half of the women with PCOS will develop type 2 diabetes by the time
they're 40, which is incredible.
And so there has been a huge amount of research showing that actually low-glycemic, low-glucose
stimulating diets that don't cause those spikes in the blood
stream can really improve our insulin sensitivity and improve PCOS outcomes. It can actually,
there have been studies that have shown that it can really reverse the hormonal abnormalities
and people can become more fertile. And there was an amazing study in 2020 that looked at only 12 weeks of what was a ketogenic
diet.
So ketogenic diet, meaning very low carb, relatively high fat.
So fat doesn't stimulate insulin very much.
Carbohydrates do stimulate insulin.
And so it was putting these women in a situation where they were not eating a diet that stimulated
much insulin.
And over the course of 12 weeks, they were able to, by and large, reverse their metabolic
abnormalities, decrease their insulin levels, increase their insulin sensitivity, improve all
their hormone levels, and decrease their weight by a very significant amount. And what I really
loved about this study is it wasn't just like a eat no carb and eat high fat all-comer diet.
It was a very healthy, what they called Mediterranean ketogenic diet.
So it was super heavy on leafy greens, low carb vegetables, unlimited amounts of greens and
vegetables, which have all the beautiful nutrients that are going to help just with general cellular
processing. And then really thoughtfully sourced fat like fish and high quality meats and eggs and
things like that. And it was actually a quite limited quantity of meat. So it was a very thoughtfully chosen ketogenic diet, which I think is partially
also why they had great success. So not to belabor the point too much, but it's just really
interesting that even something like fertility, which I think the average person walking around
would really not think about in relation to their diet, but the leading cause is very much related
to everything we're talking about. Let's take a quick pause to talk about my new favorite all-in-one platform,
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Wow.
And so have you seen the best results in terms of reversing diagnosis like PCOS or insulin
resistance through ketogenic diets?
Personally, it's not something that I've addressed very much in my practice.
And actually, most of my colleagues who are OBGYNs are actually very unfamiliar
with this body of literature because we in the United States, in the Western world,
we don't tend to reach into our nutritional toolbox as physicians to as first-line therapy
for patients. It's just, it takes a long time to explain these types of diets. And we're not
taught about nutrition in medical school.
It's much easier to actually just prescribe a pill.
And some of the pills that are prescribed for PCOS, not surprisingly, one is a diabetes
medication, metformin.
So we're actually prescribing a diabetes medication to treat infertility, but we're not really
talking about diet.
So it's been a really fun journey to speak with my colleagues about this. And people are very, very interested. But I think there's a world in which nutrition is
really going to become a first line therapy for polycystic ovarian syndrome, erectile dysfunction,
very similar, it's directly related to metabolic dysfunction. So I think actually, there's a really
interesting world around sexual health, hormonal health and blood sugar that is going to be more mainstream and hopefully through conversations like this
and really getting some of that awareness out.
Yeah, that makes so much sense.
And so going back to when you were saying this can be affecting lots of different parts
of the body from ovaries to liver to brain, does metabolic dysfunction as a whole have a number of symptoms that if anyone's
listening could hear and think, oh, actually, maybe my metabolism isn't performing the way
it should be? Yeah, I think it can really, I would categorize it into sort of like the overt
signs that are a little bit more obvious and then the subtle signs. So when we talk about overt signs of like, is the body not processing
energy properly or storing energy improperly? You think about things like obesity, that's
dysfunctional fat storage. We're clearly channeling excess energy into a storage form.
So people who are dealing with stubborn weight can't seem to lose weight. We know that as weight
goes up, insulin levels are likely higher. And so
that's a sign of insulin resistance. And that's not universal, but there is a trend of as weight
increases that we likely have more issues with insulin resistance, which makes sense because,
again, insulin is that hormone that is elevated when we have excess glucose.
The interesting thing about insulin is that the secondary purpose of
insulin is to block fat burning. So it's a signal telling the body, we have tons of glucose for
energy, don't burn fat for energy. So when it's high, we're not going to tap into those fat
resources. And so if we're thinking about weight loss, we really need to be thinking about insulin.
So overt things, obesity, overweight,
I would say overt things would be things like diabetes and liver disease, Alzheimer's,
cardiovascular disease, like heart disease and stroke, chronic kidney disease. But really,
the subtle things I think are even more interesting. When we think about what happens when the body's not making energy properly, it can look like a lot of the full spectrum of daily
pain points that we experience
in our modern life that keep us from reaching our full potential, our goals. So things like
general fatigue, brain fog, moodiness, like up and down mood lability during the day,
maybe lack of exercise endurance, maybe some acne, maybe increased pain. Oh, my neck always hurts.
My back always hurts. It could look like
hanger. When we are hangry, what does that really mean? It means that you have gone a few hours
without food and now your body feels like you really need food. And what's actually happening
in the body? Well, your body's essentially probably so dependent on glucose and not really
able to tap into fat for energy that when you don't have
glucose immediately on board through like a snack or a meal, your body just says, oh my gosh, panic,
I need to eat more. When in fact, if our bodies were more metabolically attuned and flexible,
when glucose was low between meals, our insulin would be low enough that we would just flip into
fat burning. That break on fat burning would be lifted. So I like to say like hanger or like really being anxious
before your next meal time, that could be a sign. If we're getting sick all the time throughout the
year, like bad flu cases or sinusitis or things like that, that could be a sign. We know that
high blood sugar impacts our immune system and actually decreases our immunity. This actually is very relevant to COVID because it's been known for
over a year that high blood sugar is one of the key factors in increasing COVID morbidity and
mortality. So I would say those more subtle things, certainly glucose isn't the only cause
or metabolic dysfunction, but we know for everything
I just mentioned, fatigue, brain fog, moodiness, depression, anxiety, poor exercise, endurance,
acne, poor immunity, increased appetite, these things all can be related to just essentially
not being able to harness energy from food properly.
And we end up getting symptoms arising from where that's
showing up in the body. So I like to say that glucose variability in our day tends to map on
to subjective variability in our day. If my glucose is shooting up after a high carb meal,
my body's going to release tons of insulin and my glucose isn't going to crash down.
And that can often be associated with that post meal slump, needing a little nap, like a food coma, maybe a little bit of
anxiousness in the afternoon. So really keeping glucose more stable not only helps us in the long
term by keeping our insulin lower and helping us really prime ourselves for insulin sensitivity,
but also just keeps us from going on this roller coaster during the day that can be unpleasant.
And it sounds like so from some of those symptoms like acne or mood, like changes in mood,
I think for a lot of women, we might hear that and think, oh, my hormones are playing up,
which blood sugar is definitely playing into. But when we think about maybe it's like our sex
hormones playing up, are you saying actually metabolic health and insulin,
that's really the root cause. It's not that your sex hormones are necessarily the root cause of
this, but they may be impacted because of your metabolic health. Yeah. So I think it's all
related in a really big and complex web of which one part of it is the glucose. So let's take acne, for example. This is a very, very interesting one.
So we know that essentially, again, glucose stimulates insulin and also stimulates another
hormone called IGF-1, which is insulin light growth factor one. Okay. So we're eating high
glycemic diets. We're getting a lot of insulin stimulation. Well, insulin, in the same
way that it stops us from burning fat, it helps us store energy. It tells us to store glucose as
energy. It tells us to not break down fat. It's an anabolic pro-growth hormone. Okay. So how does
this play out in the skin? Well, interestingly, in our hair follicles, there is a gland called the sebaceous gland,
and that's what produces oil around the hair.
And when our sebaceous glands are stimulated by insulin and IGF-1, they actually produce
a lot more oil.
And you get what's called sebaceous gland hypertrophy, meaning they're too big, they're
producing too much unregulated.
So that's like
an anabolic pro-growth signal in the skin. And that is thought to be part of the pathogenesis
of acne. Add to this that you've got excess glucose in the interstitial space or in the
skin, in the tissue, in the blood, which can feed bacteria, which can then interact with that oil to create worse situations for
acne, and add in the fact that high insulin stimulates testosterone production, which
can also drive jawline acne.
So from multiple levels, you've got this feeding into the complex physiology that can lead
to this.
And when you look at interventional studies of people who are on a low glycemic, lower sugar,
more blood sugar balancing diet,
again, over the course of just really short-term studies,
I think the ones I'm thinking about
are like three-month studies on a low glycemic diet,
people have significant improvement
in their number of acne lesions.
And even when they've taken biopsies of the skin,
their sebaceous glands actually shrink in size. So it's pretty fascinating stuff. Yeah, it's so interesting. And I'm so
incredibly passionate about it. Because when I found out that I had PCOS and started doing my
research, finding out that insulin resistance is at the root cause of a lot of these things,
I remember thinking, like, why is no one talking about this? Why am I only finding out about this from reading numerous books
and like digging into it? Like you said, it's not something that perhaps an OBGYN knows about right
now. I mean, hopefully that's going to change through conversations like this. But the fact
that you're saying 88% of Americans have metabolic dysfunction, there needs to be more discussion
around this. And I'm so excited about what you guys do because it's been such a game changer
and we're going to get into that. And I know one thing that you talk about is the pillars of health,
so diet, exercise, stress, and how these relate to your metabolism. Can you speak a little bit
about that so that everyone listening is like, okay, I definitely think I have some dysfunction going on. We can start to talk about what they
could be doing in their lifestyle to adjust that and strengthen their metabolism.
Sure, absolutely. And I think of everything on the level of ourselves. I just that's the way
my mind works. And I think it's interesting to think about like, we're essentially trying to
make ourselves function more properly. We're trying to make our digestive cells work properly,
our insulin receptors on our cell membranes work properly. It all comes down to function
and it all working in harmony in the body, in this unified system. And so there are a number
of pillars of health that are essentially behaviors and choices
we make that we know translate into essentially how the body functions. And there's really seven
that I tend to focus on. And all of them feed into our level of metabolic health with thousands of
papers in the medical literature to
sort of support that. So the first is food. I'll just list them all first, and then we can talk
more about any of them. But really, it's food, stress management, sleep quality and quantity,
exercise, and how much we move our body, our microbiome, our micronutrient status in our
bodies, and then how much exposure to toxins and pollutants we have
in the body. So those seven things all have an impact on essentially how our cells work.
And within each of them, there's a lot of nuance for really how we can optimize each pillar to
make sure that we are supporting our body's function. I love that so much.
And I've wrote them all down.
And for anyone listening, I'll link below so that we can list those out.
So when it comes to taking a look at someone's diet as a whole or lifestyle as a whole,
what are some foods or ways of eating that would be metabolically supportive?
And same with exercise, things like that.
Well, with food, it really comes down to
four things. So one is our actual food composition, like what we're eating and how we're pairing food,
how we're balancing meals. The second is food timing when we're eating. The third is food
sequencing. So how we're actually sequencing things in a particular meal. Are we
putting carbs first? Are we putting fat first? And then the fourth is the nutrient composition.
So actually like the quality of the food and how much nutrients it's giving us. So within the food
composition, the key thing that we want to focus on is not having large glucose excursions, glucose spikes after our meals. We want our glucose and
our bloodstream to be like gentle rolling hills, a little bit up after a meal, and then it comes
down back to baseline with just a little bit of insulin that has to be released to bring it back.
What we don't want- What's the number? Can I just ask you
for the specifics? What does that look like in terms of numbers for someone that's using a CGM?
Yeah. So if we're just going to talk about party line, what the International Diabetes Federation recommends, it's that you generally don't go above 140 milligrams per deciliter after
a meal. So you stay below 140. If you look deeper into the medical literature, it's probably more
likely that we want to stay under about 120 milligrams per deciliter
after a meal. I personally don't like to go really above like over 30 points from my pre-meal
baseline. So let's say I start my glucose before lunch at 85 milligrams per deciliter. I don't want
to go 30 points above that after a meal. I want to keep it just a gentle 15 to 20 point rise and then come back down to my baseline all within about two hours. And so if you're just out eating standard packaged foods in the grocery store, chips, french fries, breads, crackers, tortillas, it is very easy to go up 80, 90 points. We see this literally all the time. And what happens then is you're
overwhelming your bloodstream with glucose, surging out insulin, the body, which is what
is supposed to happen. Your body's trying to get it back down to baseline, but it often overshoots
when you've had that big of a spike. And then you end up crashing and actually dipping below
your pre-meal baseline. And that's called reactive hypoglycemia. So what's happened is a number of
things with that big glucose spike. The first is that you've exposed your bloodstream to all
this glucose, which actually in its own right has problems. Really high glucose in the bloodstream
can do three things. One, it can cause inflammation. Actually, a really big glucose
spike can cause your body to be like, what's going on? There's a threat or something. So it
causes inflammation. That glucose can stick to things in the body, which is called glycation.
And that can be a problem that can actually cause if glucose sticks to proteins in the body,
it can cause dysfunction with how they work. It can also cause oxidative stress or reactive
oxygen species. So like free radicals and damaging metabolic byproducts. So that's one thing that
happens when you have a big spike.
The second thing is the huge insulin surge, which again, is going to over time, if that's
happening every single day, all the time could lead to insulin resistance, which is where
your cells basically aren't taking up glucose properly because the cells are becoming numb
to insulin.
And then the third thing is that you get that crash, that reactive hypoglycemia,
where your blood sugar actually goes lower than it's supposed to after a meal, which can lead to
that jitteriness, that post-meal slump, brain fog, anxiety, et cetera. So on every level,
a huge spike is not going to be supportive of health. And it's not like one spike is going
to damage your health forever. It's just that the way we're living, where we eat three meals, we eat multiple snacks,
and the vast majority of calories in the American diet come from refined and processed foods
that tend to spike glucose.
You can imagine after 5, 10, 20 years of this, it's so much for the body to handle.
So what we want to do with food is figure out how to eat in a way that keeps that glucose
more stable. What that might look like, and sort of for practical reasons, is really pairing our
foods properly. We don't really want to eat carbohydrates just alone. I try and avoid what
I call naked carbohydrates, which is just like a big giant apple. The macronutrient that's dominant
in that is carbohydrates. So if I'm
going to eat an apple, I'm going to, first of all, try and eat a smaller, organically grown,
maybe local apple, has less sugar, grown in better soil, going to have better micronutrients.
And then I'm going to pair it with fat, protein, and fiber, because those things actually can
blunt our response to the glucose load. So for me, that looks like
putting almond butter or tahini on it and then sprinkling chia seeds all over it. That's fat,
protein, and fiber right there. Or I'll put it in some full fat non-dairy yogurt with chia seeds.
And so it will really change the way my body processes that glucose. The other thing that
we can do is think about when we're eating. We talked a
little about food timing earlier. We know that glucose loads later in the evening tend to have
a higher glucose response. Actually, eating carbohydrates more in the early part of the day
tend to have less of a glucose response. We tend to be more insulin sensitive early in the day.
So thinking about when we're eating and trying to wrap up our high carb meals well before bedtime is another strategy. And then it's just identifying
foods. This is where continuous glucose monitoring comes in, identifying foods that you're eating and
finding out which ones uniquely are spiking your glucose. One of the fascinating things is that
you and I, Natalie, could both eat the exact same
food, like the exact same banana, and have totally different glucose responses to it.
I might go up 70 points and you might go up 10 points.
So for me, it's not the best metabolic choice.
And for you, it might be a better metabolic choice.
And this has been studied in detail.
There was a great paper that came out a couple years ago called Personalized Nutrition by
Prediction of Glycemic Responses.
And what they did was just this.
They gave 800 healthy people wearing continuous glucose monitors standardized meals and looked
what happened to their glucose.
They saw that it was buried all over the place, even in response to the same mood.
Then they studied why.
What are the things that are causing people to respond differently?
One of the big factors was microbiome composition.
So how our microbiomes are actually processing that glucose before it gets into our bloodstream.
So that's where CGM can be really, really interesting is to find out which foods are
uniquely spiking you.
And then you can work to either balance them better.
You can reduce the portion size.
You could potentially, if they're huge spikers,
eliminate them and swap them for something else
that you really like.
If pasta is a crazy spiker for you,
try non-grain pasta like konjac root pasta.
Try zucchini noodles.
Like there's ways to find out
what are just massive spikers for you
and then learn to swap, pair, modulate, time, etc.
With the ultimate goal of really keeping that glucose more stable,
keeping that insulin more stable, and having those downstream positive effects.
Yeah. I think that piece around how different our responses might be to food was so interesting for
me when I was chatting to your team and hearing that. I'm like, what? It's so interesting for me when I was chatting to your team and hearing that I'm like what like it's so interesting how different everyone is and I notice it too me and my husband we both
use levels every single day and we always wear our cgms and we'll have certain foods and then
look at our response and it can be completely different and it's so interesting I'm really
curious say someone and I'll put the links below if anyone wants to join us in levels, but say someone's wearing a CGM, is there any way that they could look at that and say,
oh, I have insulin resistance or I might not have insulin resistance? Will the CGM tell you that?
That's such a great question. The answer right now is that there's not a one-to-one correlation between what you're seeing on your CGM and
whether you have insulin resistance.
But this is actually exactly what Levels as a company is studying.
We have a research advisory board with faculty at Yale, Brigham Young University, University
of South Florida, Thomas Jefferson University, incredible medical advisors,
Gerald Shulman, Sarah Gottfried, Ben Bickman, Dom D'Agostino, who are actually studying the exact
question you just asked, which is, can continuous glucose monitoring be basically a signature to
tell us what's going on? What is our underlying metabolic health based on this? So right now,
it would be hard to just look
at a glucose curve and say, I do or don't have metabolic dysfunction or insulin resistance,
unless a doctor is really looking at it and digging really deep into it. I would say,
I can look at a glucose curve and get a sense of whether someone is insulin resistant. And some of
the things that might feed into that is when they eat something high carb, a normal
response is that someone spikes up, usually within 45 minutes to an hour, they reach their
peak.
And then by two hours, they're back down to their baseline.
That means that they ate something, they secreted insulin, and their cells responded to that
insulin, and then it came back down to normal.
For someone who's insulin resistant, they might spike, spike quite high, and then stay
elevated for quite a bit longer, two, three hours. And that might be a sign that their cells are
resistant to that insulin signal, and they're not able to clear that glucose as effectively.
So that's the type of thing that you might see. You also might see just more general what's called
glycemic variability, meaning just ups and
down spikes throughout the day.
We know that increased glycemic variability, the up and downness of the static in the curve
essentially, is correlated to future risk of prediabetes or diabetes.
So we want things to be a little bit more stable.
And there's a great lab at Stanford by Professor Michael Schneider, who put out a paper
last year called glucotypes. And it looked at this exact question, which was,
can we categorize people by their glucose curves into insulin sensitivity? And it looks like
we probably will be able to over time, but now it's a little bit more of reading the tea leaves, so to speak.
What we can learn from it that is so important is have some awareness about how food is affecting
our glucose because we know that that is sort of step one, that metabolic awareness of how
we personally respond and then how we can build out essentially a lifestyle toolbox,
not just with food, but also with optimized sleep, optimized stress management,
micronutrient composition, microbiome optimization, reducing toxins, moving more. All those things can
be in our metabolic toolbox to support that flatter and more gentle glucose line. So it
gives us that awareness and that ability to build out the toolbox so that hopefully we don't move
down that spectrum and that pathway
towards further metabolic dysfunction. So I use it as really a biofeedback tool for all these things
as a daily reminder of to do these health behaviors that I know are going to ultimately
keep me flatter and more stable and making better choices. Yeah, I love that that's coming. And
that's how I use it too. And it's the same as like wearing my whoop band. Like if I have these biofeedback tools on, then I'm more likely to eat well,
to exercise, to do the things I know I should be doing. It feels like it holds me accountable.
Like in the window, when I take my CGM off and replace it, I'm like, Oh, what can we eat?
Right. Which is what's your go-to when you don't have the cgm on chocolate
yeah every time you probably notice that there's probably a trend where people take their cgms off
and just go nuts and then put them back on okay we're gonna take a quick break right now to hear
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let's jump back into the episode. I find that one of my strange weaknesses is rice crackers. I love
the crunchy rice crackers. I love topping them with lots of delicious stuff, making artful
arrangements. Rice crackers put me through the roof on glucose. Oh, really? Oh my gosh. Rice,
for me, every single one of my extremely low glucose zone scores and levels app
has either rice or sweet potato in it. And so I noticed that the only time I reach for those is
when I don't have my glucose monitor on. And that's really a premise behind our company and
behind what we're trying to do. Levels, our mission is to reverse the metabolic disease epidemic.
And that might seem surprising to people because
a lot of our early customers are pro-athletes, people interested in performance and longevity,
people who already seem healthy. But really what our goal is, is to scale this and make these,
as we grow a market for these devices and this software that interprets our glucose data,
this is going to become much more accessible, much cheaper. And we're going to be able to reach that sort of scale of people who really, really need this,
can have it, and can really learn how food and lifestyle additions are affecting them.
And so our hope really is to create a closed-loop biofeedback behavior change mechanism that gets
people really excited to make it fun to understand your body, understand all these levers
we can pull, and just really realize this is not about deprivation. This is not about not eating
food. It's not even about not eating carbs. I'm actually primarily plant-based and I eat a ton
of carbs, but it's about building a holistic approach to your life, to all aspects of your
life that make your body able to process energy
effectively. And that's really my goal for everyone is to have a body that can actually
create energy in the proper way so that cells can work and that bodies can work.
And do you think you're able to have that higher carb lifestyle because of the way all the pillars
work together for you, the way that you eat your food, timing, compass, like all of those things? It's all of them together. Yeah. I've been
wearing a CGM now and using Level software for about two years. So at this point, it's almost
like a no-brainer. I know that if I'm eating lentils, I'm definitely going to pair it with
an almond butter sauce or a coconut milk or something like that to create that fat buffering the carbs.
I know that fiber to me is like my secret weapon. When I have carbs that have tons of fiber, it tends to just keep me totally stable. So for me, that looks like beans, lentils as like primary
carb sources. So now I make pancakes actually out of like mung beans because I know that beans don't
spike me. So I've learned to create like all my favorite foods I know that beans don't spike me. So I've learned to
create like all my favorite foods out of things that don't spike me and then pair them with fat,
fiber, and protein to just further mitigate the spike. So there's really like, there's the short
term things, which is like exactly what you're choosing to eat. And I've learned a lot of things
that really spike me like sweet potatoes and grapes and corn and rice. And so now I just really tend to avoid those because there's so many other
vegetables and fruits and grains that are okay. And so I've just given up on some other really
high spikers and learned some really great swaps. And so that short term, when I eat the foods that
I know work for me, my glucose is more stable, but I also have
like the stress sleep and exercise toolbox. I know that if I take a 15 minute walk after a meal,
it's going to have a huge impact on keeping my glucose more stable. So now I just do that more
often. I know it's good for my brain. It's good for my metabolic health. I know that if I'm nervous
for something like giving a talk that my glucose is going to go up because we know that
stress hormones like cortisol tell our liver to dump glucose into the bloodstream. So it's made
me way more adherent about doing deep diaphragmatic breaths and like looking at my whoop HRV data,
my heart rate variability data to really like, if I am going to be nervous and I know my cortisol
is going to be high, I am tapping into my toolbox of diaphragmatic breathing to hopefully lower my cortisol.
I know that's going to keep my glucose and my cells working more properly.
And then with sleep, I mean, that one is just, I can't emphasize it enough.
When we get even a little bit of sleep deprivation, it throws basically all of our hormones off.
It throws off insulin, cortisol, growth hormone, our satiety hormones like ghrelin and leptin.
It throws off everything.
So sleep, I just make sure that that's dialed in, although that's my biggest struggle, I would say,
is consistent sleep. So those are the short-term things like food, exercise, sleep, stress. We can
have an immediate impact on glucose. Then there's the things that are more like lagging indicators
that I see as building a body over time that processes glucose effectively. You don't necessarily
see the results of these choices on a day-to-day basis, but you see them over time. And that's
microbiome, micronutrients, and toxin exposure. So we know that as we build an optimal microbiome,
i.e. the 50 trillion bacteria in our gut, that they actually help us process food in a much more metabolically
friendly way. Microbiome process fiber, turn it into short chain fatty acids, which we absorb
into our bloodstream. And they are just like little helpful anti-inflammatory pro-metabolic
regulators. So I think about food as like, how am I feeding my bacteria in my body to support my metabolic health? Similar with micronutrients.
We know that all the little proteins and enzymes in our cells, like our mitochondria, which
are like the powerhouse of the cell, they're the ones that actually convert fat and glucose
to energy in the cell.
They require so many micronutrients to function properly, almost like locks and keys to work. And this is things like magnesium,
manganese, zinc, lipoic acid, omega-3 fats, B vitamins, all these things that are not
macronutrients like fat, protein, and fiber, but they're micro. And you don't just eat magnesium
or selenium one day and all of a sudden all your cellular machinery is working properly. You have to do this like day in and day out. So I know now which micronutrients are important for
that functioning. And it's a lot of the ones I just mentioned, selenium, B vitamins, poic acid,
et cetera, et cetera. And so now when I go to the grocery store, I'm just on a micronutrient hunt of
like, I know I need these for my body to work. So how am I going to find them and eat them
consistently? And this is more like the months, the months and months of consistent decisions to build a body that works properly.
The last one is the toxins. So many of the personal care products we're using,
the packaging we're using for food, the pesticides on our food have endocrine disrupting chemicals
essentially in them, like phthalates and glyphosate and other things that actually just are chemicals that go
into our bodies and just break our metabolic machinery. So every day, am I drinking clean
water? Am I trying to expose myself to good air? And am I not using plastics, not microwaving
plastics, using glass instead, using clean beauty products, trying to find shampoos and stuff that
on the Environmental Working Group website aren't filled with endocrine disruptors. Again, not going to have an impact on my glucose
tomorrow, but over the course of months and years, they will have an impact on that machinery. So
that's getting in deeper to those seven things I talked about with the first four really being
about acute responses to glucose, and then the latter three being more
about building a body that is highly functional. So that's a big picture overview. But I think over
the course of years, you get to this place where you're just like, your body's able to process
glucose effectively. And I think that's what my journey has been. And I imagine it has to do with
a lot of longer term shifts with microbiome and whatnot. But it's really fun to think about. It gets deep into the weeds with biochemistry and all this
stuff. But it's beautiful to think about how the body works in this complex way to take all the
choices we're making every day and to basically transform them into our reality and our cellular
functioning. I love that because it feels almost like a roadmap. So things you can do now and things you can do that are investing in the long-term picture. And when you mentioned micronutrients
and making sure you get those in your food, do you primarily prefer to get nutrients from food?
Do you take any supplements on top of having a varied diet?
Yeah. So I think food is always the best way to get them, but I do take a bunch of supplements
to answer your question. So I'll just briefly talk about those two things. So one thing that's
worth knowing is that our food is essentially much more micronutrient deplete than it was 50
years ago, 100 years ago. And that's a lot in part because of our industrialized farming practices,
which is essentially we've sprayed our cropland in the
US with pesticides that have killed a lot of the bacteria and the biodiversity of our soils.
And the bacteria and the biodiversity in our soil, like soil is supposed to be a living thing.
There are literally billions of bacteria in a tablespoon of soil. But when we've covered our
soil and our cropland with all this terrible crap, basically, we've created sterile soil.
And so we actually can't create the nutrients in the soil that our food needs to be nutrient-rich
because that's what those organisms did for us. They recycled these things. And so we're in really
a problem with their food being more nutrient-deplete than it ever was. So even if you're
eating a beautiful, plant-rich diet, you still could be nutrient deplete
in our modern world. And just a plug for something I'm very interested in is the regenerative
agriculture movement. And this idea that we need to be going back to more traditional farming
practices on a really huge scale, where we're actually reseeding soil with biodiversity so
that we can actually have nutrients in our food so our bodies
can work. This is super tied to our chronic disease epidemics of bodies just breaking down
everywhere around us. So really thoughtfully sourcing food if you can is one of the best
recommendations I would make. And there's lots of creative ways to do it. First of all, the easiest
thing is buy organic. If you can buy regenerative, do that. But buy organic, buy local if you can. And you
can do this cheaply. You can buy frozen organic food. What I like to do is I just go to the
grocery store and I'll look for whatever's on sale that's organic. And I'll just often buy that.
And sometimes it's food that I've never tried or seen before, but then I'll just Google how to cook
it. And I'll end up having some really interesting new food like Romanesco or whatever.
And so that's one way to do it. You can also... There's services like Imperfect Produce that will
ship you organic food, but you're going to get more nutrients from organic food and you're going
to have less exposure to those pesticides that hurt the microbiome and hurt the body.
So that's really how I approach that nutrient question in food. And then also, I'm always
thinking about what each food has. So then also, I'm always thinking about what
each food has. So for instance, pumpkin seeds are one of the highest sources of magnesium that we
can get in our diet. And Brazil nuts are one of the highest sources of selenium we can get in our
diet. Selenium and magnesium are both totally critical for metabolic processes. Selenium is
part of what's called selenoproteins, which are protective against mitochondrial damage in
the body. So we really want selenium so we can build selenoproteins so that we can protect our
mitochondria. So when I'm in the grocery store, I'm like, okay, I'm on a selenium hunt. I'm on
a magnesium hunt. I'm on an omega-3 hunt. I'm on a zinc hunt. And I actually, sometimes I'll be
like, oh, I want to have some magnesium seeds. Someone's like, what? I'm like, oh, pumpkin seeds. But in my head, I'm thinking of pumpkin seeds as my magnesium source. And I've caught myself
accidentally saying that before, like, oh, I want to have a magnesium seed. And so I think it's
really that just really being thoughtful. And you can just Google. We have a ton of content about
this on the Levels blog, like which micronutrients are important for metabolic health and what the
sources are, because it can be intimidating to figure this all out. But it's actually fairly simple in a lot of ways when we
get back to principles, like high quality food, get a diversity of food, get a lot of colorful
food, and just keep it fresh and whole and unrefined. I mean, processed food strips all
these nutrients out of foods. When you take wheat even and ultra-process it
into white flour, you're just losing everything that the plant had. And so stick with as much
whole foods as you possibly can. It doesn't matter what type of diet you're on, vegan,
paleo, carnivore, whole foods is the way to go. And with the vitamin piece, so because we are
facing an uphill battle with micronutrient depletion, and even if you're
doing really well, you still might not be getting everything you need from food. I do use a test
in myself and in my practice called NutriVal, which is done by Genova Diagnostics, which is a
urine and blood test that looks at 150 different biomarkers in the body and essentially tells you
what your nutrient status
is for a lot of different things. And I use that to guide my supplementation, but also my diet.
So it helps me know about my antioxidant status, my protein, amino acid levels,
my vitamin levels, my minerals. I really, really love that test. I've supplemented based on that.
If my magnesium seems to be low,
I'll just really load up on magnesium food sources, etc, etc. So that's one of my faves.
Yeah. And I love that answer too, because I often get asked from people what supplements I take.
And I always say, I don't really want to tell you because this is personalized to me and knowing
what I need. And everyone is so different that I don't think like
a blanket approach is necessarily the right way to go. So I love that you mentioned that test.
I'm really curious what your thoughts are on intermittent fasting.
Yeah, so I think intermittent fasting, and just for people who are listening, I'm sure most people
are aware, but really, it's about there's two ways to think of it. One is really
time-restricted feeding, which is where you're actually eating in a shorter eating window during
the day. So as opposed to snacking from eating from 8 a.m. to 8 p.m., you're eating in a shorter
feeding window, like 10 a.m. to 5 p.m. So a shorter feeding window and then a longer time
when you're not eating. Then there's other types of intermittent fasting regimens, which is where you don't eat for 24 hours and then it's like a full day fast
or like five days of eating and two days of not eating during the week. So there's different ways
of doing it. But fundamentally, all of what this is doing is giving your body a time when you're
not putting exogenous glucose or other nutrients into the
body, and therefore you're keeping those exogenous glucose spikes low, and therefore you're keeping
your insulin lower. You're not stimulating your insulin. So from the perspective of giving your
body a break to just process the energy that's in your body as opposed to just using energy that you're putting in your
mouth, it's a great opportunity. It has been shown to increase insulin sensitivity because,
again, when your insulin is low, your cells are going to start to perk up to insulin again.
They're going to hopefully work against that path of insulin resistance and that numbness to insulin.
So it gives your body this state of rest from all this chemical and hormonal signaling that
happens when we eat food.
So I think that it can be a really valuable tool in the toolbox to help us with our insulin
sensitivity.
It can be a stressor on the body in some people.
Like if you're already having a lot of baseline stress, or for instance, with women, if they're
at certain parts of their cycle
and they're feeling really depleted, it may actually just be too much for them at that time
and might actually exacerbate feeling stressed or high cortisol. So I think you have to use it
thoughtfully and not as just like a blanket statement and really work with your body.
But there was a really great study that's worth mentioning that was, it took two groups of healthy
people and it had them eat the exact same amount of calories per 24 hours, actually the exact same
food. But one group ate all that food between 8 a.m. and 2 p.m. and one group ate all that food
between 8 a.m. and 8 p.m. So one group had a six-hour feeding window and one group had a 12-hour
feeding window. And despite eating the exact same number of calories and food,
the group with the shorter feeding window had better overall 24-hour metabolic parameters,
like 24-hour glucose levels and 24-hour insulin levels, which is surprising because they ate the
exact same thing. But when you think about what's happening hormonally, the group that
did it all between 8 and 2 p.m., they, of course, had that downstream insulin secretion.
They had the glucose elevation,
but they worked through it. They processed it. Their body managed it. And then they had
18 hours where everything was low and their body could just then process. When you're not eating
during that 18 hours, you're going to burn through the stored glucose in your liver. You're going to
burn through a lot of that circulating glucose. And then because you've burned through your stored energy, your insulin is low. Then you
start going into fat burning. And that's an awesome thing for the body to do. We want our
body to basically work through its stored glucose and then flip into fat burning. That's a state
called metabolic flexibility, which we know is associated with health and longevity.
Unfortunately, in our modern world, a lot of us never have the opportunity to burn fat
because if we're snacking all day and our insulin is always a little bit elevated, we
might never burn through all our stored glucose and we might never have insulin low enough
to burn fat.
So we're not metabolically flexible.
We're not working those pathways.
So fasting is
this cool opportunity to essentially let your body use what it's got. We store about three or
four hours of glucose in our liver for easy accessibility. So you burn through that.
And then your body starts harnessing these pathways of fat burning, mobilizing fat from
your fat cells, using it for energy. And that's great. We want that. So I'm a big fan
of it from a physiologic perspective, an insulin-sensitive perspective, a metabolic
flexibility perspective. But I do think it has to be used thoughtfully. And like I said, it can be
a bit of a stressor on the body. So we only have a certain amount of capacity, I think, each day
for different stressors that we put on the body. And you just have to think of intermittent fasting as one of them. Yeah, I love that. And I'm definitely no doctor,
but I agree just based on how I feel. I don't fast that often. But if I wake up and I'm not
hungry and I feel pretty energized, I'll go do a fasted workout and not eat. But if I'm waking up
and I'm feeling really hungry, tired, and I'm maybe during my period, then I'm not going to
fast. And just playing it that way has been definitely very supportive for me.
And we've had the same opinion. Anyone I ask who comes on the podcast, it's always the same,
especially for women. A lot of these studies don't necessarily have women at different points
in their cycle. So thinking about where you're at and what your body needs is so important.
I love that you talked about that. You can also tell that I have so many questions just wanting to pick your brain because there's so many things
I'm curious about. On one of our recent podcasts, it's called The Energy Formula, if anyone's
interested, we had a leading biochemist on. He was talking about all the different supplements
that excite him. And he was talking a lot about metabolic health. And he was mentioning berberine
because I'd brought up metformin.
I've seen quite a few studies on metformin and longevity. So people taking that to
extend their life to live longer. And I was really curious of his thoughts. And he brought up
berberine, which for anyone listening, I think it does a similar thing, but it's more natural.
And you can probably correct me, but what are your thoughts on that? Yeah. So berberine is a natural compound. It's essentially from nature that has a similar
mechanism of action to metformin, which is a medication that we use to improve insulin
sensitivity. And it has been shown really in robust clinical trials to have a positive impact on blood sugar. And so it can be a nice adjunct
for people. I would say while it's a useful tool that we know about, we understand the mechanisms
quite well, and it's probably been studied better than almost any other supplement related to
blood sugar. I tend to be less excited about these types of compounds that we purify and then take in sort of larger
doses to sort of get an outcome we want because the body is such a complex system. And the
framework I really like to try and emphasize is the one of thinking about the body holistically
and about so many of the health comes from the hundreds of micro decisions we make every day
related to all the things we've talked about. It doesn't ever come from a supplement or a pill.
And so I love that it's well studied. And I love that it's a useful adjunct for people who need
support and a boost. And even for people who are just trying to stabilize their glucose,
who may not have any insulin resistance, but with the caveat that it's never going to supplement for
doing the work essentially and doing the stuff day in and day out that we need to do to have
a healthy body. So there's other adjuncts like this that are worth mentioning. There's cinnamon
has been super well studied as well as something that's an insulin sensitizer that I consider
pretty natural and even in non-pharmacologic concentrated doses can be helpful. So I tend to
try and put cinnamon in my smoothies or cook with it. Also vinegar, again, not at super high doses,
just like normal cooking doses can be really helpful for our glucose responses to a meal.
So actually there's been research showing that if you take even just like an ounce of vinegar, like white
vinegar or apple cider vinegar before a carb-rich meal, that it can lower glycemic responses
significantly. So I think there's ways to really use food as medicine and food as helpful adjuncts.
And berberine sort, I mean, kind of fits into
that category because it's a natural compound. So it's certainly been well studied and appears
safe and very useful. But just the take home point I would say is that there is no magic
bullet for metabolic health. Metabolic health is our foundational health. And we ultimately just
do have to live our days out to support our body's functioning. Yeah, that makes sense. And it sounds like it's such a long term thing to that slow and steady
kind of thing. And I want to get into levels. And speaking of I love mine, I've been wearing
it for a long time. I have to ask you a very selfish question, which actually has a few of
my friends have mentioned this to me. So I think if anyone listening was CGM might be the case for
you, you might have noticed it. My blood sugar is very low at night. And so I noticed that I
often drop below 70 at night. And then by the time I wake up, I'm back to normal. Is this something
that you've seen a lot of? And is there any way to support that? Yeah. So there's a number of
interesting things about low glucose at night, some of which are physiologic and some of which actually just have to do with the sensor itself.
So I'll talk about the sensor one first.
So when we actually sleep on our sensors and put pressure on the sensors, we can have
erroneously low readings.
And that's a phenomenon called pressure-induced sensor error.
So it's been well studied.
And essentially, if we roll over and lay on it, we will see big, big dips, sometimes down
to like the 30s or 40s.
So that's one thing to note.
The second thing is that glucose actually is just lower at night and tends to be quite
a bit lower during REM sleep than other phases of sleep.
It's actually really fun to correlate levels data with WHOOP data or Fitbit data because
you can sometimes see little dips that
actually correlate with when you went into the REM stage. So 5% to 10% lower during REM,
might see some dips. And then we also know that people actually not infrequently go below a
glucose of 70 milligrams per deciliter during a 24-hour period. Below 70 tends to be
thought of as hypoglycemia. But when you actually just throw CGMs on large, healthy populations and
watch what happens over the course of a few days, people tend to spend not insignificant amounts of
time, healthy people, below 70, like in the 60s. I think in one study, it was like maybe 5% of the day or so. So
intermittent dips, I think is not something to be too worried about unless you're having
hypoglycemia symptoms, which would be like shakiness and irritability and sweats and
mental status changes and things like that. But last thing I'll say is that when we have
more glycemic variability during the day or like a really
high carb meal late at night, we can sometimes throw our body into overnight roller coaster
where we're kind of going up and down, up and down, up and down as our insulin is trying to
control our glucose while we're sleeping. I mentioned this earlier, we tend to be more
insulin resistant at night. And that's because of the effect of melatonin, one of our pro sleep
hormones on insulin function. It's really interesting. We actually physiologically are just a little bit
less sensitive to insulin at night. And so if you eat something really high carb, like at 10 PM,
a dinner with bread and then pasta and then dessert and then a sugary drink, you could just
be bouncing around throughout the night, up, down, up, down, up, down as your body tries to
calibrate. So I tend to focus on more of my like, I don't know, quote unquote, ketogenic meals towards the later day to go into
evening time with a more stable glucose. Yeah, that makes total sense to me. And I notice if
I'm ever out at dinner and have a lot of bread, pasta, wine, then my blood sugar is just dancing
away that night. So for everyone that's like, I'm so confused, what is LEVELS?
Will you explain what LEVELS is? Yes, absolutely. So LEVELS is a program that is the first program
to bring this wearable technology, this continuous glucose monitoring to a mainstream population and
to use it as a tool to essentially learn how to personalize our diet and
personalize our lifestyle. These continuous glucose monitors have been used for the past
over 10 years in people with diabetes, both type 1 and type 2 diabetes, as a treatment tool.
So these are monitors that you wear on the back of your arm. They have a tiny little probe that
goes under the skin, totally painless, that's monitoring your glucose continuously 24 hours a day, seven days a week, sending that information to your smartphone.
This was a game changer for the diabetic community because as opposed to pricking
fingers a few times a day to understand what's going on with glucose, you just have this constant,
this movie of your glucose, essentially. It's just so much more granularity. It makes things a lot
safer for management of the diseases. But what we know
is that glucose affects not just people with diabetes. We need to be thinking about glucose
decades before diabetes develops. The vast majority of type 2 diabetes is preventable
with healthy diet and lifestyle. And so why wouldn't we have more awareness into this biomarker
years, if not decades, before
we're reaching these thresholds to learn how to shape our diet, shape our lifestyle,
to keep things on track, to keep our metabolic health on point.
And so that's what we're doing.
So we're bringing this really medical technology to the mainstream and then pairing it with
the software that we have created.
So the software that's really aimed to
help people come to the insights about what we've been talking about throughout this whole episode,
how to learn how to shape diets, pair foods, learn about exercise and all these other things
to really just build a holistic understanding about metabolic health, learn how specific
foods are affecting you versus other people, and just make smart, informed decisions. So we believe that collectively, we are going to reverse our
terrible preventable chronic disease epidemic that's costing America $4 trillion a year
by empowering people with personal health information so they can make better choices
day in and day out that support healthy bodies. And that's what we're doing at Levels.
I'm obsessed with Levels. And I actually was wearing a CGM before I found out about Levels and I was wearing it. And I really,
honestly had no idea what it meant. I was like, okay, well, I'm in the window. Oh,
I've spiked above it. I've gone below it. I'm guessing that's a good or a bad thing.
I didn't really know. And I saw a friend put a screenshot of Levels on their stories. And I
reached out. I'm like, I need to get this. And so I convinced your put a screenshot of levels on their stories. And I reached out,
I'm like, I need to get this. And so I convinced your team to let me try it when there was a wait
list. And I've been so obsessed ever since, because it gives me a way to interpret the data.
Because otherwise, I feel like for me, especially the data was useful to an extent, but it wasn't
helping me make better choices or to understand where I
was at. And I've seen, for me, a noticeable difference in my hormones, in how regular my
periods are, having PCOS. I was really struggling with that beforehand, which is why I decided to
get a CGM. So I'm obsessed with what you guys do. And I love that you said the price is going to
come down. It's going to be a lot more accessible. But right now, it's difficult when you are kind of at the leading edge of a technology. It's always going to cost
more because it probably costs you guys a lot more. But for me, just speaking for me, it's worth
it. It's worth it to invest in my health and know that this is a real long-term thing. And if I get
this under control now, I think about, well, when I'm in my 30s, how much healthier am I going to be than if I didn't recognize this and get on it. And there's
really no time too late to start, I think with this stuff.
Absolutely. I love that. And thank you for trying it and your support. It's wonderful
and your feedback. And yeah, I mean, our intention is to have the price of this down to $99 a month
within the next year or so. That is our goal. So really slashing the price because accessibility is everything. The people who are suffering the most from metabolic issues in our country and most targeted by really what I would say unethical food marketing and living in food deserts and all this stuff are people who probably cannot afford these high price things. So the more we can show outcomes data that push this towards potentially even
being covered by insurance and really creating volume in the interest so that prices come down,
that is really going to help, I think, us achieve our mission. And so lots to look forward to,
I think, over the next couple of years in terms of this type of monitoring.
Yeah, I agree. And it feels good to be an early adopter because I know without people that adopt
these technologies earlier on, companies would never get the data to be able to say,
hey, look, we're actually doing something really meaningful over here and this is making a
difference. Exactly. Yeah. And we've just raised our round of funding and we're investing heavily,
heavily, heavily into clinical research at academic universities because we really believe in this.
A lot of top researchers believe in this technology as well as a tool to empower people to help people understand their bodies better.
And that is just so, so, so heartening that there's a lot of people thinking about health is not going to happen in a 15-minute doctor's visit.
It's just where there's no counseling about nutrition, no counseling about lifestyle. It's
going to happen in the home every single day, day in and day out when we're making choices.
And so how do we create tools that help people with choices and then make it fun and make it
liberating and make it social. And we need to
be thinking differently about how we're going to solve, I think, some of these massive health
issues that we're dealing with. And people love their data. They love data. We're seeing wearables
go through the roof. And so I just am very hopeful about the future and really excited
about all the innovation in this space. Me too. And I'm so grateful to you guys for doing it.
And for anyone listening that wants to try Levels,
I think the wait list is over like 100,000 people now,
but I have a link which will get you in the back door
that I'm going to put in the show notes below.
I love mine.
My husband is obsessed.
At first he was like, what is this?
And now he's obsessed.
He's like showing me his number.
So it's great.
I could pick your brain for hours, but I won't.
I will let you go. I'm so,
so grateful for you coming on the podcast and making this so understandable and easy to
understand. So thank you so much for being here. Thank you so much for having me and
wonderful questions. And I love chatting about this and I hope it was useful for people
listening. And yeah, I'm happy to connect with anyone who has questions afterwards. I'm at
Dr. Casey's Kitchen on Instagram and we post a lot about this at levels on Instagram and Twitter.
So if people have more questions, come find us and sign up for the waitlist and get on our
newsletter. There's lots of information we're putting out that's I think really, really fun
and interesting. And so yeah, we'd love to connect with anyone who's interested in learning more.
I'll put your Instagram link below
and the blog link below too.
So if anyone wants to find that,
it will just be in the show notes.
Thank you so much.
Thank you.
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