The Dr. Hyman Show - The Worst And Best Foods For Your Blood Sugar with Dr. Casey Means

Episode Date: February 2, 2022

This episode is brought to you by Rupa Health, Thrive Market, and InsideTracker. What if you had a tool that helped you not only make better health decisions but also gave you real-time feedback on how your body uniquely reacts to any kind of food? Thanks to continuous glucose monitors this is something we’ll all be able to take advantage of in the near future. Levels is one company that’s been spearheading the field of wearable technology, providing an incredible amount of information on blood sugar responses and metabolic individuality. I talk to Dr. Casey Means about what we can learn from the 51 million data points Levels has already gathered on blood glucose reactions.  Dr. Casey Means is a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, an Associate Editor of the International Journal of Disease Reversal and Prevention, and a Guest Lecturer at Stanford University. Dr. Means’ perspective has been recently featured in the New York Times, Wall Street Journal, Men's Health, Forbes, Business Insider, Techcrunch, Entrepreneur Magazine, Metabolism, Endocrine Today, and more.  This episode is brought to you by Rupa Health, Thrive Market, and InsideTracker. Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. You can check out a free live demo with a Q&A or create an account at RupaHealth.com.  Thrive Market is an online membership-based grocery store that makes eating well convenient and more affordable. Join today at thrivemarket.com/hyman to receive an extra 40% off your first order and a free gift. If you’re curious about getting your own health program dialed-in to your unique needs, check out InsideTracker. Right now they’re offering my listeners 25% off at insidetracker.com/drhyman. Here are more of the details from our interview (audio version / Apple Subscriber version):  The leading driver of mortality in the Western world (5:52 / 3:46)  The type of foods that are driving cardio and metabolic disease (8:38 / 5:03)   Learnings from 51 million continuous glucose monitor readings (12:28 / 8:53) Foods commonly believed to be healthy that actually spike blood sugar (20:39 / 17:04) How various food combinations affect blood sugar (21:16 / 17:44)  Walking after eating can lower glucose levels (23:32 / 20:00)  Foods we should never eat and surprising foods that spike glucose levels (27:27 / 22:07) Foods that don’t spike blood sugar but should still be avoided (44:22/ 38:52)  How food combinations, sequencing, and when we eat influence glucose levels (51:33 / 46:03)  What are normal and optimal blood sugar levels? (1:06:34 / 1:01:01)  Learn more about Dr. Means’ work at https://www.levelshealth.com/. Levels is currently running a closed beta program. To skip the line and participate in their early access program today, visit levels.link/HYMAN.

Coming up on this episode of The Doctor's Pharmacy. Foods that are commonly touted as healthy or that we perceive to be healthy may actually be generating shockingly high glucose spikes. Hey, Doctors Pharmacy listeners. If you're a fan of the show, I'd love your help. My team and I have put together a brief survey to hear your feedback on the podcast and learn a bit more about our audience and continue to provide you with free content around the biggest issues of our time.

We're going to be giving away five air doctors and five AquaTrue devices that are water filters. So by filling out the survey, you can enter to win one. You can do so by visiting drhyman.com forward slash fan. Again, that's drhyman.com forward slash fan, F-A-N. And just thanks so much for your support. I really, really appreciate it. I know a lot of you out there are practitioners like me helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to

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healthy pantry staples, snacks, household and body care goods, and so much more, and have it delivered right to your door. Thrive Market's an online membership-based grocery store that makes eating oil convenient and more affordable. They've got everything from ethically sourced cabinet essentials to sustainable meat and seafood, non-toxic cleaning products, personal care items, and more. And they make it super easy to search by category like paleo, vegan, low sugar, gluten-free. You can get a monthly or annual Thrive Market membership to find out how it works for you and find the perfect fit for your family. Some of my personal go-to kitchen items from Thrive Market are organic olive oil. It's from Greece. It's awesome. Miracle noodles, which are basically shirataki noodles with no carbs and no glucose effect and super fibers

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Just in case you missed that, it's thrivemarket.com slash Hyman. Welcome to Doctors Pharmacy. I'm Dr. Mark Hyman. That's pharmacy with an F place for conversations that matter. And today this conversation matters so much because it's about the one thing that ends up being the root cause of almost all the things that cause us to suffer as we age. Heart disease, cancer, diabetes, dementia, kidney failure, high blood pressure, you know, all the bad stuff. And what is that thing? It's your blood sugar. We are going to be talking with one of the world's experts on blood sugar who has more insights and data, actual hard data about what is going on with your blood sugar and how to manage it, how to regulate it, how to actually dive into the science of your own biology. None other than Dr. Casey Means.

Welcome, Casey. Thank you so much, Mark. I'm so thrilled to be here. So, Casey, you're pretty awesome. You know, we did another podcast with you so much, Mark. I'm so thrilled to be here. So Casey, you're pretty awesome. We did another podcast with you about blood sugar too. Casey is a Stanford-educated physician. She's a chief medical officer and co-founder of the metabolic health company Levels and an associate editor of the International Journal of Disease and Reversal and Prevention, which

is awesome. She lectures at Stanford University, and her mission is to maximize human potential and reverse the epidemic of preventable chronic disease, all that nasty stuff I talked about at the beginning, by empowering individuals with tools that can facilitate a deep understanding of our bodies and inform personalized and sustainable dietary and lifestyle choices. Dr. Min's perspective has been featured all over the frigging place, the New York Times, Wall Street Journal, Men's Health, Forbes, Business Insider, TechCrunch, on and on and on.

I'm so happy to have you, Casey, today because you are breaking ground with a company that is changing how we think about our bodies, that is giving us a window into our biology that we've never had before, and particularly our blood sugar and all things blood sugar and why that's so important. So thanks for joining us. Thank you so much, Mark. I'm so excited about this conversation. Okay. So the big thing is that we are facing this pandemic of COVID for sure. The reason we are dying like flies in America, more than any other country, probably three or four times the death rates per capita, is because we are so frigging unhealthy. And that poor health is related to poor metabolic health. And essentially what that means when we say metabolic

health is imbalances in your blood sugar, which causes high blood pressure, high cholesterol, and abnormal blood sugar. Those are the hallmarks of this poor metabolic health that now affect almost nine out of 10 Americans. And they're the things that are getting worse and worse and worse. So we're seeing obesity, heart disease, cancer go up. I mean, dementia rising. We're not winning the battle. We are seeing more and more chronic disease every day, more and more obesity. We're better and better at taking care of problems. We have better and better medication, better surgical techniques,

better advances in our science. And we're failing so badly because we're barking up the wrong end of the tree. And that's because we're not looking upstream for the problem. So tell us about the foods that are driving all these problems, the places we should be looking at in terms of our diet and our lifestyle. Well, I think that summary was so phenomenal. We are dealing with two epidemics that are so

interrelated right now. We're dealing with the metabolic disease epidemic, which is the leading driver of mortality in the Western world now. We like to call all these different metabolic diseases by different names, which may make them artificially seem like they have less impact. But really, like you said, the root cause is a problem with metabolism. When we talk about obesity, diabetes, heart disease, stroke, Alzheimer's, dementia, fatty liver disease. We know that all of these are related to dysregulated blood sugar. And in fact, nine of the 10 leading causes of death in the United States are in some way either directly

caused by or worsened and accelerated by dysregulated blood sugar. So to get to this question of what are the foods we need to avoid in order to prevent these diseases, also pulling the other levers that impact our blood sugar, which is of course, exercise, sleep, stress management, optimizing our microbiome, avoidance of environmental toxins that hurt our metabolic pathways. I would say that the foods that drive these cardiometabolic diseases are foods that disrupt our cells from doing what they need to do to function optimally and that then lead to insulin resistance, the physiologic process that ultimately creates the dysregulated blood sugar. These are the foods that are highly processed, that have the ultra-refined ingredients. These are the foods that make up the vast majority

of the calories we consume in this country. They have the ultra refined wheat flour, the processed sugar, which of course has more than 50 names on the packages. So it's so hard to tell, you know, which of the foods actually have processed sugar. But the answer is most of the ones that are packaged in the store. These are the foods with fructose and high fructose corn syrup, the refined seed oils like sunflower, corn, soybean oil. These are the foods that when we eat them in these super high concentrations that our bodies have never seen before in evolutionary history until about the past 50 or 100 years, they completely wreak havoc on our core fundamental processes that allow our cells to function properly, which is our metabolism,

and they disrupt our homeostasis. So those are the types of foods that you certainly want to avoid in order to prevent these diseases. And the unfortunate thing is that these ingredients sneak into so many different foods, often foods that are marketed as healthy. And so we really are in a tough position right now because the reality is that the average American wants to be healthy and is putting in work to try to be healthy. We see that 50% of American adults go on a diet every year trying to lose weight. Of course, 72% of Americans right now are overweight or obese, but half the country is making the commitment and reporting that in a survey saying that they're trying to lose weight. And yet every year we are getting sicker, we are getting fatter,

we are getting more anxious. So there's clearly an effort outcome mismatch. And that's where I think the future of medicine- Yeah, effort outcome mismatch. Yes that's where I think the future of medicine... Yeah, effort outcome mismatch. Yeah, that's a good way to talk about it. Right. And that is where I think tools that can empower people with information to actually make choices that actually impact the physiology that leads to chronic disease and weight gain is really going to shape and change the future of healthcare and really create this patient-empowered, more decentralized form of healthcare where we don't just outsource our judgment to other people, to the food companies, to healthcare systems that give

very generic recommendations to anyone. We actually are able to have the judgment about our bodies for ourselves. And I think that's pretty cool. It's huge. It's all about empowering people, democratizing healthcare, democratizing medicine, giving people their own health data, helping them learn about it, be their own autonomous health creating units. Because, you know, as we know, 80% of health doesn't happen in the doctor's office and

maybe 20% doesn't. I think that's an exaggeration. Health happens where we live. It happens in our homes and our kitchens and our schools and our workplaces and our grocery stores and our restaurants. That's where health happens. And if we don't focus on those factors and learning how to be not just waiting to go to the doctor to get fixed, but actually being in charge of our own health, being the CEO of our own health, we're not going to be able to actually break out of this horrible situation. It's kind of terrifying to me. I mean, you're sitting on the front lines of it like you are. It just seems like one of those conversations that's just not really

happening. Like nobody's really saying, hey, we're in like a crisis. Everybody's upset about COVID, but way more people die every year from bad food than die from COVID or get sick from COVID. And it's causing so much more suffering, so much more health care costs, so much more crippling of our economy. One of the things that's so exciting about the work you're doing, Casey, is that you're not using sort of these large randomized control trials and large observational trials and things that are sort of the conventional way of looking at people.

You're looking at what we call end-of-one studies. In a sense, we're looking at how does each individual respond as their own control group? Because you basically slap on this glucose monitor that measures your blood sugar continuously, called levels. You put it on your arm, you leave it there, and your sugar is just being tracked. And so you get to actually witness what your body does in response to a particular food or sugar. And you've got data from 50 million glucose readings, which is insane when you think about that amount of data that you're collecting and that people are using this technology. And we're learning so many things that are so surprising.

And I think, you know, we know, for example, that no two people respond the same to exactly the same food. For example, in Israel, they did a large study that looked at the microbiome and they found that there were differences in people's blood sugar response, depending on what bacteria were growing in their microbiome and their gut, which is like, what? That doesn't even make sense. It depends on your genetics, depends on your overall metabolic health. It depends on so many different factors, your toxin load, all these modify your individual responses. So when you've got these 50 million glucose readings from the Levels app, the continuous glucose monitor, what are the sort of surprising things that you found?

These are sort of non-diabetics, right? So it's not like you're a diabetic, although probably I bet you're picking up that. 90% of people with prediabetes have never been diagnosed. I bet you're picking up a lot of that. What are you learning? What are you seeing? What is surprising? It has been so incredible to start to see some trends emerge from this huge anonymized, aggregated data set, really the first of its kind in the world. Like you mentioned, we have 51 million glucose data points, and this is just amongst our closed beta program, 16,000 people who have gone through our closed beta program. We have almost 200,000 people on our wait list. So you can imagine that 51 million data points is going to get a lot larger when we start opening to more people. We have those 51

million glucose data points paired with 1.3 million food logs. So we can start to see for the first time ever how specific foods across a population are affecting glucose and creating this population data of a closed loop biofeedback. You mentioned the individualized aspect of this. That is so true. And that paper that you referenced, Personalized Nutrition by Prediction of Glycemic Responses, that was done about five years ago in Israel, showed how variable it is person to person. We could both, of course, eat the exact same cookie, and you and I could have a very different glucose response based on several factors, like our microbiome, our underlying insulin resistance, et cetera. So that's a really important aspect is for the individual, what kind of data they can get to really, truly personalize

their own data based on glucose response. Because of course, and we talked about this a lot in our last episode, a more stable glucose level with more gentle rolling hills after meals, avoiding the huge spikes and valleys that we see after eating large amounts of carbohydrates and sugar. That's what we want. We want the gentle rolling hills, the low glucose response. So you can start to see that in yourself and shape your diet very quickly. On the population level, then we get to see something interesting as well that actually can benefit anyone, not just the people who have a sensor on, because this becomes a database that

really informs the nutrition industry like we've never been able to before, where we start to see radical transparency about what food is actually doing to people's bodies. And I personally think in five years, it's going to seem incredibly outdated, incredibly quaint to walk into the grocery store and choose foods based on what the box says, based on interests that are not aligned with your thriving and well-being. They're aligned with taking you to your bliss point, making you dependent for it, making your dopaminergic reward systems want to keep coming back, but it's not aligned necessarily with your health. And so we're going to start to see this huge new way of choosing foods. I can imagine, you know, like a person with polycystic ovarian syndrome, for instance,

a condition that we know is directly related to insulin resistance. And studies have shown that low carb diets, a healthy Mediterranean ketogenic diet for just 12 weeks can actually reverse PCOS. This was a study done just a couple of years ago. So there's people and women are very savvy with their research and they're going out and they're reading the books, they're reading these papers, and they know they need to keep their glucose and insulin under control. They know that just being prescribed a birth control pill and metformin is not the answer to their long-term health. And so they're looking for tools.

And you can imagine that woman, her doctor says to her, oh, you don't have diabetes. You don't need to worry about blood sugar. You have PCOS. It's very different. They know, though. They've read. They do their research. People are very smart, very different. They know though, they've read, they do their research. People are very

smart, very informed. They know they're going to work to keep their blood sugar down because they know that in the research that shows that it will help. So they go to the grocery store now with this app, with something that they can actually look up every food they're buying and see exactly across tens of thousands of people what it's doing to people's blood sugar. So you go into the non-dairy milk aisle and you've got 15 different options. You've got oat milk, you've got almond milk, you've got cashew milk, blah, blah, blah. And it's like, what the heck are you supposed to get? And you think you're making a good choice because you're buying an unsweetened non-dairy milk. But the reality is from our data set that there are some of those that give you a

monumental spike, even if they're unsweetened oat milk, you know, and then there's others that actually have virtually no glucose response. So that person now can take their health into their own hand, make a consumer decision, not based on marketing, that's going to serve their goals. And I am so excited for that world because people are going to start, I think, demanding from food companies to actually create products that are not creating a huge amount of glycemic variability

or these ups and down spikes. And you can't hide from that data. And so I'm really thrilled of what that's going to do. So circling back to your main your main question of kind of like some of the themes that we've seen. Yeah, what do we see? I think one of the first things that's really interesting is our demographics, actually. So aside from glucose data, actually 52% of our beta members are women. And this is so different than what you hear in the mainstream media. You

know, there's a New York Times article about levels that talks about how this is for the worried well and the biohacker guys and the longevity crazy. You know, and it's like that is not the reality. The reality is this is this is mostly women in their ages of 30 to 40. So very, very similar to the demographic I was talking about with people who are at high risk for things like PCOS. And their primary reason for wanting to use a CGM, what they report to us is weight loss, followed by finding their optimal diet. Of men, in the 48% who are men, their number one goal is optimal diet as well. So people are clearly interested in finding what actually works for them. You know, if you go back to what you're talking about with COVID, you know, the CDC just announced yesterday, finally admitted that 75% of the people dying of COVID have

four or more of these largely preventable cardiometabolic comorbidities. People know, they know now, and now it's finally coming out in the mainstream media that we've got to get the blood sugar under control. Um, so, so that's one thing we're seeing is really interesting demographics. This is not the worried well. This is not for the celebrity rich and famous. This is for people who want to just figure out their diet and lose weight, which is great. The second thing we've seen a lot of is that foods that are commonly touted as healthy or that we perceive

to be healthy may actually be generating shockingly high glucose spikes. And I think we particularly see this around breakfast foods. We certainly see snacks, common snacks, drinks, common takeout foods. And we can certainly dive into the details on those. But it's amazing how some of these things that we just think are totally normal to just eat on a Friday night or whatever, they're actually, or grab for breakfast, or serve in school lunches at schools are actually causing these huge, huge glucose spikes. And then I think another thing that's been really interesting is showing people combinations and alternatives of foods that they can do that will do better. So for instance, combinations, we see a lot of people log something like an apple, and then they'll log an apple with like peanut butter and yogurt. And that peanut butter and yogurt is adding, of course, fat and

protein. Sometimes they'll put some chia seeds on that. That's some fiber. And we've definitely seen that when carbohydrates, sort of naked carbohydrates like a fruit, are paired with fat, protein, and fiber, people do better. In terms of alternatives, we've seen some really interesting things. We just published an article on Chipotle. We see people logging all sorts of things at Chipotle. Some of them, disaster for glucose. Some of them, virtually no glucose response, like an average of 7 milligrams per deciliter,

very low. So the really minimal glucose spiking things is the keto bowl. This is a salad that has protein, fajita veggies, guacamole, salsa, virtually no glucose spike, tons of nutrients. Burritos, on the other hand, with that gigantic tortilla, send people on average through the roof. So people start learning, if I'm going to go to McDonald's, if I'm going to go to Chipotle, if I'm going to go to Sweetgreen, what should I order that's going to give me the best bang for my buck in terms of blood sugar? And then I think the last thing I would just- And everybody's different, right? Everybody's different, right?

So it doesn't mean that what works for you, like you say, oh, I found that this screwed up my blood sugar, it doesn't mean it's gonna screw up your friend's blood sugar, right? That's definitely true. So these are more of the population-based sort of things that we're seeing that can kind of give you, I think,

a general gestalt of where you should start. And then of course, it's about actually trying it for yourself and seeing what actually works for you. There may be that person out there that doesn't spike to a huge flour tortilla, but for most people, knowing that getting the keto bowl is going to have totally stable blood sugar on average for the population, they can at least go in there and get that and see what it does to them. So it kind of, I think, nudges people in the right direction. And then the last big insight that I think we're seeing is around, this is so simple, but it's profound, is walking. We have seen that a simple walk after eating

significantly reduces glucose responses. And we actually did an experiment with our members where we sent people a 12-ounce can of Coke, two of them. And we said, hey, if you want to do this, drink this Coke on one day. And then on the next day, drink the Coke and take a walk right after you drink it. Yeah, yeah, yeah. And we actually saw across this population that of the people who completed both aspects of the experiment, the median delta of the glucose rise

was 33% lower if you just took a walk. So that was going from an average of 162 milligram per deciliter peak to 132. Over the course of your lifetime, if you're doing this every day, that's a huge difference. So how soon do you have to walk after you eat? Well, there's a lot of research that looks into this. And it really comes down to the sooner the better. Anytime you walk after a meal, even if it's an hour or two, do it. That's fantastic. But because our glucose tends to peak within an hour after a meal, I would say what I would recommend to people is after a meal, finish the conversation, 15, 20 minutes, get up with the family, take a spin around the block, put the dishes in the sink, go take a nice stroll around the block and then come back. And if you don't want to walk outside because it's cold, put on some great music and have a dance party in the kitchen or do a few squats. It's really just about moving, but these are significant effects. So that's kind of the

general layout of some of the things that have been so interesting to me just from looking at this huge, huge data set. That's just so fascinating. It's like we just sort of have this one size fits all approach in traditional medicine, and it's just so far from that, right? Hey, everyone, it's Dr. Mark. Something I get more and more excited about every year is personalized medicine. When I began practicing functional medicine over 20 years ago, it was clear to me we have to look at how unique each body is. Now with the technology advancing in amazing ways, we can truly take that concept to the next level. One of the tools I recently discovered that can help us all do that from home is InsideTracker. Founded in 2009 by top

scientists in aging genetics and biometric data from MIT, Tufts, and Harvard, InsideTracker is a personalized health and wellness platform like no other. It's purpose-built to help you live a longer, more productive life. Their cutting-edge technology analyzes your blood DNA lifestyle to give you highly personalized recommendations. Then using the app, you can track your progress every day. InsideTracker tells you what to do and why, so your health goals are clear and actionable, and most importantly, based on exactly what your body needs. My team took InsideTracker for a spin and really loved it. They discovered some important things about their health that led them to stop procrastinating when it came to certain parts of

their health, like, for example, finally taking vitamin D supplements after seeing they were deficient, or eating more iron-rich foods due to low ferritin and hemoglobin, and making an effort to embrace stress reduction techniques after seeing high cortisol levels. Health is not black and white, and your wellness plan shouldn't be either. If you're curious about getting your own health program dialed into your unique needs, I highly recommend checking out InsideTracker. Right now, they're offering my community 25% off at InsideTracker.com forward slash Dr. Hyman. That's Dr. Hyman. InsideTracker.com. That's I-N-S-I-D-E-T-R-A-C-K-E-R.com slash Dr. Hyman, D-R-H-Y-M-A-N. And you'll see the discount code in your cart now let's get back to this week's episode of the doctor's pharmacy you know you also learned about for example what would be things we should

never eat like one of those things we should just never eat well i'll go off of um just what we're learning in our data set like because we could obviously you and i could talk about this forever about general principles but um yeah but i think getting the specific data is just so fascinating. That's why I want to get into it. Absolutely. Of the categories of things that at this point, based on what we've learned, I would not really eat anymore would be certain candies, which I'll go into each of these in more detail, cereals, certain cereals, soda for sure, fast food, and lots of common takeout.

So when we look at candy, this is actually really interesting. The worst food in our entire data set of 51 million glucose data points is... I want to hear this drum roll, please. Skittles. Skittles. Skittles, wow. Not surprising because it's a refined carbohydrate. Obviously, there's refined sugar in there, but it's also kind of a naked carb, right? It doesn't actually

have fat, protein, and fiber. A Snickers bar at least has some fat and some protein. The Skittles are just like naked carbs. So the Skittles have an eating- Naked carbs. I love that term. I never heard that. I love that. They're just on their own, you know, like, and you can think of like fat protein and fiber as kind of clothing the carbs. So Skittles have an average glucose rise in our data set of 83 milligrams per deciliter. So that's certainly going to take you up. It's way more than a Coca-Cola and you are going to almost inevitably crash after that type of spike.

Because of course, when you spike that high, you release all this insulin to soak up that glucose out of the bloodstream. And that huge surge of insulin can overshoot. The body responds sort of in an exaggerated way. You take up all that glucose. And then people often dip to below their baseline and have that reactive hypoglycemia after the spike, which is when they feel shaky, tired, lethargic. Yeah, exactly. The beauty of achieving more of the gentle rolling hills is that you don't end up having that reactive hypoglycemia that can make you feel really crappy, that post-meal slump that people are often like, oh, I just need a cup of coffee or something. It's like, no, it's the Skittles. And so Skittles have a huge... The other candies that are in the worst part of our data set are Sour Patch Kids, Caramel Corn,

Twizzlers, and Jelly Beans. So you notice they all are similar. They're all these kind of... Jelly Beans. Not chocolatey, no protein, no fat, just like straight congealed sugar basically. Yeah. So those are the candies. We used to have those things when I was a kid. It was like this powdered stuff, Lick-O-Mate or something. Like I forget what it's called.

Lick-O-Mate. You put a stick in, you lick it, it's just pure sugar. Yes. And the stick was made out of sugar too. Wasn't it like a candy stick? I don't remember seeing that anymore. I mean, I don't really look for it, but I was like, that was my main go-to thing. It's like when I was six, seven years old, I wanted to lick a maid. It was like a fentanyl lollipop.

I mean, we use sugar as a pain management tool in hospitals. This is, it's, this is abhorrent, but when children undergo circumcision in the hospital in their first days of life, what do they give them for pain medication? This little dropper called a Sweeties, which is just sugar water. That is the analgesic. So it's like exactly like you said, it literally is like a functional lollipop. Um, so that's candy. So, yeah. So get, get rid of the Skittles. You know, a Snickers bar literally has half the glucose spike of Skittles. So it's pretty amazing. Then it's cereals. Oh my gosh. Get the cereal out of the house. We should eat those. You mentioned takeout and other things too, right?

Well, just to tell about the cereals, Cinnamon Toast Crunch, Honey Nut Cheerios, Lucky Charms, about 60 or above on glucose responses wait wait honey nut cheerios so we think honey is good nut is good and cheerios are good so it's like actually just a wolf in sheep's clothing it sounds like after cinnamon toast crunch it's the worst yeah oh my god worse Froot Loops or Pebbles or Cocoa Puffs or any of that? Those, you know, I haven't checked those precisely in our data set. But when you look at just like the top 50 worst foods that people log, all three of those, I mean, these kids are going to school after having these spikes and crashes.

And, you know, Mark, like a lot of them are probably eating a glass of OJ on the side, which these are isolated food logs. I mean, Casey, I'll just break in for a minute. I remember when I was filming the movie Fed Up, and one of the scenes was where the mother was trying to get her kids to lose weight and her family to lose weight. And she's like, well, what I really focused on is healthy breakfast cereals. And she pulls out these cereals that are marketed as quote, health foods. I mean, Kellogg,als that are marketed as, quote, health foods. I mean, Kellogg, who invented breakfast cereal as a breakfast food, which wasn't a thing, right?

These are basically dessert for breakfast. It's 75% sugar. And that is having a soda with breakfast. So I think people need to get that cereal and starch for breakfast is a huge no-no. If you can do one thing to change your biology quickly, it's get rid of any starch or sugar for breakfast. Yes. Yes.

You said that it's like eating sugar for breakfast. I will up the ante here. It's much worse than eating dessert for breakfast. Peach pie has an average glucose spike of 46 milligrams per deciliter. Cinnamon toast crunch is 59. It's, you know, and they both have, of course, the refined seed oils and the flour. It's worse. So. Okay. Give me the peach pie. I love peach pie. I know. Exactly. Exactly. So you mentioned, you know, getting rid of the breakfast foods that

have the refined starches. This has been one of the most fascinating things we've seen because all the common American breakfast foods are in the worst 100 foods that score. And these, just to run through them really quick, we're talking about, this is in our worst 50 foods, egg McMuffin, bagel with cream cheese, French toastast, Pop Tarts, Cereal, English Muffin, Blueberry Scone, Cinnamon Roll, Cheerios, Croissant, Toast with Jam. Those are all above a 40 milligram per deciliter spike. So that's a big spike. Which is a lot. It's a lot.

If you look at then the best foods in our data set, like very little glucose spike, you also see a handful of breakfast foods. And so these are the ones we want to eat. We see frittata, we see avocado and egg, avocado and greens, chia pudding, Greek yogurt and berries. And we actually see this, a lot of people log this, I think because Kelly Levesque is sort of close in our network, but we get a lot of logs for the Fab Four smoothie, which is a smoothie that she has popularized, which is really balanced. It has very minimal fruit, a lot of protein, fiber, fat, and greens. And all of those that I just mentioned all score below 20 milligrams per deciliter. So you want to get – I mean, it's basically, Mark, it's the vegan diet. Like, it's, you know, people can read your book and like, but it's, it's, it's the, it's the beautiful sort of like nutrient dense foods that none of those have refined carbs. And I think people sometimes

assume that, Oh, if I'm going to have a keto breakfast or a low carb breakfast, I need to eat the animal products. That's not true. Half of those things I just mentioned don't have animal products, the fab four smoothie, the chia pudding. You could do non-dairy yogurt with some berries, some avocado. And so that's just something important to remember, that breakfast is this one's straightforward. Don't eat those first things. Eat those things. Fat and protein for breakfast, get rid of the starch and sugar.

Yes. Very important. And I think it's super important. In my sugar detox book, I create a smoothie, which is essentially nuts and seeds. So it was raw nuts, almonds, walnuts, pecans, whatever, hemp seeds, chia seeds, flax seeds, putting in like cranberries, which is actually very low glycemic, a little lemon, maybe some berries, unsweetened macadamia milk or whatever. And it's basically in greens, you can put in there an avocado. And it's basically a protein and fat smoothie that

tastes delicious. And it's not all the typical, I mean, oh my God, like things like Ensure, Boost, all these sort of meal replacement things. Most traditional smoothies are full of sugar, artificial sweeteners are processed, highly processed protein powders. I mean, it's so good to get just real food. So I love that, a real food smoothie. I want to ask you a couple more questions. So there are a bunch of things you learn just because this is such a new area. We're just learning about in real time what happens to real people in a continuous glucose mounting setting, which people have to realize this is not a technology that's been around for a long time. It's relatively recent. And it's even more recent that it's being used at scale by non-diabetics. So that's a huge thing. We're just learning stuff that we just

never had insight into before. And Levels is capturing that data and making sense of it. It has so many beautiful lessons. And for you, I mean, for anybody listening, Levels is going to be launching. It's a great technology to actually see what's going on with your own biology and i i was super surprised too and shocked and i'll just give you a little anecdote of what happened to me but the first night we got it i i used it i was at my friends and we had this big dinner we ordered all the healthiest food from this like regenerative farm and like lamb and all these veggies and it was like so healthy and not sugar there was no starch it was like amazing and we like ate so much food was no starch. It was amazing. We ate so much

food. We just ate a huge volume of food, of healthy food. We both were going to bed, checking our sugar and texting each other like, what happened? Our sugar is like 160. This is freaking me out. What's up? Any big meal also can cause a spike. There's a few things you learn. One of the surprising things you learn that One is, what are the surprising things you learn that we should really never eat? I mean, sorry, that actually spike your blood sugar that are surprising to you? And what foods might not actually spike your blood sugar, but you still should get kind of rid of? This is such a great question. You asked for some surprising foods that spike blood sugar. I want to preface this

answer by saying that some of these foods, it's not necessarily that you should avoid them completely because they're actually nutrient dense whole foods. It's that it's good to be aware of how they're affecting you so that you can figure out how to eat the food in some different way. Maybe eat a smaller portion, maybe pair it more with fat, protein, and fiber, maybe take a walk afterwards. But the intention is not to hear these foods and then say, oh, I can't eat that again. It's not a good food. So this brings me to one of the first ones, which is certain fruits. There are certain fruits that spike people on average a lot more than others. The ones that we see in the data set are banana, which is maybe not that surprising, but grapes.

Grapes have an average glucose spike of over 40 milligrams per deciliter, whereas like a mandarin orange, for instance, is like 20. So it's a very big difference. We also see even within fruits like different types of oranges, a mandarin orange has a low spike. A sumo orange is almost double that. And I mean, those sumo oranges are like so unbelievably delicious. And it also could be kind of a size thing, but chop up those oranges, put them in some yogurt and add some Zen basil seeds or chia seeds or something with tons of fiber, it's going to potentially blunt that spike. So fruit juice is not a huge surprise, but like orange juice,

huge spike, average of 40 milligrams per liter. So I would say, of course, avoid liquid sugar, which I would consider juices to be liquid sugar. But certain fruits do have more of a spike than others for sure. The next one, corn on the cob. What? Average glucose spike of 46 milligrams per deciliter, which is the same. What if you lather it in butter? Well, maybe doing some grass-fed. And what if you have it with you? Yeah.

I think it's a good point. Grass-fed beef with it as before? Or grass-fed butter. You know, some really nice butter, some ghee. I actually put corn now. I only use corn really now within recipes because I know that if I eat corn alone, it's going to spike me. So for instance, I make these really great hearts of palm crab cakes. So they're crabless crab cakes and they have some corn in there. They don't spike me. I eat it with an avocado relish.

There's lots of other stuff going on. So I just have figured out how to balance it to not spike me. We also see big spikes to some foods that are totally marketed as low carb. Like I hate to throw some certain brands under the bus, but Smart Sweets, they market themselves as having significantly less sugar than other candy. Um, but they have a higher glucose spike on average than a cinnamon roll. So that that's where marketing, you know, people are like, Oh, you eat the low carb candy. You got to test it on yourself. Um, and then this one was interesting. So the fasting mimicicking diet has become really popular. And actually, this one in our top 10 worst scoring foods. So right next to Skittles is-

You mean the fasting mimicking diet, the Prolon diet? The tomato soup has an average glucose spike of 53 milligrams per deciliter. I don't quite know what to- So it wasn't the whole program. Nope. It wasn't the whole program. This is an individual food. Yeah. One of the soups.

So I need to talk to Walter Longo and tell him to swap out that soup. You should just send it to him. I will. I'm going to. I'll send him the episode. You know, we have not met personally. But the thing is, their results of the data of that program are profound. And it is clearly evidence-based that it is extremely effective for improving cardiometabolic biomarkers.

What I would say, though, is that there's probably a way to even more tweak that program if the ingredients were slightly modified. I don't think that glucose spike in the context of basically eating like 500 calories a day for five days is really going to hurt people, but we want to reduce glycemic variability, you know, and it's probably pretty simple to swap out some ingredients there. So that's good information to have, you know, and the last thing I'd mentioned that has really blown me away is the energy bars. We probably have over 50 different types of energy bars logged in the data set, ranging from Quest bars, Bulletproof bars, Cliff bars, Luna bars, all of these. And the spectrum is profound. Yeah.

We see that- Yeah, somebody's like, what bar should I eat? It's such a big question. What protein bar? What bar do I have? What's good? And people are eating stuff and I'm like, I wonder about it. They're walking to Whole Foods and you go to that aisle with all the bars and it's just colors galore, beautiful packaging, all these claims on every box. Each one has a different thing. It's like, oh, this has no sugar alcohols. This has high protein, et cetera, et cetera. This one's organic. How the heck do you know what to choose? Well, in the future, we can look it up like this and figure it out.

So for instance, like Clif Bars have a spike around 42 milligrams per deciliter. That's almost 10 points higher than a Snickers bar. Like I used to eat those. I used to live on those things. Yeah. Go macro bars have a spike of around 44 milligrams per deciliter. And then you look at some of these others like bulletproof bars are like very low, perfect keto bars. And so I'm just, you know, this is all just sort of your kind of, you know, anecdotal data. This is obviously not controlled trials. But what I get excited about is that that person in that aisle who has made the commitment to try to lose weight, to try to be healthier is not at the mercy of the food marketing,

of what the box says. They actually have some agency now in the face of, unfortunately, industries that are not necessarily aligned with our long-term health. So those are some of the surprising ones that we've seen. Yeah, I bet. I mean, a lot of people are trying to design products that are good, but they never had this tool before. So now they can reformulate, maybe think about it. And I think that's the key. We have to stay current with what's true. And I think your work and getting this data is going to be so important to helping us be empowered around making the right choices in general, but also for us, right? So you also mentioned things that could spike your blood sugar. I mean, they don't spike your blood sugar, but actually we should still get rid of what,

what, why, why is that? Well, this is such an important question because I want to be very clear. Glucose is not the only biomarker that you need to orient your diet around. There are other, it's right now, it's the only continuous biomarker that we have that can give us closed loop biofeedback on nutrition. We don't have anything else that we can put on our bodies and see exactly how food's affecting us. You know, I think of course, both you and I would probably love to see an inflammatory monitor, an oxidative stress monitor, you know, these things that also affect our health. Insulin. Insulin, of course. You told me you were into insulin.

Of course. And so that's what kind of gets into the things that won't spike glucose, but you still should avoid for optimal metabolic health. The first and the biggest one is fructose. So fructose alone will not spike blood sugar or insulin. But we know from the mechanisms of how insulin resistance develops that it directly contributes to insulin resistance through a really interesting pathway. Fructose is broken down into a byproduct called uric acid, which goes into the mitochondria, the seed of our

metabolism in the cell, and generates oxidative stress, this damaging free radical activity that actually causes the mitochondria to become dysfunctional and process glucose less effectively and shunt glucose to fat storage. So then you start getting fatty liver disease because of fructose, and that fatty liver disease causes liver insulin resistance, which then makes you less able to stabilize and regulate your blood sugar. So fructose has this really interesting side pathway that ultimately leads to more instability in glucose, but will not show up on a CGM if eaten in isolation. Now, of course- It's a really important thing. I just want to stop there because you said something super important. You know, if you're, for example, eat

a sugary soda with, you know, with high fructose corn syrup, you know, you'll get a mixture of glucose and sucrose. But if you have like pure fructose, which is like agave, for example, that's just pure fructose. And that actually turns out to be pretty bad for you. If you're eating fructose in the matrix of a fruit, it's probably not as bad, right? It's actually can be okay to have it in a complex of a meal. We'll talk about food pairing in a minute. But the idea that you can be eating certain foods, fructose, which a lot of, like for example, processed food is mostly fructose. Like they use high fructose corn syrup, but it could be 75% fructose. And that isn't going to spike your blood sugar like you said, but it's going to create a cascade of events that actually makes you

more likely to get diabetic by increasing the uric acid in the liver or the insulin resistance. And the uric acid story is a very fascinating one. And David Perlmutter just wrote a book about it called Drop Acid, which isn't what you think it's about. It's about the uric acid in the blood that's causing so many of these issues. And fructose is a huge culprit. So I just wanted to pause there. which isn't what you think it's about. It's about the uric acid in the blood that's causing some of these issues. And fructose is a huge culprit. So I just wanted to pause there. It's so important. So going off of like, what else should we be thinking about? I would love to see a uric acid continuous monitor because then all of a sudden, if we could measure both those things, then we start to see a more holistic view of how food is affecting us.

Because ultimately our mission at Levels is to help people know how food affects their bodies so we can reverse the metabolic disease epidemic. But right now, there's still some blind spots. So like you mentioned, David Perlmutter is coming out with a book called Drop Acid about how fruit is affecting our health. We also, in February, are getting another book by Rick Johnson from University of Colorado that's called Nature Wants Us to Be Fat, which is also all about uric acid. And so I think we're going to be starting to talk a lot more about that come February, which is awesome because fructose is absolutely killing us.

There's just absolutely really no two butts about that. And like you said, it's not the fructose that comes in fruit, which is in a complex of fiber, in a whole food, slower to digest and smaller quantities. It's the refined liquid versions that go into our processed foods and that we find in juice that we should really avoid. Because what happens is the liver knows how to process fructose and it knows how to just produce small amounts of uric acid that our body knows how to handle. It's when we overwhelm those pathways in a short period of time that we get the uric acid skyrocketing and create that oxidative stress. So it's really a lot about pacing. And they've even done research showing that if you drink a Coca-Cola slower, like over the course

of an hour or two hours versus in five minutes, it actually has less of a damaging effect on liver. Because you have to think we're just made up of a ton of cells that are trying their hardest to process this stuff, right? And so if you can process and clear, process and clear, it's better than if you just jam it down your throat and overwhelm the enzymatic, all these enzymes in the body that are trying so hard to get through it. And then you end up creating excess of these damaging byproducts that ultimately lead to organ dysfunction. So fructose is a big one. The second big one I would mention is the pro-oxa of stress-inducing foods that come from more like

refined fat. So it's like the seed oils that we talked about. Again, the name of the game is in many ways, oxy of stress, which is this process that damages our mitochondria. So you want to avoid those refined seed oils that are in everything that's packaged. And you really be vigilant about looking at labels and trying to opt for things that only have oils like avocado oil, olive oil, coconut oil, ghee, butter that are less prone to oxidation. So are you saying this based on your data from levels around the refined seed oils or just in a general way? I'm not saying that based on our data set. None of these actually. These ones for this question, not talking about our data set. None of these actually. These ones for this question, not talking about our data set. The thing is about the data set is that what we're seeing is the real we'll start to see the longer term, the lagging effects of how these other products like fructose and refined seed oils and excess alcohol over the longer term

lead to glucose instability. A lot of that we just don't have much knowledge about because we haven't been looking at pre-disease very much in our medical system. We don't really study healthy people and how they go from healthy to pre-disease to disease because that's not the way that our healthcare system works. We wait until disease and symptoms emerges and then we react. And that's a problem. So I think we're going to see a shift here in starting to understand, but this is more based on what we just know from the mechanisms, the, the fructose and the seed oils. Yeah. Amazing. So I have a question about another aspect, which is not exactly what we're eating. It's, it's dealing with more complex

nuances around what do we eat with what, when we eat, right? The timing of eating, you know, what we eat first, second, third. This is really interesting. And I remember talking to an endocrinologist at Harvard, I think, a while back. He said, you know, we're finding like if you have a glass of wine at the beginning of a meal, it messes up your metabolic health. But if you eat it like halfway through or drink it halfway through or have it after, it doesn't. Or if you eat a piece of bread before dinner, it's a disaster, but you have it like halfway through the meal, it doesn't spike your blood sugar as much. So

tell us about what you're learning about what you should eat with what to kind of minimize the spikes in blood sugar. And two, what you should eat first, second, third. And three, how does time-restricted eating affect all this blood sugar stuff? Yeah. Well, I think the alcohol example is really interesting and is an important one to mention, especially both in relation to your last question and this one. Alcohol is really interesting because straight alcohol, like spirits, no mixers that have sugar, actually often cause people to see a decrease in their blood sugar on their continuous glucose. You mean, you mean me like tequila, not like wine, wine, wine actually fits in there as well. So wine, tequila, other sort of like hard alcohol,

that's not mixed with anything. People often see that it blunts their glucose response. And this is a well-known phenomenon. Um, the way that alcohol acts on the liver is that it actually stops us from doing what's called gluconeogenesis, which is the process where, or it inhibits that process where, and that's where we make glucose in the liver from other substrates. So it's one of the pathways that our body uses to make sure our glucose never gets too low. But when you block that, it can make glucose just look artificially a little bit lower because that's one of the streams of glucose going into the body. Food is another one, but you're turning it off. And so that's an interesting thing where it will not spike your glucose, and I wouldn't say it should be avoided completely, but in excess,

it should be avoided because over time, you know, two or more drinks a day is associated epidemiologically with worse metabolic outcomes. Interestingly, if you look at the risk of alcohol and metabolic disease, it's actually a J-shaped curve, meaning that if you drink no alcohol, people actually are in a slightly higher risk for developing metabolic disease, very minorly higher. But one drink seems to be associated with the lowest amount of future development of cardiometabolic disease. And then after one, it sort of goes up. So it's a J-shaped curve.

This is not to say you should drink for your metabolic health, but it is kind of an interesting thing that you do see in the literature. So that's sort of the case with alcohol. It won't spike your glucose, but an excess should be avoided. And another interesting thing about alcohol is that it, of course, disrupts the microbiome and can create, you know, some transient leaky gut. It also conventional wine is filled with pesticides and food additives that we know can impact the gut. And like we talked about earlier in the episode, gut health and microbiome diversity is one of the predictors of, of your response to, um, to different foods in terms of glucose response. So, you know, this is, it gets, it gets kind of complex. If we could also track our microbiome, this also might help us, uh, help us understand our diets a little bit more. So, um, we want to,

you know, certainly be thinking about microbiome and about environmental toxins when we're eating, even though some of those things are not necessarily going to spike your glucose in real time, eating pesticides is not going to spike your glucose, But over time, it can create the toxic damage to our cells that ultimately does lead to insulin resistance. And we know that certainly with several of these chemicals in our environment, like persistent organic pollutants, that of course are not going to spike glucose immediately, but which over the long term create cellular dysfunction. So kind of getting back to your question about how to pair foods and time them and sequence them, the key point is balance. You want to eat carbohydrates with fat, protein, and fiber.

That is generally going to blunt the glucose spike by slowing digestion. And fiber actually can sometimes block the amount of sugar you even absorb from the gut. Um, they've looked at studies, I think with, uh, with nuts, for instance, which have a good amount of fiber and the calories that are on the bag may not be the calories that you actually end up absorbing because fiber blunts some of that absorption. So I think of fiber as like a total magical life hack. And I end up adding, I end up adding chia seeds. And I love this other type of seed called zen basil seeds, which actually have more fiber than chia, just sprinkle it on stuff. It's like a little

superpower. No, you could even take a spoon of metamucil in glass of water and drink that. I mean, I actually have studied that it helps PGX another one, polyglycoplex, which is from cognac root of Japanese fiber, the shirataki miracle noodles. That stuff is amazing and that can be powerful. And you give it before a meal. I've had people lose 40 pounds like that just adding that to their diet because it stops the spike in insulin, stops the spike in glucose. Pretty amazing. It is amazing. I mean, the shirataki noodles that you mentioned, which I think generally have like konjac root in them and some tofu, this root, konjac root has so much fiber. It's actually eating this food has been shown to improve metabolic outcomes, you know, and

reverse obesity. And you think about like, you could either eat like white pasta with refined white flour with very few nutrients, or you could eat some kon white pasta with refined white flour with very few nutrients or you could eat some konjac root which has tons of fiber and nutrients like that's the type of swap that a lot of our members are like it's kind of changing their lives like yeah like i still get to eat my pesto pasta but um and they taste pretty good and they're actually called they're actually called cognac cognac it sounds. I'm sorry. It sounds like cognac. And it's not the cognac you drink.

But I was corrected by David Boulay, who's a friend of mine who's a chef. I'm like, oh, cognac. He's like, no, no, no. It's cognac. I'm so happy to know this because I eat them constantly. I have a recurring subscription to New Pasta, which is the brand that makes these hundred. The only ingredient, I I think is cognac. Amazing.

Amazing. The last point I'll touch on is the sequencing that you talked about, which is how to order your foods in what order to eat them to get the best glucose response. And this has actually been studied in a lot of peer-reviewed data as well. If you eat protein and fat before your carbs, people tend to have a significantly lower glucose response to those subsequent carbs. So it's kind of the opposite of what we do in the restaurant where we get the tortilla chips and the bread rolls before our salad and our main course. We should do exactly the opposite. We should be eating, you know, the roughage of the salad, put something, some good fiber in our bellies, maybe have, you know,

the chicken, you know, if you're looking at a plate that has chicken breast, a bunch of greens and asparagus and mashed potatoes, you know, the way to do it is eat your salad before the entree, then eat the chicken, then eat, you know, and eat the chicken, then eat the vegetables, wait two or three, four minutes, and then eat the mashed potatoes. That will likely have a better response than if you ate the potatoes first and then everything else. And so I think about that now when I'm kind of thinking about how to approach my plate or how to serve food at a dinner party, just simple shifts in ordering can make a big difference. It also can be satiating, right? So you eat that protein and that fat, which is more satiating first. You may end up finding that you

don't want as many of the rolls or the tortilla chips or the mashed potatoes after eating those things first. Amazing. I think what you're saying is so important, and it speaks to something people really don't talk about enough, which is this idea of glycemic load. So the glycemic index, you're talking about does a particular food spike your sugar? If you eat that food in isolation, this is what you'll see. But when you look at how we actually eat, we eat food in a food matrix. We eat protein, fat, fiber. In fact, there are very few foods that are just pure whatever. So protein, like meat, is pretty much protein. And just olive oil is pure fat. And sugar is pure sugar. But often when we eat nuts or seeds or even vegetables, vegetables have fat. They have

carbohydrate. They have protein. So it's interesting to kind of look at how do you design a way of eating that is actually creating a meal that can include foods you think are maybe forbidden, but actually you can add them in in small amounts in ways that their effect is blunted because they're in this food matrix of protein, fat, and fiber. And protein, fat, and fiber are your friends for regulating your blood sugar. That's the bottom line here. Absolutely. Absolutely. And one of the things that I love to do is while I'm cooking, you know, I'll have some of these foods that you just mentioned kind of out on the counter for people to graze on. So things that I know don't spike glucose, but which have those fat protein and fiber. So some of my

favorite things is having an assortment of nuts. We see that pilly nuts and pistachios and walnuts and macadamia nuts are some of the best ones that we see. Then I'll have some olives, which very little glucose spike, lots of fat, delicious. And some flax crackers or some seed crackers, which have so much fiber. And maybe have some sort of like a sardine dip or something, which has some fat, some protein, some omega-3s. So a little bit of like a really healthy charcuterie that is going to make people, you know, when we get to the meal, not necessarily want to dive into whatever carb is on the plate.

So really simple, delicious stuff. And another one I love to add is coconut chips, like the little dried coconut. They have virtually no glucose response and have a good amount of fat in them. So those are certainly some pre-meal stuff you could try or even things you can pack in your bag to have snacks throughout the day that have a low glucose response. That's great. I mean, there's a lot of tips. I created a video once called How to Never Be in a food emergency. And it's kind of a goofy video you can find on my website. But essentially, I kind of put all the snack foods that I choose to travel with so I don't get in a food emergency. And, and everything from you know, olives, you can get packages or nuts or seeds or canned fish, salmon, jerkies, grass-fed beef jerkies, for example. And I have all this stuff. So it's all stuff that is the opposite of people's typical snack foods. So snack foods aren't necessarily bad. I mean, I don't really snack. I don't think we should be snacking. I don't think we should be eating after dinner. I mean, I think snack culture is just

ridiculous and it's actually a driving force because how do we produce an extra five to 700 calories a day per person in America? What are we going to do? The food manufacturers want to sell that. The farmers want to sell that. So we're pumping in all this extra food in the marketplace, mostly in the form of these real snack foods. And it's a disaster. But if you're going to be on the road, you might need to eat.

And I can tell you, I carry a day or two of food in my bag all the time. So I never get in a food emergency. I'm never in an airport or somewhere where I'm like starving to death and have to make a bad choice because I'm just like everybody else. If I'm hungry, I'm like, and I'm going to die because I haven't eaten something, which is what your body basically does. It's like a limbic response, the fight or flight mechanism. It's your reptile brain. You're not going to make a rational choice. So I make sure I keep all that stuff with me all the time. And it's great to learn from you what are the things that are the most effective. So that's really great. I want to ask a couple more questions before we close, unless you have a comment to make about that.

Oh, I was just going to say one of the beautiful things about keeping your blood sugar more stable over time is that, and I'm sure, I imagine you've noticed this in your own life, I certainly have, is that when you keep that blood sugar down and you get on top of your insulin levels, you end up being more metabolically flexible. And actually that can really diminish that type of, you know, that craving and hunger that we feel all throughout the day to have those snacks, right? Like it's the spikes and the crashes that lead to this dependence on glucose where our body is more biologically equipped to process glucose than fat. Um,

so by actually keeping glucose more stable, um, keeping our insulin levels under better control, we tap into fat burning much more effectively. And we all have several weeks where the fat, even a lean person on their body that can help us get, you know, stay satiated and not so, you know, viscerally hungry in between, in between meals and not so dependent on glucose. So that's one of the other things that I really love about this technology is that it trains people to kind of manage like anger and manage their cravings and become that is really what one of the side benefits of metabolic flexibility is, is not, you know, having that desperate feeling of like, I have to snack. And I've definitely had times in my life when I've more, I know I've been less

metabolically flexible because I'm always looking out for where's the Hershey kiss, where's the snack, where, what if I don't have food with me? And that's not really a, that's not really a great place to be in, you know? And so it's very liberating to, uh, to kind of be able to go longer between meals. And I was at a talk by Dr. Terry Walls at a conference just a few weeks ago. And she takes it to the extreme, which is that she's she's so metabolically flexible that when she travels, because obviously airports are just a disaster land for getting healthy food unless you bring your own. She just doesn't eat on travel days. Those are her extended fasting days. And she's trained her body to be so metabolically flexible over time that, you know, she can tap into her fat stores during those travel days and not have that kind of panic. And so, um, so that's definitely one of the things

that motivates me as I keep my glucose more stable is I know I'm becoming more metabolically flexible and therefore I'm becoming a little bit more free from the dependency on always having a glucose hit. That's amazing. Yeah. I, you know, I, I agree. I mean, I find that my, I'm never in a state of emergency with food. I know what to eat when, and I have my way of balancing my blood sugar and I just, I never get these crazy swings. Some like a few days, you know, if I really like kind of missed the boat or was with friends or, you know, we, we have some kind of, I don't know, my schedule gets disrupted. Yeah. I will get hungry or hangry like everybody else, but I really learned how to actually regulate this. And it's so, it's so great. Cause you don't, you're not like stuck in this vicious cycle of sort of looping on, um, high and low sugars and insulin and ending up, you know, craving foods you shouldn't crave. I mean,

it's really quite, quite amazing how if you just learn a little bit about your biology, you can fix this problem. Um, so, uh, the other thing I want to talk about was like, what do you find instead of this whole conversation about what's normal blood sugar? Because the, you know, the way we learned in medical school is if your blood sugar is a hundred or less, you're okay. Actually, when I was in medical school, it was like 110 or 115. Now they've lowered it to 100. But it's actually learning, we're actually learning that maybe that's,

even 100 is not that great. So tell us about what we're learning about the spectrum of blood sugar, fasting, and even after eating food. What's that tell us about what we should be having as our blood sugar as opposed to what we think of as normal? Yeah. Well, I have to admit a lot of what I've learned about this comes from you. I mean, reading the blood sugar solution, I think when I was in medical school, one of my favorite books of all time, everyone should read it. And, but I mean, it's a wake up call. Cause that book is based on the

research and it was not what I was learning at Stanford Medical School. That if a patient walks into the office and their glucose is 99, that bill of health, it's under 100, you're totally fine, you don't need to think about this. That is false. And we have learned there was a paper in the Lancet from, I think, two years ago that showed that fasting glucose is really a very lagging indicator of metabolic dysfunction and therefore probably not the best screening tool for us to use to identify people who are on their way to big problems. And this conversation- So what does lagging indicator mean? Meaning that it's not going to change until the train is really off the rails. So by the time your blood sugar goes up, it's already way too late. It could be decades of

metabolic poor health before your fasting blood sugar ever goes up. And this paper was conservative, I would say, based on the methods and showed that it was about 13 years before your fasting blood glucose starts throwing problems that you probably had underlying insulin resistance. So the body is so amazing. We put all these stresses on it, like repeated glucose spikes. Each one of those glucose spikes is telling your pancreas, it's stressing your pancreas and telling it to create that insulin surge that takes the glucose out of the blood stream. And as that happens repeatedly over and over again, and as your liver insulin resistance develops because you're eating so much fructose, these things are working together to basically make you less sensitive to insulin, to create insulin resistance, which is the body's protective way of saying,

whoa, too much insulin, too much glucose coming around. We can't get this all into the cell. We can't process it fast enough block, but the body is smart and adaptive. And the pancreas says, well, we got to get that blood sugar out of the bloodstream. So I'm just going to produce more insulin to keep driving that glucose into the cells. So you're having this rising insulin, keeping that fasting glucose at a seemingly normal level while you march down this trajectory of worsening insulin resistance. Of course, we do not check fasting insulin in conventional medical practice. The ADA guidelines do not recommend checking it in virtually any patients, even if you have diabetes. And so we miss this window where the body's working so hard to overcompensate while our fasting glucose remains low. But one of the, and only when that process really starts breaking down do we start to see that fasting glucose creeping up where those compensatory mechanisms have essentially kind of gone off course? So we really want to keep our fasting glucose in that lower normal range, more from 70 to 85. And there's large

studies. New England Journal of Medicine has shown that people in the lowest quartile or quintile, I forgot the exact data, but in the lowest range of normal blood sugar, so more in that 70s, have a much lower risk of future diabetes development than someone who's in the high normal range. And yet, for many of these people, their doctor is telling all of those people in that category that they're normal. So the cool thing about continuous glucose monitoring is that as you become more insulin resistant, you tend to have a more unstable post-meal level of glucose. Like you spike higher to the same food. And so seeing

sort of where you are in terms of your responses to foods can be a little bit of an early indicator of whether you're moving down the spectrum of insulin resistance. And Michael Schneider at Stanford has done amazing work showing that basically that we get more 24 hour continuous glucose variability as we march down that spectrum of insulin resistance, even in the face of a normal fasting glucose. The second thing, of course, and I'm just obviously preaching to the choir here is ask your doctor to order a fasting insulin test. You want to make sure that fasting insulin is in a low and healthy range, which is a sign to you that your body is not having to do all this extra work and overcompensation in the face of silent insulin resistance that's developing. Yeah. I think this is so important. I remember a case

of a patient who was, I think I might've mentioned on this podcast before, because it was so striking to me. She was classic shape of apple, which is big belly, skinny arms and legs, classic pre-diabetic insulin resistant. I thought, I'm going to look at her blood sugar. She's going to be diabetic. And she had perfectly normal blood sugar. We even did a glucose tolerance test and her blood sugar never went over 110. And it was like 80 fasting, maybe a hundred, 105 after a sugar load, like drinking two Coca-Colas. And she, her sugar was like perfect. And we also checked her insulin, which most doctors never do. And her fasting insulin was like 50 and it should be less than five, ideally two or less.

And anything over 10 is like yikes, right? And she was 50. And then her post-glucose challenge insulin was like 200, 300. It was just off the chart. And I've rarely seen these spikes that high. And honestly, I think we probably would see it in the culture much more because my patients already come in, they're pretty health conscious, they're health focused, they're not eating fast food, they're not drinking tons of soda. So I see a lot of problems. But when I have these kind of virginal patients who are just eating

the typical American diet, it's shocking to see the levels. And you often will miss things. If you check the hemoglobin A1C, if you check fasting blood sugar, which is what typically doctors do, you're going to miss a lot of cases of people who are really in the metabolic health crisis. So I think what your point is really, really important. Well, and that example we've seen several times in our members so far, we actually just recently launched a new offering for our members, which is a metabolic health lab panel that tests insulin. Because so many people were telling us, my doctor won't order this for me. So we have a way now where we send a phlebotomist to the patient's house and they get a cholesterol panel, a fasting glucose, a fasting insulin, inflammation markers, et cetera, so that you can start to see that type of thing. But we had an amazing member. I will mention her by name because we actually recorded a podcast

with her for the Levels podcast, A Whole New Level. Her name is Betsy McLaughlin. She's actually an incredible businesswoman. She was a CEO of Hot Topic, which is a huge clothing company. She's on the board of Good American and Bark and all these companies. She's a huge powerhouse, but she struggled with weight for like 40 years. And she had some great functional medicine doctors and they ordered fasting insulin. And her fasting insulin was like 35 fasting. They didn't do the two hour insulin tests like you were talking about, but it was way too high. Like we want it somewhere between like two and six or so for our fasting insulin. So she couldn't get the weight off. So she put levels.

She put a CGM on. She basically cut out these foods that spiked her above 120. And in about a year, she lost 81 pounds and her insulin dropped from over 30 to five. So she became profoundly more insulin sensitive. Her liver numbers all improved, her fasting glucose levels improved. And over time, she was actually able to reintroduce a lot of foods that originally spiked her because she had regained insulin sensitivity and she could now tolerate those foods. So it was a really inspiring example of how just having that personal data about what works

for you can be the game changer in a lifelong struggle and how avoiding the foods that are creating the liver fat, clear the fat out of the liver by avoiding the fructose, minimize the glucose spikes that are generating those repeated insulin surges. And you'll start to see your body perk up again to that insulin signal because it's requiring less of it to function normally. That's amazing. That's so amazing. But so you're saying basically we should never have our sugar over 120 after we eat, right? So we check our levels monitor. We should never go for 120. Is that right? Or what's your cutoff? This is not yet agreed upon by the medical or scientific bodies that be, again, because we have not done longitudinal

studies that show that certain post-meal levels ultimately lead to disease. We are actually doing a lot of that research right now. We're working closely with Sarah Gottfried at Thomas Jefferson University, Gerald Shulman at Yale, several people to actually look at what should our glucose be after meals. But from everything I've seen in the literature, it really shouldn't go above 110 to 120. Yeah. Wow. Amazing. Amazing. I'd be curious to hear your threshold. Yeah. I think we don't know yet. I mean, I think it's really up in the air and I agree. I don't know yet i mean i think it's just it's really it's really up in the air and i agree i think i i don't think probably should go over 110 yeah i think a lot of people do but that's you know it's interesting well this is such you know this has been such an incredible conversation

casey your work is so important i i really love having you on the podcast and i i actually uh you you are offering to people who are listening the the audience, a beta program to get over the wait list, which is kind of cool. There's 120,000 people in the wait list. So if you want to skip the line, go in, try it early, go to levels.links forward slash Hyman. It's going to be in the show notes, levels.links slash Hyman, and you can get into the beta test. It's super fun. I've done it. It's really interesting to learn about your biology. Casey, your work is so important. We're probably going to have you back on when you learn more and more about this. And everybody should check it out. And if you love this podcast, please share it with your

friends and family on social media. Leave a comment. What have you learned about your managing your own blood sugar? Maybe you've tried these CGMs. Subscribe wherever you get your podcasts. And we'll see you next week on The Doctor's Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know

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