WHOOP Podcast - Understanding metabolic health: The effect of sleep, exercise, diet & stress on glucose levels

Episode Date: November 3, 2021

Only 1 in 8 of Americans are considered metabolically healthy – a measure of your blood sugar, cholesterol, blood pressure, waist circumference and triglycerides – which is alarming considering metabolic dysfunction is the root cause of many chronic illnesses. WHOOP VP of Performance Kristen Holmes sits down with Dr. Casey Means, a Stanford-trained physician and Chief Medical Officer and Co-Founder of the metabolic health company Levels, for an in-depth discussion on metabolic health. They discuss the prevalence of chronic disease (2:37), inflammation (4:14), chronic illness and lifestyle (6:13), glucose spikes (7:56), metabolic health warning signs (12:55), sleep (17:33), exercise and glucose (25:21), a WHOOP-Levels metabolic health study (28:53), the importance of sleep consistency (39:43), walking after meals (46:33), and why we need to change our lifestyles (50:39). Support the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

what's up folks welcome back to the whoop podcast where we sit down with top athletes scientists experts and more to learn what the best in the world are doing to perform at their peak and what you can do to unlock your own best performance i'm your host will omit founder and ceo of whoop where we are on a mission to unlock human performance we got a good episode this week covering a topic that is on the rise. Metabolic health. Only one in eight Americans are considered metabolically healthy. Gosh, that's scary, isn't it?

A measure of your blood sugar, cholesterol, blood pressure, waist circumference, and triglycerides. That's metabolic health. And that's an alarming statistic. One in eight Americans is considered metabolically healthy. Our VP of Performance, Kristen Holmes, fearlessly sits down with Dr. Casey Means. a Stanford trained physician and chief medical officer,

co-founder of the metabolic health company levels, for an in-depth discussion on metabolic health. Dr. Means is one of the leading experts on this topic. She's a guest lecturer at Stanford University, and her work has been featured in the New York Times, Wall Street Journal, men's health, metabolism, and more. She is on a mission to reverse the epidemic of preventable chronic diseases, and that all starts with the right choices

when it comes to your diet, sleep, exercise, and so. stress. Casey and Kristen discuss how our bodies respond to glucose and what we need to do to set ourselves up for success, the warning signs we often ignore when it comes to our metabolic well-being, the role inflammation plays in chronic illness, how walking for just 90 seconds can lower your glucose and insulin, and a new whoop level study that shows that higher levels of sleep and lower measures of stress were associated with better metabolic health. As a reminder, you can get 15% off a WOOP membership. You've used the code will. That's W ILL. And without further ado, here are Kristen and Dr. Casey Means.

I don't think I'm overstating things when I say that I really believe this is one of the most important podcasts we've done at Woop in terms of the aggregate impact this information can have on health and longevity. Dr. Means, we are so thrilled to have you. Kristen, I am so thrilled to be here. Thank you so much for having me on the Woop podcast. Casey, I love for you to describe how you made the transition from head and neck surgeon to building levels health. I think this is an important part of your story that I think really sets the conversation for today. Absolutely. I mean, fundamentally, the change had to do with waking up and realizing that pretty much all of the interventions I was doing in my conventional

medical practice and head and neck surgery was reactive in nature. It was not proactive. It was waiting until symptoms and diseases emerged and then coming in with some sort of heroic effort for the patient, whether it be heavy-duty steroids or, you know, if those and antibiotics don't work, then surgery, which is a huge act. And realizing that there's not a lot of room or incentives built in to our current health care system to really spend the time helping patients understand what's causing their illness and then helping them prevent or reverse that. So this really took the form of looking, taking stock of what I was doing day to day in ear, nose and throat head and neck surgery, and realizing that so many of the conditions I

was treating were fundamentally rooted in inflammation. And, you know, you know this just by hearing the names of the conditions we treat like sinusitis, laryngitis, thyroiditis, all these itases. That's the suffix in medicine that means inflammation. So that's what I was seeing day in and day out. Inflammation is the immune system reacting to something that it considers a threat. And instead of asking what is that threat that our bodies are responding to, why is it on high alert and sort of upregulating these inflammatory cytokines that are creating these ear,

nose and throat symptoms, why aren't we asking what's causing that? You go to the operating room and you can suck pus out of a sinus, but that's not actually changing the underlying inflammation that led to disease. And so I became really interested in understanding the root causes of inflammation and how to mitigate those really in hopes of keeping people out of the operating. room. And in that journey, we realize that one of the key fundamental triggers of inflammation in the body is dysregulated blood sugar and metabolic dysfunction. And unfortunately, our modern life makes it incredibly difficult to escape metabolic dysfunction. This may not be

a term that someone listening is heard, but 88% of American adults have at least one biomarker of metabolic dysfunction. And this means that there's some issue with how the body is making, processing, or storing energy. And it's affecting 88% of Americans. And so that became really interesting to me. Why aren't we talking about this? Why isn't this a word that's on the tip of everyone's tongue? Why when we think about inflammation, are we not immediately thinking about these key drivers, one of which is metabolic dysfunction? So this really turned into a journey of me thinking how can I have the highest leverage as a doctor to help people actually be healthy and attacking this really seemed like a really important way to do it. So that led me to leave

the surgical world and move away from the operating room and start my own functional medicine private practice where I was just really digging in deeply with patients in two-hour visits about all the triggers of inflammation in their life. And then starting my company levels, which helps people optimize their blood sugar and personalize their diet through a biowarable called a continuous glucose monitor. And for the first time, understand exactly how the foods they're eating and the choices they're making around things like sleep and stress management and exercise and food are affecting their blood sugar, which ultimately is what leads to whether, you know, our metabolic health, whether our blood sugar is dysregulated and elevated. This directly feeds

into our underlying metabolic health because the vast majority of the issues we're dealing with the United States are chronic illnesses that are related to diet and lifestyle. But we are not treating them in a way that actually approaches diet and lifestyle. And that's why we're failing. That's why Americans are getting sicker, why life expectancy is going down, depression is going up, weight is going up, chronic disease is going up, and health care costs are going up because we're not actually approaching the issues by addressing the mechanisms that actually cause them. I'm super excited to just basically dig into everything metabolic health and think about in the context of all the things that we track at Woop. I think this is going to be a really cool conversation. But before we do that,

why don't we just give listeners kind of a high level overview of, you know, what is a CGM, you know, just give us kind of a broad outline of what people would expect, you know, interacting with these data. Continuous glucose monitors, which is a biosensor. It's a quarter-like device that you stick on the back of your arm. It has a small probe that goes just four million meters under the skin, totally painlessly. And it's actually doing a lab test on your arm 24 hours a day, seven days a week. What we want to strive for is ultimately fairly flat and stable glucose levels in a low and healthy range. That is one of the biggest life hacks you can achieve in terms of current performance, wellness, and sort of mental clarity, as well as athletic performance, as well as

long-term avoidance of chronic disease and longevity. So when you're talking about any of these things, having stable glucose levels in an optimal healthy range is in immediate positive steps towards achieving those goals. Just to break it down. So basically, you know, peaks in glucose are problematic. And there's really no way around that, right? That's exactly right. I mean, you want the least spiky graph possible.

You do not want the peaks in valleys. You want the gentle rolling hills. And of course, if you eat something with carbohydrates in it, which, you know, even vegetables have carbohydrates in it and we definitely want to eat vegetables, you're going to see these little gentle ups and downs, and that's totally normal. Our body knows how to respond to that. It's the really big repeated spikes that can cause severe dysfunction in the body relatively rapidly. And unfortunately, the standard American diet, because it's the vast majority of our calories in America come from ultra-processed foods where it's like really rapidly

digesting carbohydrates that go straight into the bloodstream as glucose, we are seeing the average American with high spikiness, which is the science word for that is, glycemic variability, glucose variability. You want less glycemic variability because we know that glycemic variability increases your risk for diabetes, obesity, heart disease, and all the other issues. And the way that it does that is that it basically does four things. Three immediate things that can do is cause inflammation, big glucose spike, increase in inflammatory markers. It causes oxidative stress, which is too much like free radical damaging activity in the body. And it causes glycation, which is where high.

sugar in the blood sticks to things all over the body, like proteins and fats and cell membranes and DNA and whatnot, causes dysfunction. So that's just high sugar can do those three things, glycation, oxidative stress, inflammation. But what it also does is this insulin pathway. It spikes your insulin. And when that happens over and over again, multiple times a day, you know, day after day, week after week, year after year, decade after decade, your body actually becomes resistant

to those high levels of insulin. And it says, oh, my gosh, there's so much insulin around. We need to basically stop responding to it because it's too much. And so you become what's called insulin resistant by these repeated spikes of insulin. Then the body says, okay, well, we got to get the sugar out of the bloodstream. So we're going to produce more insulin to overcome this resistance. So now you start getting cells that are not responding to insulin. Insulin's going up.

Glucose isn't able to get into the cells, so it's going up. And now you start ratcheting up on this spectrum towards diabetes. and all the associated illnesses that are related to this metabolic dysfunction. So when we think about high glycemic variability, insulin resistance, metabolic dysfunction, they're all kind of in that same cloud and ultimately progress towards diseases that we hear about a lot like diabetes, obesity, heart disease, stroke, Alzheimer's dementia, which is being called type 3 diabetes, and many, many other conditions. So that's why we want to keep that spikiness down and ultimately kind of stay in that gentle

rolling hill category and a spike here and there fine it's really about the these massive trends that we're seeing in the western lifestyle because you know it's croissant for breakfast pop tart for a snack moccuccino for at noon a sandwich with white bread tortillas and it's just so much of that that we're seen an unnatural amount of the spikiness you definitely hear a lot of folks who you know are like well i'm not i'm not diabetic you know i'm not pre-diabetic why do i need to be monitoring my glucose level And, you know, obviously, it's an oversimplification for a lot of reasons. But if you talk about it, maybe from the lens of folks are just trying to lose weight and are counting calories, what is problematic with that?

And maybe how a practitioner or a doctor might actually treat an individual who comes in and might actually be in the upper quadrant, but not quite in that range yet where it's problematic. Just kind of talk about that whole landscape and that whole journey and how monitoring glucose levels can kind of cut through a lot of the noise that exists around kind of that whole paradigm. Why should someone without diabetes monitor their blood sugar? Behind that is essentially the foundation of the structure of our health care system, which is waiting until disease emerges to pounce on it. And I've heard from countless people who say, oh yeah, my doctor said my blood sugar was creeping up, but not to worry about it until it gets to the level when we actually need to

treat it. To me, like, that is painful for me to hear that you would wait until someone gets to the clinical threshold before you address it. Like, that is the opportunity as it's creeping up to move things in the way. And then they'll just give you medication. Right, exactly. Oh, of course. Yeah. I mean, there'll be some sort of general comment about watch your diet and then it'll be metformin and all the things, you know, and of course, you know, comorbid with the high blood pressure and the heart disease of developing all these things, and there's a pill for each one. And so that is a problem that is systemic with the fact that we sort of don't focus on it. So that's one thing we just need to kind of wake up from and realize that these issues are starting likely decades before that clinical diagnosis.

I think there's a really great paper from The Lancet, a premier medical journal that came out just two years ago showing that a person who's diagnosed with type 2 diabetes likely had signs of insulin resistance up to 13 years before they actually got the diagnosis. I think another thing that's just worth mentioning is that I think a lot of people don't realize that a lot of the pain points we have as young people who don't necessarily have a diagnosis of type 2 diabetes are significantly related to metabolic dysfunction, but we don't necessarily hear about that from sort of the mainstream messaging. We tend to isolate diseases into different silos and don't think about how they're all related.

But for instance, an example of this is infertility. The leading cause of infertility in the United States is polycystic ovarian syndrome, which is fundamentally related to insulin resistance. It is essentially insulin resistance of the ovaries. When we are insulin resistant, like we were talking about earlier, and our body starts pumping out more insulin to overcome that, it actually stimulates a cell type in the body. the ovary called the Thika cells to produce more male hormones, androgens, testosterone, which creates the menstrual irregularity and a lot of the associated symptoms like hair growth

and acne and these other sequelae we see. So there have been incredible studies showing that in 12 weeks of a ketogenic diet, a very low carbohydrate diet that's, of course, going to reduce your glycemic variability, increase insulin sensitivity, can reverse PCOS. We don't necessarily hear about this a lot. And what's interesting about PCOS is that one of the key treatments is metformin, which is a diabetes medication that improves insulin sensitivity. So that's one example. A rectile dysfunction is essentially a red flag saying that you have metabolic dysfunction. If you have erectile dysfunction, you essentially almost certainly have metabolic dysfunction and blood sugar issues that are early. You may not have gotten the diagnosis of type 2,

but it's just a huge flag saying you are moving in that. that direction, gout, depression, anxiety, fibromyalgia, many of these have a close relationship, but we don't necessarily have that label of type 2 diabetes yet. But they should be warning signs to us that there may be something off with our blood sugar. And the biggest one is you mentioned weight. 74% of people in the United States, adults in the United States, are dealing with overweight or obesity. And we think about, you know, obesity. as certainly insulin resistance contributes to obesity and obesity contributes to insulin resistance. It's a bidirectional relationship. But the interesting thing about the hormone

insulin is that what it's doing is saying take up the glucose out of the bloodstream for energy. But what it's also saying to the body is we have enough energy from glucose, so we don't need to use fat for energy because we've got all this glucose in the bloodstream. So not only does it help take up the glucose out of the bloodstream, it stops the body from burning fat for energy. So if you're dealing with stubborn weight loss issues, it is very likely that insulin is high in your body blocking that pathway. You may not hear about that from your doctor because we do not measure insulin in the body. And your glucose may look fine because the body's in that compensatory state where insulin is high keeping the glucose

under control until, you know, you get farther down the spectrum and that process kind of falls apart and you start really seeing the blood sugar rise. So I would say weight is one of the biggest ones. If we're dealing with trouble losing weight, we should definitely dig into the insulin story. But that's kind of some of the reasons why the average person should be thinking about this. Can you talk a little bit about sleep? I know you know a ton about how sleep impacts insulin and potentially how our fueling behaviors during the day impact our sleep. I don't think it can be overstated how important sleep is on determining our level of metabolic health and our glucose levels day to day. It is the four pillars, I would say that it have the biggest impact are food,

sleep, exercise, and stress management. It would be trying to rank which one's the most important would be like picking a favorite child because they all have just copious research to suggest why it's important. But sleep, the mechanisms are what are so interesting. So the first thing that we know just generally is that the less sleep you get, the higher your glucose lovers are going to be and the more insulin resistant you're going to be. And this can happen acutely. This is not like over the course of a decade you get more insulin resistant if you're not getting in sleep. It's like three or four days of sleep deprivation can make you look like a pre-diabetic individual on your labs. And fortunately,

that's reversible, but it's causing huge strain on your body. So some of the ways in which sleep impacts glucose. One is that sleep deprivation increases cortisol in the bloodstream. And cortisol is really supposed to be lower at night. But when we don't get sleep, we often see higher cortisol levels. And that is going to actually drive the liver to break down the stored glucose that's in the liver and release it into the bloodstream. Cortisol is a stress hormone that mobilizes glucose because it thinks we have some threat we need to fight. And so sleep deprivation through cortisol can increase glucose levels. We also know that sleep deprivation increases inflammatory markers, which can directly lead to issues with our glucose. So just a few nights

of sleep deprivation has been shown to increase inflammatory cytokines like TNF alpha, interleukin-6, both of which contribute to insulin resistance and obesity. There was a fascinating study that showed that in healthy normal weight individuals, those who frequently slept shorter amounts, and it wasn't even that short. It was less than 6.5 hours per night, which I think is what a lot of people are getting. They performed similarly on a test of oral glucose tolerance to people who slept 7.5 to 8.5 hours per night, but the people who slept less than 6.5 hours had to secrete 50% more insulin to get the glucose back to normal levels. So basically just to break it down even more. You gave people this oral glucose tolerance test where they chugged 75 grams of glucose

and then saw what happened in the two hours afterwards. And the people who got 6.5 hours or sleep or less were so insulin resistant from that sleep loss that they had to secrete 50% more insulin to drive the glucose into the cells, which is just absolutely incredible. And then... I mean, a level of stress that must put on your body must be just insane. Right. It's like just throwing your body for a loop, like telling your pancreas to work 150% as hard because you put your cells under this like biologic stress. And so they've done a lot of different studies like this. There was one with young boys who they basically deprived of sleep for six days. They were healthy young boys. They gave them four hours of sleep for a week and showed that basically

after that intervention of just sleeping four hours a night per week, which I imagine, a lot of college students might be in that boat, they basically became pre-diabetic. And then they allowed them to have essentially unlimited sleep for the next week, like about 12 hours a night of sleep. And they went back to normal. But it's just profound to think how these choices our sleep can affect our glucose. I think one sort of more epidemiologically, we also know that people who have interrupted sleep, so not just less sleep, but more interruptions in their sleep, have a much higher risk for developing diabetes. There was a study, I think it was done in Japan, in adult, healthy men, and they showed that those over an eight-year course, an eight-year period,

those who had more interruptions in their sleep had two to three times more likelihood of developing diabetes. So I always tell patients, like it's not just about when you're going to bed, but it's about all the interruptions, the light, the beep, the dog jumping on the bed, the cat jumping on the bed, all these things, like, they seem small, but they could cost you, you know, your health and, you know, risk for chronic disease. So you've really got to eliminate those interruptions in the bedroom that you can control. So those are just some of the research that certainly motivate me, but the bottom line is sleep and glucose very closely related, and it can be not just a long-term effect.

but a very short-term effect. And it's a huge lever we can pull to improve our metabolism. And even if you're eating the perfect metabolic diet, you will not be optimally metabolically healthy if you're skimping on sleep. What about blood sugar kind of going into bed? Are there any data to suggest that there's lots of blood sugar, you know, very high spikes in blood sugar close to bed, increase sleep disturbances or any data to show that?

There's not that I know of in a non-diabetic, population. However, there is interesting research showing in a healthy population that hypoglycemia, low blood sugar at night, can lead to what's called cortical arousal, which is like essentially your brain waking up and becoming vigilant because hypoglycemia is a very scary sort of situation for the for the body. We want we don't want glucose to be too high. We don't want it to be too low. We wanted to be in this nice, healthy range. So when it gets too low, it will wake you up to essentially get you to go get food and get your blood sugar back into a normal range. Interestingly, eating late at night, something with a high glucose spike can lead to that

sort of big spike and big crash that could lead to hypoglycemia at night. So I think a lot about going into bedtime with very stable glucose because I do not want to be bouncing around all night and being like normal range cortical arousal, normal range hypoglycemia cortical arousal. Like you just, you don't want that. So the more stable, the better. So I tend to maybe front load my carbs a little bit more in the day and move towards the sort of keto at night and, of course, try and space out food and sleep by a few hours so that I'm going into bed really in like the 70 to 80 milligrams through.

leader range, which is kind of like a low, healthy, normal place. I certainly don't want to be coming off a spike as I'm falling asleep because it's possible that could kind of, that could kind of wake you up. And the other thing is that we are more insulin resistant late at night. Naturally, we go through this sort of phase in a 24-hour cycle where it's actually interesting. Melaton seems to have an impact on insulin sensitivity. So when we release that melatonin to get tired at night seems to make us a little bit insulin resistant. And so there's been studies that have shown that if you eat the exact same meal in the morning versus late at night, like after dark when the melatonin's, you know, out in the body, you're going to have a higher glucose response to that exact same meal late

at night versus in the morning. So just let me to think about as you're choosing when to time, those really carb-heavy meals and just making sure you're balancing your meals at night. If you're going to eat the pasta, make sure there's fiber, there's protein, there's adequate fat, take a walk after, maybe have a shot of apple cider vinegar before the pasta, which can stabilize glucose levels. Do the things that you know are going to be helpful so that you're not having these like massive spikes at night. So you mentioned, you know, so we're talking about kind of spikes from food. I'd love for you to talk about spikes from exercise and kind of what's happening mechanistically there. You know, I notice when I do, you know, Tabata or like a really hard

track workout. I get pretty severe spikes in glucose, but, um, so just unpack what's happening there. Definitely. This is so interesting. And for a lot of people listening to the Wooop podcast, I imagine this will affect them. And so it's really good to know about. Essentially, aside from spiking after a meal, you can see a big spike after a high intensity interval training workout. Typically, when you go above about 80% of your VO2 max or as a proxy, about a proxy about 80% of your max heart rate, you are going to start to see glucose rise in the bloodstream, which would be incredibly confusing the first time around because it's like, whoa, whoa, I thought I was using the glucose. Like, why is it going up? But actually what this is is a signal

that you're working really hard and your body is perceiving that workout as a stressor. So it's releasing cortisol. It's releasing these catacolamine hormones that are saying, oh my God, what are they running from? We need immobilize energy for this person so they can actually run from whatever threat this is when really you're just like on the peloton. But like the body doesn't know that. And so it releases the cortisol, which goes to the liver and tells the liver to dump its short-term storage of glucose into the bloodstream to feed the muscles. So it's kind of an advantageous thing. You're giving the body this fuel. So even if you're totally fasted, like your first thing in the morning, no calories, you still have this glucose stored in the

liver. And we only have about two hours worth of glucose in their short-term bank in the liver. And so the body's releasing that to feed the muscles. And the cool thing about the muscles is that they can take up glucose in an insulin independent mechanism. They don't need the insulin to unlock that key for the cell to take up the glucose. Just the muscle contractions themselves can actually facilitate glucose uptake and also exercise is going to stimulate the muscles to increase the transporters on the cell membrane, these glute four transporters and others to take up more glucose to use. So it's a spike that is coupled with a sink, a glucose sink that's actually pulling it out and using it. So what you're doing is you're clearing the liver

of some of the stored glucose. You're using it in the muscles. It's not just sitting in the bloodstream. And in doing so, you're likely moving your body more towards metabolic flexibility. Because when you deplete that liver glucose, that short term storage bank of glucose, your body still needs energy. And so it's going to then start tapping into your fat stores. It's going to say, okay, liver's empty. Let's start burning fat. So it's this cool cycle. And I actually think about this when I'm working out now, especially when I'm doing a fasted workout. When I see that glucose spike, I'm like, cool, empty my liver. Let's say I'm going to fast for a few more hours after this workout. I know essentially that I'm moving into fat burning. And what's cool is that I'll often measure

my ketones later in the day, which is a measure of fat burning. So I'll either do it the breath monitor or the biosense or I'll do the keto mojo blood prick. And I'll see my ketones going up. So it's this feedback loop of like, cool, I use the glucose. I started bring fat. I have my fat read out. So that's kind of a fun experience to do, but it's not something to worry about because the key thing is you're coupling that spike with a sink to use it, which is the muscles. And you're likely not going to see this with a less strenuous workout. A very light jog. When my heart rates at around 130 to 140, like really zone two training, I don't see my glucose go up. When I'm sprinting in my heart rates in the 160s to 180s,

my glucose is going to go up a little bit. So that's what's going on there. These data just give us this incredible opportunity to just start to kind of knit together how all these various lifestyle factors, like actually impact are, you know, in this case, our glucose levels and kind of how that is either helping, you know, serving us or not serving us. And I think, you know, this will kind of lead hopefully nicely into the study that we did with levels where we had woof data and levels data. And we were really trying to just basically do this kind of, you know, observational study with these two data sets, just trying to, you know, understand how blood glucose levels, you know, interact with things like sleep and exercise and recovery.

And, you know, there are some caveats so we can maybe talk through Casey kind of what the limitations of the study were. But it was really fun to do this with levels and be able to find, you know, really cool insights in kind of how these data sets work to. together and what's actually happening. I would say it was a dream come true to do this like small, small pilot with your guys team. It was just really fun to work together. And I think what we saw is is really, really interesting. And certainly like you said, lots of caveats because it was a very small study, but definitely generates a lot of cool hypotheses, I think, for future research. Yeah, I think so. One of the, you know, things that we saw was, which was, I think,

pretty interesting was an association between, you know, kind of higher levels of sleep and lower measures of stress. So looking at resting heart rate and heart rate variability, we're associated with better metabolic score. Take us through kind of interpretation of what those data might mean. So it's basically showing exactly what we were just talking about with that sleep research. You sleep more, your glucose is better, your sleep is higher, your stress measures are lower. And certainly can't talk about like correlation, I'm sorry, causation with this, but but it fits with what we know from the research. And I think there's like two ways to kind of work.

It's like more your body is going to be able to manage glucose better. Like just that's just the, I mean, that's just the reality. Yeah. Exactly. And it showed up in this population. And I think it's just, you know, key to remember that like many of the things that promote metabolic health also

promote good quality sleep. And so, you know, I think that when you're focusing on these lifestyle things like to keep your glucose stable, which is like physical activity and eating balanced diet, stress management, you know, high stress like we talked about through cortisol will raise glucose levels. So keeping your stress under control, doing those mind-body practices like breath work and meditation and other things, these things all connect to both the sleep quality and the glucose.

So I think there's probably something in there about general healthy lifestyle leading to both of these outcomes and then also just the fact that if people are sleeping better, their glucose is going to be better the next day. A really interesting thing that we saw in the data was that actually the levels metabolic score positively associated with the Woop Recovery Score. So this was really neat because these are both proprietary metrics. And the levels metabolic score essentially a aggregate metric that looks at different factors of the glucose, including taking into account sort of average glucose levels and glycemic variability. So it's this sort of merger of several different aspects of the glucose trends. And then, of course, the Woof Recovery

Score has many different factors that goes into it and is essentially showing how ready you are to take on strain that day. And these things positively correlated. So really neat to kind of know that if I'm going into a day with a high recovery score, I'm likely, going to see a better overall glucose parameters. Yeah. And I can say, you know, I wear a glucose monitor, you know, 300 days of the year. So, you know, I have to have huge amounts of data. And I definitely, literally the metabolic school predicts my recovery. Like it's, I'm not even kidding. Like it's really in that direction. The glucose tracks. Oh, yeah. Yeah. They track really, really closely. So I, yeah, that was just another one of many reasons I wanted to kind of do this case study was just to see

if that was really happening here and, you know, if there's any other details we could glean from that because I found that really fascinating. Yeah. And I have found, again, this is now data showing what I've intuitively found of the past year using both whoop and levels in that for me, I'm pretty sure that if my recovery score, if I wake up and I see that it's about less than 40, then I am going to eat differently that day. Like I am going to avoid the higher carbohydrate foods. That's not the day for me to eat sushi because my response will be higher. And I've seen that.

And so that's the day that I'm going to be opting for cauliflower rice instead of rice. That's the day that I'm going to be opting for free range eggs, spinach and avocado instead of, you know, I don't really eat oatmeal for breakfast usually, but like instead of something like that. And just making sure I'm keeping things more stable because I know I'm going to get hit harder on the days when my recovery is lower. in terms of my glucose. Yeah, I think too, like the days where I have a lower recovery, like I'm definitely like more vulnerable to like making poor decisions, um, dietary decisions. So it actually kind of is a reminder, all right, I got to really double down. Like my body might not be signaling in ways that are actually appropriate. Um, in that, you know,

my ghrelin and leptils, you know, like my hormones are just not working as, as effectively. And, and, you know, so I think there's like something really powerful there in terms of using the data to be like, all right, I'm, I'm going to be a little bit more vulnerable today. I'm not going to make as great decision. So, yeah, I just need to be more mindful. Like, I mean, I think it's like an incredible opportunity to just really understand how to tackle your day. It's so true. And I think that awareness is key because, and I didn't mention this in our earlier conversation about like sleep and glucose.

But what you just mentioned is actually a key well-studied thing, which is that sleep deprivation, even for as little as two days, changes our hunger and satiety hormones, ghrelin and leptin. Leptin is our satiety hormone. Grealin is mostly a pro-hunger hormone. And just two days of less sleep can increase, can change those levels, increase our appetite, increase our behavior towards seeking high carbohydrates, high calorie-dense foods. So unfortunately, the hormones are not in our favor when that recovery score is low, but the awareness gives us that cognitive control to maybe make a different decision than our biology would be driving us towards.

It's not a mystery anymore. It's like, and also it takes away some of that, I think, like self-judgment. Like, oh, gosh, first I didn't sleep well. And now I'm eating chips and I'm just the worst. And this is, it's like, no, like you got poor sleep. Whoop told you why. So you can do it differently next time. And I'm going to be really careful today and be a little bit more conscious.

And tomorrow's a new day. And like, we're not going to follow. Yeah, exactly. I'm just underslept, so you're taking that instead of eat the cookies, yeah. For me, like, that's the opportunity with these data, you know, you just can just be more aware of just your lifestyle choices. And it kind of takes to your point, you make a great point of just, it does remove the judgment in a lot of ways, you know, and it just becomes a more objective conversation.

And it just allows you to kind of cut through what sometimes, you know, are decisions based on emotions, which are guided by, you know, what's happening physiologically, right? They're such a bidirectional relationship, and I think we can just be way more control of our life when we kind of have the subjective feedback. I mean, I think it just makes things, it just simplifies things so much, in my view, you know, when you understand what's happening. All right. So another finding is we saw that yesterday's measures of glucose management associate with today's sleep consistency. For folks who might not be aware, although we talk about sleep consistency a lot. Sleep consistency is basically just when you go to bed and when you wake up and how

consistent that is. And, you know, there's lots of, you know, research at this stage kind of talking about the importance of sleep consistency. But if you want to talk about this, Casey, in the kind of context of feeding behavior and how that might impact other decisions and certainly how it impacts your glucose levels. I think that this really gets at this idea of how important kind of the regular circadian clock is when it comes to both food and eating but also sleep. Someone who's been talking a lot about this recently and I've been loving his work is Andrew Huberman talking about the importance of more structure in our days around when we're eating and when we're sleeping. Matt Walker as well talking about this. But just because we get

eight hours of sleep a night, if it's shifted by different times, it's not as good for us as if we do it the same times every night. And what we're learning is that the same is true. for food. We probably want to be eating in about, you know, an eight hour window probably at the most. And that window should probably be the same each day. And oh my gosh, I am so not on this train yet. I am all over the place with my eating window. You know, each day is different. And it's sort of like for me personally, it's very hard in our, in our modern world to like stick on this game schedule every day. But the more and more we learn about it, the more we realize how important it is. Because it's actually changing our gene expression. We have clock

genes that need these regular inputs to be able to be expressed appropriately. So it was interesting to see that in this result from the study that yesterday's measures of glucose management were associated with today's sleep consistency. And, you know, I think what we're probably seeing here is that we likely had a population of people who are pretty, you know, aware of kind of these sleep consistency schedules. And so kind of seeing that the days that we're more in tune with that, we're also getting, we're also more on top of our sleep. So it's sort of like if we're controlling our environment, we're doing it in, in like lots of different ways and sort of showing just the importance between these relationships. It's also interesting because so many of the things that affect our glucose, you know, also affect whether we're able to fall asleep easily.

And so sleep consistency is not just a factor of when we choose to go to bed, but also I think like if we're able to fall asleep, and stay asleep. And so that's very related to what's going on with our glucose. If our glucose is all over the place, it's going to impair our sleep quality and like our arousals and when we get how much we wake up at night. So by keeping things more stable during the day, it may even just promote our ability to fall asleep and wake up at times that we intend to. So yeah, I'd be curious to hear also how you kind of interpreted this one. Yeah. I mean, I definitely think, you know, a lot of my research is focused or is looking at kind of circadian factors. And, you know, and it's funny, you know, sleep consistency bubbles to the surface in every single research project that we do in

terms of predicting, you know, heart variability and resting heart rate and, you know, measures of subjective resilience. I think it's actually the core behavioral anchor. To me, it's becoming more and more obvious that, you know, if we're kind of to focus on one behavior, it's to stabilize our sleep wake time. Because I think, and I think what we saw in this study is, that, you know, it does give you, I think there's some real biological and physiological things happening, you know, mechanistically that bring about more control behaviorally, right? Like I, I think that there's this like very, you know, it's not at a conscious level, but there's things happening biologically that enable you to have more, you know, control and regulation over your day.

And I do think just there's just a really powerful, you know, if you are stabilizing your sleep break time, you have the ability probably to have more stable kind of feeding windows and you know you're going to be viewing light at maybe specific times and you know you're going to be kind of exercising probably at a regular time so you know you kind of basically hit you know all the levers that are going to influence the circadian clocks and I think that's probably what we're seeing here sleep consistency it's funny it just comes up in every conversation we have so it's kind of cool all right so I love for you, Casey, you're just like a wealth of insight. It's, it's kind of mind-blowing. So I'd love to shift and just talk. You've kind of throughout the podcast today, you've talked about, you know, various types

of practical tips people can do. You mentioned walking. I'd love to double-click on that for a second because after meals, because I think that's probably one of the simpler things that we can do to really help manage our glucose levels. And then you talked a little bit too about, you know, kind of stacking foods, you know, adding maybe fat to the oatmeal. You know, so if you can just kind maybe walk us through just some really practical things listeners can do to kind of just manage their glucose levels across the day. I definitely want people to leave this conversation not feeling like they need to have a continuous glucose monitor to improve their metabolic health because there's a lot of principles that we learn from populations using continuous glucose monitors that can

be applied to everyone. So some of those key ones, I would say, relate to food parents. which is something we've touched on a few times today. So this is making sure we're not eating naked carbohydrates. So I consider a naked carbohydrate, a meal that's like very carb forward without many other macronutrients. So that would be like just eating a banana all by itself, eating oatmeal all by itself, you know, not adding other things, other macronutrients. And we know that that's going to actually spike glucose more than if you pair things in a balanced way properly. We hear all about balanced meals. There is some truth to it. The key thing, you want to balance your carbs with, I'd say it'd be hard to rank them in order of importance,

but I would say fiber is a really big one at the top. Fiber is this magical aspect of, of plant food that will prevent you from absorbing all of the glucose in your food and also slows the digestion. And so, you know, it's going to, you know, give your body more time to absorb things. It's also going to bulk up what you're eating. And so, you feel fuller, quicker. It's also going to feed the microbiome, which makes, when you feed the microbiome fiber, they make all these amazing byproducts like things called short chain fatty acid, which are anti-inflammatory and go into the body and essentially help with our metabolic processes.

It's amazing. So if you're eating oatmeal, dump chia seeds on top of it. Chia seeds are one of the best sources of fiber or flax seeds or something like that. I incorporate a lot of beans and legumes into my diet because they are a very hard. high fiber source. And over time, I think a lot of people who end up adding quite a bit of fiber to their diet find that they tend to not be quite as spiky over time. And I think that's probably related to microbiome shifts. But fiber is a big one. The other two, sorry, I could go off on fiber for a long time. So carbs and fiber. Can you talk a little bit about net carbs real

quick? Just kind of when you're on, you know, because I know, depending on the fiber and the protein, in the carbohydrate, that's going to affect kind of the net carb. Can you just kind of talk about that dynamic real quick and just educate us on how to think about that when we're reading labels? Sure, absolutely. Yeah. So the label is going to have the total carbohydrates. And then underneath that, it's going to say things like fiber, dietary fiber. And it's going to say added sugar and sugars, essentially. So if you're looking at a fruit, like an apple, let's say it had a nutrition label on it, it might say 30 grams of carbohydrates, maybe 20 of those are sugar, zero or added sugar, because no sugar was added.

to the apple. They were naturally occurring. And then the 10 grams might be fiber. So your total carbs were 30, 20 were sugar, 10 were fiber. When we think about net carbs, we take the total carbohydrate and subtract the fiber to see what the real like glucose impacting portion of those carbohydrates were. So, you know, for beans, for instance, someone might be like, oh, those are a high carbohydrate food, which they are. But they have so much fiber that they the actual accessible carbohydrates to your bloodstream are pretty low. They, I don't have a can of beans in front of me right now, but I would say probably an average serving has about 25 grams of carbs, but nine grams of fiber.

So like you're actually in the teens in terms of what the, what the carbs that could be digested by our system and go into the, um, the bloodstream are. So that's how to, and so you, you know, you want to shoot for things that essentially have a very low ratio of total carbs to fiber so that your net carbs are lower. And chia seeds are an example of that. I think probably the total carbs of a tablespoon of chia is maybe six or seven grams, but the fiber is five. So the actual carbs are fairly negligible. So that's the way to think about it. So if you're going to eat carbs, eat carbs with high fiber. Yeah. And then in terms of the other things that can buffer the oatmeal, for instance, protein and fat or the other two, fiber, protein and

fat adding these things to the meal of carbohydrates or before the meal like preloading a big carbohydrate load with some protein or fat can help with the glucose response what that might look like in the way the research has been done is you give people for instance an ounce or two ounces of almonds which has mostly fat but some protein before a high carbohydrate meal like a couple slices of white bread or pasta and you see that when you give them that fat beforehand they have lots of a glucose response to the subsequent carb load the same things has been done with protein, um, where they've given people like chicken breast or eggs before a high carbohydrate meal and see a lower glucose response, um, to that. So that's one thing you can do.

The second like easy take home point is taking a walk after a meal. Walks are powerful. We actually just did an experiment at levels where people voluntarily voluntarily at the company did an experiment or we drank a can of Coke, of Coca-Cola, um, which was, you know, horrifying to most of the levels employees because we, you know, are a glucose company, but a 12-ounce can of soda by itself. And then shortly thereafter at the same time of day, ideally after the same amount of sleep, drink the can of Coke and walked for 30 minutes to an hour after the can of Coke. And we saw about a 35% reduction in the post-meal glucose spike. So my personal data, I went up to 100. It was a lot. By just taking, I mean, you can imagine,

like let's say you had something high carb and you have meetings for the rest of the day, just jump on your phone and take a walk for 30 minutes. It was it was not hard to do. And my peak with the Coke was 162 milligrams or deciliter. And my peak with the walk plus Coke was 132. So it was a huge shift. And walking is just, I mean, incredible for metabolic health in general. There's been lots of studies showing that just walking a minute and a half every 30 minutes can totally change your glucose and insulin level.

throughout the course of the day. So setting a timer for just like that quick stand-up, walk around the house three times can have a profound impact. And then the last one I'd mention, so pairing foods, walking, really just thinking about like easy swaps. Like a lot of meals have a lot of great components and then they kind of get screwed with like one ingredient that will spike the glucose. So you have all these beautiful ingredients and then it screws you up. An example of this, This would be like a beautiful salad with lots of great ingredients, but then you've got a dressing that has added sugar and you've got like a bunch of dried cranberries on there and croutons. So if you can see on, you know, your monitor, for instance, like levels will help you break down

the ingredients and say these were the ones that likely caused the spike, you just remove those or swap them and all of a sudden you get the great nutrients without that collateral issue. And if you think about it, you go from having a salad that spiked your insulin to one that didn't, which means that your hormonal response to that meal is different. The way your body's thinking about storing the calories from that meal is different if you do or don't spike your insulin. So it's not just about the glucose spike. It's about how your body is going to physiologically respond to the other good ingredients

in that meal. So I'd say like really trying to identify like where are the added sugars hidden in your meals and really work to get rid of them or swap the things that are likely kind of the culprit in a meal. This could be like a, you go to Chipotle and Chipotle has a lot of great food, but like that tortilla probably has like 50 grams of carbs. So you're getting the beans and the fajita veggies and the guacamole and the lettuce and the salsa, all this great stuff. But with that tortilla, your glucose is going through the roof. So what if you swapped it up a little bit and said, okay, I'm going to get the bowl with a tiny bit of rice, lots of beans, fajita veggies,

chicken, guacamole, lettuce, tomatoes, no corn, no tortilla, both of which will likely spike glucose. And I have this gorgeous meal that's not going to spike me. So just thinking about some of those swaps, thinking about added sugar, I think is kind of the key thing we can do. Read the labels and learn what the alternative names for sugar are. There's about 60 names for sugar. you can Google alternative names for sugar, print it out, put it in your wallet, and bring it to the grocery store. So that would be kind of a key thing as well. Is there anything that we kind of missed that you feel like our listeners need to know in the area of metabolic health and fitness? Goodness. I think we covered a good gamut here. I know. This is really impressive.

Yeah. You got through so much. Yeah. But I think that we, I think that the key message is that as an American adult, unfortunately, if we're not doing something different than the norm of American life, we are going to get a chronic illness. That's essentially a given. If you're going on the treadmill of the way culture is pushing you, meaning standard American diet, sitting eight hours a day at work, having your screens in bed, having your phone alarms going off at night, you're going to get sick. Like we can't, I can't say with 100%, but that's, we're seeing those great where it's 80, percent with metabolic dysfunction, 74% with overweight or obesity, these chronic diseases increasing life expectancy going down. So we have to have to have been different. And there are ways to make

that really fun these days, but we do need to kind of bring community into it and bring, you know, get the support. And the nice thing about the body and the resilience of the body is that it can move in, like even if you're going down the spectrum of developing symptoms or disease, you can go in the other direction. The body is so adaptable, but the conditions need to be different. So I'm very grateful for WOOP for helping me on this spectrum, absolutely identifying things in my life. But basically, we can move in the right direction. It's not a one-way street, but we do have to do things differently. I think before we let you go, where can folks find you if they want to follow you? Where's the best place? So you can find levels at www. www.levelshealth.com.

blog is an amazing resource of information. And then our social resources, I just want to mention is you guys do a sensational job. And it's audio too. You know, you can basically listen to all the articles. Like it's really, it's a wonderful website with huge amounts of insights and knowledge. And that's a great place to start. Thank you. And then at levels on Instagram and Twitter, which is fun because you can kind of see

the experiments people are doing in the program and kind of learn from like what types of learnings they've been having. So at levels on Instagram and Twitter and I'm at Dr. Casey's Kitchen at DR Casey's Kitchen on Instagram and Twitter as well. Casey puts on her Instagram just tons of like recipes and you're always like cooking all these like perfectly proportioned meals with low glucose variability. So I really appreciate that. But yeah, it's a super fun to follow you. Awesome. Well, thank you Casey and we'll chat soon. Thank you to Dr. Means for coming on the WOOP podcast. If you enjoyed this episode, please leave us a review.

Make sure to subscribe to the WOOP podcast. Check us out on social at WOOP and at Will Ahmed. And you can get 15% off a W-W-M membership if you use the code Will, W-I-L-L. That's all for now, folks. We'll see you next week. Stay healthy and stay in the green. Thank you.