Betsy McLaughlin is a longtime Levels member who has held a number of executive leadership roles in many different areas of retail. She was the former president and CEO of Hot Topic, a position that she held until 2011. Prior to that, she was the company’s senior vice president of merchandising and marketing at Hot Topic during their IPO in 1996. Under her leadership, Hot Topic grew from 16 stores in 1993 to more than 800 stores in 50 states and Puerto Rico. She is now on the board of several companies, including Good American, Everlane, and Bark, and she previously held board positions at companies including Veggie Grill and Pinkberry. She has received many awards for her leadership and strategy and was recognized as one of the best CEOs in America.
Betsy recently appeared on our podcast, A Whole New Level, to speak with Levels co-founder and chief medical officer Dr. Casey Means about her experience with Levels, losing 81 pounds, and managing her metabolic health alongside cancer treatment. This is an edited version of that conversation.
Dr. Means: You have gone through a lot in this last year, losing 81 pounds since September of 2020, something that so many people hope to do, but very few accomplish. I’d love for you to walk us through your health journey prior to September 2020, when you made some new changes, and what your health goals had been and tactics you’d tried previously to achieve them.
Betsy McLaughlin: I was not blessed with favorable metabolic genetics, so I have struggled with weight my entire life, through elementary school, junior high, high school, yo-yo dieting. It’s very tough to be a teenager and be overweight. My first loss of 40 pounds happened when I was 13 years old, using the Weight Watchers program. But as my life went on, you try to work around things, you recognize you’re never going to be the thinnest person in the room, you get educated on what truly is important and what isn’t important. I’d always been very athletic, so I had the benefit of having good muscle structure. But as I got into my career, I recognized that I was traveling quite a bit, I was eating out quite a bit, I was under great stress. Certainly as I look back now, subconsciously, I realized that it wasn’t just my weight, but there were things that change in your body as you age.
As you go through and do all your testing, you realize that, “Gee, okay, is the cholesterol creeping up? What’s happening with my heart health, and what’s happening with my weight?” I recognized probably right around 40 that the upward direction of all of these numbers I obviously was not able to control, and that I needed to get my arms around it. I was very lucky that I had the means to be able to go to doctors and trainers. I went through many nutritionists and used some overseas doctors who were doing some experimental work to try to figure out what was happening with my metabolism. I’ve been on every diet you can imagine. I’m very disciplined, and so it wasn’t as if I couldn’t follow what was being asked.
I actually had a treadmill desk when I turned 42, so I was standing all day and walking one to two miles per hour, all day, including during meetings. And still I was unable to drop weight. Again, I just kept at it because I thought, “There’s got to be an answer to this, I’ve just not found it.” For the 20 years between 40 and basically 60 years old, anything that anybody threw my way, any specialist that was doing something different, I engaged in, and it did not work.
On managing metabolic health and cancer treatment…
Betsy McLaughlin: At 54 years old, I was diagnosed with stage three breast cancer and went through the process of surgery and then also five years of treatment. One of the things they tell you when you go on extended treatment is that the drugs work against you, especially as it relates to metabolism. Part of it is what happens with your joint health. You tend to become less active, you tend to not pay as much attention to what you’re eating, and even if you do, you see this gradual weight gain.
When I was diagnosed and when I started the treatment, I promised myself I would not change my exercise regimen at all and that I would continue to be dedicated to exercising six days a week, doing weight training, doing cycling. I had retired in 2011 and had met an amazing guy by the name of Michael Stavec who became my personal health coach, and he got me into a great routine to keep me healthy. Then the cancer happened, and we continued to be in that routine despite the fact that there were many mornings I didn’t even want to get out of bed because I was in so much pain, but I did it anyway.
Despite the fact that I continued my exercise and actually amped it up, I actually started exercising harder and longer and more thoughtfully, I still gained weight. I was just beside myself that over this course of time, I was going to put on probably tens of pounds. I knew this was happening. I could see it because I knew what my background was, and I could see, over the first year and a half, what was happening. I was still moving around. I still felt relatively healthy. But I felt like I just didn’t have control over what was going on. Michael actually is the person who introduced me to Levels.
He said, “Listen, I know that you don’t register as a diabetic. I know you’ve probably never measured your glucose other than going and getting your point-in-time reading, but this is something that I think is one of the only things you have not looked at in detail to address your metabolic health. And it hasn’t been on the market before, this is really revolutionary, and it is a wearable.” I was like, “I have to put it in my arm? It has to stay in my arm?” And he said, “Yes, but you can’t see it. It’s really not invasive.”
On changing her diet using Levels…
Betsy McLaughlin: I was a bit skeptical, but he literally brought it over and stuck it in my arm. I’ll tell you how important that day was. It was October 4th of 2020—the day that changed my life. I put it in and what he said to me was really interesting: “Just continue to do what you’re doing. For two weeks, I just want you to monitor and eat, and let’s just see what’s happening with your glucose.” Of course, I said, “I don’t have a glucose problem. I don’t have an insulin problem. I don’t have a diabetes problem. I’ve watched this, my dad has diabetes, so I’m a little sensitive to it, but I’ve been crazy about this my life, because I don’t want to be a diabetic.”
Sure enough, this monitor went on. By the way, once I was diagnosed with cancer, I decided I was going on a plant-based diet and would eliminate all meat and all alcohol. At the point in time when I put the monitor on, I had been plant-based for almost four years. I thought I was doing the greatest ever. I was eating quinoa and brown rice. I was eating sweet potatoes steamed, then put in the refrigerator so they were cold. I would eat them like apples. I was eating very, very clean tofu and gluten-free soy sauce, tamari. The silver lining in the cancer was that I had transitioned my nutrition to be plant based.
I wouldn’t really say I was cocky, but I came in thinking, “I’m not really sure what this is going to teach me because I’ve already taken out anything that I believe has any negative impact on your insulin levels.” I had not had fast food for 20 years. I don’t drink sodas, I have very little processed sugar. These habits had all been established during the 20 years that I was trying to figure out what was happening with my metabolism, and every specialist that came in took me off of something.
My glucose monitor goes in, and over the first three or four days, I was shocked because the first meal I had was a boiled sweet potato and my glucose shot up to 180 or 190, which was nuts. It stayed there for three hours. I just remember thinking, “Did I eat something that I didn’t know I ate? Or is there some secret here? Did something go into the sweet potato?” I was just really, really shocked. And then I had some quinoa and the same thing happened. And then I had lentils the next day and the same thing happened and it became very clear to me that I had made all of my food choices based on issues other than glucose or insulin. It was all about what the plant-based diet said to have or what I thought in my mind was good for me.
After about two weeks, almost everything that I had been eating spiked my levels. And not just up and down, but spiking them in what I call “scary domes” that last for five hours. You’ll eat dinner and it goes up, and then it just never comes down until like 3:00 AM, when it crashes, and then you work your way back up to normalcy. It was happening every single day and it was a very intellectual process for me, in addition to the emotional—”What the hell just happened?” But I thought, “My gosh, you mean I have been doing this for decades, trying to figure out what the issue is, and this has been the issue all along?” Nobody has made a comment to me about insulin levels because I haven’t registered [as someone with] diabetes or the threat of diabetes.
After two weeks, I went back and looked at the Levels instructions and read everything I was supposed to do because, of course, I went into this thinking, “Oh yeah, I’ll put it on. I’ll figure this out for myself.” I was like, “Oh my gosh, okay. I’ve got to log everything. I need to make my list.” The amazing thing was when I did the juxtaposition. There’s a list that says, try brown rice versus white rice, try X versus Y, and I went through most of that list because now I was just curious about all the food that I eat on a regular basis—how does it work and what does it do to me? It became a fascinating journey.
By the end of October, I had a list of the 30 foods that did not spike me, and I made a commitment to myself that I would, for one month, only eat those 30 foods. In the meantime, I would research what else I could do or whether there is a second level to this, as opposed to just knowing food on its own. So I ate the 30 foods and within the first month I dropped 15 pounds. No change in exercise, I just changed what I was eating and I was shocked. Everybody around me was shocked. The doctor was like, “Okay. This is great but remember your first month could be water. Let’s see how it adjusts.”
Losing 80 pounds—I hit that seven months in. And then I went to have my checkup and run all the numbers again. Usually you get the text from the guys who run your blood that says, your numbers are there, you can look them up. I received a text from my internist who just said, “Holy shit, I’ve never seen anything like this.” It was crazy. My A1C went from 6.1 to 5.2, my glucose went from 117 to 84. My insulin went from 30 to 5. It was nuts and I became an evangelist for Levels.
I’ve turned on more of my friends who also have had issues, either with metabolism or just having trouble losing weight—just to understand how this all works. It really is a game-changer for me. I’m so grateful that Michael introduced me to Levels because I know I would still be struggling right now, and who knows where you are when you continue to gain weight as you get older. I still have 60 pounds I would like to lose in addition to where I am—I’ve plateaued a bit and so I’ve had to shake it up a little—but I’m very happy that I have my friend on my arm all the time to both keep me honest and to inform me on a regular basis how my body is doing.
Dr. Means: Thank you for sharing all of that, Betsy. it’s really an incredible and inspiring story and really a testament to how we can be working really hard and really disciplined and doing all the right investments, nutrition, exercise, getting a great team on board and yet, if it’s not what’s right for our body or what our body really needs, we may be not seeing the results we want.
I’m curious about your experience prior to October of last year, because you just mentioned some of your lab changes that were really profound shifts. In retrospect, looking back at those labs from September of 2020, had anyone told you that you were on the spectrum of metabolic dysfunction?
Betsy McLaughlin: There was concern that the glucose was rising and that I was pre-diabetic, but nobody had answers because the answers were lifestyle. The default is: “In order for you to get these numbers in order, you need to follow this program.” It didn’t matter if the doctor was in Europe or Asia or the US. Everybody believes that if you follow this program, this is what will happen. But there are many of us who don’t fall into those categories, and so what am I told to do? I’m told to “make sure I exercise three times a week.” Okay, I exercise six times a week. “You need to get your heart rate above X amount for 20 min.” Okay. I do that. “You have to do 10,000 steps.” I do that. All right, what’s next?
“Have you considered a plant-based diet?” I’ve been on a plant-based diet for three years. “How much alcohol do you drink?” I stopped drinking alcohol. “How much processed sugar do you have?” I stopped that 20 years ago. Then everybody just goes, “We have no idea. We don’t know what to tell you.” I will say that in most cases, they think I’m not telling the truth.
You get discounted because the belief is that if you did all of these other things, this wouldn’t be a problem. That’s what our science and our history tells us. That’s not true because one of the things I have found as I’ve gone through Levels is that there are foods I can eat if I eat them in the right order. If I eat my protein first, and then I have a carb, it absorbs much better for me. Nobody ever went through that with me.
One of the things that Levels does is it’s personal. No one’s going to have the same Levels readings as you have. No one’s going to have the same program.
On changing her approach to eating…
Dr. Means: Something that comes to mind is that so many of the foods you were eating were healthy foods, and these things were spiking you through the roof. What it really highlights is that the body handles different things in different contexts. That’s so different from what we’ve traditionally thought about nutrition, which is that food has inherent properties. But that’s not the reality.
You’re putting food into this complex context of the body, which is dynamic. The microbiome, as well, is hugely dynamic. It’s not just the insulin sensitivity but also what’s going on with the gut. You mentioned some of the foods did not work for you at the beginning, but they do now. How did you shift your diet during the process? And how has that now evolved into where you are today?
Betsy McLaughlin: I was concerned that if I gave myself too much latitude, I would not be able to remain disciplined. I also picked up fasting and timed feeding, where I only eat two meals a day. I don’t eat until one o’clock and I don’t eat any later than six o’clock. I only have a five-hour window when I eat, which is just fine.
I started fasting one day a week. And every month, I would do a longer water fast for three or five day. That made eating a simple process for me, as opposed to every day going to the farmer’s market or figuring out, “What am I going to cook tonight?” I had to remove all of that initially, because I knew that if I wanted to do this I needed to be very, very disciplined. I went down to my 30 foods that didn’t spike me and had no problem with it. It was a very simple life.
When you’re not thinking about food all the time, you eat less. If I’m going to have three hard boiled eggs, some almonds, some string cheese, and two cups of lettuce as a salad, it doesn’t really excite me, but I’m also not thinking about food an hour before and an hour after. It put me into a process that said, “Listen, what you’re eating is really important and you want your body to certainly start working at a more optimum level, but you don’t have to think about it all the time. Though you pride yourself on being a creative cook, we’re going to take that out for the short term, and then we’ll bring that back.” And I said that to myself over and over again: This is only temporary.
I also happened to do it in the middle of COVID, where I wasn’t going out to eat three or five or ten times a week. Restaurant food, as any chef will tell you, always has hidden elements in it. I had total control over what was going into my body. It was interesting that even with the fasting and with the very limited diet, I had more energy than I’ve ever had in my life. In fact, my workouts started to go from one hour to two hours. On some days when I had time, I’d add an extra hour. I was easily able to increase weight in my weight training, and in cycling my endurance increased.
I kept having the validation and the encouragement because I was feeling so good. I stayed true to that routine, both the fasting and the Levels diet, until about March of this year. Then I started to play with combinations. Interestingly enough, one glass of red wine didn’t spike me. One glass of red wine, combined with some carbs, keeps the carbs down for me. I could actually have two little fingerling potatoes with a couple of sips of red wine and my glucose would stay okay.
I was very prescriptive about it. I was taking so many notes because I became my own science project. I don’t think that has to happen, but again, I spent how many decades trying to unlock what the mystery was, and now that I finally had an opening into this, I just became incredibly curious.
Fast forward to today, I still have 60 pounds to lose. I’m certainly losing a lot slower. I lose about a pound a week, which is great and probably the healthiest thing that I can do. It was my birthday last weekend and I wanted ice cream. I had six tablespoons of Salt and Straw ice cream—my very, very favorite—and I went from 90 to 150 and then came back down so fast.
As you get into this, you realize it’s the domes that you fear. The spikes, if you can manage them, [are] okay. I was so happy. It was the fact that I could eat ice cream, spike up, spike down, and be completely normal. That was a celebration unto itself.
On the value of 24/7 monitoring devices…
Dr. Means: Happy birthday, and what an amazing choice for the birthday! How empowering to watch that insulin sensitivity at work—that is amazing.
As a lifelong athlete who has used other types of wearables and trackers, what aspects of these devices have really helped with your journey aside from Levels? How do you see them fitting into this metabolic disease epidemic that we’re dealing with?
Betsy McLaughlin: It’s always good to have a real-time report card. For so long, it’s been that you don’t get the report card until you go to the doctor, and then they tell you, “Here are the things you need to do.” Then you do them for six months or a year and go back and get another report card.
I’m a retailer. We get sales every day. We know every single day whether what we’re putting in front of our customers is something they like, they don’t like, or they’re ambivalent about. I’m a little bit of a junkie as it relates to real-time reporting. I’ve gotten used to that in so much of my life and so to me, this is an extension of that.
I look at the Whoop strap that I wear all the time, and I want to know what my strain is every day. I want to know what my sleep is every morning. I want to know what my resting heart rate is, I want to know what my HRV is, I want to know what my respiratory rate is. I didn’t know what was good before, and now through these wearables, I know what is optimal and I can work toward it. If you have a bad day, you have a bad day, but in your mind you’re still able to rationalize and understand.
The Whoop strap has been terrific, especially as it works with my fasting and with Levels. I had used Cronometer because I wanted to understand my macros. The beauty of Levels or Whoop is that as you change through the day, you’re able to get real-time reads. I don’t think there’s any replacement for them. If you really want to get to the root of a problem, you have to understand how your body is working 24/7 and this is the only thing that will allow you to do that.
Dr. Means: Having used Whoop and Levels together and working out so frequently, did the continuous glucose monitor have any impact on how you were shaping your workouts?
Betsy McLaughlin: Yeah, it did. My coach, Michael is fanatical about this. I was always doing an early morning fast and training, and during high-intensity workouts my glucose would rise. We didn’t want my glucose rising during long, slow, distance workouts, so we would use Levels to see how fast my glucose would return to normal after I did HIIT training. As time went on, I returned to normal much quicker than I had when I started, and I still do that today. I think it’s a good discipline to know how your body is reacting when you’re doing intense workouts versus these long, steady workouts.
On approaching wellness as a business executive…
Dr. Means: We already have so many great take-home points from just hearing about your story. I’m curious: You had a very busy and intense career with all these executive roles that you held. In those environments, wellness may not be top of mind every day. How do you think people who might be in the grind right now, building their careers, can think about approaching health and nutrition and wellness in a way that keeps them on track? Is there anything you wish you’d implemented earlier during your career?
Betsy McLaughlin: I always looked at the relationship of food with body weight: eat more food, gain weight, eat less food, lose weight, exercise more, calories in, calorie out. It was a very linear way of looking at food. I wish that, instead of taking food and coupling it with weight, I took food and coupled it with fuel and spent more time understanding how food fuels your brain. I wish I would have spent more time understanding the connection between food and fuel. When you’re in a state of stress, you already have inflammation, and food can aggravate that inflammation. Understanding that there are certain foods that you can eat that will decrease the inflammation, and therefore decrease the stress, would have been incredibly helpful to know 20 years ago.
We all know that you have to be active every day, don’t smoke, limit your alcohol, and get sleep. These are all things that are very public and very understood. If insulin was brought into that conversation and that narrative, I think it would have been a heck of a lot better for me and, I think, for so many people,
Unfortunately, until we can rotate and broaden the thinking, most people think that the only time you really have to worry about this is when you’re having a diabetic event, and that’s not the case. It is part of your body’s functioning. If it doesn’t work correctly in your body, everything else doesn’t work, much like sleep. For anyone listening, if you do one thing, it’s to really understand the food-fuel dynamic and to understand your own insulin.
On the need for systems-level change in our approach to healthcare…
Dr. Means: Health is not black and white. It’s not an on-off switch where one day you don’t have Type 2 diabetes, and the next you do. It’s much more of a gradual evolution and we miss the early parts because we’re not actually looking at it or testing it, or giving people the tools to manage it in their own lives.
You’ve been an executive leader for decades, thinking on the systems level. What can we extrapolate from your own personal and leadership experience to the broader population in terms of public health and systems-level approaches to the metabolic disease epidemic?
As a physician, something that I’ve seen to be a very damaging line of conversation is this idea that we shouldn’t focus on diet and lifestyle because patients are going to be non-compliant. Your experience is the poster child for why this is a ridiculous way of thinking, because people are trying, people are working hard, but if you’re not doing what works for your physiology, it’s not going to work.
Betsy McLaughlin: We as humans are always looking for the silver bullet. I think we’re willing to work to a certain extent, but we’re not really willing to change our lives completely. We have a lot going on. I will say this is the closest thing to a silver bullet that I’ve seen as it relates to understanding and being able to make an impact. It doesn’t require you going to the doctor on a regular basis.The app is done in such a way where you learn very quickly. And I’m just a firm believer that education is the beginning of all of this.
We have to educate first. I mean, nobody believes anything unless they’ve actually heard it multiple times. We know that from effecting any kind of systemic change, you have to start with constant education over and over and over again. Our healthcare system is designed to address chronic illness versus rewarding prevention. We wait until there’s a problem, and then that’s what gets covered. If you’ve done any preventative work on your own, insurance usually doesn’t cover it. They’re getting better, but it’s much easier to get something covered that’s already happened and requires you to have a drug or have poison shot into your body. You can get that covered, but boy, you’re not going to get covered for those things that would prevent that from happening.
Going back to the education piece of it is really important. As socially modern humans, we have short attention spans, and the thing about Levels is that boy, in one month’s worth of time, you can learn so much about yourself that you can apply. And if you do apply it, it can be the silver bullet. I’ve been through a lot of these diets that promise that and that’s not the case.
I think that this technology is still special. The more people that have access to it and can try it, I mean, boy, if I was running an insurance company and I wanted to get my chronic disease down, I’d probably supply Levels because it’s the quickest way for somebody to figure out exactly how to control their insulin levels.
I will say that for people who have been struggling for a long time to try to figure it out and really have put the effort in, listen: If you don’t want to put the effort in, don’t do it, don’t waste your time, don’t waste everybody else’s time. But I don’t believe in noncompliance. I believe, as you said, that 50% of people actually are trying to do something to help in the health category. And if you can find something that will give you results in a quick way, that just reinforces that you’re heading in the right direction. Michael was saying to me the other day that he met a doctor who said, “If I could just put a Levels monitor on every patient 30 days before they walked into the office, I wonder how much would change both what I’m able to do for them and how they look at their health?”
That’s the magic of this kind of wearable, and we just need to get more and more people to do it. I have shared Levels with, I want to say, maybe 15 people at this point. There’s not a single person that has not learned something from it that they believe will impact the rest of their lives.
Dr. Means: That is so heartening to hear. I agree completely, especially with the statement that it really starts with education. I found this certainly when I transitioned out of the surgical world into functional medicine, a holistic integrative practice. I was spending two hours with every patient. When patients understood their physiology in detail, and the mechanisms of how the interventions were going to shift that physiology, things happened so much faster. Education and understanding underlies behavior change in a way that we probably don’t even fully understand yet, but something about the mental model makes it easier to make those hard commitments when you know you really have a good grasp on why it’s going to help.
Betsy McLaughlin: What is interesting is that so many of us just don’t want to be the textbook answer. The beauty of this is that it is personalized. It is just your body that’s being read, it is just you that sees the results, and it’s up to you to do what you want with it. And it actually puts control into the user’s hands. I find that to be a very powerful component.
On the regenerative food movement…
Dr. Means: I could not agree more. The big mission at the company is that we want to give agency to the individual and decentralize the control and health care to the person. Like you said, when the report card comes just from the doctor, it’s a very different relationship than your report card being generated by yourself, every day. It totally changes the way I think, feel motivation, or get inspired.
I’d love to wrap by talking about your interest in the regenerative agriculture movement, which I think is very tied to metabolic health. What does this movement mean to you?
Betsy McLaughlin: I’m just really learning about this. I have a friend, Richard Christiansen, who runs the Flamingo Estate here in Los Angeles and is very dedicated to the regenerative food movement. He’s really been educating me and his customers on the importance of thoughtful farming. For everybody who doesn’t know, it’s a holistic land management practice that uses photosynthesis and plants to keep carbon in the soil. It improves soil health, it improves the yields of crops in the field, it improves water resilience, nutrient density. It’s a very circular movement and combats climate change because of the carbon being kept in the ground.
For those of us who want to help the planet and want to do it in other ways than just giving money, it’s very interesting to make your choice in food—food that has been grown with the utmost respect for the planet and the animals on the planet. I actually transitioned all of my meats to be game meats, whether it’s elk, antelope, venison, or even beef that is farmed correctly or through using these principles.
Nutrition-wise, do I notice the difference? I mean, I noticed they taste better. It’s like when my mother used to talk about how tomatoes just don’t taste the same way anymore. I always thought, “Oh yeah, it’s your parents saying that everything that happened back then was much better than it is now,” but I really can taste the difference. When I get a farmer’s market box that is all regenerative farming, you can taste the purity of the vegetable. You almost can taste the love and the respect that’s gone into growing this, and it’s changed how I think about things. I’m just beginning on this journey, but I think this is a movement that, very quickly, is going to grow.
As we all recognize that every single thing we put into our bodies is reflected in the way that our bodies work, I’m hoping this is a movement that will be available to everybody so that you can make those healthy choices and can feel the difference. I can’t say that I eat this asparagus versus that asparagus and feel the difference immediately, but psychologically, I absolutely feel it, and it tastes better. And again, I don’t know whether that’s just me saying this is new and this is exciting, but I’ve had other people who’ve said to me, “The quality of the meat and the quality of the produce certainly on regenerative farming is much superior.” I’m just a novice in all of this, but I think this is the next wave.
Dr. Means: It’s great to hear that overview. Particularly with metabolic health, for us to be optimally metabolically healthy, our microbiome has to be on point, our micronutrients have to be on point, our omega three levels have to be on point. All of those things are related to soil health. We’re not going to be able to fudge it or fake it with crappy food and really get these machines—our bodies—working the way we want them to. I’m excited to see how these types of fields co-evolve together and it’s really neat to hear from you about how you’re starting to get into this world. And I know this episode is going to inspire a lot of people to take control of their health in a slightly different way. So thank you, Betsy, for being here.
Betsy McLaughlin: I thank you, Casey, and thank you to the Levels team. You guys have changed my life and I am forever grateful.