122 Metabolic Health With Dr Casey Means on Losing Weight to Gain Control
Episode introduction
Dr. Casey Means is passionate about treating medical conditions in ways that go beyond the surface level. In a modern world rife with widespread diseases, processed foods, and a lack of science-backed dietary education, we’re spiraling out of control fast. For Dr. Means, it’s also rooted in a personal search for answers – as a child, she could have gotten her own health under control quickly if she had known what she does today. That’s why her company Levels is all about literally putting the power of knowledge in peoples’ hands – or should we say on their arms, in the form of a continuous glucose monitor. Listen to host Gwen Alexander chat with Dr. Means about all things diet on the Losing Weight to Gain Control podcast.
Show Notes
Key Takeaways
02:37 – Why we should stop throwing steroids at medical conditions
Most conditions are rooted in chronic inflammation caused by the body being trapped in “threat mode.” The two most common triggers are high blood sugar and metabolic dysfunction.
“So many of the conditions I’m treating are actually fundamentally rooted in chronic inflammation. So things like sinusitis, laryngitis, thyroiditis, all these itises, that’s the suffix that means chronic inflammation. And I stepped back and said we’re throwing a lot of steroids, a lot of medications, a lot of surgeries at these conditions, but we’re not actually stepping back and asking what is the root cause of the inflammation? Inflammation is fundamentally the body being triggered, thinking that there’s a threat that it needs to fight against. And so what are these triggers that are causing the body to be in threat mode. When you look into that a little bit more deeply, we know that chronic inflammation can be generated from a lot of the daily choices we’re making in regards to diet and lifestyle. One of the key fundamental triggers of inflammation in the body is high blood sugar and metabolic dysfunction. And this is something that unfortunately is very difficult to escape in our modern world.”
11:43 – A shared root cause of disease
Blood sugar issues can impact any area of the body – and the area that is impacted most is the one that will start to show symptoms of disease, whether that’s brain fog, infertility, or anything in between.
“We have trillions of cells in the body and every single one needs that energy of function. And when it’s not happening properly, we see the breakdown of tissues. And breakdown of tissues leads to symptoms. And wherever that’s happening in the body is what the symptom is going to look like. So you can imagine if you’re not getting energy properly in the brain because the brain is insulin resistant, that could look like any brain symptom. It could look like neurodegeneration, Alzheimer’s, dementia. It could look like general brain fog. It could look like chronic pain, fibromyalgia. It could look like chronic fatigue syndrome. It could look like a mood issue like depression and anxiety. All of those conditions I just mentioned associated with the brain are associated with blood sugar dysregulation. Because if the brain’s not getting energy, it could look like so many different things. If that’s happening in the ovary, it could look like infertility, polycystic ovarian syndrome…All of these conditions are rooted in dysregulated blood sugar, and that’s because this energy deficit is showing up in different places, which can look like different symptoms. But the way I like to visualize it, it’s like this metabolic dysfunction, insulin resistance and high blood sugar levels, uncontrolled blood sugar levels is the trunk of a tree with like all these branches that look different, but it’s actually rooted in large part by a very similar root cause.”
14:04 – Control insulin to lose weight
Regulating blood sugar level and controlling insulin helps us maintain healthy insulin sensitivity. When insulin levels are low, the body can switch to burning fat.
“When we keep our insulin high, because of the way we’re eating, that is a blocker on fat burning and that leads to excess weight. So one of the key things that we can do to bring that weight down is starting to control our insulin levels. And insulin levels tend to rise and be higher and we tend to develop insulin resistance probably over a decade before our blood sugar actually changes, because we can overcompensate. We can just keep producing more insulin to keep our blood sugar looking okay, when really we’re just going down this path of metabolic dysfunction. So insulin resistance precedes blood sugar changes. But the more we can keep our glucose stable and low day after day, the more we’ll keep our insulin lower day after day, and the more we will improve our insulin sensitivity. And as we keep our insulin levels low, we unlock fat burning. So long story short people dealing with excess weight, that would be a signal that maybe blood sugar is something you want to focus on.”
16:19 – Can stable glucose improve our mood?
Not having spikes or glucose during the day can help maintain a stable energy level, which will help maintain a stable mood and cognitive function.
“Everyone responds to carbohydrates differently in terms of how they affect your glucose. So knowing personally how a food is affecting you can change everything. I’ve seen a lot of people transition from an oatmeal breakfast to something more like avocado and eggs which is going to have virtually no glucose spike, because there’s very little carbohydrates in that. And their whole morning transforms. Because when glucose is stable, a lot of other things in our lives stabilize as well. So I think variability in glucose often maps to variability in our d ay-to-day experience. And the more stable and lower glucose levels are the more our mood, our energy, our cognitive performance are going to be stable as well. It’s certainly not the panacea for those things. When you stabilize glucose, it doesn’t mean you’re just going to have the perfect mood and the perfect energy, but it is really good stuff.”
21:11 – Changing the medical world from the bottom up
Complex systemic issues have resulted in bad marketing and medical misinformation. With continuous glucose monitoring, Levels is trying to arm people with the information that will help them make informed, healthy choices about their bodies.
“It’s just a huge web of systemic and cultural factors that make it that we have bad information. So I don’t think it’s doctors not having faith in their patients. I think it’s just a very complex set of issues that we’re just unfortunately caught in the middle of. And because of that, because of all the interests at play, humans become the product. Companies are vying for our dollars basically, and we are unfortunately lost in that shuffle. So my premise and Levels’ premise is that if we can give people access to information about their own body, what my body is doing, you break through a lot of the marketing claims, you break through a lot of the confusion. You just have an answer. You eat oatmeal, you see how it affects you. You know if it’s a heart-healthy food for you or not. And that question, you never really have to answer it again. It just cuts through a lot of the craziness that I think is driving systems-wide issues. So my hope is that if people had more access to their own information and could interpret it well, we actually see a shift in consumer choices. We’d see a shift in what patients are expecting of their doctors. And we’d actually see things shift from the bottom up. But I think it’s rooted in bad information, unfortunately.”
24:00 – Not all calories are created equal
The calorie in, calorie out diet is not sustainable. When people can see exactly what each food consumed is doing to their body, they will be able to make smarter, more holistic decisions.
“We’ve heard that many times, it’s all about calories in versus calories out. But in a lot of the research studies, we’re finding that that type of model doesn’t actually lead to sustained weight loss, and that’s where really this hormonal aspect of weight loss is starting to take more front seat in this discussion. Which is that a calorie that stimulates a hormonal response, like an insulin response, is going to have a different effect on your ability to lose weight or burn fat than a calorie that doesn’t cause an insulin response. So that calorie might have the same amount of molecular energy in it. That’s how calories are defined, you know, like a unit of energy. But one is going to stimulate her hormonal cascade, and one is not. And so that’s something key that’s shifting is our understanding of that. So that’s one thing. And I think the other thing is that a lot of people associate diets with things like deprivation, and that this is hard and this is going to take away something that brings me a lot of pleasure. And especially when you’re not even really sure if that thing is causing a problem, it’s easy to just sort of be like, okay, I’m going to keep eating the donut, it doesn’t seem to be causing a problem. It’s this many calories, which is fine on my diet and whatnot. But I think having that little piece of extra information, like, okay, I can see exactly what it’s doing to me, just gives people at least informed decision-making with that process.”
27:25 – Does fasting promote weight loss?
Eating in a shorter window of time helps keep insulin and glucose levels low, which leads to much better metabolic health and ultimately supports weight loss.
“So let’s say you’re eating pretty much all day, which is like the average American breakfast, lunch and dinner, maybe 8:00 AM to 8:00 PM with a few snacks in between. You can imagine you’re just going up and down all day, and basically your insulin and glucose are staying kind of high throughout the whole day. Now imagine that you just ate between 11:00 AM and 5:00 PM, but the exact same amount of calories. Well, you’re going to get those same glucose spikes, but it’s going to be in a much narrower window. So you’re going to have all this extra time outside of that feeding window where your insulin and your glucose are low, which means that you’re actually burning through the glucose in your body for energy. And you may actually start tapping into fat burning. And condensing the amount of time or eating per day into a shorter window has been shown to be healthy. And that’s kind of behind this whole concept of time-restricted feeding or intermittent fasting that’s becoming more popularized. And I think one of the reasons why that’s been shown to be somewhat effective for weight loss is because you do end up creating more time when you’re in a lower insulin state and can tap into fat for fuel, which is ultimately, what’s going to burn off some of the extra stored fat that is extra weight.”
34:32 – Setting our sights on healthy benchmarks
Instead of defining what’s unhealthy, perhaps a better medical system approach would focus on studying young and healthy individuals in order to provide a clinical definition for health. In the case of glucose values, an ideal range is between 70-120.
“There’s been studies where they’ve put glucose monitors on really healthy young people and looked at their glucose values over 24 hour periods. And if you do that, you find that the majority of people never really go above 120. So the idea that we should ever be getting close to 140 is a little bit crazy. We should probably be sticking somewhere between 70 and 120 all the time, and rarely ever going above 120. We know above that you’re going to have a bigger insulin spike. You’re going to have higher blood sugar, which can cause problems. And so sticking to that tighter narrow range is probably better for health, but there are no standard criteria that a doctor is going to say for that type of thing right now. And that’s just because we’ve mostly focused on disease states in our medical system. We haven’t really focused on these healthy populations, these preclinical populations, but I think focusing energy on those populations before you develop these issues is a really high-value thing to do.”
37:32 – Food education is a missing piece of the puzzle
Dr. Means would have better controlled how much processed food she ate if someone had told her that it would help clear up her acne, PMS, lower back pain, and anxiety.
“I was well over 200 pounds when I was in eighth grade. And looking back, I wish I’d known a lot of this. Even at that age, I knew a lot about it. I was reading about nutrition and magazines. I thought everything was about low fat then. And that’s what totally caused problems because when we went low-fat as a culture in the nineties, what happened was we filled foods with sugar, and that was one of the biggest mistakes we ever made in terms of a scientific community and committee recommendations. Because ultimately that stat increase in sugar during the low-fat movement is what’s driven a lot of our problems today, and certainly mine as a child in high school or late middle school, thinking about some of the things that I was struggling with like acne and like PMS and things like mood, anxiety, and angst and things like that. And I remember being so sore after my sports practices, my joints would hurt and I used to get low back pain all the time. You just take Advil for things, it’s all normal. But it’s not normal. None of it is normal. And if someone had told me like, oh, hey, if you get rid of all this processed food you’re getting at Costco, it actually will clear up most likely all of these things in one fell swoop. Who knows if I could have broken that sort of addictive food pattern at that point, but I sure as heck think it would’ve helped.”
Episode Transcript
Gwen Alexander: [00:00:00] Losing Weight to Gain Control. Today’s episode Metabolic Health with Dr. Casey Means.
Welcome to today’s episode of the Losing Weight to Gain Control Podcast and this is Gwen Alexander, your host, and today we have a special guest with us. We have Dr. Casey Means and Dr. Means is a Stanford trained physician, Chief Medical Officer, and Co-founder of the metabolic health company Levels and associate editor of the International Journal of Disease Reversal and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. She is an award-winning biomedical researcher with past research positions at the NIH Stanford School of Medicine and NYU.
So Dr. Means welcome to the podcast.
Dr. Casey Means: [00:01:25] Thank you so much for having me, Gwen. I’m thrilled to be here.
Gwen Alexander: [00:01:28] Good. I was so glad when your team reached out to me about having you on the podcast, because I have done a few episodes about insulin and how that affects your eating and weight loss or weight gain. But I try to go from the limited knowledge I have, and I’m not a medical doctor. It’s not my specialty, but I think what you’re going to talk about today is going to help a lot of people understand better how their blood glucose levels can affect not just your weight but just your overall health.
So what I’d like you to do is just tell the audience what led you to get into the medical field that you’re in now and get into a starting Levels?
Dr. Casey Means: [00:02:03] Sure, absolutely. So what got me into metabolic health really – it’s a circuitous route, to be honest. I actually, after medical school, I trained as a head and neck surgeon. So I was practicing head and neck surgery, which is treating the diseases of the ear, nose and throat primarily. And after about four and a half years of my training in this after medical school, I stepped back and I realized, “Oh my goodness, so many of the conditions I’m treating are actually fundamentally rooted in chronic inflammation. So things like sinusitis, laryngitis, thyroiditis, all these itises – that’s the suffix that means chronic inflammation. And I stepped back and said, we’re throwing a lot of steroids, a lot of medications, a lot of surgeries at these conditions, but we’re not actually stepping back and asking what is the root cause of the inflammation? Inflammation is fundamentally the body being triggered, thinking that there’s a threat that it needs to fight against. And so what are these triggers that are causing the body to be in threat mode? And so when you look into that a little bit more deeply, we know that chronic inflammation can be generated from a lot of the daily choices we’re making in regards to diet and lifestyle. One of the key fundamental triggers of inflammation in the body is high blood sugar and metabolic dysfunction and this is something that unfortunately is very, very difficult to escape in our modern world.
Recent research suggests that 88% of Americans have some element of metabolic dysfunction, some biomarker of poor metabolism and only 12% of Americans are metabolically healthy. And this is likely the root cause of so many of the chronic conditions that are killing Americans today as well as just many of the symptoms that we’re dealing with that make normal daily life more difficult.
So blood sugar, high blood sugar, metabolic dysfunction, key drivers of inflammation. Also things like lack of sleep, lack of adequate sleep. There’s an epidemic of not adequate sleep right now (people are not getting enough), chronic low grade stress, and even being sedentary (so not moving enough). These can all be triggers of inflammation in the body.
So it became really imperative to me to step back from my surgical career and think, if I really want to help people feel empowered to make decisions in their life that will minimize chronic inflammation and maybe have an impact on a lot of these conditions that I’m treating in ear, nose and throat, maybe that’s where I should be focusing my time. So I shifted my clinical energy into thinking through how to help patients make these healthier decisions and choices every day that are foundational for metabolic health and not only do that for the individual patient, but how do we scale these solutions? If we have 74% of Americans with overweight or obesity, we have 128 million Americans with diabetes or pre-diabetes, 88% of Americans with metabolic dysfunction. Based on the study I had just mentioned, nine of the ten leading causes of death in the US are related in some way to dysregulated blood sugar levels. If this is all the case, then what I realized I wanted to focus on in my medical career was helping with blood sugar, helping people get that blood sugar under control and do this through scalable solutions that could affect big populations. And so that’s what drove me to start Levels, which, ultimately, is the first tool to allow the average individual to know exactly how their food and lifestyle choices are affecting their glucose levels and their health in real time and the first tool that allows us to close the loop on nutrition in general, to know this is what I ate, and this is exactly what it did to my body. And with that information, I think it arms people to make easier choices, consistent choices that generate health and circling back, ideally in the long run would help keep them out of the operating room.
So that’s my journey and how I got to starting Levels.
Gwen Alexander: [00:05:43] Did any of your patients, did you try with them before you got involved with Levels of trying to get them to change their behaviors, like behavior modification, to help them with the symptoms that they were having?
Dr. Casey Means: [00:05:55] I did. After coming to a lot of these realizations, when I left surgery, I actually first started my own private practice and it was very different than my surgical practice. I created what I would consider the practice of my dreams. I was like, if I want to make people healthy, what does that have to look like? And it was radically different than surgery. So I was spending maybe 10-15 minutes with patients when I was in my surgical training, seeing 30-40 patients a day sometimes. And in my practice, the new practice I created, I was spending two hours with people and I was focusing deeply on what was driving them to make choices that were leading to poor health? What were the barriers in their lives that were stopping them from making healthier choices, and really focusing on behavior change and coaching. And I did give continuous glucose monitors to a lot of patients and it was reviewing that data with them intensively to say, “Okay. You ate this food and this is exactly what happened to your glucose. So this might not be the best option for you.” Or, “We should pair this carbohydrate with other things like protein or fat or fiber to help minimize the glucose spike.” Or, “When you got less sleep, your glucose seemed to be higher. Maybe we need to focus on getting higher quality sleep.”
So I was doing all of this in a very, very high touch way, and that’s part of what drove me to realize, “Okay. This is an effective tool. It’s really useful.” But this is a lot of one-to-one energy with people to help them understand this data and I think that a tool like a digital tool could actually do this better than I could do it. So that’s what Levels is. Levels is the software on top of a continuous glucose monitor data stream that takes that data from this wearable sensor and interprets it for people. It makes it super easy to understand, makes it actionable and does what I was doing in my own practice but in a way that’s much more efficient, in more real time and ultimately, like I mentioned, scalable to larger populations.
So that transition into my own practice using continuous glucose monitors and it helping people intensively improve their lifestyle and behaviors and diet to improve metabolic health is what got me to build that product.
Gwen Alexander: [00:07:55] I couldn’t imagine spending two hours with my doctor. It would be nice, but I know they have to, like you said, get the patients through and I think a lot of what you said about behavior modification is huge. I’ve had to adjust my… I have lupus also. I was diagnosed a few years ago and actually this past year, I cleaned up my eating a lot more. I say cleaned up. It’s not probably the definition of clean eating, but one of the things you talked about with the blood sugar levels, I actually adjusted what I eat in the morning because I noticed, I felt so sluggish still. It just was so bad that I thought I needed to adjust something, so I switched to a different type of meal in the morning and big difference. I feel a whole lot better. I feel more awake. My body doesn’t feel like you said, inflamed, and it’s not just the lupus, I would feel puffy and things like that.
Can you tell our listeners what are some of the symptoms they might notice if they are having insulin issues? If not diabetic, but maybe their blood sugar isn’t where it probably should be for them that’s optimal, what kind of symptoms they would see?
Dr. Casey Means: [00:08:56] Yeah. It’s a great question and it can be different for everyone, to be honest, and backing up a little bit, if that’s okay, I would just say first and foremost, what is metabolism? And that will help lead into a discussion of symptoms that people might see.
So fundamentally our metabolism is how we produce energy from our food and our environment. We take in food. We have to convert it in our bodies into something that our bodies can use for energy. So there’s this conversion process and when that process is not happening efficiently, we can’t make energy for our body. And that process is co-opted by unhealthy diets, especially diets high in refined carbohydrates and sugars, because what happens is we’re giving our body all this energy source as glucose and carbohydrates, but we’re actually not able to convert it properly to energy we can use. And the reason for that is because elevated blood glucose in the body, blood sugar, high blood sugar causes our body to release insulin. Okay. And insulin is that hormone from the pancreas that tells glucose to be taken out from the blood into the cells. So it helps get the sugar out of the bloodstream into the cell so it can be converted. When that process happens over and over where you spike glucose, spike blood sugar, and then you spike insulin, over time the body actually becomes numb to that signal of insulin and it becomes resistant to insulin. And it says we’re trying to shove way too much sugar into the cells. There’s way too much insulin around. We’re going to actually block more sugar from coming into the cells because it’s too much. So then what happens is you have a lot of energy in the bloodstream, in the form of blood sugar and refined carbohydrates that turn into blood sugar, but you can’t get it into the cells to be able to actually be used.
And that’s fundamentally what insulin resistance is. The body overcompensates then by producing more insulin and saying, we’re going to shove that blood sugar into the cell so we’re going to produce more insulin to get it into the cells. And so what you ended up getting essentially is this vicious cycle of rising insulin levels, rising glucose levels in the blood and this causes so so many problems. And the downstream result is that our bodies are not getting enough energy in the cells to function. We have trillions of cells in the body and every single one needs that energy to function and when it’s not happening properly, we see breakdown of tissues, and breakdown of tissues leads to symptoms. And wherever that’s happening in the body is what the symptom is going to look like.
So you can imagine if you’re not getting energy properly in the brain, because the brain is insulin resistant that could look like any brain symptom. It could look like neurodegeneration, Alzheimer’s dementia. It could look like general brain fog. It could look like chronic pain, fibromyalgia. It could look like chronic fatigue syndrome. It could look like a mood issue, like depression and anxiety. All of those conditions I just mentioned associated with the brain are associated with blood sugar dysregulation because if the brain’s not getting energy, it could look like so many different things. If that’s happening in the ovary, it could look like infertility, polycystic ovarian syndrome. Leading cause of infertility in the country is insulin resistance of the ovaries. If it’s happening in the penis, it could look like erectile dysfunction. The well-established cause of that problem is blood vessels being clogged, basically, vascular dysfunction caused by high blood sugar. If it’s happening in the liver, it could look like chronic fatty liver disease. If it’s happening in the heart it could look like heart disease or in the blood vessels that could look like stroke. All of these conditions are rooted in dysregulated blood sugar, and that’s because this energy deficit is showing up in different places, which can look like different symptoms. But the way I like to visualize it, it’s like this metabolic dysfunction, insulin resistance and high blood sugar levels, uncontrolled blood sugar levels is the trunk of a tree with all these branches that look different, but it’s actually rooted in large part by a very similar root cause.
So to answer your question, it’s hard to say exactly what it’s going to look like for one person because it could look like many, many different things. But there are some key indicators. One is that if there’s excess weight, if someone is struggling with overweight or obesity, that’s pretty much a clear sign that there’s some problem with insulin, because going back to our story about insulin and insulin driving glucose from the bloodstream into the cells, the other purpose of insulin, other than taking out blood sugar from the bloodstream is that it stops us from burning fat for energy. It’s a signal to the body that, “Oh! We have tons of energy in the form of sugar. We don’t need to burn fat for energy.” Those are our two forms of energy that we have in the body, fat and sugar. If insulin is high, it’s a signal that we don’t need to burn fat. So when we keep our insulin high, because of the way we’re eating, that is a blocker on fat burning and that of course leads to excess weight.
So one of the key things that we can do to bring that weight down is start to control our insulin levels and insulin levels tend to rise and be higher and we tend to develop insulin resistance, probably over a decade before our blood sugar actually changes, because we can overcompensate. We can just keep producing more insulin to keep our blood sugar looking okay when really we’re just going down this path of metabolic dysfunction. So insulin resistance, preceeds blood sugar changes. But the more we can keep our glucose stable and low day after day, the more we’ll keep our insulin lower day after day, and the more we’ll improve our insulin sensitivity. And as we keep our insulin levels low, we unlock fat burning. So long story short people dealing with excess weight, that would be a signal that maybe blood sugar is something you want to focus on.
The second thing generally, I would say is people who are having kind of variability throughout their day. If your mood is all over the place during the day, if your energy is all over the place during the day, if your cognitive performance like brain fog is up and down throughout the day, mood, energy, cognitive performance, I would think about blood sugar. You had mentioned that your breakfast, you changed your breakfast and it changed the way you experienced your morning. You felt more energy. I think we see this all the time. We’re eating foods that we think are healthy and we’re trying our best. I think oatmeal is a great example. A lot of people eat oatmeal for breakfast because they think, “Oh, it’s a heart-healthy food and it’s got whole grains and the box makes it look so healthy.” But if you actually check your blood sugar, for a lot of people it might be causing a very high glucose spike leading to that whole cascade of things that I just spoke about. And there’s a lot of people out there who at 11:00 AM every morning are like, “I didn’t have my second cup of coffee.” Or, “I’m having a little bit of an anxiety moment or a little mid-morning slump. And they think, “Oh, I didn’t have enough coffee or I didn’t sleep well, or I got a stressful email.” But then if you actually see… Okay, I have a continuous glucose monitor on. I ate oatmeal. My glucose spiked super high and then it came crashing down and that’s exactly when I started feeling tired. Maybe it’s my breakfast. Maybe this is not a healthy food for my body. And everyone responds to carbohydrates differently in terms of how they affect your glucose. So knowing personally how a food is affecting you can change everything. And I’ve seen a lot of people transition from an oatmeal breakfast to something more like avocado and eggs, which is going to have virtually no glucose spike because there’s very little carbohydrates in that. And their whole morning transforms because when glucose is stable, a lot of other things in our lives stabilize as well. So I think variability in glucose often maps on to variability in our day-to-day experience and the more stable our glucose, stable and lower glucose levels are, the more I think our mood, our energy, our cognitive performance is going to be stable as well.
It’s certainly not the panacea for those things. When you stabilize glucose, it doesn’t mean you’re just going to have the perfect mood and the perfect energy, but it is really a good start.
Gwen Alexander: [00:16:22] I’m glad you, you mentioned about oatmeal because that’s generally, like you said, looked at as a healthy food and when somebody tells you, “Oh, here’s what you should eat to be healthy.” Even fruit and I usually say, “Hey, you might want to still watch that.” Because I don’t like to tell people, “Here’s what I ate to lose my weight. And here’s the plan.” I like to try and guide them, “Okay. Let’s figure out what will work for you.” Maybe what I can eat, like you said, what might spike your blood sugar to the point where you’re just all over the place and for me it doesn’t do anything. I’m fine when I eat that type of food and that’s what… I’m glad you mentioned that.
Do you think if more doctors would actually try to talk to their patients about that type of behavior modification that it might work, or do you think patients still want the, “Give me a pill to fix the one symptom. I don’t want to change.” Have you experienced that?
Dr. Casey Means: [00:17:13] I think that people by and large want to be as healthy as possible and I think by and large, they want to, people are trying to do their best with the information they have available to them. Unfortunately, the information that we’re getting is really bad. We have a lot of confusion in the nutrition space. You go on Instagram or the Internet and you see people all over the spectrum in terms of nutrition, dogma. You have vegan, carnivore, paleo, keto – everyone saying it’s the only diet for health. It’s very confusing. You’ve got millions of Americans going on diets each year and most of the scientific research shows that diets do not by and large work.
You’ve got doctors telling you one thing about nutrition, the government telling you one thing about nutrition and the reality is that there’s probably a different optimal diet for everyone and it’s probably different even at different times in your life and based on what your health status is at the current point in time. So it’s wildly confusing.
Couple this with a food marketing culture that is highly unregulated, claims are rampant and don’t really need to be proven before you make a claim. The claims are very one-size-fits-all when really there’s so much biochemical individuality involved. And so you go into the store and it’s almost like everything’s marketed as healthy. This bar is healthy. This cereal is healthy. People put claims about individual ingredients, but don’t actually… You can say that something’s heart-healthy because it has whole grains in it, but then it has a ton of refined sugar in it. So that information is bad.
And then we have a political culture that also is reinforcing poor food decisions. We have doctors who are really slammed for time because of the way healthcare is reimbursed. You’ve got 10 to 15 minutes with a patient who may have four, five, six chronic conditions that have to be gone through. It’s a lot easier to manage and prescribe than it is to deeply talk about the psychology and the nuances of nutrition or lifestyle and the barriers to those things in an individual’s life.
And then you’ve got political factors. So things like our farm bills. So our farm bills are these multi-billion dollar investments from the government to basically stabilize the price of crops over time. But unfortunately, in an effort to stabilize crop prices for farmers, what we’ve done is invest in some of the foods that are most disease-promoting in the country. Things like wheat and soy and corn, the majority of which are turned into feed for animals in mass agriculture, industrial animal raising and poor quality meats. Or it’s refined into refined corn oil, refined soy oil, or high fructose corn syrup. So we’ve got subsidized foods that are bad for health, and that are disproportionately affecting people of lower socioeconomic status and the people who need access to healthy food the most.
And so it’s just a huge web of systemic and cultural factors that we have bad information. So I don’t think it’s doctors not having faith in their patients. I think it’s just a very complex set of issues that we’re just unfortunately caught in the middle of and because of that, because of all the interests at play, humans become the product. We become the thing people are vying… Companies are vying for our dollars basically and we are unfortunately lost in that shuffle.
So my premise and Levels’ premise is that if we can give people access to information about their own body, “What is my body doing?” You break through a lot of the marketing claims. You break through a lot of the confusion. You just have an answer. You eat oatmeal, you see how it affects you. You know if it’s a heart-healthy food for you or not. And that question, you never really have to answer it again. And so it just cuts through a lot of the craziness that I think is driving systems wide issues.
So my hope is that if people had more access to their own information and could interpret it well, we actually see a shift in consumer choices. We’d see a shift in what patients are expecting of their doctors and we’d actually see things shift from the bottom up. But I think it’s rooted in bad information, unfortunately.
Gwen Alexander: [00:21:12] Yeah. Like you said, a lot of what I’ve learned over the years has been just reading and trying things out on myself, but you have to really dig sometimes to get through that, like how you’re advertised to by the food industry and understand their business. They need to make money, but the way that they’re advertising to us makes it almost where you’re just not going to win. A cookie is considered breakfast. Have you seen breakfast cookies?
Dr. Casey Means: [00:21:37] Oh, I’ve seen them.
Gwen Alexander: [00:21:38] Yeah and I just…
Dr. Casey Means: [00:21:39] Pastries are considered breakfast.
Gwen Alexander: [00:21:41] No they’re not.
Dr. Casey Means: [00:21:42] You walk into the store and you actually could think, “Oh, this is a breakfast food,” when in fact it’s a dessert. And so, yeah. It’s crazy.
Gwen Alexander: [00:21:48] Yeah. And I’m not putting down anybody. If you’re listening and every morning you have to have your doughnut. But for me, I had to change my way of thinking of what was considered a healthy type of food. Because at one time I was just focusing on the calories and a doughnut, I can tell you how many calories, fat carbs are in a doughnut, but then I got to the point of, it doesn’t make me feel the best. I would feel sluggish after having that and a big cup of orange juice with my doughnut.
Once I learned that and I think for many of us, that’s how the process goes. We start at the place of listening to the outside forces of what is healthy and then we figure it out for ourselves once we get more information. But like you said, it’s getting that information and which information do you trust when you hear it?
Dr. Casey Means: [00:22:33] I think that’s all such great points and I think that we are seeing a big shift now in this paradigm that we’ve had of it’s all about calories. A calorie is a calorie. We’ve heard that many times, it’s all about calories in versus calorie out. But in a lot of the research studies, we’re finding that type of model doesn’t actually lead to sustained weight loss and that’s where really this hormonal aspect of weight loss is starting to take more front seat in this discussion, which is that a calorie that stimulates a hormonal response, like an insulin response is going to have a different effect on your ability to lose weight or burn fat than a calorie that doesn’t cause an insulin response.
So that calorie might have the same amount of molecular energy in it. That’s how calories are defined like a unit of energy, but one is going to stimulate a hormonal cascade and one is not. And so that’s, I think, something key that’s shifting is our understanding of that. So that’s one thing.
And I think the other thing is that I think a lot of people associate diets with deprivation and that this is hard and this is going to take away something that brings me a lot of pleasure. And especially when you’re not even really sure if that thing is causing a problem, it’s easy to just be like, “Okay, I’m going to keep eating the doughnut.” it doesn’t seem to be causing a problem. It’s this many calories, which is fine on my diet and whatnot. But I think having that little piece of extra information like, “Okay, I can see exactly what it’s doing to me.” Just gives people at least informed decision-making with that process. Maybe it’s not causing a big spike for them. Okay. But it at least gives you a little bit more entryway into understanding what’s really happening.
Gwen Alexander: [00:24:09] I wanted to ask you also… We were talking about food and how the CGM monitors your glucose, but have you found in any of your research, that the time of day you eat certain food makes a difference? Because I noticed for me, I actually did adjust a few years ago what I ate for lunch. I noticed certain foods when I would get back to my desk, I was ready just to go to sleep and I thought I can’t keep doing this anymore, because I would eat sandwiches or things with lots of rice. And so I stopped. That’s done. I don’t eat sandwiches anymore for lunch or really carb-heavy meals. I’d eat a protein vegetable and maybe I might have a little dessert. I like my desserts, but they’re ones I made and so I’ve controlled what goes in them and how much of it. But does, is there something to that, depending on what time of day you eat certain foods?
Dr. Casey Means: [00:24:56] There is. Yeah. Generally speaking carbohydrates eaten earlier in the day are going to have less of a glucose response than carbohydrates eaten at night and the reason for that in part is because we tend to be a little bit more insulin resistant at night, just naturally. When we actually, before we go to sleep, our body releases this hormone melatonin. Some people actually take melatonin as a supplement to help them go to sleep. And this actually blocks the pancreas, which makes insulin from making insulin and it makes our body a little bit insulin resistant. So basically the same amount of carbohydrates late at night, because of this effect, are going to stick around in the bloodstream longer because you’re not actually going to take that glucose up as effectively. So there’s been some studies looking at eating the exact same meal, first thing in the morning versus late at night. And there seems to be lower glucose response first thing in the morning.
I think something else to keep in mind is this idea of feeding windows, like how long were eating throughout the day. So if we are eating from 8:00 AM to 8:00 PM at night, that’s 12 hours worth of eating, which means 12 hours of potentially spiking insulin and every time that insulin is spiking we’re blocking our ability to burn fat. So let’s say you’re eating pretty much all day, which is like the average American breakfast, lunch and dinner, maybe 8:00 AM to 8:00 PM with a few snacks in between. You can imagine you’re just going up and down all day and basically your insulin and glucose are staying kind of high throughout the whole day. Now imagine that you just ate between 11:00 AM and 5:00 PM the exact same amount of calories. You’re going to get those same glucose spikes, but it’s going to be in a much narrower window. So you’re going to have all this extra time outside of that feeding window where your insulin and your glucose are low, which means that you’re actually burning through the glucose in your body for energy and you may actually start tapping into fat burning. So condensing the amount of time you are eating per day into a shorter window has been shown to be healthy.
And that’s behind this whole concept of time restricted feeding or intermittent fasting that’s becoming more popularized. And I think one of the reasons why that’s been shown to be somewhat effective for weight loss is because you do end up creating more time when you’re in a lower insulin state and can tap into fat for fuel, which is ultimately what’s going to burn off some of the extra stored fat that is extra weight.
So that’s just two things relating to timing of food that I think are relevant.
Gwen Alexander: [00:27:15] Yeah. That was one thing that I actually adjusted to. I was going to ask you about the intermittent fasting because that has been something that’s been pretty prominent and I know a lot of people are doing it and I’ve somewhat done it. Like you said, I’ve shortened the window of when I usually eat and I’ve been going mostly on feel because I don’t have a, I didn’t have the technology to tell me, but I could tell that I did feel better when I shortened my window of when I’m consuming my food. And so I thought, I guess there’s something to this, but I like to hear that you said, yeah, there is a correlation between this, because sometimes, like we were talking about the information we get there’s something to back it up. It’s just, you feel like somebody’s throwing it out there and is this something that really can work?
Dr. Casey Means: [00:27:58] Yeah. And I think also just one of the reasons I love continuous glucose monitoring and seeing this data throughout the day is because when you’re fasting… Let’s say you stop eating at 5:00 PM and you’re not going to eat the next day till 11:00 AM. You can see your glucose levels come down and stabilize, and that’s a really powerful reward to see like, “Okay, I’m making a decision that is, it feels hard. I know that when I stop eating early in the night, it’s hard. I want a snack late at night. I want to eat later at night. That’s my natural impulse. But when I can see that what I’m doing is actually having a positive impact, it’s actually doing something. I think it’s really, it helps motivate me and I think others to just keep going, “I just have to stick with it overnight.” And seeing a big… Let’s say I cave and at 11:00 PM I have a snack. You see that spike and you know, that that spike is taking you out of probably that fat burning. It is raising the insulin and it might actually impair sleep quality. We know that glucose spikes late at night can cause problems with sleep. It can elevate your body temperature, which makes sleep harder. Your glucose can bounce around throughout the night and cause arousal throughout the night, like waking up a little bit. And so having stable glucose throughout the night can really help with sleep. So it’s just nice to have that source of information to know if what I’m doing is actually doing something and I know that if I go off course, I’m going to get some negative feedback here and know that it’s impairing my goal of good sleep.
Gwen Alexander: [00:29:15] What kind of numbers should somebody be shooting for with their glucose? I know everybody’s different, but is there a standard, like you need to be between this number and this number in order to feel your best or where doctors won’t be concerned about you.
Dr. Casey Means: [00:29:30] Yeah. There are standard criteria of what the American Diabetes Association recommends for healthy glucose levels. And so I’ll run through those briefly. The three tests that we use to diagnose whatever people have an objective blood sugar problem is Fasting Glucose, what’s called an Oral Glucose Tolerance Test and what’s called a Hemoglobin A1c. So Fasting Glucose is like, you haven’t eaten for eight hours. It’s first thing in the morning and you get a fingerprick glucose and see what your glucose levels are. And if that value is less than 100 milligrams per deciliter, you’re considered normal, a non-diabetic. If that’s between 100 and 125, it’s considered pre-diabetes and if it’s 126 or above, it’s considered diabetes. Then Oral Glucose Tolerance Test is another test for diabetes where basically they have you drink a glucose drink with 75 grams of glucose, and then they take your blood sugar for two hours after that drink and see how you went up and came down and if after two hours, your blood sugar is below 140 milligrams per deciliter, you’re considered normal. It doesn’t matter how high you went during the test just as long as you’re under 140 two hours after the test. And then Hemoglobin A1c is a test where it’s actually a blood test looking at a three month average of blood sugar and the way they can do that is because blood sugar sticks to red blood cells in the bloodstream, and you can take red blood cells and see how much sugar they have stuck to them and that’s a marker of three month glucose levels. So if the percentage of red blood cell’s hemoglobin with sugar on it is less than 5.7% basically, you’re considered normal. Anyway, that’s like the standard criteria, but that doesn’t actually really tell us what is necessarily optimal for people. It tells us that you’re not in a clinically diagnosable range, but doesn’t tell us really what to shoot for.
So I’ve done a really extensive review of the literature and looked at what would we want to actually shoot for to stay in a good range and for fasting glucose I think it’s probably a much tighter range. It’s probably more between 72 and 85 that would be optimal, not just anything under 100. And the reason we know that is because if you look at studies of people in the normal range, so under 100, as people go from the low end of normal to the high end of normal, so from around 70 to 100 milligrams per deciliter, you see just this linear increase in their risk of disease, of future disease. So at the higher end of normal, you see higher risk for diabetes in the future, higher risk for heart disease and stroke. And if you stay down below 85, you’re in the lowest risk for ever developing diabetes or stroke or heart disease, heart attack, things like that. So I look at that data and I say, “Okay, I’d like to stay in that lower range, so why not shoot for better than less than 100? Why not shoot for less than 85?” Which is totally achievable. But unfortunately most of you are going to walk in their doctor’s office. They could have a glucose level of 99, a fasting glucose, and their doctor says, “Oh, you’re fine. You’re not diabetic. You’re fine.” When in fact we should be saying, “Hey! You’re 99, but studies show that under 85 is going to be a lot better for your health.”
Another thing I think worth mentioning is that our post-meal levels. Getting up to a blood glucose level of 140 after meals, which the oral glucose tolerance test would tell us that being at 140 two hours after a meal is normal. That’s actually probably way too liberal. There’s been studies where they’ve put glucose monitors on really healthy young people and looked at their glucose values over 24 hour periods. And if you do that, you find that the majority of people never really go above 120. So the idea that we should ever be getting close to 140 is a little bit crazy. We should probably be sticking somewhere between 70 and 120 all the time and rarely ever going above 120. We know above that you’re going to have a bigger insulin spike, you’re going to have a higher blood sugar, which can cause problems. And so sticking to that tighter, narrow range is probably better for health. But there are no standard criteria that a doctor is going to say for that type of thing right now. And that’s just because I think we’ve mostly focused on disease states in our medical system. We haven’t really focused on these healthy populations, these preclinical populations. But I think focusing energy on those populations before you develop these issues is a really high value thing to do.
And circling back to what I said earlier about how our bodies can overcompensate with insulin for years and years and years before we actually see blood sugar going up. So if you just keep pumping out insulin in higher and higher levels, it’s going to drive that glucose, that sugar out of the bloodstream, into the cells and make your glucose look like it’s okay, when in fact you’re becoming more and more insulin resistant. So by the time someone’s glucose starts to rise and their lab values start to become abnormal, they’ve probably had insulin resistance and metabolic problems for over 10 years. And so that’s another reason why someone who comes in with a blood glucose, a fasting glucose of 99, they might be considered normal by a glucose standard, but almost unquestionably that person has insulin resistance and they are super close to just falling into that higher risk category. So I would think that over the next few years, we’re going to see doctors orienting more around lab markers of insulin sensitivity and less about glucose levels because that’s the precursor to changes in glucose levels.
Gwen Alexander: [00:34:30] This is something I wish that they would actually teach to kids in high school or even teach it to the young kids on their level because I remember when I was in high school, which was many years ago, we would get the candy bars and the potato chips, not thinking about what that’s doing to your body. I knew it tasted good and I didn’t feel too great after, but boy, it was so good. But if we could explain it to them in a way where they understand like this is going to affect you, not just when you’re 16, but when you’re 21, then when you’re 31, and then when you’re in your 40’s. Many women in… I’m in my 40’s, we get to the point we’re like, “What happened?” We can’t do all cardio exercise and our body responds, or even the way we eat sometimes. It’s like a major overhaul and I think a lot of this is because of what we’ve, like you said, done to our bodies over the years and what we’ve put in that we didn’t think about at that time.
Dr. Casey Means: [00:35:20] I think it’s so true. My personal experience, I was very overweight as a child. I loved food so much. I was well over 200 pounds when I was in eighth grade and when I’m sort of looking back I wish I’d known a lot of this. Even at that age, I knew a lot about it. I was reading about nutrition in magazines. I thought I… Everything was about low fat then, which totally caused problems because when we went low fat as a culture in the nineties, what happened was we filled foods with sugar and that was one of the biggest mistakes we ever made in terms of a scientific community and community recommendations, because ultimately that increase in sugar during the low fat movement is what’s driven a lot of our problems today and certainly mine as a child and in high school or late middle school, thinking about some of the things that I was struggling with acne and PMS and things like mood, a young teenager, anxiety and angst and things like that. And I remember being so sore after my sports practices. My joints would hurt and just all these things and I used to get low back pain all the time when I would… And I’m like, “This is crazy that this was considered… Everyone is doing this and you just take Advil for things and whatever. It’s all normal.
But it’s not normal. None of it is normal and if someone had told me like, “Oh, hey! If you get rid of all this processed food you’re getting at Costco, it actually will clear up most likely all of these things in one fell swoop.” Who knows if I could have broken that addictive food pattern at that point, but I sure as heck think it would’ve helped if someone had told me, “You don’t need to be using all these acne medications. You can literally just focus on shifting your diet from this to this and it’s still delicious. You don’t have to be deprived of any food. You just have to change the amount of refined sugars and carbohydrates and stuff.” I think I would have done it, but I had no idea and it’s taken over 20 years, and not even stuff I learned about in medical school, to realize how much our nutrition is impacting so many aspects of our health.
So yeah, I’m right there with you and I think it’s… So my passion and my goal is to help people learn and understand and be empowered so that they’re not going through life misattributing stuff that’s happening to maybe the wrong things and just feel empowered by some information to maybe make some slightly different choices.
Gwen Alexander: [00:37:31] Yeah. That’s why I started this podcast was to get the message out of being consistent, making behavior modifications, dealing with your mental aspects of what could be driving you to eat certain foods that have the higher sugar. That was my motivation too.
I wanted to ask you, if somebody did want to get a continuous glucose monitor, is that something they can go to their doctor and say, “Hey! I want one.” Or is that something they can get themselves? How would someone go about getting one of those?
Dr. Casey Means: [00:37:59] Yeah. So if people have a diagnosis of diabetes, so Type 1 or Type 2 diabetes, they should definitely go to their doctor and ask for a continuous glucose monitor because it’s going to be a much more optimal, efficient way to track your glucose as opposed to doing a fingerprick where you have to lance your finger and use a meter to basically check your glucose. That’s going to give you maybe three or four readings a day if you prick three or four times a day, but a continuous glucose monitor is going to take readings every 15 minutes, 24 hours a day and send that information to your smartphone or to a small reader if you don’t have a smartphone, which can tell you your levels. So as opposed to getting photographs of your glucose, you’re getting a movie of your glucose, which is just so much more information.
For a non-diabetic individual who wants to just basically use this glucose feedback to optimize their diet and really help just get their diet and lifestyle really tuned up to help just improve their thriving, maybe improve weight but don’t actually have a diagnosis of diabetes, a doctor is probably not going to prescribe this because we’ve been so trained in medicine to focus on not giving tools or advice unless people reach a fulminant disease state. So currently these devices are actually only FDA approved for Type 1 and Type 2 diabetics. But as we’ve talked about those in podcasts, there are so many reasons why someone before they get to that end part of the spectrum of metabolic dysfunction would benefit from this. So Levels, the purpose of our company is to expand access to these monitors, to the more wellness population, the non-diabetic population.
So our program is a one month program of using continuous glucose monitoring to optimize your diet and lifestyle. It’s intended for people without diabetes to be used as really a wellness tool for biofeedback and so we actually have set up a telemedicine network of physicians who are evaluating people for these devices and then we have a pharmacy that ships them to people if a prescription is generated. So this is actually an off label use of an FDA approved device. An off-label use basically just means that it’s being used for an indication that it wasn’t initially approved for, but where the benefits outweigh the risk and using a continuous glucose monitor is an extremely low risk painless device and so the information you can get, in my opinion, far exceeds any risk associated with wearing the small sensor on your arm.
So that’s really our mission at Levels is to empower people, a new population of people who can benefit from this information. So certainly you could go in and ask your doctor for one of these, even if you don’t have diabetes and could say, “I listened to this podcast and I heard all this stuff, and I really want to track my glucose.” But I think there’s a lot of doctors who are not going to really, at this point, understand that benefit. But I think people are really more metabolically aware and I think that over time, we’re going to see doctors shifting to understanding the value of this type of preventative information.
Gwen Alexander: [00:40:43] Casey, I want to thank you for coming on the podcast today and this was very informative to me. It educated me even more and I hope the listeners get educated too. I know, I love hearing numbers. I love hearing about percentages and I’m into how things affect your body. And I think the more you know, the better decisions that you can make.
But if someone does want to reach out to you, if they have any questions or if they want to check out Levels, is there a website or social media that they can find you on and information about that?
Dr. Casey Means: [00:41:13] Absolutely. Yeah. So we’re on Twitter and Instagram @Levels and our website is levelshealth.com. And we are trying to put out as high quality research based information as possible on our website. So you can go to levelshealth.com/blog and read so much more about this from MDs, PhDs, guest experts, so I highly recommend checking that out.
I’m personally @drcaseyskitchen on Instagram and Twitter and I’m actually plant-based, whole foods plant-based and so I focus a lot on plant-based diets and metabolic health and glucose control and how that all relates. So I would love to connect with anyone on those platforms for people who do want to try out CGM and Levels, we’re currently pre-launch right now. We’re in a beta program, so people can sign up on the website for our waitlist and we will be working really hard in 2021 to get everyone who wants access, availability of the program.
Gwen Alexander: [00:42:05] Thank you again and it was great having you on the podcast.
Dr. Casey Means: [00:42:08] Thanks, Gwen.
Gwen Alexander: [00:42:10] The information provided in this podcast is for informational purposes only. The views of any guest on the podcast are their own. The host of this podcast is not a medical doctor, nurse or health professional. You should consult with your doctor, nurse or health professional before you begin any weight loss or maintenance or exercise program.