Dr. Casey Means had a thriving career as a surgeon. After first-hand experience with how metabolic dysfunction affects people throughout the surgery process, she teamed up with Josh Clemente to create a solution. Levels Health helps individuals track their glucose levels through a continuous glucose monitor (CGM), which provides insights about how different lifestyle choices affect glucose levels throughout the day. Dr. Means is now the Chief Medical Officer at Levels Health. In this episode of Waist Away: The Intermittent Fasting Podcast with Chantel Ray, they talk about their experiences with monitoring glucose levels, how beneficial CGMs are, and how to be healthier by controlling glucose levels.
1:55 – Glucose levels and storing fat
Elevated glucose levels signal to the body that it should store fat and not break it down, which can affect weight loss.
“When glucose is elevated, it stimulates the hormone insulin to be released from the pancreas and that insulin is such a key player in weight and weight loss, because when insulin is elevated, it tells the body, ‘fat glucose storage mode.’ It’s an anabolic hormone. It’s a growth hormone. So when that glucose spikes really high after a high carb or high sugar meal, or because you’re stressed, or because you don’t get enough sleep, that glucose is elevated, that insulin is coming in. That insulin is what signals the body, ‘don’t break down fat. Store fat and store excess glucose as fat.’ And so it’s just this incredible little tool that you wear, and it’s actually the only tool we have right now that’s measuring sort of an internal biomarker in our body continuously at home.”
2:30 – What makes a CGM so unique?
Continuous glucose monitors track internal factors while other devices only track external factors.
***“*And so it’s just this incredible little tool that you wear, and it’s actually the only tool we have right now that’s measuring sort of an internal biomarker in our body continuously at home. You’ve got the fitness trackers, the sleep trackers, we’ve even got trackers now that measure stress like the Oura Ring and the WHOOP and things like that. And these are amazing, but they’re all measuring externally, like your heartbeat or temperature. And this [CGM] is actually measuring something in your body, which is pretty cool. So it’s the first bio wearable that we can use to track how nutrition and other lifestyle factors are affecting our health in real time.”
4:56 – A photograph versus a movie
The continuous data stream provided by a Levels CGM helps to reveal information about immediate lifestyle choices as well as information about a person’s underlying health.
“Traditionally, people with diabetes and pre-diabetes who are checking their blood sugar, they would use these test strips. You have to prick your finger, get the blood, and then put it in this little machine and it gives you a reading. But that really just gives you a photograph or a snapshot of what’s happening to the glucose in your body after a meal or whenever. Whereas, a continuous glucose monitor, it’s a continuous data stream. It’s doing it all the time, and so, it’s like a movie of your body. So you can just imagine how much more insight and information you can get between a single snapshot versus the movie.”
6:14 – Fluctuating glucose levels
Glucose levels fluctuate throughout the day based on diet and other lifestyle choices. With traditional testing methods, people might miss valuable information about how their body reacts to different choices.
“So there’s just so much information about health and insulin sensitivity embedded in that curve, which you can imagine if you’re just pricking your finger and then testing it maybe at 15 minutes and then an hour, and then two hours, you might miss a lot of what’s actually in that information. You might prick after an hour and be catching your glucose on the downswing and not actually know what your peak was. So that’s why I am such a big fan of continuous biomarker tracking is because you just get so much more granularity about your health basically, and how you’re responding. And the other thing is it’s painless. You don’t need to actually prick yourself whenever you want to get a glucose reading, which is just a huge advantage. You just put it on once. The sensors last on your arm.”
8:16 – Vinegar and blood glucose levels
There’s a lot of research that supports the theory that vinegar helps to control glucose level spikes.
“So acetic acid, which is a key component of what makes vinegar tart, that seems to be the thing that has an impact on our metabolism. And there’s a couple of proposed mechanisms of why this happens. One is that it may delay gastric emptying a little bit to make it actually slower for you to move the food through your digestive tract. So it’s going to be less of this carb load hitting the stomach and raising your glucose and causing your glucose to be elevated and more of a slow sort of thing, and so that you’re not going to get that sharp peak. You’re going to be a little bit more gradual and sustained. The second, is that it may increase our insulin sensitivity.”
13:37 – The Dawn Phenomenon and cortisol levels
Cortisol is a stress hormone that fluctuates throughout the night and affects how the liver produces energy.
“At night, our cortisol climbs in the early part of the night. But then, as you get closer to your wake-up time, cortisol rises again because we need that cortisol to help us get out of bed. And so when that cortisol rises just before you wake up, it’s actually having this function in the body of telling your liver to produce glucose. So we can eat glucose and it can go into our bloodstream, but our liver can also just make glucose. It can break down stored glucose. It can make glucose from other things like fat and amino acids. That’s a process called gluconeogenesis. And cortisol basically gets the liver to do that because you need energy for your muscles to get out of bed and to wake up. So because of that rise in cortisol in the morning, we tend to see glucose rise, right when we wake up. You open your eyes, the cortisol is getting you alert and your glucose also tends to rise. So that’s called the Dawn Phenomenon and because people with diabetes are going to be more insulin resistant, they’re going to have more trouble taking that glucose up into their cells. It’s going to look like a higher elevation. They’re not going to be using that glucose as efficiently as someone without insulin resistance because they’re not responding to insulin as normally. So that’s why in a person with diabetes, you’re going to probably see a much larger Dawn Phenomenon.”
22:22 – How does exercise impact glucose sensitivity?
No matter what type of exercise that people do, something as simple as walking can help increase glucose sensitivity.
“First thing is that any type of exercise is going to improve insulin sensitivity, no matter what. Basically the research shows that if you’re walking, if you are doing high intensity interval training, if you’re doing strength training, all of these have a positive impact on our insulin sensitivity. And part of that is because our muscles are one of the biggest glucose sinks in the body. They take up so much glucose and when you are using them, even if it’s just a walk, you are taking up glucose and really activating genetic and cellular pathways that tell the body, “Oh! This person is using a lot of glucose, so we need to make sure we’re ready to take that glucose up. We need to become insulin sensitive.” So it is just basically long story short, and everyone knows this, glucose exercise is good for glucose control and insulin sensitivity.”
23:13 – The benefit of fasted workouts
Fasted workouts are beneficial for burning fat because the body’s insulin levels are likely lower after fasting.
“So when we think about fasted workouts, this is a really fascinating topic, which is actually getting some more research attention. What this means is that you basically work out first thing in the morning or in the late morning, but you haven’t eaten anything. So let’s say you finished dinner at 7:00 PM, you’ve consumed no glucose until after your workout, you just are eating in this fasted state and what this does is it’s basically exercising in a low insulin state because if your glucose, if you have not consumed any glucose, your insulin in the body is likely going to be lower at that time, which means that you’re going to be more likely to burn fat. Fat and glucose are our two energetic substrates in the body. We can use glucose or we can use fat for energy and if you’re in a low glucose, low insulin state during your workout, you’re going to be more likely to shift towards burning fat in your workout, so that can be a positive for people.”
34:37 – Avoid artificial sweeteners at all costs
Artificial sweeteners may not show an immediate impact on a GGM; however, they can have a long-tern, negative impact on other aspects of our health.
“So I would say like long story short, avoid the artificial sweeteners at all costs. So that’s saccharin, sucralose, aspartame. Those are the three main ones. Anything that comes in a pink, a yellow or a blue packet, never, never eat it. That’s what’s in Diet Coke and most diet sodas. Because these are going to have a number of effects on the body and the science isn’t totally slam dunk, but there’s a lot of research to suggest that it has negative metabolic effects. So first thing it will not raise your glucose on your CGM. You might look at your CGM after a Diet Coke or something, the glucose doesn’t change at all, but that doesn’t necessarily mean it’s okay, because it has longer term effects on the metabolism. The mechanism of that is thought to be its effects on the gut microbiome. So it actually changes the composition of the bacteria in the gut and in a negative way. The gut bacteria have a huge impact on our metabolism. They make a number of metabolites, like short chain fatty acids that are actually very good for our metabolism and our insulin sensitivity and how we process glucose. And over time, artificial sweeteners can change the composition of the microbiome and make it less metabolically friendly.”
Chantel Ray : [00:00:00] She’s a business mogul (Number One) and wellness expert. (How can I help?) And now Chantel Ray and her amazing guests are here to guide you on your wellness journey. (Time to level up). Welcome to the Waist Away Podcast.
Chantel Ray: [00:00:16] Hey guys, welcome to today’s episode and I’m so excited to introduce you to Casey Means. She’s the co-founder and chief medical officer of Levels Health and today we are talking all things about Continuous Blood Glucose monitors, and I know for me, this has been a game changer for me and so we are so excited to have you. So welcome, Casey.
Dr. Casey Means: [00:00:41] Thank you. I’m so happy to be here, Chantel.
Chantel Ray: [00:00:41] All right. So let’s just give a brief introduction to people who don’t know about Continuous Blood Glucose monitors, and why they are so amazing.
Dr. Casey Means: [00:00:50] Yeah. So Continuous Glucose Monitors or CGMs are these incredible little wearable devices. They’re the size of two quarters and stacked on top of each other, stick on the back of your arm and what they do is they tell you 24 hours a day about an internal biomarker on your body. So it’s like this little lab on your arm, and it’s telling you about glucose and what’s happening, basically every second 24 hours a day. And this is important because glucose is our key metabolic biomarker in the body. It is the substrate through which we make energy in the body and it goes up and down all the time throughout the day. It goes up and down based on what we’re eating and whether we’re stressed and if we’ve exercised and if we’ve had enough sleep or not enough sleep. It’s fluctuating like a little static throughout the day and that information is really, really, really valuable because for optimal health and for weight loss, we actually want that glucose to be fairly stable and we want it in a low and healthy range. When glucose is elevated, it stimulates the hormone insulin to be released from the pancreas and that insulin is such a key player in weight and weight loss, because when insulin is elevated, it tells the body, “Fat glucose storage mode”. It’s an anabolic hormone. It’s a growth hormone. So when that glucose spikes really high after a high carb or high sugar meal, or because you’re stressed, or because you don’t get enough sleep, that glucose is elevated, that insulin is coming in. That insulin is what signals the body, “Don’t break down fat. Store fat and store excess glucose as fat.” And so it’s just this incredible little tool that you w ear, and it’s actually the only tool we have right now that’s measuring sort of an internal biomarker in our body continuously at home. You’ve got the the fitness trackers, the sleep trackers, we’ve even got trackers now that measure stress like the Oura Ring and the WHOOP and things like that and these are amazing, but they’re all measuring externally, like your heartbeat or temperature. And this is actually measuring something in your body, which is pretty cool. So it’s the first bio wearable that we can use to track how nutrition and other lifestyle factors are affecting our health in real time.
Chantel Ray: [00:03:00] One of the things I also love is… Because I used to be crazy about just those regular blood glucose monitors that you buy from Walgreens and then prick your finger and kind of check it. And I will tell you, I tried all different ones and I felt like they were sometimes completely inaccurate. So what I would do is I would check my blood and then I would check it again. And sometimes I would check it and it would say 90. Then I’d say, “Okay, let me check it right again.” And I’d take a second sample of blood and it would go to 70 and I’m like, “What ? That doesn’t even make sense. I just checked it.” And I would literally sit there. And if you really wanted to check your blood, think about how many times you’d have to do it because it would be like, “Okay. Let me do my blood now. Then let me see just right away or 15 minutes, how much, what it did and then an hour or an hour and a half, what it did.” Like this tool to me is so amazing because who wants to sit there and prick their finger every few times and how inaccurate some of those things are because I’ve tried all different ones. I’ve tried the Walgreens brand, the CVS brand, the best brand out there, and they gave different numbers after every time I checked it. So I think these are so much more accurate.
Dr. Casey Means: [00:04:24] It’s so funny, you bring that up because my co-founder Josh Clemente, he’s the original founder of the company, he was actually checking his glucose with the finger prick method that you’re talking about, where you prick your finger and you use a test strip and the test strips are not cheap also.
Chantel Ray: [00:04:38] No. They’re not.
Dr. Casey Means: [00:04:39] And he was doing it like 60 times a day, because the thing about… Traditionally, people with diabetes and pre-diabetes who are checking their blood sugar, they would use these test strips. You have to prick your finger, get the blood, and then put it in this little machine and it gives you a reading. But that really just gives you a photograph or a snapshot of what’s happening to the glucose in your body after a meal or whenever. Whereas, a continuous glucose monitor, it’s a continuous data stream. It’s doing it all the time, and so, it’s like a movie of your body. So you can just imagine how much more insight and information you can get between a single snapshot versus the movie. And especially after a meal, when you… L et’s say you eat something that’s got glucose in it, which is really anything with carbohydrates or sugar, carbohydrates are going to get broken down into glucose. You’re going to have this elevation and then a peak, and then it’s going to come down. And that information about that up and down little mountain is… It’s got so much information embedded in that curve. How long you stay elevated, tells you something about your underlying health. How quickly you peak tells you something about your underlying health and how high you peak and then how low you go after you come back down. And all of that, it can take somewhere between an hour and a half for that full cycle to happen. It could take three hours, if you’re more insulin resistant or diabetic, which actually it’s slower to clear the glucose from your blood. So there’s just so much information about health and insulin sensitivity embedded in that curve, which you can imagine if you’re just pricking your finger and then testing it maybe at 15 minutes and then an hour, and then two hours, you might miss a lot of what’s actually in that information. You might prick after an hour and be catching your glucose on the down swing and not actually know what your peak was. So that’s why I am such a big fan of continuous biomarker tracking is because you just get such more granularity about your health basically, and how you’re responding. And the other thing is it’s painless. You don’t need to actually prick yourself whenever you want to get a glucose reading, which is just a huge advantage. You just put it on once. The sensors last on your arm. The one that I use, Abbott… M y company uses the Abbott FreeStyle Libre. It lasts for two weeks on the arm. So you only have to put it on and take it off every two weeks, which is great.
Chantel Ray: [00:06:51] That’s awesome! Well, I do have a question that a listener asked. She put this in a couple of weeks ago, but it was… It’s from Wendy Rumor in Atlanta, Georgia. She said, ” I love your show and I think you have me convinced to get a continuous blood glucose monitor. I can’t wait until the founder of Levels guests, that you were talking about, is going to be coming on. But quick question, I heard about vinegar helping with blood glucose Levels. Why would a shot of vinegar blunt the glucose spike from a carb heavy meal? Do you know any research or tips for working vinegar into your diet? Wendy Rumor from Atlanta, Georgia.
Dr. Casey Means: [00:07:33] Such a good question from Wendy. Thank you for submitting that one. And it’s actually, there’s lots of research on this and we actually, just last week, put an article on our blog about this with tons of research. So I highly recommend going there. It’s Levelshealth.com/blog, and it’s basically about how does vinegar impact glucose? But the long story short is that the research is very strong that it does. So acetic acid, which is a key component of what makes vinegar tart, that seems to be the thing that has an impact on our metabolism. And there’s a couple of proposed mechanisms of why this happens. One is that it may delay gastric emptying a little bit to make it actually slower for you to move the food through your digestive tract. So it’s going to be less of this carb load hitting the stomach and raising your glucose and causing your glucose to be elevated and more of a slow sort of thing, and so that you’re not going to get that sharp peak. You’re going to be a little bit more gradual and sustained.
The second, is that it may increase our insulin sensitivity. So we’d talked earlier about… Insulin is a hormone released from the pancreas when glucose is elevated in the blood. And what insulin does, it tells your cells to take up glucose. But another one of its functions is to… It’s just telling the body, Oh, we have a lot of glucose on board for energy. It also tells the body don’t burn fat. And when we have glucose elevated frequently in our body because of what we’re eating or how we’re living. Like let’s say we’re eating carb rich snacks every two hours, our insulin is going to be up all the time and what that eventually does to the body is it makes it insulin resistant. The body is just sensing so much insulin, it’s basically a signal to the body that we’ve got so much glucose on board and so the cells actually become resistant to insulin. It says, “We don’t want more glucose in the cells. We’re going to block your function.” And then the body actually produces more insulin to basically overcome that insulin resistance and of course you can imagine, if you’re trying to lose weight, that’s more insulin telling the body not to burn fat. So insulin resistance is a problem and in many, as BMI goes up, insulin resistance goes up. Those are correlated, and hopefully that makes sense why. And so vinegar and acetic acid seem to have a counter effect to this. It makes your cells a little bit more insulin sensitive, so they’re going to respond to that hormonal signal and take the glucose out of the blood. So that’s part of the science behind the vinegar, although it’s not a hundred percent fully assessed. I don’t think we fully established… I don’t think we know all the mechanisms for this yet, but those are some reasons why. There is also good research showing that, really more clinical research where they’ve given people an ounce or two of white vinegar or other vinegars before eating carbohydrates and seeing what happens to their glucose. One of the studies I’m thinking about was they gave people white bread and they either gave people white bread before or after… I’m sorry, they either gave people white bread with a shot of white vinegar before, or no shot of white vinegar before, and when you had that white vinegar before the bread, the glucose was statistically significantly lower. And I think it was by around 10 or 20 points. I don’t remember exactly, but we can maybe link the article. And so it was significant. It wasn’t just like a few points.
So ways to work it in. There’s so many. It could be as simple as adding more vinegar to your salad dressings, making sure your salad dressings don’t have added sugar, like honey or sugar or other sweeteners, and then add more vinegar. It could be cooking with vinegar. If you’re going to… There’s a lot of beautiful meat dishes, like chicken dishes that do have like vinegar in them. So really just thinking about recipes that have that. There’s also a lot of people who actually just take a shot of vinegar to help blunt their glucose responses and my favorite to do that is Apple Cider Vinegar because it tastes, it’s got a little bit of an apple flavor. So putting an ounce or two in an eight ounce glass of water and drinking that 20 minutes before a meal. It’s really not so bad to drink it and it may cause the glucose elevation from the meal to be lower, so…
Chantel Ray: [00:11:24] Okay, perfect. I have one more question and this is from Kelly G in Round Rock, Texas. I didn’t even know that was a city. She said, “I loved your episode with Thomas DeLauer. I think that was my favorite episode to date. I loved when you were talking about the Dawn Phenomenon or Dawn Effect. I don’t have diabetes, but my blood sugar ranges from about 95 to 110 almost every morning. I do intermittent fasting in a six hour eating window. I still have about 20 pounds to loose. I can’t wait until your new book “One Meal and a Tasting” comes out. I think one of my biggest problems is I’m currently doing two meals and a tasting and maybe a little snack. So maybe that’s my problem. But can you get a guest to talk a little bit more about the Dawn Phenomenon? Kelly G in Round Rock.
Dr. Casey Means: [00:12:15] Thanks, Kelly for the question and yes, we can absolutely talk about the Dawn Phenomenon. So the Dawn Effect is a really interesting physiology. Basically, when we’re asleep at night, that’s when our cortisol is generally lowest, as we’re going to bed and as we’re sleeping in the early part of the night. Cortisol is one of our hormones that sort of… It’s considered, it’s colloquially called the stress hormone. But really it also has the function in the body of keeping us awake and alert and vigilant. So it’s an important physiologic hormone, but in many of us who are dealing with low grade or chronic stress, it’s going to be elevated. And so at night, our cortisol climbs in the early part of the night, but then, as you get closer to your wake-up time, cortisol rises again because we need that cortisol to help us get out of bed. And so when that cortisol rises just before you wake up, it’s actually having this function in the body of telling your liver to produce glucose. So we can eat glucose and it can go into our bloodstream, but our liver can also just make glucose. It can break down stored glucose. It can make glucose from other things like fat and amino acids. That’s a process called gluconeogenesis. And cortisol basically gets the liver to do that because you need energy for your muscles to get out of bed and to wake up. So because of that rise in cortisol in the morning, we tend to see glucose rise, right when we wake up. You open your eyes, the cortisol is getting you alert and your glucose also tends to rise. So that’s called the Dawn Phenomenon and because people with diabetes are going to be more insulin resistant, they’re going to have more trouble taking that glucose up into their cells. It’s going to look like a higher elevation. They’re not going to be using that glucose as efficiently as someone without insulin resistance because they’re not responding to insulin as normally. So that’s why in a person with diabetes, you’re going to probably see a much larger Dawn Phenomenon. There is some research to suggest that the bigger the Dawn Phenomenon, even in a non-diabetic individual, that actually is a signal that your cortisol is elevated in the morning, or that you may be on that spectrum of insulin resistance. Hearing those morning glucose numbers, 95 to 110… For anyone in the audience who doesn’t know the ranges, so basically fasting glucose, which means glucose after eight hours of not consuming any calories, if that’s less than 100, that’s considered normal. If it’s between 100 and 125, that’s considered pre-diabetic and if it’s 125, 126 or above, it’s considered diabetic. So, having that fasting glucose in that 100 to 110 range, that’s going to be indicative of maybe insulin resistance pre-diabetes that you want to get on top of.
So definitely, the beautiful thing is that we can all move in the right direction on that spectrum as we improve our insulin sensitivity, as we improve our glucose processing, those numbers come down. So that’s a great thing about our metabolism is that we always have the opportunity to become more metabolically fit, improve our metabolism, improve our insulin sensitivity. And we can do that through dietary and lifestyle behaviors through how we eat, getting adequate sleep, stress management, exercise and other tactics. So yeah, I hope that answers the question.
Chantel Ray: [00:15:31] Yeah, but I think one of the things that is very interesting is that they say the blood glucose that you take as soon as you wake up is the best for you to take. But to be honest, I think that really, the best would be like before you ate, but maybe an hour after you woke up would be the best to take because I think everyone, from what you’re saying, everyone is going to have a little bit of a spike in that blood glucose to get them going. Right? You need that cortisol to get you, like you said, out of bed. So you’re going to have a little bit of a spike. So I’m wondering, in general, why they wouldn’t say, maybe without eating, maybe fasting an hour after you woke up. Because an hour after I wake up, even for me, I would say my blood glucose, looking at it when I first wake up, is around like 95. It’s in the high 90s. Every once in a while I might go to 105, but an hour later, I’m at 70 across the board. So it’s like, “Okay. Am I pre-diabetic because one day I woke up and I was at 105?” No, I’m not. Right? And if you look at my A1C numbers on my blood work, I just got it down and my doctor was like, “Wow! Your blood sugar Levels are fantastic.” And they’ve been even more fantastic since I got the blood glucose monitor. Because I can get a little obsessive with it because I’ll be like, “Oh my gosh! Let’s eat this and see what my blood sugar is.” Right? But I think that… What is your thought on that of like really almost waiting an hour after you wake up and seeing what those numbers are without eating. What do you think?
Dr. Casey Means: [00:17:23] These are such great points to bring up, and what I would say is, the beauty of the continuous glucose monitor is that you’re getting all the data. You’re getting that data. The moment you open your eyes, you’re getting that data of your Dawn Effect, and you’re getting the data right before you eat your meal. And the thing is, this is all information. There’s not one single time point that is the most important. You want to actually consider all of those time points because if that Dawn Effect does have a large magnitude for you, that’s worth exploring for anyone. Is it that there is some high cortisol Levels? Is there something with the adrenals and with stress or something with sleep? Is there something going on with the sleep during the night that’s causing the cortisol to be more elevated? And I will say… You said everyone’s going to have a spike in the morning. I would say that’s not… We actually see people who virtually have not, maybe like one or two points, but it’s barely perceptible. And in myself, I notice it changes day to day. So some days it’s just like I wake up and it’s completely flat. Other days I have a 15 point rise. And to me, that’s all information. That’s all important information because those days that my Dawn Effect might be higher, I’m thinking, ” What happened? Did I get poor sleep? Did I have more caffeine? Did I not exercise yesterday? So maybe I’m a little bit more insulin resistant today. Did I eat a high carb meal before bed?” I’m just thinking through like, what are all the things that made this different than it was yesterday? And I think that’s… In our medical system, we unfortunately really have focused on these single time point numbers. You go into the doctor once a year, you get your glucose checked and somehow that’s exactly how you are and who you are. And that’s not true. It changes every single day. Fasting glucose can… For me, you can bounce around, like you said, anywhere from 75 to 85 some mornings. If I get no sleep, I’ve had no exercise and didn’t eat well the day before, it might be in the 90s. So it’s really dynamic and I think that’s actually really great to know about, because what it does is it helps us realize, “Okay. When we make different choices, or maybe sometimes we can’t identify any differences we made, it might be different the next day. And it’s very motivating, I think, to really stick with the health behaviors and do the best we can to get our insulin sensitivity on point. And so yeah, I think what you said about checking an hour after you wake up, that’s fine. That is still a fasting glucose. You haven’t eaten for eight or nine or 10 hours. So it still is a fasting level. And when you think about it, when you go to the doctor’s office to get a fasting level, you’ve usually been up for a couple hours. You drove in and got a test, so that’s more similar to what you might see in the doctor’s office. But I think it’s also valuable to see what that first thing as you opened your eyes glucose was, how big the Dawn Effect was, what happened because that dynamic activity actually also has information embedded in it. So, making the long story short, it’s very dynamic. It can be dynamic day to day and all of that information can be valuable.
Chantel Ray: [00:20:24] Let’s talk about working out in a fasted state and is that going to help insulin sensitivity, and talk about different kinds of workouts. So maybe you say, “Okay. What you’ve seen with people with the CGM, if they’re just walking, what is that doing to their blood glucose Levels? But maybe if they’re doing a major high impact workout, what is that doing?
Dr. Casey Means: [00:20:49] Yeah, such a great question. First thing is that any type of exercise is going to improve insulin sensitivity, no matter what. Basically the research shows that if you’re walking, if you are doing high intensity interval training, if you’re doing strength training, all of these have a positive impact on our insulin sensitivity. And part of that is because our muscles are one of the biggest glucose sinks in the body. They take up so much glucose and when you are using them, even if it’s just a walk, you are taking up glucose and really activating genetic and cellular pathways that tell the body, “Oh! This person is using a lot of glucose, so we need to make sure we’re ready to take that glucose up. We need to become insulin sensitive.” So it is just basically long story short, and everyone knows this, glucose exercise is good for glucose control and insulin sensitivity. So when we think about fasted workouts, this is a really fascinating topic, which is actually getting some more research attention. What this means is that you basically work out first thing in the morning or in the late morning, but you haven’t eaten anything. So let’s say you finished dinner at 7:00 PM, you’ve consumed no glucose until after your workout, you just are eating in this fasted state and what this does is it’s basically exercising in a low insulin state because if your glucose, if you have not consumed any glucose, your insulin in the body is likely going to be lower at that time, which means that you’re going to be more likely to burn fat. Fat and glucose are our two energetic substrates in the body. We can use glucose or we can use fat for energy and if you’re in a low glucose, low insulin state during your workout, you’re going to be more likely to shift towards burning fat in your workout, so that can be a positive for people. The first time you do a fasted workout, it might feel horrible because you’re like, “I have no energy. I’m tired. This is terrible.” Because your body has not adapted to using fat during a workout. You haven’t flexed those cellular signaling pathway muscles very much. If you’re always working out after a protein shake or a banana or a bar that has sugar in it, your body is primed to use glucose during your workout. So that first time you do a fasted workout, you might not have adapted to be a really good fat burner during a workout and it might feel really, really hard. But over time, the body does adapt and if you’re working out in a lower glucose state, your body’s going to have to start becoming more efficient and using fat for the workout. So that’s that benefit of working towards being able to exercise in the fasted state. And there’s a whole league of professional endurance athletes out there who are actually very big proponents of training in the fasted low carb state. They’re called fat adapted or keto adapted endurance athletes. And the reason why someone would want to do that is because we only have about two hours of glucose stored in our body for exercise. The liver can store glucose that we can use during a workout and it’s about two hours worth of energy. But we have like weeks worth of fat to burn in our body. Even if you’re lean, we have so, so much more fat to burn. So if you’re an endurance athlete doing an Iron Man, or a five or six hour event, if you are really only adapted to use glucose during your workout, then you’re going to be having to replenish glucose with gels or bars or whatever, all throughout your workout to be able to have energy. But if you train in a low carb or a fasted state, your body is going to become much better at just tapping into fat switching, metabolically, switching from glucose to fat burning during your event. And so you can imagine after they start running, after about an hour or two hours they’ve really depleted their liver glycogen, their
stored glucose and their body just switches on to doing much more fat burning. And what you find in the blood of these athletes is that their ketone Levels, which is the byproduct of fat burning in the body, they’re high, they rise, so they’re clearly burning fat. And there’s marathoners out there who are running marathons fasted, like 26 miles out, because their bodies can use the fat for energy. And certainly that’s not… I can’t do that. You can’t just immediately do that, but there’s adaptations that happen over time. So if people wanted to dip their toe in that, I wouldn’t recommend just jumping into a 10 mile run fasted. That’s going to feel terrible if your body’s used to burning glucose during a workout. But you can ease yourself into it. You’re going to kind of day by day, maybe eat a little bit less of a carb rich snack before your workout, maybe move towards just having a fat based snack before your workout, like nuts or avocado or something like that and then, when that sort of feels okay, try just working out first thing in the morning having not eaten anything and see how it feels. But certainly, I would recommend people talk to their doctor about it and definitely stay hydrated. But that’s the science behind it is the idea that you’re needing to burn energy in a low insulin state, which is going to move your body towards burning more fat.
Chantel Ray: [00:25:41] Hey guys, I’m so excited. My new book “One Meal and a Tasting” is out now and if you order the book on Amazon, just the regular paperback edition, if you go in and make a review, you will get the audio book for free. Send a copy of your receipt to [email protected] and you’ll get the audio book right away.
All right. This next question is from Salamanca in Great Neck, New York. My grandmother lives in Great Neck, New York, Salamanca. She said, “Love your podcast and I’ve been checking my blood glucose now, after listening to a few of your episodes. I can’t wait to get a CGM. But I want to tell you something strange after checking my blood sugar. One day, I had black coffee and my blood sugar, just from black coffee, went from 80 to 85. I thought it wasn’t supposed to raise it. And then, I did coffee with coconut oil and it was around 80 and went down to 70. Is that a fluke or is there something to it? Also when I have a burger with no bun versus a cheeseburger, it seems the cheese keeps my blood sugar lower. Is this in my head or is any of this actually true?”
Dr. Casey Means: [00:27:00] That’s such a great question. So with the black coffee, it’s certainly possible that coffee can raise your blood sugar, and actually it’s because of the exact same mechanism as the Dawn Effect, it’s because caffeine and coffee can elevate our cortisol levels and cause us to mobilize glucose from the liver and basically raise the blood sugar. So that’s totally possible. The coffee with the coconut milk is really interesting because theoretically the coffee, even with the coconut oil, should raise, potentially slightly raise the glucose because of the caffeine, but with all that fat in there, I don’t know the exact reason why that’s counteracting the caffeine. It seems like on that day, it didn’t seem to affect her as much. It’s, again, talking about that day-to-day variability. There are so many other factors involved that might be at play here. For instance, if she got a great night’s sleep before that second experiment she did with the coconut oil, her cortisol was more stable that day to begin with. It’s possible the caffeine didn’t have as much of an effect on her. So a lot of day-to-day variability other than sleep. Let’s say she was more stressed the day that she had the coffee without the coconut oil. That could have contributed to that caffeine induced cortisol rise. So there are so many variables. And that’s why experimenting every day and taking some observations about different conditions and how your glucose is being affected can be just so valuable.
The company that I started, Levels, that’s what our software does. It helps people tease out all those variables that might be affecting what’s going on with your glucose. Because sometimes, just like she had said, it’s a little confusing. Like why is it going up today and not the other day? But if we bring in those other variables, you can start to make some really interesting insights. So definitely not in her head.
And then the burger and the cheese, that’s a great question. The fat and protein tend to both be macronutrients that cause our glucose to be stable, or even sometimes if there’s no carbs involved in the meal, like she said, maybe go down a little bit after the meal. They’re not going to contribute to glucose in the blood at all. So when she adds that cheese to the burger, what we’re doing is we’re adding more fat and more protein. So those are things that do tend to stabilize glucose. So that kind of makes sense, what she’s talking about. There’s a lot of research showing that if you eat fat or protein before a carb rich meal, it’s actually going to cause the glucose elevation to those carbs to be lower. So I tend to recommend really thinking about not eating carbs in isolation or not eating naked carbs, as I like to call it, and actually making sure that if you’re going to eat the carbohydrates, to either preload them with fat, fiber or protein, or eat them with fat, fiber or protein. So these days for me, if I’m going to eat an apple, I’m going to have peanut butter or almond butter or tahini and chia seeds on top of it. That’s going to be fat and protein. If I’m going to eat bread or something like that, make sure you’re eating some nuts or something like that as well. So that’s going to offset that carb spike. So yeah, fat and protein, I would say, are your friends in terms of blunting a glucose spike.
Chantel Ray: [00:30:02] Let’s talk a little bit about sugar free foods, like sugar alcohols, like sorbitol, xylitol, any of these natural flavors. Have you seen that when people… Because one of the biggest questions we get on a regular basis is people saying things like, “Can I have Diet Coke while I’m fasting or can I have coffee? Can I put Splenda in my coffee?” Those kinds of questions and the big question, “Is this spiking your insulin?” What have you seen from your end on seeing lots of people? Do you have any tests that you’ve done saying, okay, what is these kind of things? Splenda, the sugar alcohols, what is that doing to people’s blood sugar?
Dr. Casey Means: [00:30:50] Yeah. So the artificial, the non-nutritive sweeteners, that’s the big bucket that I would put these all in. Non-nutritive sweeteners means they have a sweet taste, but they don’t actually have calories. But that’s actually a very large bucket because within non-nutritive sweeteners, there’s artificial sweeteners, which are sweeteners that are essentially made in the lab. So that’s things like saccharin, sucralose, aspartame. So like Sweet’N Low, Splenda, Equal, Sweet One, things like those. Those are artificial sweeteners. Then there are sugar alcohols, which are like erythritol… Off the top of my head, I’m not… But sugar alcohols are a different class basically. And then we’ve got natural sweeteners. So that’s things like stevia, monk fruit, yacon root, things like that and those are actually natural. They’re from nature, but they don’t raise, they don’t have glucose in them, but they still have a sweet taste. So those three buckets are all very, very different things in terms of how they affect your metabolism. So yeah, the sugar alcohols would be like xylitol and erythritol. So we have to think about them differently and the research actually shows very different metabolic effects. So I would say like Longstory short, avoid the artificial sweeteners at all costs. So that’s saccharin, sucralose, aspartame. Those are the three main ones. Anything that comes in a pink, a yellow or a blue packet, never, never eat it. That’s what’s in Diet Coke and most diet sodas. Because these are going to have a number of effects on the body and the science isn’t totally slam dunk, but there’s a lot of research to suggest that it has negative metabolic effects.
So first thing it will not raise your glucose on your CGM. You might look at your CGM after a Diet Coke or something, the glucose doesn’t change at all, but that doesn’t necessarily mean it’s okay, because it has longer term effects on the metabolism. The mechanism of that is thought to be its effects on the gut microbiome. So it actually changes the composition of the bacteria in the gut and in a negative way. The gut bacteria have a huge impact on our metabolism. They make a number of metabolites, like short chain fatty acids that are actually very good for our metabolism and our insulin sensitivity and how we process glucose. And over time, artificial sweeteners can change the composition of the microbiome and make it less metabolically friendly. There’s also just this thought that when you have an artificial sweetener, even though it’s not glucose, it’s not actual glucose in the blood, it does trigger the brain through the sweet, the hyper sweet taste to think that glucose is coming in and so you can have what’s called a cephalic insulin response. Cephalic means head, and so it’s like an insulin response triggered from the head, not the blood and what that does, is it actually might cause your body to release insulin, even though there’s no glucose coming in and so that can potentially contribute down the road . That’s when we have insulin elevated over time, the insulin resistance in the body. So for all those reasons… Oh, and there’s actually a third reason as well, which is that artificial sweeteners seem to potentially affect our hormone levels. Like in the gut, one is called GLP-1, and this is associated with appetite regulation and artificial sweeteners impact it. And so it may be that when you eat these artificial sweeteners, it’s actually contributing to you being more hungry and wanting more food. So microbiome, GLP, cephalic insulin response, just a lot of reasons why these may not be long-term your friend in terms of glucose control. But again, if you see it on your CGM or you test your finger prick, you might see, “Oh, it didn’t change my glucose at all. It’s fine.” But there’s other more long-term reasons.
And this is not all bad because there are actually other things that you can use that might be healthier and that’s the natural sweeteners. So this is monk fruit, stevia, yacon root, and these are natural substances that have a sweet taste and which don’t raise glucose levels. And these have much more favorable research in terms of how they’re affecting your microbiome and insulin levels and whatnot. So you’re not going to generally see a glucose elevation on your CGM and they don’t seem to have the long-term effects associated with long-term artificial sweetener use.
They may still contribute to that cephalic insulin response that I talked about. So, I would say, if you’re going to use something, use the natural sweeteners, the monk fruit, stevia, yacon root, and use them just in moderation. It’s not a freebie, it’s not a free pass. It’s still going to prime your brain to have a reward circuitry associated with sweet foods, which we know that people who slowly declined sweet foods over time, whether it’s non-nutritive or glucose, they will break that desire and that addiction to want sugar. So the more we can lower that desire in our body by over time lowering our sweet consumption, that’s good because over time, it’s just going to become less desirable. And when you do eat these non-nutritive sweeteners, whether it’s natural or artificial, you’re still activating those reward pathways that make you want sweets. So I would say, stick with the natural sweeteners and try and use them in moderation and kind of wean down over time would be my recommendation.
Chantel Ray: [00:35:56] And the thing is that with intermittent fasting, I used to be pre-diabetic and one of the things why I love this continuous blood glucose monitor, cause my A1C test… And if you guys don’t know what that is, it’s a test that provides information about a person’s average levels of blood sugar over a two or three month period before the test. And for me, once I got this CGM, my blood levels were even better. My doctor was like, “Chantel, oh my gosh, your numbers are fantastic.” And it’s because when you have the monitor, it basically just makes you be like… It’s funny because I would eat a meal and I would literally show everyone what my blood sugar levels are and they’re like, “Yay! Great job, Chantel.” But it does, because you have that accountability. It makes you want to eat less sugar at once. You can have a lower carb meal so that your numbers stay low and that’s just one of the benefits of intermittent fasting. But this just adds that tool. It just makes it so much better.
Dr. Casey Means: [00:37:00] It’s so true, and I think as more people started using this that it’s going to be fun at meals. Like let’s say, me and you and three other people were at a meal and all had the same thing, what’s fascinating is that all of us would probably have a totally different response to that meal. And we used to think, because of concepts like the glycemic index, that if you eat a specific food, your glucose is going to go up a certain amount. That’s just inherent to the food. If we all eat a piece of white bread, the glucose is all going to rise to the exact same. That’s what that whole glycemic load, glycemic index concept sort of promoted. But the reality is that everyone seems to respond differently to the same carbohydrate load. So it’s really quite personal and I love when I’m with my Levels team, we’ll sometimes do experiments where we all eat the same, like the exact same cup of oatmeal, or we’ll all eat the exact same amount of black beans and everyone has a totally different glucose response. And the reason for that is because there’s a lot of biochemical individuality between people. And a big factor of that, that’s been studied is the microbiome. People’s different microbiome composition means that they might respond to different carbohydrates differently based on how their microbiome is processing it. But also things like body type, baseline insulin sensitivity, how much exercise or sleep the people got the day before, all of those things can change that response. So I think it’s going to be a fun, it’s going to be a party trick that we can all pull out our glucose levels and say, “How did you respond to the cake?” And someone else has a totally different response. So yeah, I’m with you on…
Chantel Ray: [00:38:29] Now let’s talk about first of all, how do you put it on? How do you wear it? How does the process work? How does someone get it? Like walk them through if they say, “Okay. You’ve convinced me. I want it. What’s the next step?” And let’s give them all the details.
Dr. Casey Means: [00:38:45] Yeah, absolutely. So these are prescription-only devices. So they are medical devices. You can only get them from the pharmacy. In many other countries, actually, they are over the counter, but here in the US, they are a prescription, and so, people could go into their primary care doctor’s office and ask for one. Part of the reason I started Levels is because a lot of physicians… Currently the indication for these devices is for people with type one or type two diabetes. They’re intended to help them with their management of their disease, help with medication management. The company I started is because I think there’s a huge, huge potential for people who are non-diabetic to use this tool, just like you and I have been using, to just optimize our diet and lifestyle and our sleep, our stress, and see how all these things are affecting our glucose so that we can improve our levels and hopefully ward off these downstream diseases. The vast majority of diabetes and pre-diabetes is preventable with dietary and lifestyle, and so if we have this metabolic information early, before we have a big problem, we can work to keep it stable or to improve it. So right now, if you go to your doctor, some doctors who might be in the same mindset might say, “Oh yeah, I’ll prescribe this to you so you can optimize your diet and you can personalize your diet and lifestyle.” But a lot of people might just not be aware that this is something that non-diabetics should even use or try. So that’s actually why I started Levels because our company has a physician, a telemedicine physician network that our customers can come and talk to our physicians and get a prescription that way and then we pair it with software that interprets all of the data. So the sensors just get shipped straight to your home from a pharmacy, people get the software, which helps them interpret the data. So basically those are the routes you can take. You can go to your own doctor and try to get one of these. They’re not going to be covered by insurance if you’re non-diabetic, and in that route, you’re going to have to just interpret the data yourself. Or you can go through a company like Levels and actually that’s just a full service operation where you fill out a form online with our programs. So you go in, you have a link, and we have a link for your listeners. And basically you’ll fill out just like a 10 question survey, which is actually the online medical consultation and that’s just about your underlying health and just questions about whether it’s safe for you to get one of these. A physician in your state on the backend, will review those answers and if it does seem safe for you to have a CGM, our pharmacy will ship two sensors to your door and then you’ll get access to the Levels app, which interprets the data. And so when you get the sensors, there’s two of them, each of them last on your arm for two weeks. So together, those two sensors will take you through 28 days of generating glucose data. You’re going to open the box and there’s going to be this little applicator, and that’s going to have this sensor in it. And you’re going to clean off the back of your arm with some alcohol. I think they’re best to put on after a shower when you’ve really cleaned your arm well with soap, get all the oils off your skin because these are going to have to stick with usage to your arm. You’re going to take this little applicator and you’re going to hold it up to the back of your arm and you’re going to press it down and that’s going to basically push the sensor onto your arm. Now it does use a needle to push this little tiny hair-like filament under your skin and it only goes about four millimeters. It’s just like a hair-like filament and that’s what’s actually testing the glucose in the body. And crazily enough, you cannot feel the needle. I think most people, when they put it on, they’d be shocked to know that a needle was even involved because it’s just like a millisecond and it’s just pushing this hair-like filament under the skin. And then on the surface of that sensor there’s adhesive, which is keeping it stuck to your arm, and then throw a patch on top of it. So we have these what we call it performance covers through Levels, which basically make it waterproof and swim proof and will keep it on, an extra layer of protection for those two weeks. You then scan your phone against it and that’s going to activate it and then it’s going to start generating that data and sending that data to your smartphone. And then after two weeks, you just pull it off, throw it away and put the new sensor on. And so that’s how the process works. It’s really easy and get tons and tons and tons of data.
Chantel Ray: [00:42:47] So let’s talk about… Different people put those CGMs in different places. So I’ve seen people put it on their stomach. I’ve seen people put it on the back of their arm. Where do you suggest and why?
Dr. Casey Means: [00:43:01] Yeah. So it depends on the brand of CGM that you’re using. So there are three brands on the market. There’s Medtronic, there’s the Dexcom and there’s the Abbott FreeStyle Libre. So my personal favorite are the Dexcom and the Abbott FreeStyle Libre. The Abbott FreeStyle Libre, I think, is nice because it’s… And the Abbott FreeStyle Libre is the one that Levels ships to people, although soon, we’re going to be also shipping Dexcoms as well, for people who have that preference. And they’re just a little bit different. They both do very similar things. The Abbot is indicated for the back of the upper arm. So that’s where it’s supposed to be. I wish I’d worn on short sleeve shirt, but mine is… You can see the outline of it right here. So it’s in the fleshy sort of fatty part behind the bicep. You don’t want to get it right into the muscle. You really want to get it into a fatty area, and that’s where it’s indicated for. The Dexcom is indicated for the abdomen and many people use it on the back of their arm as well. And so I think from an ease of use and just all aspects, I think back of the arm is easier than the stomach. It’s very discreet, especially when you have the performance cover on top of it, it actually looks just like an interesting athletic thing and so it’s a little less invasive, I think, than putting it on the abdomen, but that’s a personal preference for people. If they have the Dexcom, whether they want to put it on their abdomen or the back of their arm.
Chantel Ray: [00:44:18] Awesome. And this is the thing that’s so important. You guys have to use this link, the levels.link/waistaway. I will put that into the Show Notes because right now you guys have a really long wait list and if you use this link, you’re getting moved up to the top of the list. Correct?
Dr. Casey Means: [00:44:40] That’s right. Yeah. So we’re a pre-launch company. We’re in a beta phase right now and so we actually… There’s 80,000 people on our wait list right now, but with the code, you basically just get your order processed immediately. So yeah, we’d love for anyone who wants to try it out to join the program. It’s really fun.
Chantel Ray: [00:44:58] That is awesome. This has been so amazing. You are a wealth of knowledge. Thank you so much for being with us. Is there anything I didn’t ask you that you want to tell listeners?
Dr. Casey Means: [00:45:09] Well, thank you so much for having me. It was really fun to chat and it’s always fun to talk to someone who’s used a CGM before and has seen its power. I would just, I think ,close by saying, the beauty of metabolism is that it’s not a one-way street. It’s not just like we march along and get worse over the course of our lifetime. You can always move in the right directions and you can do it quickly. And so having that data to do that is really valuable. But it’s very hopeful because we can improve just with very small, easy choices. And I would say from a weight loss perspective, I think for people who have been stalled or having trouble and just don’t know why, I think it can be a breakthrough in seeing if there’s any sort of healthy foods that you are eating, or times of day that you’re eating that you think are fine. But then you see if you have a CGM on, or you’re testing your glucose with a finger prick, noticing that might actually be causing a problem for you. We talked about that biochemical individuality, that’s really what we’re talking about here. What might not be a problem for someone else in terms of their weight loss journey, may be for you, because it’s spiking your glucose, it’s causing insulin release. So yeah, I think it’s just when we think about weight and fat storage and fat burning through the lens of hormones, as opposed to just calories, we start to unlock this sort of whole area where we can make more actionable changes that might be really simple, but we just weren’t aware. So yeah. So lots of hope, I think.
Chantel Ray: [00:46:33] And you do have to look at it individually because I know for me, I’m like the girl who asked the question about the fat, because for me, if I want to see, like if I add avocado or any kind of fat, my blood sugar stays extraordinarily level. If I don’t have that fat in whatever I’m eating, my blood sugar… Even if it’s lots of veggies and lots of other things, if I don’t have that fat, my blood sugar you’ll see will spike more than it would if I didn’t. So I have to be very cognizant of adding that avocado, adding a little bit of fat in there. It makes a world of difference. And that’s what you get to see is, what is it for you that works or doesn’t work. So make sure you guys go get that link. It’s a game changer. It’s levels.link/waistaway. It’s in the Show Notes. Click that, and we will see you next time. Thanks for being with us. Bye bye for now.
Chantel Ray: [00:47:38] Hey guys, thanks for listening to today’s podcast. If you enjoyed the podcast, it would mean the world to us, for you to leave a review on iTunes, to get this podcast out to others that may have the same questions that you do. And as always, if you have a question that you want answered, email those to questions, chantelrayway.com. Thanks again, and we’ll see you next time.