Dr. Casey Means: Attacking The Root Cause of Disease With Self-Quantification And Behavior Change

Episode introduction

Is your doctor acting like a contractor, or like a plumber? A plumber will fix leaks as they spring up, essentially putting a bandaid on existing structural issues. A contractor will make sure the entire house is built on a strong foundation. The is the analogy that Dr. Casey Means of Levels Health uses to describe the flawed modern medical system. The goal of Levels is to improve holistic health by measuring glucose, one of the key contributors to illness and disease. As a guest on Get Over Yourself, Dr. Means talked to host Brad Kearns about how health care economics, the science behind glucose, and why we should be moving toward a value-based healthcare system.

Show Notes

Key Takeaways

6:07 – Moving on the spectrum towards health or disease

Making smart choices is key, because while our genetic make-up is fixed, what we eat, what we do, and how we live also affects our metabolic health.

“When I was an undergrad, I came into understanding the human body as we are this really unique individual genetic blueprint and environmental factors like what we expose ourselves to, what we eat, what we do, how we live, change the expression of this biologic blueprint. And so in that sense, it’s an incredibly empowering view of health because while we do have this sort of set blueprint, we have agency in what we choose to expose ourselves to. And we can have a differential expression of that template by those choices. Making smart choices is really the key to moving on the spectrum towards health or disease.”

10:24 – Doctors should be contractors, not plumbers

While plumbers are highly useful when there is a leak, what we really need are contractors who can build a stronger structure that will not cause leaks. Dr. Means says that this is the approach medical practitioners should take towards health.

“With the plumber, there is always going to be this great role for someone who can come in and fix a problem. If you have a broken bone or get in a car accident and your skull is split open, that’s not the time to probably talk about nutritional interventions or environmental exposures. That’s when our ultra-advanced healthcare system can really come in and be lifesaving and that’s wonderful. But the reality is that the majority of the diseases that are plaguing our country and more and more our globe are diseases that are chronic illnesses based on lifestyle and dietary decisions. And these daily decisions that have stacked up day after day, year over year, have led people towards chronic disease. And so to approach those diseases with this reactionary mindset, as opposed to trying to unpack the factors that lead to disease, starts to feel a little bit illogical.”

14:42 – The common links between diseases

When doctors start looking for the common links and patterns in diseases, they can then start treating those underlying dysfunctions rather than treating only the manifestations of those dysfunctions.

“Currently, because we’re in a labeling medical system we say ‘these symptoms lead to this disease.’ But that’s not actually talking about what is the physiology that leads to disease. And when you can understand the core root cause physiology amongst disparate diseases, instead of then playing constant medical whack-a-mole where you’re just like one disease – isolated silo, whack-a-mole! With a symptom-based drug, whack-a-mole! For our arthritis, whack-a-mole! For sinusitis, whack-a-mole. For anxiety, whack-a-mole. For cancer, whack-a-mole. For prostatitis. You look at all of them and you say, oh, interesting. All of them have upregulation of TNF alpha and inflammatory cytokine. All of them have upregulation of NF-kappa B, a genetic pathway that’s a master inflammatory pathway. And then you start to think, how do I impact that? How do I impact inflammation?”

17:59 – History of health care economics and the US medical culture

Healthcare economics in the US works on a system of specific codes for specific illnesses. Dr. Means posits that this has led to doctors fitting the diagnosis and treatments around the codes for easy billing, moving away from looking at the body as a whole.

“So when we were setting up how we were going to finance healthcare 50, 60, 70 years ago, we decided that we were going to basically code things, and then we were going to bill for codes. And that honestly was the beginning of the end for thinking about prevention. Because you can code diseases and you can code objective abnormalities, like objectively lab values that are problematic, but you can’t code just being healthy, metabolically functional. So you code problems and then you bill for those problems. And so that was a way to organize the system for efficiency basically. We set up this fee-for-service healthcare system, where you get paid when you do something. So there’s really a bias towards action. And what’s interesting about a healthy patient is that you don’t really have to do anything to them. When you get a patient who is healthy, you have essentially lost a customer because you don’t have to do anything to help them at that point.”

19:58 – Moving towards a value-based care system

A value-based healthcare system would provide a lump sum amount of money to spend on a patient as needed. This incentivizes keeping patients healthy so there are lesser interventions required.

“You hear a lot of talks now of moving towards what’s called a value-based care system, which is a move in the right direction so the value equation is outcomes over cost. So you want good outcomes and low costs that would lead to a high-value number. So you see in Obamacare and a lot of those discussions, they started talking about we’re going to pay for value. And so we’re going to objectively measure outcomes and we’re going to object to them at your costs and try and make that better. Well, what’s great about that is that lifestyle interventions like improving diet or exercising are the highest value interventions you could possibly have. Exercising 150 minutes a week is going to slash your risk of chronic disease and it’s essentially free. So that is a positive movement. And then you’ve got other systems separate from the fee versus service systems like capitated models and HMO models. These are systems where instead of paying a fee for service, you are giving a lump sum of money to a healthcare system for a particular patient and saying, this is the money that you get, do with it what you will, but what you make in terms of profit is what’s left over after your interventions. So that’s going to promote high value. You are having to compete for customers, so you have to do a good job and you want the highest bottom line.”


25:41 – Symptoms don’t just arise in a vacuum

Biological dysfunction starts at a cellular level. When doctors can understand and treat at that level, it’s going to lead to a high-touch, personalized treatment plan for the patients that includes a diet and exercise plan.

“Symptoms don’t just arise in a vacuum. It’s not just this magical thing that happens. Symptoms arise from biological dysfunction. If we can understand cellular and biologic dysfunction, we can then try and impact at that level, and when you affect it, that level symptoms melt away. So this is not about treating symptoms like treating pain with a pain medication that blocks your perception of pain. It’s treating the pathway that leads to pain…Once you get to the bottom of them and create a very personalized plan for these things, it’s often a very efficient process. They get better, they feel better and you’re sort of done. And so that was so heartening to me.”

31:25 – Why should we measure glucose?

Glucose is easy to track. It’s also highly reactive to not just diet, but also exercise, stress, and sleep, which makes it a fabulous biomarker to track in the body.

“Glucose is a fabulous biomarker to track in the body. It’s the only biomarker you can track at home from the blood in real-time. What’s so great about it is that it is a core substrate of our metabolism. So glucose has sugar. And when you process carbohydrates, glucose goes into the bloodstream and your glucose levels go up and down all the time throughout the day. And so what’s really unique about glucose is it’s not only affected by food but it’s also affected by exercise, it’s affected by sleep, it’s affected by stress. So it’s this readout of all these multi-variate inputs that many of us are trying to optimize in our daily life already. And it closes the loop between how those different behaviors impact your health in real-time…the really cool thing about wearing a continuous glucose monitor is you can say like, oh, I had a pressed juice, which I thought was healthy, but it skyrocketed my blood sugar to 180 and then it crashed down to like 65 and you had reactive hypoglycemia. And then I immediately felt tired. That’s really interesting. And so all of a sudden you can link that action, the juice, with some subjective experience and your glucose numbers and say, you know what, maybe that juice is not for me.”

35:45 – What is worse than sustained high blood sugar?

Frequent spikes in blood sugar can cause glycaemic excursions. This triggers massive inflammation and creates a highly harmful hormonal cascade which leads to tissue damage and eventually lead to many chronic conditions.

“It’s this idea that there’s this light switch that goes off of all of a sudden you were fine, and now you’re not fine. But that’s not what’s happening on the biological level. On the biological level, you’re marching along the spectrum from optimal metabolic and glucose function to dysfunction and glycemic variability, which is these up and down swings that you were speaking about is a big contributor to long-term dysfunction in this regard. And we don’t have any insight into that because we don’t have any sensor or tools currently, other than the technology to see it.”

46:50 – When is a spike in blood sugar a good thing?

Lifting heavy weights can trigger the liver to release stored glucose in the bloodstream. This glucose does not need insulin because the muscles have a unique sugar uptake mechanism. This makes the body insulin sensitive in the long term, which is the goal.

“What you’re referring to is this idea that when you work out, you’re basically telling your body, okay, I’m lifting a bunch. This is translated in the body as stress, so you start creating catecholamine hormones, which are stress hormones. Those go to the liver and they say, liver, our muscles need sugar to function and to produce ATP for muscle contractions. And so we’re going to dump out all of our stored glucose or some of our stored glucose into the bloodstream, so it can travel to the muscles to be taken up. What you end up seeing, especially with high-intensity interval training workouts or power workouts with lifting is that you get this dumped into the bloodstream and you get a glucose spike, actually, that’s totally exercise-induced even if you’re fasting. And what we know about powerlifting and high-intensity interval training is that these are actually associated with metabolic health. Even one high-intensity interval training workout can cause improved insulin sensitivity the next day measurable.”


49:18 – What should people who are trying to gain muscle mass eat?

The conventional wisdom of eating complex carbohydrates one to two hours after a workout is not for everybody. According to Dr. Means, most people are better off eating a more balanced meal to avoid a glucose spike in the bloodstream.

“For people that are trying to gain muscle mass, it is thought that eating some sort of an ideally a complex carbohydrate and not necessarily like a refined sugar carbohydrate, like you’d find in ice cream in the first hour to two hours, right after a workout is the best time to replete that liver glycogen and the muscle also stores some glycogen. And so for you to get the maximum sort of build, that’s a good time probably to eat some complex carbohydrates. But what I think is valuable about wearing a continuous glucose monitor is that some people may just totally overdo it, pound tons of gels and tons of protein shakes filled with different refined sugars, and then eat some sweet potatoes and this and that to try and get as much as they can in. And I’m not confident that that’s necessary to get the same effect you’d get from a more balanced, slower carbs eaten right after a workout. You may be able to mitigate this huge insulin surge, this big hyperglycemic sort of potentially inflammation response. Keeping it a little bit steadier and more balanced may allow you to have the exact same glycogen storage, glucose uptake to the liver and muscle without some of the collateral damage of a big insulin surge, an energetic crash afterward.”

56:09 – Why we can’t lose fat

We’re eating at least 10 times more sugar than we should be and storing it as fat. Our bodies are producing a lot of insulin to keep up with the sugar and we are slowly becoming insulin resistant, leading to even more fat storage.

“We’re eating at least 10 times more sugar than we should be. We’re going to store that extra as fat. So insulin actually tells the body to store excess glucose as fat in our adipose cells. And what it also does is it tells the mitochondria don’t burn fat. We don’t need to burn fat. We just got tons of energy. So if you’re spacing out your food, little carbs all the time throughout the day, you’re constantly getting these insulin spikes and you’re literally telling your body in very clear language, do not burn fat. You don’t need to versus if you eat your calories in a much more condensed period, yes, you’re going to get that glucose surge, but you’re only going to get it for a very short period of time. It’s going to come up, it’s going to come down. And then for all those other hours during the day, when you’re not eating, your insulin is low, you’re going to burn through your stored glucose. And your body’s going to say, Oh, there’s no insulin and no foods coming in. We better start burning fat…And so all of a sudden you’ve just totally pulled the rug out from under this idea that weight loss is impossible.”

01:02:24 – The breaking point

The modern diet is essentially a toxic one. If we don’t start thinking about food in a different way, our bodies will pay the consequences.

“We are dealing with just absolute carbohydrate toxicity in our culture. We are eating 150 pounds of refined sugar on average per person per year now, when a hundred years ago, we were eating like two pounds of refined sugar per year if any. Its orders of magnitude. And the carbohydrate toxicity, the substrate toxicity that we’re dealing with, our poor little bodies and our mitochondria that process glucose, have absolutely no idea what to do. And we’re just seeing bodies break, which is why we’re seeing astronomical rates of chronic lifestyle-related diseases that are just absolutely bankrupting the human capital and the economic capital of our country.”

Episode Transcript

Intro: [00:00]               Thanks for listening to The Get Over Yourself Podcast brought to you by: CAROL Fit Stationary Bike Program- 8minute workouts to get super fit. Perfect Keto- the cleanest, highest potency ketone supplements. MOFO- Male Optimization Formula with Organs to boost testosterone. Let’s get checked at Home Testing Kits. Try LGC.com. Almost Heaven- beautiful compact home use sauna kits. Brad’s Macadamia Masterpiece- the mind-blowing nut butter blend and check out bradkearns.com/shop- my personal selection of favorite products for health, fitness and peak performance. And here we go with the show.

Casey Means: [00:47]  I came into understanding the human body really as, we are this really unique individual genetic blueprint and environmental factors. So what we expose ourselves to, what we eat, what we do, how we live, these are all environmental factors that change the expression of this biologic blueprint. I really came to understand that the root of chronic inflammation that underlies the majority of our chronic diseases is based in diet and lifestyle. There’s so many ways to affect metabolic health. Really good sleep improves metabolic health. The right diet and food combinations and food timing affects metabolic health. When you eat has a huge impact on your glucose levels, how you manage stress, your exercise, what type and frequency of exercise you’re doing.

Brad Kearns: [01:43]                Listeners, we have a live wire on the line. It’s Dr. Casey Means. And get ready for a fast moving, super exciting, incredibly informative show about metabolic health. And oh my gosh, what a story Casey has for you of her life journey through the traditional medical environment and intensive training to become a surgeon, and then having this awakening, this life change, where she realized that all the people she was operating on were coming to her with inflammatory conditions that could be possibly righted by healthy lifestyle practices and that plunged her into a completely different career path. She’s at the forefront of technology and functional medicine. She’s going to talk to you about the amazing continuous glucose monitoring, new technology that you can access yourself and learn about all the different lifestyle practices that affect blood glucose. So we’re going to talk through all manner of topics relating to the traditional medical care environment, the traditional approach, the disease-based approach and all the different options and alternatives you have, including this breakthrough technology of strapping a device onto your body and checking your glucose readings throughout the day. It’s been absolutely life-changing for many people, and you’re going to get some good scientific insights from Dr. Casey, but she does a wonderful job coaching them in practical terminology and easy to understand approach and also, quick tips. One of them was when you have that glucose dip, you know, that afternoon blues where you’re likely to reach for a snack to get a boost, she suggests instead, waiting it out, profound advice. Your body will come back strong, but if you keep going on the roller coaster, the jack-in-the-box approach. So we got jack-in-the-box mentioned, we got whack-a-mole mentioned, it’s a really fun and lively show. I’m going to have her on again because we teed up a part two at the very end of the show when we talked about alternative approaches to healthy eating, fascinating insights. Here we go with Dr. Casey Means of Dr. Casey’s Kitchen.com. Dr. Casey Means, we are so warmed up, like never before for a zoom episode. Why? Because we hung out in a beautiful park in Portland only a week ago, just random, you know, scheduling and then here you are on the podcast. It’s so great to connect with you. We’re going to hit it hard right now.

Casey Means: [04:23]  I am so happy to be here. Thank you for having me, Brad. And it was definitely the highlight of my week, to get to meet you last week in person. So, what a serendipitous event, to have you driving through Portland the week before this podcast. So wonderful.

Brad Kearns: [04:38]                Oh, thank you. And what was also amazing was to hear just a tidbit of your life journey. So I’d love to introduce you to the listeners with this amazing, I guess, transformation of going hardcore into the mainstream educational medical career. Here she is. She’s all set up. She did her hard eight years at Stanford. Not four people, but eight and wearing red every time I see you just because of that and you have the right to, of course. But tell us about your educational background and then the changes that came about quickly into your career as a surgeon.

Casey Means: [05:19]  Absolutely. Yeah.  So, I started at Stanford as an undergrad in 2005. So this was right after the human genome project had just wrapped up and Silicon Valley was just abuzz with personalized genetics and, you know, direct-to-consumer personalized gene testing. And so 23andMe was popping up and it was just a very exciting time to be interested in biology and at Stanford. And so that was really formative in terms of my medical education, to be in that sort of ecosystem of personalized health. And so that’s what I majored in. I studied personalized genetics. I was a TA for Russ Altman’s, you know, first sort of personalized genomics class at Stanford. He’s head of the bioinformatics department there. And I worked at 23andMe when I was an undergrad.  So flash forward, you know, I go to medical school and I’m also at Stanford for medical school and there, it was a totally different ethos about health than what I’d been exposed to as an undergraduate, because.

Brad Kearns: [07:47]                Down the hall in one building over, people are talking about gene expression and epigenetics, and then you go to medical school and they’re like,  cut here with the scalpel to remove the tumor.

Casey Means: [07:59]  Exactly. You know, it’s a little bit paint by numbers and it’s very, very cookbook. And really, modern medicine is all about pattern recognition. It’s, here are a set of symptoms which are subjective factors and here are signs which are objective factors about a patient, and if these signs and these symptoms match up then we’re going to label it with this diagnosis, and then once you have that diagnosis, ding, ding, ding, you’re set because now you have this set of drugs or this set of invasive interventions to offer the patient. And that’s pretty much A to Z. And so that was somewhat disheartening to me because I was coming with a very different perspective of really thinking about biochemical individuality and the biochemistry of disease and really cellular biology. But a lot of those things, while we learn about them, in terms of actual clinical practice, kind of get brushed under the carpet in favor of this very, you know, high throughput pattern recognition and reactionary medicine. And so, with that pattern recognition, you also get into this mindset of a very reactive nature of healthcare. So, a healthy person’s not going to have a lot of signs and symptoms so the doctor’s job really isn’t necessary there. It’s only until you have those signs and symptoms that you come to the doctor and they do this labeling process. So what it does is it creates a culture where you’re really not thinking about or addressing the patient without disease. And you’re only really giving them attention and energy when they’ve started to have dysfunction and symptoms emerge. So.

Brad Kearns: [09:37]                And I guess that’s okay. Because when my plumbing pipes are backed up, I want to call the guy with the tools to clear them up but he’s not the same as the contractor that should have installed it the right way in the first place. And, you know, I’m coming from a medical family and they do such wonderful work, especially on the front lines. And it seems like anytime you hear like a criticism of mainstream medicine, it might be warranted but it’s also taken out of context. And I think the patient has so much responsibility to make good choices and protect their health so that they’re not coming in a disease state or relying on medicine and pharmaceuticals to, you know, to right a course that could be easily righted in another way.

Casey Means: [10:23]

Brad Kearns: [16:50]                Cool. You said a few interesting things. One of them, the lucrative nature of playing whack-a-mole and I’m wondering, I know the medical world is not filled with devious, deceitful people looking to make money like a used car salesman that lie about the odometer, but I’m wondering if there’s an element of laziness or lack of space in the brain to step back, like you said, quote, Dr. Casey said, quote, I stepped back out of the operating room and realized that all these are inflammatory-based conditions and, you know, when you have a full slate of surgery scheduled, you don’t have time to step back. You just have to get the pus out of the sinus, to speak graphically to our listeners, but I’m just wondering why we haven’t come to these revelations as a society. Is there like influences like the profit motive that’s blinding us or something?

Casey Means: [17:57]

Brad Kearns: [21:39]                Yeah. The billboards by Kaiser, they must cost a lot of money where they’re saying thrive and pictures of people out there being healthy. So it seems like they have a vested interest in keeping people healthy. This might be an aside, but I’m curious, you know, healthcare premiums are not cheap, right? But even someone like me who’s paid into the system my whole life, as healthy as can be, and I had a single incident in the last 40 years where I ruptured my appendix, I had to have emergency surgery, I had some complications and, you know, I was into the doctor’s office and having follow-up surgeries and that pretty much busted all my premiums and then some, and I’m, I would say one of the healthier people who consume healthcare. So how are these companies even making a profit when even the slightest trip to the surgical center is such astronomical costs?

Casey Means: [22:34]  In the companies, in terms of insurance companies?

Brad Kearns: [22:37]                      Yeah.

Casey Means: [22:38]  It’s a good question. I think that, first of all I’m sorry to hear about your appendix. That sounds like quite the ordeal.

Brad Kearns: [22:50]                Little tidbit to the listeners, if you go into the emergency room and you report your pain is 10 out of 10, don’t go home. Because they sent me home saying that I was fine. And then I went home and had it burst in bed. And I laid there for 12 more hours and it turned into being a horrible situation. It could have been easily, you know, kind of alleviated, but I was trying to be such a tough guy because I don’t want to go and get extra care that I don’t need or take pain meds or any of that silly stuff. But I learned my lesson and totally recalibrated my approach to health and well-being where there’s a time and a place to be self-sufficient and then when you got 10 out of 10 pain, you go in there and you stay there until they figure something out and back to the show with Dr. Casey Means.

Casey Means: [23:35]  So one benefit that insurance companies have is that they share a risk across a large population, some of which are going to be very ill and some of which are going to be very healthy. And part of having this universal mandate for healthcare that was proposed with Obamacare is that if you can get more, especially the healthy population into the insurance pools, it’s essentially going to lower costs overall.

Brad Kearns: [23:59]                We’re going to pay for all them smokers. Alright. Thank you. Yeah.

Casey Means: [24:03]

Brad Kearns: [25:07]                Oh boy. Okay. So you, once and for all walked out of the operating room, never to return most likely, and you had this vision to make a difference at the symptom level. And where did that take you?

Casey Means: [25:23]

Brad Kearns: [27:54]                Great visit. Thank you, Dr. Casey. Great advice. I got so many tips. Thanks for the handout. Okay, bye. Where’s the salt and straw. Is that down the street? Yeah. Okay.

Casey Means: [28:05]

Brad Kearns: [30:14]                It seems like this emerging technology of the continuous glucose monitor is one of the most powerful, potential behavior modifiers, because you have this real time information, your company’s called Levels right? And tell us a little about what they do. I know they have the CGM technology, and I think you have ambitions to add more biofeedback and other tools for the self-contained human to make good decisions.

Casey Means: [30:43]  Yeah. So, so essentially this company that I co-founded, it’s called Levels, and it is leveraging this technology called continuous glucose monitoring technology as a biofeedback tool to help people make decisions about diet and lifestyle in real time that are best for their personal biology. So you can kind of think of the Levels system as like Fitbit for glucose and for people watching the video, I’ve got my little sensor around my arm.

Brad Kearns: [31:09]                Youtube viewers, she’s got a sensor on her arm. Pretty cool.

Casey Means: [31:12]

Brad Kearns: [34:19]                So generally speaking, we want to have a tight regulation of our blood glucose levels. I’ve read that there’s only a teaspoon in your entire blood volume of six or seven liters or something, which is such a mind-blowing thing. So we’re really working hard in the liver with whatever we’re doing, producing insulin to lower it, making glucose if we’re starving, those kinds of things, and so we’re trying to keep this tight level, which I imagine would be our ancestral experience because we didn’t have regular meals and all that. And now today, like you described at the fresh juice place, we’re prompting these spikes and these drops due to not just eating too much sugar, but all kinds of disturbing things that are related to stress management or glucose regulation, I guess.

Casey Means: [35:13]  Exactly. So most people associate essentially, if they’re a yearly fasting glucose level is going up, that’s bad. That’s usually the only insight we have into glucose levels.

Brad Kearns: [35:25]                Right. Once a year, once every six months, one snapshot.

Casey Means: [35:28]

Brad Kearns: [43:27]                Salt and Straw. Dum-da-dum.

Casey Means: [43:28]  Yeah, let’s do it head-to-head.

Brad Kearns: [43:30]                Yeah.

Casey Means: [43:31]

Brad Kearns: [45:06]                Right. So it’s been debunked now. So in about 17 to 20 years, it will be widely accepted by conventional society that the glycemic index is a bunch of nonsense.

Casey Means: [45:18]  Right. Exactly.

Brad Kearns: [45:20]                Are there, what kind of particulars might influence our varied response to a white rice? Could it be that I have some, an allergic response or maybe a genetic predisposition to react to a certain food that works for you and are all these things in play, when you’re doing health consulting with someone where they love their wheat bread sandwich every lunchtime, and there’s no adverse glucose response, so you give them a thumbs up or the next person should run screaming from a bread of any kind?

Casey Means: [45:53]  Hm.  Well, it definitely does come down to that where one person may do really well with a particular food and another person might not. And so I would, as a clinician say, this is probably something that is not going to be super harmful for you to include in your diet whereas this might be very harmful for someone else. We never want to have big glucose swings. There’s no purpose for a huge glucose swing.

Brad Kearns: [46:18]                Oh. Never? Like  what about at the CrossFit session from minute 30 to minute 40? Is that going to be a dumping of glucose in the bloodstream to finish the workout?

Casey Means: [46:29]  I should say a dietary induced glucose spike.

Brad Kearns: [46:31]                Oh. Ok. Yeah.

Casey Means: [46:33]  I think you’re bringing up a great point though, which is about exercise induced glucose spikes, which is a sort of different physiologic pathway that isn’t necessarily going to have the same biologic effect.

Brad Kearns: [46:43]                Oh.  So not as harmful, you mean? Yeah.

Casey Means: [46:48]

Brad Kearns: [50:45]                Back to those afternoon blues that you’ve mentioned a while back where you just feel like, heck, and you need to take a nap. You can’t concentrate, is this always associated with a blood glucose drop to below normal, below manageable, or are there other outside factors? Like this happens to me, let’s say, you know, now and then where I just have an afternoon bomb out, sometimes I link it to extremely difficult workout, you know, eight hours prior or something. But I haven’t tracked my glucose on those occasions, but I’m just curious. Are there other factors that might come into play? Like just when your brain feels fried and you need to go down for a break.

Casey Means: [51:29]

Brad Kearns: [52:50]                Just a quick one, I suppose if you were noticing a blood glucose drop for whatever reason, maybe too stressful of a morning, traffic altercation, crappy breakfast at the pancake house, what’s a good strategy to try to rebuild your energy for a productive afternoon?

Casey Means: [53:09]  That’s a good question. Yeah. So if you’re finding yourself in that sort of reactive dip, which we call reactive hypoglycemia, in the very short-term?

Brad Kearns: [53:19]                An excursion, you called it. I’ve taken an excursion to the shithole because I can’t anymore. And how do I get into a different type of excursion?

Casey Means: [53:30]  Amazing.

Brad Kearns: [53:32]                I’m here for you and our listeners. We’re keeping it, you know, we’re keeping it fresh. The next interview might not be as fun for Dr. Casey, just trying to get up there on the scoreboard. Okay. How do we do a positive excursion?

Casey Means: [53:46]

Brad Kearns [54:19]                Oh, you just described the weight loss diet book industry of the past 50 years. That what all the books, 80% of the books out there are trying to do, what was the term you just used? The, not the whack-a-mole, the one earlier?

Casey Means: [54:33]  Jack-in-the-box.

Brad Kearns: [54:34]                      The jack-in-the-box, we have Jack-in-a-box, we have whack-a-mole, I’m getting a good podcast title now, if you keep up for a third one, then we’re all set.

Casey Means: [54:44]        I will think about it. I’m going to dig deep.

Brad Kearns: [58:26]                Wow. I mean, that’s the heaviest insight around, that we’ve heard, you know, in decades really that this meal timing. Thankfully, it’s the centerpiece of our new book that Mark Sisson and I are putting out called Two Meals A Day, but really to put this all together and to realize that just the timing of what you eat, and you said the two groups in the study, and I know there’s been many studies, Jason Fung mentioned numerous ones where they ate the same stuff, but one ate it from 8:00 AM to 2:00 PM and the other one on their snacking mode and had a third of a PowerBar here and a third of a PowerBar there. Sorry, this show is not sponsored by PowerBar, the ultimate snacking tool to keep your insulin and glucose high. But that’s pretty huge because, I don’t know, I talked to real people all the time. I’m sure you do too, Casey, that aren’t highly motivated and living and breathing this stuff. And people are looking to enjoy their lives, there’s habit patterns and cultural forces. And so, if we can at least urge people to get a unit on their arm, because that’ll, you know, be hugely impactful. But if you can just kind of, you know, strategize to have a feast or famine mode in your life, you’re going to have an explosion in health predictably.

Brad Kearns: [01:00:59]          Right. And that’s not just your opinion because you’re gathering the data from real humans. And I know we have to wrap up, but I’m teeing you up for an entire repeat show and we have all these notes to talk about because of your strategies and your personal dietary habits and the data that you’ve gathered, but, you know, you talked, you gave me a few soundbites that, you know, this keto or a low carb diet that’s poorly formulated and poorly contemplated where you’re snacking on fat bombs all day long, you’re still inhibiting fat burning and you’re inviting adverse consequences, such as failure to drop excess body fat, even though you’re following the rules that are written in the best-selling books including ones of my own that are being misinterpreted and taking out of context. So I love the practical insights there and also the variability between individuals.

Casey Means: [01:01:55]

Brad Kearns: [01:04:44]          Dr. Casey Means, you killed it. It was fascinating. And we’re totally teed up for show number two, with these varied approaches to healthy eating and metabolic health. And I’m excited because I feel like when we talked personally about this in Portland, we got a little further down the road. We’re going to bring that to the listener next time, but it kind of helps to reconcile some of the controversy dispute, argumenting back and forth among health experts. And now we can kind of try to pursue some common ground and realize that if we get the bad behaviors out of the way and, we only touched on this briefly but you know, when you’re getting in those traffic altercations and a stressful workplace environment, you’re spiking your glucose just like if you go down the street and get a Hostess pie. So we’re going to do some big picture reconciling and boy, what a pleasure it was to have you on the show and give people a little tidbit about this new technology. Where can we learn more about you and the Levels operation and all that?

Casey Means: [01:05:50]

Brad Kearns: [01:07:07]          Awesome. Thank you, Dr. Casey Means. Thank you listeners.

Outro: [01:07:14]        Thank you for listening to the show. We would love your feedback at [email protected] and we would also love if you could leave a rating and review on iTunes or wherever you listen to podcasts. I know it’s a hassle. You have to go to desktop iTunes, click on the tab that says ratings and reviews, and then click to rate the show anywhere from five to five stars. And it really helps spread the word so more people can find the show and get over themselves because they need to. Thanks for doing it.