Podcast

Dr. Casey Means, CMO & Co-founder Levels Health, How a continuous glucose monitor is key to improving your sleep & wakeups!

Episode introduction

Dr. Casey Means is a former surgeon and an award-winning biomedical researcher who’s worked at NIH, Stanford Medical School, and NYU. Her passion for understanding how our everyday choices impact our long-term health, particularly diseases caused by chronic inflammation, led her to co-found the metabolic health company Levels Health. Levels uses continuous glucose monitoring to empower users to make healthier decisions about food, sleep, exercise and stress management. On this episode of Sleep is a Skill, Dr. Means talks to Mollie McGlocklin about how glucose levels affect your overall health and wellness, when to eat carbs to have a better night’s sleep, and how monitoring your glucose levels can help you make the smartest food choices.

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Show Notes

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Key Takeaways

9:07 – From surgery to startup

Before Dr. Means co-founded Levels Health, she was a head and neck surgeon for years. She started seeing a pattern emerging among all of the patients she was seeing: chronic inflammation. That led her to research what was driving so much inflammation in adults and what could be done to stop it.

“So that whole process of stepping back and thinking about some of these root causes of chronic inflammation got me just really evangelized to think like, okay, before I make more cuts in the operating room, I want to figure out how to help people on this front end and to take control of some of these triggers. And that led to a whole other journey, which is like, how do I do that? How do I do that effectively? And as a doctor, ultimately what that means, doing that effectively, is how you will change their behavior and make sustainable, positive, personalized decisions every day to sort of really optimize those conditions, those behaviors that will generate health if they’re done consistently. But as doctors, we’re actually not like great agents of behavior change. Like a 15 minute conversation is not necessarily enough to get someone to change a huge entrenched habit in their life. And that’s what got me really interested in digital health. How can we use tools that people have with them every single day, like their phones and their wearables, to motivate really personalized decision-making.”

 

 

16:21 – High blood glucose can lead to more than just diabetes

Every cell in the body converts glucose into energy. That means that ailments related to insulin resistance, or when your cells become “numb” to glucose when they’re exposed to too much, can affect organs throughout your body.

“So imagine your brain not being able to convert glucose to energy well anymore because the brain is insulin resistant. Well, that could look like Alzheimer’s, other forms of dementia, depression, anxiety, fatigue, brain fog, chronic pain, all conditions that are associated with metabolic dysfunction. If it happens in the ovary, it could look like polycystic ovarian syndrome, which is the leading cause of her infertility in this country and is associated with metabolic dysfunction. If it happens in the liver, non-alcoholic fatty liver disease. The kidney, chronic kidney disease. The heart, cardiovascular disease, hypertension atherosclerosis. So it’s sort of like whatever cell type is insulin resistant and not able to get the energy it needs, you’re going to see a symptom. So hopefully that paints this picture of sort of the physiology, and why you can imagine if we keep those glucose spikes and the amount of glucose from kind of dumping into the body, from the diet lower, we keep the insulin lower and the cells stay perky.”

19:28 – If you’re blood glucose levels are high, you’re not doomed

Metabolic health is a spectrum that can always be improved or worsened with our daily choices.

“I think one of the most exciting things, and one of the reasons why I was really compelled to focus on this as the company I wanted to start is because you’re not screwed wherever you are. This is a spectrum where we can move, you know, in the right direction, in the wrong direction, unlike sort of the way we think about it. Normally we’re like, oh, we’re healthy when we’re young and then one day we might get diabetes and it’s like an on/off switch. That’s not the way it works. Every day we’re actually moving back and forth on this spectrum of metabolic health. It’s not like one day you wake up and your glucose is in a range that you’re not diabetic. That’s been happening for years or decades. And you know, even at that later stage, you can still move in the right direction. Because again, it’s like what I was mentioning where if you can keep the glucose and the insulin spikes lower, your cells will start to hear it more again, and you can regain that insulin sensitivity and that metabolic function.”

20:41 – Continuous glucose monitors provide crucial information

CGMs give you instant biofeedback and show you how different foods and habits affect you personally so you can make better choices.

“You can have a Clif Bar, and in one hour know whether that’s a good or bad choice for you. And it’s just like, black and white. And like you mentioned, it’s different between each person. So you and I could both eat a Clif Bar and you could go up just a tiny bit on your glucose and I could go through the roof. It might be a better option for you than it is for me, because it’s likely causing less of a glucose and insulin response in you and a big one in me. And there’s been research study in this deeply. Why would two people respond differently to the exact same set of carbohydrates? Like I thought there was low-glycemic foods and high-glycemic foods.Why would it be that two people are responding differently? But it’s actually, there’s this biochemical individuality to it. And a big factor that’s been studied is microbiome, so just the difference in composition in the gut and how the bacteria are processing these foods has an impact on how much the glucose rises in the blood after eating a specific carbohydrate. So there’s a lot of variability between people on that. Also things like body type, how much sleep people got the night before. Those can have an impact on how a carbohydrate in the mouth is converted into glucose in the blood.”

22:10 – Tech tools can help us understand the data from CGMs

Software like what Levels offers can help people see what actions cause glucose spikes and which ones keep it steady.

“That’s where software can make it really fun. Because there are lots of things that go into how much the glucose rises after a meal. It is what you ate. It is how you paired the food. Were you eating a carb alone, or were you eating it with protein and fat? What time of day did you eat it? Was it morning or night? Eating carbs later at night, for many people tends to spike glucose higher because of the impact of melatonin on the pancreas. How much exercise you did that day? Exercise has a profound impact on same-day glucose metabolism. How much stress you’re under. If your cortisol is high during the day, your glucose levels are going to be higher. And then a really key one is sleep. How much sleep you got the night before. How much sleep you got over the prior weeks. But even one night of sleep deprivation can make people more insulin resistant. And so the beauty of the CGM is you can start parsing out: what context am I building for my body to process carbohydrates? How do I leverage all these levers that have to do with glucose to my advantage?”

 

 

24:41 – Glucose and the menstrual cycle

Insulin sensitivity varies throughout the menstrual cycle. Estrogen and progesterone affect blood glucose differently, so people should shift their habits slightly throughout the cycle and into menopause.

“So typically – and this is going to vary for each person – in the follicular phase, which is pre-ovulation, when there’s a higher estrogen to progesterone ratio, tend to see better glucose levels, slightly lower, more insulin sensitivity. Estrogen seems to be a bit protective in terms of metabolic health. Then post-ovulation when both estrogen and progesterone are rising together, but that ratio is a little bit lower of an estrogen to progesterone ratio, you start to see a little bit more insulin resistance, a little bit higher glucose levels. And so that’s something that’s going to be interesting to track and may influence the choices we make during that phase. If things are going on up a little bit, and we’re a little bit more variable on our glucose, that might be a time to sort of tighten up a little bit on the refined foods we’re eating and the refined grains and stick to sort of more the foods that are low-glycemic for us to kind of keep things stable. So there’s some really, really interesting stuff there. And for the menopausal women, when estrogen declines in menopause, it’s an interesting time. Because that’s when we start to see women really increase their rates of both obesity and diabetes. So that’s like this risk time where estrogen, which seems to be protective for metabolic health, is plummeting.”

29:13 – Help for anxiety and depression

Studies have shown that people with diabetes have two times the rate of depression compared to non-diabetics and 40% higher rates of anxiety. But inflammation from glucose spikes can impact the mental health of non-diabetics too.

“When you think about it, you eat some food, your glucose is going to go up. It’s going to come back down. When that is a big, big spike, your body is releasing tons of insulin and it can sometimes overshoot on the amount of glucose that gets soaked up into the cell and create a situation called reactive hypoglycemia. So you can imagine mountain, and then a valley that is lower than the baseline. That moment of reactive hypoglycemia has been associated with anxiety. It’s like moments of anxiety. And I think I personally have felt this if I have a really big high carb meal or just, you know, an unhealthy breakfast or whatever. And you kind of like two or three hours later are tired, maybe a little moody and grouchy and like want to take a nap. Kind of a post-meal slump type of situation. Something that has been powerful for me, and I know a lot of customers, is being able to now link that to a specific biologic event that’s happening. Like I can say, this is how I feel. This is what happened to my glucose and this is what I ate to make it happen. And that trifecta, that feedback loop is so empowering because you can say, Oh, well this is something I can modify. I’m not just anxious. This is just not my personality necessarily. This is something that was a choice and this happened and I can change it.”

33:23 – For better sleep, don’t eat close to bedtime

Carbs and sugars should be avoided before you hit the hay. That’s because melatonin keeps the pancreas from producing as much insulin.

“You can imagine if you’re eating like pasta or bread products and, you know, carbs or a big dessert late at night when your melatonin is active, you are dumping all this glucose into your body, with not a lot of insulin to have it be taken out. So that’s just like sitting in your bloodstream and slowly getting absorbed into the cells and likely just kind of bouncing around throughout the night. If there’s one practical tip to definitely give people, it’s do not eat your carbs late at night. You know, try to ideally not eat that close to bedtime in general, like winding down, eating around 5:00, 6:00 PM, give your body time to digest. But if you are eating later, really focus on more the protein and the fat and the green leafy vegetables and not the higher carb meals, because you’re essentially getting like a double punch from that because of the way your hormonal system is working at night. And just like with the anxiety with wake ups and sleep, if your glucose is bouncing around throughout the night, that’s going to have a big impact on your sleep, potentially. As the glucose dips and maybe, you know, bumps back up, you may see wake ups at those times because your body is dealing with this lability, this labile glucose. And the other thing is that elevated glucose at night can cause the blood, it can change basically our thermal regulation at night. It can change the way the blood vessels function and it can make you hotter. So acute blood glucose spikes late at night can make you sleep hotter. And we know that elevated body temperature at night is associated with worse sleep quality.”

38:26 – The impact of alcohol on blood glucose

Alcohol can inhibit the liver’s ability to make glucose, which can cause our blood glucose levels to go too low.

“If you’re fasting, or if you’re on a Keto diet and your glucose is already super, super low and stable and flat, if you add alcohol to that and you block one of the ways of getting glucose, that can be a huge problem. You might actually see glucose go down in a dangerous way. And for the more average person who’s eating regular food, what they might see is that if they’re eating a meal that normally would cause a pretty big glucose spike, they might actually see a lower glucose spike if it’s in the context of alcohol because of the way that you’re kind of blocking this one faucet of glucose into the bloodstream. And that’s not necessarily to say that this is a good thing to do, it’s just a physiologic thing that we see. And I should caveat that this is for like, sort of pure spirits. So wine, hard alcohol, things like that. Obviously, if you’re having a sugary cocktail, this is a moot point. That sugar is going to affect you. But we see that a lot where the red wine or something like that with a fairly high carb meal sort of tends to blunt the spike a little bit. So zooming out, that’s sort of the physiology of that. And it’s definitely dangerous too, I would say, to drink if you are fasted or on a really heavy duty ketogenic diet. So just something to think about. Another interesting thing, just epidemiologically looking at large population studies, it actually seems that people who have the best metabolic health outcomes are people who drink one drink per day, essentially.”

 

43:02 – Applying a CGM is painless

Application involves pressing the small monitor, which contains a tiny 4 millimeter sensor to test your blood, into the back of your arm.

“I think a testament to how simple it is to put on is that there’s now been this trend we’re seeing on social, where people are posting their application videos. So they are making TikToks and making cool little videos where they show them applying their continuous glucose monitor. So, you know, that’s obviously a testament to it not being too scary. I will say though, I am like super needle-phobic, which is ironic since like I was formerly in the surgical world, but I was so nervous the first time I put one on and I was like, is this going to hurt? What’s it going to feel like? Dah, dah, dah. I had to blast music on my Bose headphones before I put it on. I had to amp myself up, like pregame before a basketball game, with the music. It literally took me an hour. And then I put it on and I just was laughing so hard. I was like, I cannot believe I got myself so worked up about that. It was nothing.”

49:20 – The simplicity of food modifications

Just because a particular type of food doesn’t agree with your body doesn’t mean you have to eliminate it. As a vegan, Dr. Means has learned to pair “trigger” foods like sweet potatoes with fat and fiber so that she can follow her chosen diet and thrive.

“I do think that there is risk with any diet for having this metabolic collateral damage that we’re not aware of and it’s certainly true of plant-based veganism. You know, there are so many plant-based products out there that are going to be horrible for the blood glucose. And even within the healthy foods, there are things that may not be right for your body and isolation. For me it’s been corn, grapes, sweet potatoes. You know, very healthy foods, but by themselves they just send me to the moon in terms of glucose. So learning how to modify those, like adding a ton of tahini and coconut cream on top of some of these carbs to really kind of blunt that glucose spike or add chia seeds and fiber. It’s amazing how you can just modify the foods to not get that collateral damage. So that’s really what I’m all about sharing with people. By doing that, you might be able to really block some of this absorption of glucose into the bloodstream or the quickness of how it gets into the bloodstream. And I’m able to actually have ketones. So I’m able to keep ketones up even on a fairly high carb diet, because, and really an interesting point is that high carb doesn’t mean high glucose. They’re two different things. And so the in-between there is where a CGM can really fit in.”

Episode Transcript

Mollie McGlocklin     (00:04) Welcome to the Sleep Is A Skill Podcast. My name is Mollie McGlocklin and I own a company that optimizes sleep through technology, accountability, and behavioral change. Each week, I’ll be interviewing world class experts ranging from doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Let’s jump into your dose of practical sleep training.

Mollie McGlocklin            (00:35) Welcome. Our guest today is Casey Means. She is the Co-founder of Levels Health and out of just about all the gadgets and gizmos that we often have people testing out at Sleep Is A Skill, a continuous glucose monitor tends to be one of the core things that I would recommend people at least test out. For if you were to try some of these for just a month, the understanding that you’ll have will far surpass the average person of what food can do to impact so many aspects of your health, but also your sleep. So we’re going to get into the details of that.

Mollie McGlocklin            (01:09) This company in particular is pretty exciting. They’re actually still in beta right now, but they have – Now they’re at, I believe, a 40,000 person waitlist. So if you do go to the website, you’ll be added to that waitlist, but they have hooked us up, the Sleep Is A Skill community, with a link that will have you  bypass that waitlist. So if you do want to check that out a little bit sooner than the average population or public, then you can do that at levels.link/sleepisaskill, again, levelslink/sleepisaskill and you can use the promo code sleepisaskill as well. So all of that is going to give you the opportunity to see what your food is doing to your glucose levels, but around that, how that can influence the quality of your sleep.

Mollie McGlocklin     (01:56) So a little background on our guest. Casey Means MD is a Stanford trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, and associate editor of the International Journal of Disease Reversal and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventative chronic disease by empowering individuals with tech enabled tools that can inform smart, personalized and sustainable dietary and lifestyle choices. Dr. Means’ perspective has recently been featured in Forbes, Entrepreneur Magazine, The Hill, Metabolism, Endocrine Today, EndocrineWeb, Well + Good, the list goes on and on. So I really want you to be excited to dive in on all the things that Casey has to share with us about glucose for, not only your health, your mental health, but also your sleep.

Mollie McGlocklin            (02:53) And welcome to the Sleep Is A Skill podcast. Casey, I am so grateful that you were able to take the time to speak today. I know we’ve already been chatting it up. We got lots to dive into. So thank you. Thank you for taking the time.

Dr. Casey Means      (03:04) So happy to be here, Mollie. Thanks for having me.

Mollie McGlocklin     (03:07) Wow! So we’ve got a lot in common, a lot that we can actually dive into around a shared passion around sleep. And I know you’ve been integral in doing a lot in that area, but particularly what we’re going to be focusing in on is your work as Co-founder of Levels, a very exciting company, and I just really, really cannot wait to dive in more about this topic.

Mollie McGlocklin            (03:29) But what you’ve created is this continuous glucose monitor to be available for the masses, even outside of people that might be dealing with pre-existing things, around diabetes or what have you. So please share how it is that you came to co-found this company, and just how that passion is also relating to the world of sleep and how those things can be connected?

Dr. Casey Means      (03:52) Yes. Absolutely. So Levels is the company that I am a Co-founder and Chief Medical Officer of, and we are a metabolic fitness company. So we are laser-focused on helping people understand their current level of metabolic health and then learn how to optimize and improve it. And so the way you can think about this is it’s a wearable.

Dr. Casey Means      (04:14) So it’s a continuous glucose monitor, which is a little quarter-sized device that you wear on the back of your arm and it is measuring an internal biomarker, glucose, 24 hours a day, 7 days a week and sending that information to your phone. And glucose goes up and down all the time throughout the day in response to what you eat and exercise and sleep and stress and many other things. And so this closes the loop really for the first time about what’s happening in your body in response to things like lunch or a poor night’s sleep or a stressful meeting. We’ve had many other fabulous wearables to track many things about our health in the past. So namely, exercise and activity monitors, heart rate monitors, stress monitors like HRV trackers and sleep monitors. And I’m of course, I love all these products, but we’ve actually never ever had one that monitors your response to nutrition with a wearable. And so that’s a really neat thing about continuous glucose monitors, is that you can finally do that and see immediately how a food affected you.

Dr. Casey Means     (05:19) So what Levels does, is it gives people access to these continuous glucose monitors and pairs it with software that helps you interpret the data stream, and helps you understand what to do differently to improve your glucose levels, which in turn improve your metabolic health.

Dr. Casey Means     (05:34) And just as a little background, these monitors, they were traditionally available only for diabetic individuals. So they’re this game changing technology for the diabetic community because instead of having to prick your finger, you can wear this painless monitor that gives you so much more data, so much more granularity into this internal biomarker of metabolism. And what we know more and more now in the biomedical sciences is that glucose is not just something that’s just relevant to the diabetic population. This is a biomarker that all of us really should be thinking about and making sure it’s stable in our bloodstream, because it has a huge impact on our energy levels, our sleep quality, our athletic endurance, our propensity for gaining weight, and then of course, for a whole host of downstream diseases and conditions that are associated with glucose. So that’s what we’re all about, is making this more mainstream, getting access for people to really uplevel their lives by managing glucose.

Dr. Casey Means     (06:29) And to get back to the other part of the question, which is what got me here. It’s a somewhat circuitous route because I started in surgery. I trained as a medical doctor. I was at Stanford for my undergrad and medical school training. And then I went into surgery and I was practicing head and neck surgery for about four and a half years. And in that field, I stepped back after almost five years of practicing and realized, “Oh, my gosh! This is so interesting. Almost all the conditions I’m treating in this field are inflammatory in nature.” All these itises – sinusitis, thyroiditis, all the itises of the inflammatory disorders, vocal cord polyps, which are inflammatory masses, ear infections, which is just inflammation of the middle tissue. And I was just like, “Oh, my gosh! Why is everyone so inflamed?” This just seems like we’re inflamed at scale. And we also know that so many of our chronic conditions that are plaguing our country, like diabetes, obesity, heart disease, Alzheimer’s – these are also diseases characterized by upregulation of the immune system. And so I really stepped back and I was like, “Okay. I’m making some big cuts into people in the operating room and I want to really understand a little bit more about, is there anything we could be doing up front, on the front end, to help with this whole chronic inflammatory situation before people get to the point where they have to be knocked out and go under the knife. And that was really a journey for me that led me to reading so much literature and really coming to the conclusion that so much of what drives the inflammation in the body is what we expose ourselves to every day.

Dr. Casey Means     (08:12) And what I mean by exposure is the types of things our bodies are registering. And the main categories of that is the food we eat. That’s all molecular information that goes in the body and either could be registered as a nurture thing or a good thing or a threat. Obviously, we’re exposed to a lot of processed, highly processed frankenfoods these days, a lot of chemicals in our food. These things can trigger our immune system. Then of course, stress. Stress can be seen as an inflammatory trigger in the body. Toxins in our food, water and air can trigger the immune system. Even being sedentary can trigger the immune system. Our bodies aren’t meant to be sedentary and so having just a full day of not moving is not good for our pathways in the body and can get the immune system revved up. But a huge one is sleep. When we don’t sleep, our immune system revs up. We see an increase in the same inflammatory mediators that are upregulated in so many chronic diseases.

Dr. Casey Means     (09:08) So that whole process of stepping back and thinking about some of these root causes of chronic inflammation got me just really evangelized to think like, “Okay. Before I make more cuts in the operating room, I want to figure out how to help people on this front and to take control of some of these triggers.” And that led to a whole other journey, which is, how do I do that? How do I do that effectively? And as a doctor, ultimately, what that means, doing that effectively is, how you will change their behavior and make sustainable, positive, personalized decisions every day, to really optimize those conditions, those behaviors that will generate health if they’re done consistently. But as doctors we’re actually not great agents of behavior change. A 15 minute conversation is not necessarily enough to get someone to change a huge entrenched habit in their life.

Dr. Casey Means     (09:56) And that’s what got me really interested in digital health. How can we use tools that people do have with them every single day – like their phones and their wearables – to motivate really personalized decision-making. And this was years in the process, but ultimately, I felt like I wanted to take the training and the insights that I had generated throughout the early part of my career and really focus it on building tools to empower people to make these choices that we know are associated with better health outcomes.

Mollie McGlocklin     (10:29) Oh, wow! How you put it, yeah, evangelizing these topics, I feel very similar and how important it can be and how valuable it can be, when we do have some of this information while – Often I’ll speak about some of the problems around sleep being related to increase in artificial lights and stimulus and gadgets and gizmos and all that, at the very same time, my experience has been that in order to help people make a difference with that, often having that technology and using it to our advantage with certain ways to measure what is really going on, can help be the exact path out of some of the problems that we’re experiencing with our sleep. And I think the same applies with glucose and glucose’s relationship with all of those things, so holistic.

Mollie McGlocklin     (11:17) I know you guys are fans of, or at least from Twitter, you guys had mentioned being fans of the Why We Get Sick book, which I think is so helpful for – Just really all-encompassing, how huge this topic is and how much it splinters into so many areas of health. So I really get your passion and hear that, and I was wondering if we could help parse out a bit more for people that still are confused, just a little bit of the ABCs of why it’s so important for us to think about glucose and sleep, and I know you mentioned the bidirectional relationship that they have, so that people can – for those of us that maybe it’s newer to us – to  understand why this is so important for both our sleep quality on one side of it, but also from a preventative measure, and what that can do to help support our sleep. So glucose and sleep and how they are so closely connected.

Dr. Casey Means     (12:08) Yes. Absolutely. So first of all, major plug for the book you recommended Why We Get Sickby Dr. Ben Bikman. It’s really, honestly, it’s like a manifesto of why we’re doing what we’re doing at Levels. And what Dr. Bikman does – and I’ll try and describe briefly here about this core physiology – is explain why and how glucose and metabolic dysfunction are at the root of so many of the conditions we’re seeing today. We in medicine today and just in the general health ecosystem, we like to think of all these different diseases we see as totally separate isolated silos. So it’s like, acne is its own thing, and depression and anxiety are their own thing, and brain fog is another thing, and cancer is another thing, and obesity is another thing, and they’re all separate. And we treat them as such. We treat each of these diseases differently, and when you actually look at the molecular biology of these conditions, and when you look deeper at the root cause, all of them have an association with our metabolic health, and all of them can be improved by improving metabolic health. And really what that means – You have to go back to what is metabolism.

Dr. Casey Means     (13:25) So metabolism is the way that we produce energy in the body from our food and environment. So we take in food, carbohydrates, fats, protein, and we have to convert these basic building blocks to energy that our body can actually use. This is fundamental. Every  single cell in our body, and we have trillions of them, requires glucose or some form of usable energy to actually just do its processes. And when metabolism, this fundamental pathway of converting things like glucose and fat to usable energy, when that’s not working properly, you can imagine how it could have so many different faces. It could look like so many different things because it can affect every cell type and every organ system. And based on where that’s showing up most pronounced in a person, it’s going to look like a different disease. So that’s step one.

Dr. Casey Means     (14:17) The second really is thinking about the process of how glucose works, which does set the stage as well for talking about why sleep is impacted by metabolic health. So when you eat carbohydrates, they’re generally converted to glucose in the bloodstream, and that glucose needs to get inside of cells in order to be converted into usable energy. For that to happen, insulin has to be released from the pancreas, which binds to the cell and allows glucose to be taken up into the cell where it’s converted into usable energy. But if you do that over and over again, where you’re eating lots of carbohydrates, the glucose rises in the blood, you’re getting this insulin release. What happens when you do that too much and that process – glucose, insulin, glucose, insulin – happens too frequently, too much of a magnitude, your body ends up having to produce tons and tons of insulin. And  your body actually gets a little bit numb to insulin. And it doesn’t hear the signal as loudly because it’s been hearing too much of it. You can imagine like losing your hearing, because you’re exposed to too much sound.

Mollie McGlocklin     (15:16) Right.

Dr. Casey Means     (15:16) And so that’s a process called insulin resistance. And so to get the same amount of glucose into the cells, you then have to produce more insulin. And this is this pathway of hyperinsulinemia. There’s a couple of downstream effects of that.

Dr. Casey Means     (15:31) First of all, insulin, because it’s a signal saying your body has enough glucose, it also tells the body, we’re good on glucose energy, we don’t actually need fat energy. So it stops you from breaking down or burning any fat. So in the whole weight loss situation, that’s a huge, huge implication. If glucose and insulin are high, you’re not burning fat.

Dr. Casey Means     (15:52) And the second thing it does is that over time, you might not even be able to get enough glucose into your cells. Your cells might get so numb to insulin, that it’s actually very difficult to even officially get enough glucose into the cells. So then what happens glucose levels rise in the blood, you start going into the doctor and they say, “Hey, you’re pre-diabetic,” or “You’re diabetic,” because your glucose is just at baseline rising. You can’t get enough in anymore. And you’re not able to make energy properly anymore. So imagine your brain not being able to convert glucose to energy well anymore because the brain is insulin resistant. Well, that could look like Alzheimer’s, other forms of dementia, depression, anxiety, fatigue, brain fog, chronic pain – all conditions that are associated with metabolic dysfunction. If it happens in the ovary, it could look like polycystic ovarian syndrome, which is the leading cause of infertility in this country and is associated with metabolic dysfunction. If happens in the liver, non-alcoholic fatty liver disease, the kidney, chronic kidney disease, the heart cardiovascular disease, hypertension, atherosclerosis. So whatever cell type is insulin resistant and not able to get the energy it needs, you’re going to see a symptom.

Dr. Casey Means     (17:05) So hopefully, that paints this picture of the physiology and why you can imagine, if we keep those glucose spikes and the amount of glucose we’re dumping into the body from the diet lower, we keep the insulin lower, and the cells stay perky. They stay ready to hear insulin. You don’t need so much insulin. They’re really sensitive to it and so just a little bit is going to get the glucose in, and you don’t get all this downstream insulin resistant effect. So I’ll pause there because I want to make sure that clear and makes sense.

Mollie McGlocklin     (17:36)  Yes. That was so all-encompassing, and I’ve never heard anyone call them perky cells. I like that. No. That was so well-said and it really paints the picture of how insidious this can be if we don’t have this under control, and how it can leak on into all these areas of our lives.

Mollie McGlocklin     (17:52) And also, I think it’s important. So I’ve had clients that have said, “Oh, you know what? Okay. This is a bit of an investment to get a continuous glucose monitor. I’ll get one and then my partner and I eat about the same thing. So we’ll figure it out ourselves that way.” But you also pointed to how bio-individual this can be, as well, depending on the person. Their baseline might be a little bit different than the other person, even if you’re eating the exact same foods, which can be so  fascinating.

Mollie McGlocklin     (18:18) And I think for a lot of the people listening, very curious minds, there’s a spectrum of people that show up to Sleep As A Skill that might either be having real troubles with their sleep or looking to really fine tune the optimization element of things with their sleep. So they, depending on where they’re at, the through line often tends to be very curious on how to improve their health, as well as sleep. So I think that I’m really excited that you’re helping to show how this can not only help improve sleep, but so many other areas of your health and wellbeing. So I’m wondering if we can then – So  since you did such a great high level approach – So  what would that look like? So say if people are like, “Okay, so you’re saying that glucose can not only impact so much of my health, but also, I’m looking to really improve my sleep. This is my area. I’m going to take this on this year, or whatever.” So they get the monitor. So once they do that, what are we starting to go after? What’s  possible in this area? Are you screwed If you have certain results and you’re stuck there? Is it something that we can really start to immediately make changes in? How do you set up people powerfully for getting this and what to expect?

Dr. Casey Means     (19:27) Yeah. So I think one of the most exciting things and one of the reasons why I was really compelled to focus on this as the company I wanted to start, is because you’re not screwed. Wherever you are there’s still –

Mollie McGlocklin     (19:39) Yes! Thank you.

Dr. Casey Means     (19:40) Yeah. This is a spectrum where we can move in the right direction, in the wrong direction, and unlike the way we think about it normally, we’re like, “Oh, we’re healthy when we’re young and then one day we might get diabetes,” and it’s like an on/off switch. That’s not the way it works. Every day we’re actually moving back and forth on this spectrum of metabolic health and it’s not like one you wake up and your glucose is in a range that you’re now diabetic. That’s been happening for years or decades and even at that later stage, you can still move in the right direction. Because again, it’s like what I was mentioning, where if you can keep the glucose and the insulin spikes lower, your cells will start to hear it more again. And you can regain that insulin sensitivity and that metabolic function. And so what you need then is to know how to keep your glucose levels lower. And that’s really what we built at Levels.

Dr. Casey Means     (20:30) And so the first step is testing out the foods that you’re eating and seeing how you’re responding to them. And this is the beautiful part about continuous biofeedback is that it’s a closed loop. You can have a Clif Bar and in one hour know whether that’s a good or bad choice for you, and it’s just black and white. And like you mentioned, it’s different between each person. So you and I could both eat a Clif Bar and you could go up just a tiny bit on your glucose and I could go through the roof. And so it might be a better option for you than it is for me because it’s likely causing less of a glucose and insulin response in you and a big one in me. And there’s been research studying this deeply. Why would two people respond differently to the exact same set of carbohydrates? I thought there was low glycemic foods and high glycemic food. Why would it be that two people are responding differently? But it’s actually – There’s this biochemical individuality to it and a big factor that’s been studied is microbiome. So just the difference in composition in the gut and how the bacteria are processing these foods, has an impact on how much the glucose rises in the blood after eating a specific carbohydrate. So there’s a lot of variability between people on that.

Dr. Casey Means     (21:42) Also things like body type, how much sleep people got the night before, those can have an impact on how a carbohydrate in the mouth is converted into glucose in the blood. So with CGM, you’re testing those things and seeing what is impacting you the most. And then people might say, “Okay, great! So I’m going to find out that a cookie spikes my glucose and I shouldn’t eat the cookie. I knew that already.” But it’s actually so much more complicated than that. And that where software can make it really fun.

Dr. Casey Means     (22:12) Because there are lots of things that go into that, how much the glucose rises after a meal. It is what you ate. It is how you paired the food. Were you eating a carb alone? Or were you eating it with protein and fat? What time of day did you eat it? Was it morning or night? Eating carbs later at night, for many people, tend to spike glucose higher because of the impact of melatonin on the pancreas. How much exercise you did that day? Exercise has a profound impact on same day glucose metabolism. How much stress you’re under? If your cortisol is high during the day, your glucose levels are going to be higher. And then a really key one is sleep. How much sleep you got the night before. How much sleep you’ve gotten over the prior weeks. But even one night of sleep deprivation can make people more insulin resistant.

Dr. Casey Means     (22:58) And so the beauty of the CGM is you can start parsing out, what context am I building for my body to process carbohydrates? How do I leverage all these levers that have to do with glucose to my advantage? Because ultimately, we want that line to be fairly flat and fairly low, and that’s a protective state. And every day that you keep it lower and you keep it flatter, that’s like a rep. It’s like going to the gym and that’s like your reps to get stronger. Well, these are your reps to build insulin sensitivity, to build metabolic fitness. And so you’re learning how to just turn all these knobs, pull all these levers to create the best conditions in your body for that flatline, which are going to be different for everyone.

Dr. Casey Means     (23:41) I will say, for most people, the sleep component is going to be pretty – That’s pretty clear that low sleep is not good for anyone in terms of their overall glucose control and metabolic health and the research is fairly overwhelming on that one.

Mollie McGlocklin  (24:01) Absolutely. And I’m wondering too, for women listening that are of menstruating age, to the connection for them? Also to be aware of the different parts of their cycle and how that can influence it too. And I think what’s great about Levels is there’s a lot that you can tag or take notes basically about what you’re doing and when, and I think that that’s an exciting area for women to just start getting connected to different parts of their cycle. Have you seen a lot for that too, for women, to be aware of?

Dr. Casey Means     (24:31) Yeah. There is research on this, and it is interesting that actually glucose levels will fluctuate and insulin sensitivity based on different parts of the cycle. So typically, and this is going to vary for each person, in the follicular phase, which is pre-ovulation, when there’s a higher estrogen to progesterone ratio, tend to see better glucose levels, slightly lower, more influence sensitivity. And estrogen seems to be a bit protective in terms of metabolic health.

Dr. Casey Means     (25:00) And then post-ovulation when both estrogen and progesterone are rising together, but that ratio is a little bit lower of an estrogen to progesterone ratio. You start to see a little bit more insulin resistance, a little bit higher glucose levels. And so that’s something that can be interesting to track and may influence the choices we make during that phase. If things are going up a little bit and we’re a little bit more variable on our glucose, that might be a time to tighten up a little bit on the refined foods we’re eating and the refined grains and stick to the foods that are lower glycemic for us to keep things stable. So there’s some really, really interesting stuff there.

Dr. Casey Means     (25:36) And for the menopausal woman, when estrogen declines in menopause, it’s an interesting time, because that’s when we start to see women really increase their rates of both obesity and diabetes. So that’s like this risk time where –

Mollie McGlocklin     (25:49) Yeah.

Dr. Casey Means     (25:49) – estrogen, which seems to be protective for metabolic health, is plummeting and we see this inverse relationship with these metabolic conditions. And then, of course, downstream metabolic conditions like cancer, Alzheimer’s, which are very much related to blood sugar, and you see all of that going up. And so I think there’s a really neat opportunity for, in that phase of life, to be tracking glucose and just making sure you’re not accidentally falling off a metabolic cliff that you’re just not aware of.

Mollie McGlocklin     (26:19) Yes. That metabolic cliff? Absolutely. It’s interesting, too, because there’s two things that I hear people speaking about often as it relates to glucose and as it relates to sleep. So two that I’d love to get deeper with you on are 1) wakeups and glucose management regulation, and 2) anxiety and glucose. Because I think so many people aren’t quite aware of how glucose can impact both of those and certainly anxiety plays a lot into the role. We tend to have an anxious bunch around Sleep As A Skill and dealing with their sleep management. And so I’m wondering if you could speak to, could start with wakeups and glucose, and how those might be connected for people to be mindful of.

Dr. Casey Means     (27:02) Yeah. Yeah. So you can think about, if glucose is going up and then down, that is usually associated with other lability in our general subjective state – whether that means mood, energy, wakeups. If there’s fluctuations in our glucose, there’s often going to be fluctuations in our lived experience of the day or night. So stable on glucose is stable with everything. And certainly,  it’s not like the panacea for sleep or mood or energy, but it is widely studied in those realms and so it is absolutely a factor, a modifiable factor that we can tap into, just like avoidance of artificial light before bed is one. This is one that is very much researched and we should be thinking about. And a lot of us aren’t.

Dr. Casey Means     (27:55) So with anxiety, there’s two things to mention there. One is that people with diabetes, so overt conditions of metabolism. I think we’re talking about much more of the non-diabetic population in this podcast, people who are trying to tighten up the fluctuations in glucose, but haven’t reached this clinical stage yet. But in that clinical stage of diabetes, we see much, much higher rates of anxiety and depression, 2X rates of depression in people with diabetes. And I think it’s 40% higher rates of generalized anxiety disorder. I have to double check that number, but it’s quite a bit more. And it is thought that some of this is related to the chronic inflammation that happens in the body and the brain in states of metabolic dysfunction. Also the insulin resistance in the brain and how that’s affecting our ability to get the glucose to the brain cells properly and to feed the cells in the way that they’re  supposed to be fed. So that’s just to say epidemiologically, people with worse metabolic function have worse mental health outcomes, unfortunately.

Dr. Casey Means     (28:58) Now, let’s talk more about maybe the people who are just non-diabetic, but what would a big glucose spike or fluctuation, how would that impact their anxiety? And it seems like it may be doing just that. When you think about you eat some food, your glucose is going to go up, it’s going to come back down. When that is a big, big spike, your body is releasing tons of insulin, and it can sometimes overshoot on the amount of glucose that gets soaked up in the cell and create a situation called reactive hypoglycemia. So you can imagine mountain and then a valley that is lower than the baseline. That moment of reactive hypoglycemia has been associated with anxiety, moments of anxiety, and I think I personally have felt this. If I have a really big high carb meal or just an unhealthy breakfast or whatever, and two or three hours later, you’re tired, maybe a little moody and grouchy and want to take a nap, a post meal slump type of situation. Something that has been powerful for me, and I know a lot of customers, is being able to now link that to a specific biologic event that’s happening. I can say, “This is how I feel. This is what happened to my glucose, and this is what I ate to make it happen.” And that trifecta, that feedback loop is so empowering, because you can say, “Oh! This is something I can modify. I’m not just anxious. This is just not my personality necessarily. This is something that was a choice, and this happened, and I can change it.” So that’s very empowering.

Dr. Casey Means     (30:26) Yeah. So that reactive hypoglycemia moment tends to be what’s associated with anxiety. And in our culture, with the food that is out there marketed as healthy, you can imagine, this could be happening many, many times a day. With things like pop tarts and cereal for breakfast, and pasta as a normal dinner and bread at every meal, people are often on an absolute glucose roller coaster, and getting reactive hypoglycemia multiple times a day, and we just don’t know.

Mollie McGlocklin     (31:01)  Absolutely. No. I think it’s such an important element for overall mental health to be really tightly aware of this, because I’m pretty convinced that – I certainly didn’t have continuous glucose monitor years back, but part of the reason I created Sleep Is A skill is because for so many years, I was going to bed crazy late, living in the middle of Manhattan, stressed out and then until I went through my own period of insomnia, and it was just such a trying time. But coming out on the other side of that made me so – Couldn’t get off the soapbox about sleep. So with that – But I really believe that so much of the anxiety that I was experiencing for so many years was just a disconnect of realization of how much of a roller coaster I was really on. And for so many of my clients, we’ll discuss their food, and they’re truly trying to make great choices and they’ll say, No. No. No. That’s not me. I have a smoothie. I have this. I have that. And then you put the continuous glucose monitor on and it’s just spike city and you get to see “Oh my God! Okay. Wow!” Once we see it in black and white, it can really make a difference. So yes, I think that’s really, really important.

Mollie McGlocklin     (32:06) And the other thing that we’ve found, too, with these wakeups is just occasionally for people that are eating later on in the night, and I love how you spoke to glucose being on a circadian rhythm and the the difference that it might have, during the morning versus the night, that people that are eating right before bed, and it might not even be right before bed, but still even within those couple hour threshold before bed, having those more fragmented sleep patterns and waking up throughout the night. Have you been able to see that too in your data? Because it’s exciting because it is so hard to find data on glucose for healthy individuals or quote unquote, healthy individuals that are not pre-diabetic or diabetic? Is that something that you see a lot for people?

Dr. Casey Means     (32:47) So in our personal data set, this isn’t something that I have seen yet because we’ve just brought in sleep tracking as part of our product. So I’m really excited to see what we find.

Mollie McGlocklin     (32:55) I’m so excited. Great! Okay. All right.

Dr. Casey Means     (32:59) But, in the research literature, you do see this. So like you mentioned, the circadian rhythm of glucose, I think the key point to note is that, at night we secrete melatonin, ideally from the pineal gland, which helps us get sleepy and go to bed. It tells our whole body to go to bed including our pancreas. And actually, it is thought that melatonin stops the pancreas from producing as much insulin. So you can imagine if you’re eating pasta or bread products and carbs or big desserts late at night, when your melatonin is active, you are dumping all this glucose into your body with not a lot of insulin to have it be taken up. So that’s just sitting in your bloodstream and slowly getting absorbed into the cells and likely just bouncing around throughout the night.

Dr. Casey Means     (33:48) If there’s one practical tip to definitely give people, it’s do not eat your carbs late at night. Try to ideally not eat that close to bedtime in general, winding down eating around 5:00, 6:00 PM. Give your body time to digest. But if you are eating later, really focus on more the protein and the fat and the green leafy vegetables and not the higher carb meals because you’re essentially getting a double punch from that because of the way your hormonal system is working at night.

Dr. Casey Means     (34:17) And just like with the anxiety with wakeups and sleep, if your glucose is bouncing around throughout the night, that’s going to have a big impact on your sleep potentially, as the glucose dips and maybe you know bumps back up, you may see wakeups at those times because your body is dealing with this lability, this labile glucose.

Dr. Casey Means     (34:39) And the other thing is that elevated glucose at night can cause the blood – It can can change basically our thermo regulation at night. It can change the way the blood vessels function and it can make you hotter. So acute blood glucose spikes late at night can make you sleep hotter and we know that elevated body temperature at night is associated with poor sleep quality.

Dr. Casey Means     (35:01) So for so many reasons, it’s not ideal. And unfortunately, it’s a vicious cycle because if your sleep quality is poor, that’s going to set you up the next day to make worse choices metabolically. And what I mean by that is that our sleep quality has an impact on our hunger and satiety hormones, ghrelin and leptin, and even one bad night of sleep can affect these hormones and make us be more likely to be reaching for the high carb, sugary, calorically dense foods the next day. So it can just be so perpetuating.

Dr. Casey Means     (35:34) So yeah, I would say wrap up the carbs way earlier in the day and if you’re going to eat later in the evening, focus on that more keto-like meal of low carb, higher fat, higher protein, green leafy vegetables. Avoid the starchy stuff.

Mollie McGlocklin     (35:48) I’m so glad you’re saying that because I think that’s been a bit of a misnomer for quite some time for people and a real strategy of, “Oh, I purposely eat higher carbs in the evenings because it makes me tired.” It’s almost like Thanksgiving dinner or something. So you’ll hear people really have that as they think that they’re doing something that’s serving their sleep, and I’m so glad you’re helping to shed light. And certainly, if you put on the continuous glucose monitor, people can see that for themselves, the real difference that makes.

Mollie McGlocklin     (36:15) And I love that you’re pointing to the earlier meal timing. So that last meal, ideally being between that five to six range, plus or minus depending on people’s schedule. I think that’s really, really huge. And if we could start to make that trendy to have the early bird dinner, then that would be fantastic.

Dr. Casey Means     (36:36) Right? Yeah. When all the New York restaurants start having the five to seven window be hard to get, we’ll know we’re moving in the right direction

Mollie McGlocklin     (36:45) Love that. Please. And the other thing I wanted to just touch on too is, these seem more like a given as it relates to sleep but I think they are interesting, is both alcohol and caffeine and how those can show up differently for different people with the continuous glucose monitor. And some people having surprising effects for – Some people maybe not noticing it with the caffeine or coffee. Some people noticing it more with alcohol, depending on the type of alcohol, might even see it drop lower on their continuous glucose monitor, and how they can make sense of all of that as it relates to – Certainly that can impact our sleep quality, too.

Dr. Casey Means     (37:22) Yeah. Absolutely. So the alcohol thing is really, really interesting, its impact on blood glucose. So a couple things with that. So first is that alcohol, one of the effects it’s going to have, is it’s going to block our liver from making glucose. And so what does that mean? So we don’t want our glucose to get too low. We want it to be in this perfect golden range that’s good for optimal metabolic health. And we want it to be in this narrow space. But if it gets below that, it can be very, very bad for the body. We don’t want our glucose to go too low. And one of the protective mechanisms our body has to make sure that we don’t ever go too, too low is that our liver can actually just make glucose from other substrates in the body, like lactate, and that’s a process called gluconeogenesis. And alcohol blocks that process in the liver. And so one of these feeders of glucose into the blood that’s always constitutively active to just give us this low grade baseline of glucose will be blocked by alcohol. So you can imagine if you are eating, if you’re fasting, or if you’re on a keto diet, and your glucose is already super, super low and stable and flat, if you add alcohol to that, and you block one of the ways of getting glucose – that  can be a huge problem. You might actually see glucose go down in a dangerous way.

Dr. Casey Means     (38:43) And for the more average person who’s eating regular food, what they might see is that if they’re eating a meal that normally would cause a pretty big glucose spike, they might actually see a lower glucose spike, if it’s in the context of alcohol because of the way that you’re blocking this one faucet of glucose into the bloodstream. And that’s not necessarily to say that this is a good thing to do. It’s just a physiologic thing that we see. And I should caveat that this is for pure spirits. So like wine, hard alcohol, things like that. Obviously, if you’re having a sugary cocktail, this is a moot point. That sugar is going to affect you. But we see that a lot where the red wine or something like that with a fairly high carb meal tends to blunt the spike a little bit.

Dr. Casey Means     (39:28) So zooming out. So that’s the physiology of that and it’s definitely dangerous to, I would say, to drink if you are fasted, or on a really heavy duty ketogenic diet. So just something to think about.

Dr. Casey Means     (39:40) Another interesting thing, just epidemiologically looking at large population studies, it actually that seems that people who have the best metabolic health outcomes are people who drink one drink per day, essentially. So more than that, risk of metabolic disease goes up, and less than that, risk of metabolic disease goes up. It’s a J-shaped curve with the absolute lowest rates at one serving of alcohol a day. To mention our servings are very skewed in our world these days. The types of glasses of wine we get poured in a restaurant are sometimes two or three times the size and so could be putting us at actual risk. But I think that it’s an interesting factoid, that it’s a – Yeah.

Mollie McGlocklin     (40:19) Absolutely. No. And I’ve heard of some of those studies, too, which are very interesting. That same, maybe a little bit of that stressor might make us actually stronger. The same way sitting in a sauna or cold therapy or certain things or working out could be – So there are lots of possible theories around all that, but very interesting stuff.

Mollie McGlocklin     (40:41) So with this, maybe hopefully, we’ve piqued some interest for people because it can be just so eye-opening and I really advocate for people, even if you were just to do this for, most of your packages being around a months’ time, just to begin to get that insight. It can just be so long-lasting and then maybe use it as a tune-up or however you might want to look at it. I think it can be fantastic for people to just forever have burned into their brain, oh, I’ve got to think twice about having, whatever, that sandwich or something and what that will look like for them.

Mollie McGlocklin     (41:14) So people are interested. Now how does this process – Look, I’ve had a lot of people just feel like, “Oh, this is very invasive,” or “This is going to be very complicated,” or “It’s going to hurt to put in.” Could you just help demystify that a little bit, if you could help just share that it doesn’t have to be such a scary thing.

Dr. Casey Means     (41:32) Totally. Yeah. So it is a device that has a sensor that goes under the skin. So that can be a little bit scary. But it is actually – It’s so simple and it is, in my opinion, painless. It really does not hurt at all and I think most of us who put on the sensor are shocked by how you don’t even know that it actually went in. I think a lot of people have thought that their applicator of the sensor didn’t work because they didn’t even know that it went in.

Dr. Casey Means     (41:58) So we’re talking about a four millimeter hair-like filament that is sensing glucose just under the skin, and it’s really almost like dental floss. It’s totally flexible. So you get this box. It’s this prescription device, and it’s got a little applicator and you just put it on the back of the arm and you press down and it sends this little hair like filament just under the skin to test the glucose. And yeah, I don’t know how your experience was Mollie, but I have never felt any pain.

Mollie McGlocklin     (42:25) Same. Yeah. And I’m pointing this out not to be just crazy with the details, but I’ve had clients that will receive the box, but the box sits there for like ages because they’re intimidated. How do I do this? Or will be intimidated even just to order because it just seems like a big thing. But once they do it, it’s like, “Oh my god! That was so easy.” So just helping to share that it’s not, it’s no longer for the weird biohackers. It can be very easy to do. I’ve got clients in their late 60s doing it or actually in their 70s too,  whatever. It’s very user friendly.

Dr. Casey Means     (43:02) Yeah. And I think a testament to how simple it is to put on, is that there’s now been this trend we’re seeing on social where people are posting their application videos. So they are making TikToks and making cool little videos where they show them applying their continuous glucose monitor. So that’s obviously a testament to it not being too scary.

Dr. Casey Means     (43:24) I will say though, I am super needle phobic, which is ironic since I was formerly in the surgical world. But I was so nervous the first time I put one on and I was like, “Is this going to hurt?” “What’s it going to feel like?” da, da, da. And I had to blast music on my Bose headphones before I put it on. I had to amp myself up like pre-game like before a basketball game, the music. It literally took me an hour and then I put it on and I just was laughing so hard. I was like, “I cannot believe I got myself so worked up about that. It was nothing.” And then of course, the next time, I’m like, “I want to show this off on Instagram. I want to show everyone, this is so fun and cool and I’m becoming a cyborg and it’s amazing.”

Dr. Casey Means     (44:06) So it’s a journey, but we try and make it as accessible as possible. On our Instagram, we have a whole set of people, users, customers, CGM application videos that we’ve reshared. I’ve got a sensor application video that walks you through every step of it. And the whole process of getting the sensor, we try and make it really easy. So it’s just a very quick form on the Internet that’s sent to a physician in your state. The physician reviews your answers, and if you’re approved for a CGM prescription, we ship them to you in a nice box. And then, of course, there’s all these resources for putting on your sensor. So it’s not bad.

Mollie McGlocklin     (44:40) Exactly! Oh, my goodness! Yeah. I found it to be a very seamless process, both the ordering process, receiving it, putting it in. And that’s a great idea to record the actual application process. I’ll have to do that in the next one.

Mollie McGlocklin     (44:52) Okay. So I hope that this piques some interest for people to hopefully take that step and connect how this could be a real strategy. I know we only touched on a sliver of what’s possible with it, but I like to speak to people often about both the anxiety element really from a mental health strategy, to be mindful of this and putting ourselves back in the driver’s seat around just our2 experiences throughout the day, our energy levels, our productivity, and how this can play a big role. And then, of course, anxiety is so related for sleep. And people finally, if they’re riding that roller coaster all day long, and then they lay in bed, and no surprise, having difficulty falling asleep, or staying asleep. So I think that’s super important, and of course, those wakeups that we spoke to. So I really appreciate you really taking this time to share all this information with us. And I really encourage people to follow you guys on social, too, on all the platforms. But do share as far as where can people go to find out more about you? And also the waitlist? How is this all working? Fill us all in.

Dr. Casey Means     (45:56) Yes. So to learn more about Levels and sign up for the waitlist, you can go to levelshealth.com. We also have a blog that I contribute a lot to and a lot of our guest experts, including the author of Why We Get Sick, Ben Bikman. He’s written some amazing articles on our blog. And really, it’s just to flush out a lot of these topics we’ve been talking about. Why does glucose relate to the average  person? How can stabilizing glucose help really uplevel your life? So check out the blog. You can follow Levels on Twitter and Instagram @Levels. And then me personally, you can follow @drcaseyskitchen. So D-R-caseyskitchen on Instagram and Twitter.

Dr. Casey Means     (46:31) And I write a lot about metabolic health from the standpoint of a plant-based person. So I’m vegan and I’m really into plant-based nutrition, and I think a lot of people think that that may lead to glucose spikes because it’s generally thought of higher carb, but that is not necessarily true. So I love writing about that and giving some really practical tips on how to incorporate plants in a glycemic friendly way.

Dr. Casey Means     (45:55) And yeah, and so right now we do, like Mollie mentioned, we do have a waitlist. And we are in a beta program. We haven’t fully launched yet. But for people who are interested in joining the beta, Mollie has a code and that will get you in front of the waitlist. So it’ll skip the waitlist and you can get access now. Yeah.

Mollie McGlocklin     (47:12) Absolutely. What did you say the waitlist is at now? It’s crazy.

Dr. Casey Means     (47:16) 40,000 people.

Mollie McGlocklin     (47:17) 40,000? That’s what it was. Yes. Because it’s kept growing over the time that I’ve been speaking with you guys. It was 20,000. Then it was 30,000. Now it’s 40,000 people. It’s  incredible. I’m so excited for what this could do for the planet. Really just what awareness this could bring about for people. And yes, absolutely. What I’m excited with working with you guys is that your team has been awesome and just really thinking outside the box and has created the dashboard for us to be able to start to really begin to overlay with sleep results. So happen to be pulling in the Oura rings data. But there’s lots of other sleep trackers, too, that we can start to play with. But certainly the Oura ring data and the dashboard at Levels. So I’ve been able to really work with different clients to see how this impacts their sleep results and it’s fascinating. So definitely, if you’re interested in that, check out Levels, and you can use the sleepisaskill code in order to skip that waitlist so that you’re not waiting quite so long and we can start experimenting.

Mollie McGlocklin     (48:17) And I really encourage people to check out your social media, too. Your blogs are incredible that you guys have from all different contributors, as well as what I think is super interesting, is all the user information. So we’ll see. I love following you guys on Twitter, Instagram, all over, because people will share what they’re experiencing day to day, “Oh my god! this yoghurt, when I have it at 8AM, it acts totally different than when I have it at 8PM,” or whatever, just really interesting data. And I love that you also mentioned too, being plant-based because maybe it’s just the bubble that I’m in, I’m often hearing, whether it’s paleo or keto, people really excited about continuous glucose monitors. I’m so happy that you’re representing – No, it’s not just exclusive for that team or crew or category. It’s, no, no, no, this is a whole really important area for also people that are having a plant-based lifestyle and I have a lot of friends and clients that are doing that and could really get into this conversation more actively. Really great.

Dr. Casey Means     (49:19) Thank you. And I do think that there is risk with any diet for having this metabolic collateral damage that we’re not aware of, and it’s certainly true of plant-­based, veganism. There are so many plant-based products out there that are going to be horrible for the blood glucose and yet even within the healthy foods, there are things that may not be right for your body in isolation. For me it’s been corn, grapes, sweet potatoes, very healthy foods but by themselves they just send me to the moon in terms of glucose. So learning how to modify those, like adding a ton of tahini and coconut cream on top of some of these carbs to really blunt that glucose spike or add chia seeds and fiber. It’s amazing how you can just modify the foods to not get that collateral damage. And so that’s really what I’m all about sharing with people. And by doing that you might be able to really block some of this absorption of glucose into the bloodstream or the quickness of how it gets into the bloodstream. I’m able to actually have ketones, so I’m able to keep ketones up even on a fairly high carb diet. And really an interesting point is that high carb doesn’t mean high glucose. They are two different things. And so the in between there is where a CGM can really fit in. So yeah, I could go on about that.

Mollie McGlocklin     (50:42) I have to control myself on these topics because there’s just so much. Well, I really appreciate you taking the time and sharing all your information.  You have such astute training and wisdom and background to bring to this topic. It’s really, really exciting what you guys are up to. So thanks again for your time and I’m very excited to continue to learn more about what you guys have going on. The platform is gorgeous and lots of exciting things in the works, I know.

Dr. Casey Means     (51:08) Thank you so much for having me on Mollie, and thanks for the amazing message that you’re spreading on your podcast. It’s so so important.

Mollie McGlocklin     (51:15) Thank you.

Mollie McGlocklin     (51:18) You’ve been listening to the Sleep Is A Skill Podcast, the number one podcast for people who want to take their sleep skills to the next level. Every Monday I send out something that I call Mollie’s Monday Obsessions containing everything that I’m obsessing over in the world of sleep. Head on over to sleepisaskill.com to sign up.