Struggling with managing your glucose? In this episode of Keto Diet Podcast, host Leanne Vogel chats with Levels co-founder Dr. Casey Means about the best way to combine foods to spur metabolism, the key to reducing your glucose levels, and why a healthy diet doesn’t need to be restrictive.
09:16 – Disease is rooted in cellular dysfunction
Dr. Means shares why a well-functioning metabolism is the key to a healthy life.
It came down to two things. One was my personal experience and one was just stepping back and observing the system. So, starting with the system side of things, if you just look at the basic statistics, blood sugar dysfunction and metabolic dysfunction are just absolutely epidemic proportions. A recent study out of UNC University of North Carolina from two years ago surveying tens of thousands of American adults, suggests that 88% of American adults have at least one biomarker of metabolic dysfunction and metabolism, that’s the core primordial pathway in the body of how our cells create energy. We have 37 or so trillion cells in the body, and every single one needs a well-functioning metabolism to function properly. And disease and symptoms, like these words that we use, really a lot of that, all of that, is rooted in cellular dysfunction. Symptoms emerge because there’s problems inside the body at the smallest level.
10:20 – The dangers of the standard American Diet
Dr. Means believes that poor food choices are hijacking many systems in the body.
Our standard American diet, the way we’re living in the modern western world, is just hijacking a lot of the systems that allow us to make and process energy properly in the body, and what this shows up as is metabolic dysfunction. And then when you look at sort of the top causes of death in the United States, eight of the 10 leading causes of death in the United States are in some way related to dysfunctional metabolism or poor blood sugar control. And they’re not diseases that we saw 100-200 years ago, because we are in totally different conditions now. We are dealing with an industrialized food system, a sedentary lifestyle, chronic low-grade stress, chronic low-grade sleep deprivation that just are totally hijacking these systems and making us sick.
11:04 – We need to fix metabolic dysfunction at scale
Most Americans at least have one biomarker of metabolic dysfunction. Dr. Means that large-scale problems call for large-scale solutions.
So 88% of Americans have one biomarker of metabolic dysfunction. 74% of American adults are overweight or obese. 128 million Americans have pre-diabetes or type II diabetes, which is largely preventable. And then, these problems underlie so many of the other chronic illnesses were seeing like heart disease, stroke, Alzheimer’s, dementia, depression, anxiety, infertility. They all have roots in poor blood sugar control. So, I’m looking at all that and I’m like this is huge and why aren’t we talking about it? And part of the reason we don’t really talk about in this framework of like we need to fix metabolic dysfunction at scale is because, in our conventional system, we look at diseases all as really isolated, separate silos, these different things, and we treat them all as such.
19:03 – The role of CGM
Dr. Means explains that up until now, nutrition has been a “black box,” with no insight into how the foods we eat impact our body. Levels’ CGM tech changes that.
We have literally never had that closed-loop biofeedback with nutrition before. Nutrition has just been this black box. We eat around a metric ton of food per year, and several pounds of food per day. This is a massive amount of stuff just going through our body, becoming our body, and serving as the information for our body about what to do, genetically chemically, all these things. It’s so freaking cool. And yet we basically have no information or immediate feedback on what it’s actually doing to our body. We may be able to tune in to how we’re feeling after a meal, which is great when people can do that, although it’s hard. It’s hard in our modern world to tune in to how our bodies are feeling because we are eating a lot of that just makes us feel crummy. Crummy kind of becomes our baseline.
27:08 – Same foods, wildly different glucose responses
In a landmark study, 800 participants were put on the exact same diet. Interestingly, their glucose responses were sometimes the polar opposite.
They put continuous glucose monitors on around 800 healthy non-diabetic individuals, and they looked at what happened to their glucose when they give them standardized meals. And what you’d expect from the concept of the glycemic index, or even from the perspective of a ketogenic diet, you’d think oh, well, if they’re all eating the same food, it’s going to have the same impact on all of their glucose levels. There’s this idea that there’s some inherent property to food in terms of how it actually impacts your glucose levels. What they found was the opposite, which is that with a standardized meal across 800 people, people had wildly different glucose responses in terms of what actually made it from the food into their bloodstream, and how that response happened from completely flat, to huge spikes, and then all across the spectrum. So, what this say’s to us is that there’s something happening between the mouth and the bloodstream that’s basically changed in the way we’re processing food.
28:45 – All diets are not created equal
The most liberating takeaway from glucose research for Dr. Means is the fact that there is no right or wrong diet.
I’m someone who you’d look at my diet and someone would be like, oh my God, that’s the opposite of ketogenic. Like, that’s literally everything you can’t have, like beans, lentils. I don’t eat a lot of grains and things like that, but you know fruit and yet my glucose stays pretty much flat all the time. And usually, my ketones are up there, like around 1.2 to 1.7. And so, I’m technically on a ketogenic diet, right, because I have ketones and I’m in ketogenesis, but it’s not the label of keto or whatnot. And that’s because for whatever reason, with my physiology, the way those carbohydrates are interacting with my body is resulting in not a lot of glucose spikes in my bloodstream and my body is still looking to burn fat for fuel. And so I just think there’s like the future of the nutrition landscape, and how we talk about diets and dietary philosophies is going to look very different in the context of personal data. And my hope is that it kind of liberates people from the more restrictive, “I’ve got to do it because this is what the pamphlet says,” to more like “oh, there’s a lot of different roads to getting to the goal I want.”
34:41 – Make the most of your calories
Each food you eat provides the building blocks for your health, and dictates how well your body will function.
The way I think about food is you want to maximize. I mean we only have a certain number of calories per day that we’re going to eat, whether that’s between like two or 5,000 or whatever, depending on your body, and in each bite, we’re putting in the information of what’s going to build our bodies, but also give the information to tell our bodies how to function. So, I think of food as this very precious internet action. It’s like depositing into the bank of yourself like this information that’s critical. And so, you want to get every nutrient, every possible exciting, fun building block, and molecular information to tell your body what to do possible within that set amount of calories that you have per day, with as little damaging stuff as possible.
36:37 – Food swaps and alternatives
Sometimes you can still enjoy the food you love without spiking your glucose, by making simple swaps.
In the grain situation, for instance, if farro and quinoa and rice, if they’re all spiking my glucose, well, the beautiful thing is there’s a million alternatives to these. I love cauliflower rice. I love broccoli rice. I like RightRice, which is made of lentils. These don’t spike my glucose and have a bunch of nutrients as well and fiber. And so, if you can think about swaps or alternatives to continue to enjoy the food that you love, but not have that side stuff, that’s ideal. But if you look at our levels data set, so you know we’ve had about 13,000 people go through the program and you can see basically in the data what are our top 50 foods that cause people to spike the highest. And some of the really surprising ones we saw in the dataset, one was actually açaí bowls, which was interesting because a lot of people logged açaí bowls and açaí itself doesn’t have any sugar.
Hello, hello. Welcome. It’s episode 348 of the Keto Diet Podcast. I do really like singing random words. Today, we’re chatting about glucose in a pretty healthy person. We want to chat about the glycemic responses for non-diabetics. So much of the glucose content and figuring out what’s best for your health as it relates to your glucose, is all for diabetics. And while this is so incredibly important information, and for them, this is like oh, it’s such a gift to be able to wear CGM and get a handle on their glucose. I work with a lot of women who are pre-diabetic, who are definitely on their way to having a pretty nightmare situation with their glucose and for them to be able to wear CGM and start to see what’s happening with their levels on a moment by moment basis, is life-changing. It’s life-changing. I know it has changed my life significantly.
And many of those women you’d be surprised, are CrossFit athletes, are people that fast often, and their glucose is going from 50 to 200 fasted. Like there’s some big issues. And so, I wanted to have this conversation with my friend, Casey Means, about what to expect when you wear a CGM, or how to manage your glucose as a nondiabetic, some of the surprising foods that will spike your blood sugar that you think no way will it spike my blood sugar, and how to not eat meat and still keep our glucose-regulated. We talk about a lot of things like that as it relates to just managing your glucose as a nondiabetic because it is important. And I see crazy fluctuations in non-diabetics and we really need to get a handle on this because it’s not good.
So, our guest today, like I said, is Casey Means. She’s been on the show before. She’s an MD and Stanford-trained physician, chief medical officer, and co-founder of metabolic health company, Levels, an associate editor of the International Journal of Disease, Reversal, and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. Dr. Means perspective has been recently featured in the Wall Street Journal, New York Times, Men’s Health, Forbes, Business Insider, Tech Crunch, Entrepreneur Magazine, The Hill, Metabolism Endocrine Today, and more. She has held past research positions at the NIH, Stanford School of Medicine, and NYU.
Like with that sort of bio, you’d think that Casey is going to be just incredibly talking over our heads, but she is such a personable human that just wants to help people understand their bodies and it is just such an encouragement. If you want to follow Casey, you can do so, Dr. Casey’s Kitchen. I’ll include that link in the show notes today and you guys know how much I love Levels. In fact, I’m planning around this time to put in another device and share with you some of the things that I’m learning about my body because every time I put on a CGM, I’m like wow, I had no idea that was a thing. So, it’s such a gift to continue to use every couple of months. So, go ahead and follow me at Leanne Vogel. That’s V-O-G-E-L and we’ll have some fun.
So, just a reminder, we are shifting episodes from Sundays to Tuesdays in the new year so you’ll see the first episode going live Tuesday, January 4th, and the next one the following Tuesday, and the following Tuesday. So, we were doing bonus episodes this year, just sprinkled here and there. I don’t think we’re going to be doing that this year. We’re just going to be rolling with Tuesdays. I felt very called to stop working on Sunday, and stop publishing things on Sunday, and just take a day of rest. It is a lot of work running a business solo and just making sure that everything is on point. So, thank you so much for being here. Thanks for your support. Thanks for listening. Thanks for sharing the podcast with your friends. It means so, so, so much.
So, this is one of the last episodes we’ll have on Sunday. We have another episode going out Sunday, December 26th, about keto and your hormones, what you need to know and how to manage them and then we’ll start off the new year, January 4th, with an on fertility, keto, and hormones. So much hormone stuff. You know how much I love hormones. So yeah, just keep that in your mind over the holidays or not. Just come back here in January and know that episodes will be going forward on Tuesdays, not Sundays, not Wednesdays, Tuesdays. And if you have questions about today’s episodes or you just want to chat, you can go to healthfulpursuit.com/contact. You can ask me. You can also follow up with show notes and links from today’s show and all the things you need by going to ketodietpodcast.com. Just look for episode 348 on that page.
Okay, let’s do this thing. Welcome to the Keto Diet Podcast. The show all about keto for women so you can burn fat, balance your hormones, and heal your body. Starting and maintaining keto can be challenging without the right support so just for listening to the podcast, I want to give you 20% off the Keto Beginning with the coupon code, ketopodcast. That’s all one word. This 30-day program gives you a clear step-by-step how-to, so you can quickly adapt to a ketogenic diet, avoid common struggles, and get the results you crave. Go to healthfulpursuit.com/begin to get your Keto Beginning discount today. If you’re new around these parts, I’m Leanne Vogel. You may know me as the international best-selling author of the keto diet, founder of happyketobody.com or maybe you know me as the nutritionist that likes dipping pork rinds in avocado oil mayo. I’m so glad you’re here with me today. Thanks so much for listening.
Hi, Casey. How are you?
Dr. Casey Means (06:22):
Is great to see you, Leanne.
Dr. Casey Means (06:23):
Thanks so much for having me back on.
Oh, of course. We were just saying before we press record, it’s been a year since we’ve talked. Like how does this happen?
Dr. Casey Means (06:31):
Unbelievable. Yeah, time has flown.
I didn’t watch the original that we did. Can you tell us a little bit about who you are and what lights you up?
Dr. Casey Means (06:41):
Yes, absolutely. So, my name is Casey Means. I am a medical doctor. I am the co-founder and chief medical officer of metabolic health company Levels. I practice a very root cause approach to healthcare where I’m really trying to help people figure out what links the symptoms and the conditions that are happening and how to treat at that level in a really proactive way and how to create the conditions in the body that generate optimal function for our cellular biology, rather than just waiting until people get sick and prescribing a pill or a treatment. Like really a proactive, empowering approach. I trained as a head and neck surgeon of all things, originally. I did that for five years and I was just blown away by the monumental impact of metabolic dysfunction and metabolic disease on patients. And it’s just something we’re just not talking about enough I think in our country.
Dr. Casey Means (07:35):
We like to think of diseases as separate things that are all sort of isolated in their silos but what we really know from the research is that metabolic dysfunction links a lot of these diseases and we should really be approaching it head-on in a big way in our country. And so, that’s really where my passion lies. In terms of what lights me up, certainly empowering people to live their healthiest lives by giving them access to information that helps them understand their bodies better. That is what lights me up so that people can make their own decisions and understand their own bodies because I think that is the root of sustainable, positive living, and choices.
Dr. Casey Means (08:10):
On a more personal level, what lights me up is being outdoors. I would sleep in a tent in the backcountry every single day of the week if I could. That’s my favorite thing is waking up looking at the mountains and so, I was really fortunate to actually visit the co-founder of my company, Andrew for the last 10 days in Durango, Colorado. And we did a bunch of camping together and that definitely filled my cup and really lit me up.
Oh, I’m sure. That sounds lovely. You know sitting in Florida and it’s so hot here, I would kill to just be outside with fresh air that’s not so humid.
Dr. Casey Means (08:44):
It was amazing. It was about 65 degrees, and blue skies, and the sound of rushing babbling brooks everywhere, and sensory overload in terms of all the good things.
I’m sure. I’m sure. And so, at what point did you start realizing that glucose management and really understanding that like you were talking about the empowerment of people understanding their data and being able to move forward with their own plan? At what point did you start to see that was where you wanted to focus and where kind of the missing link was?
Dr. Casey Means (09:16):
It came down to two things. One was my personal experience and one was just stepping back and observing the system. So, starting with the system side of things, if you just look at the basic statistics, blood sugar dysfunction and metabolic dysfunction are just absolutely epidemic proportions. A recent study out of UNC, University of North Carolina from two years ago, surveying tens of thousands of American adults, suggests that 88% of American adults have at least one biomarker of metabolic dysfunction and metabolism, that’s the core, this core primordial pathway in the body of how our cells create energy. We have 37 or so trillion cells in the body and every single one needs a well-functioning metabolism to function properly. And disease and symptoms, like these words that we use, really a lot of that, all of that, is rooted in cellular dysfunction. You know you can’t… Symptoms emerge because there’s problems inside the body at the smallest level.
Dr. Casey Means (10:16):
And a big aspect of that is our metabolism of ourselves basically not working properly. Our standard American diet, the way we’re living in the modern western world, is just hijacking a lot of the systems that allow us to make and process energy properly in the body, and what this shows up as is metabolic dysfunction. And then when you look at sort of the top causes of death in the United States, eight of the 10 leading causes of death in the United States are in some way related to dysfunctional metabolism or poor blood sugar control. And they’re not diseases that we saw 100, 200 years ago because we are in totally different conditions now. We are dealing with an industrialized food system, a sedentary lifestyle, chronic low-grade stress, chronic low-grade sleep deprivation that just are totally hijacking these systems and making us sick and so I’m looking at that.
Dr. Casey Means (11:04):
I’m looking at you know, so 88% of Americans have one biomarker of metabolic dysfunction. 74% of American adults are overweight or obese. 128 million Americans have pre-diabetes or type II diabetes, which is largely preventable. And then, these problems underlie so many of the other chronic illnesses were seeing like heart disease, stroke, Alzheimer’s, dementia, depression, anxiety, infertility. They all have roots in poor blood sugar control. So, I’m looking at all that and I’m like this is huge and why aren’t we talking about it? And part of the reason we don’t really talk about in this framework of like we need to fix metabolic dysfunction at scale is because, in our conventional system, we look at diseases all as really isolated, separate silos, these different things, and we treat them all as such.
Dr. Casey Means (11:50):
You know, for your arthritis, you get an anti-inflammatory medication. For your Alzheimer’s, you get an Alzheimer’s medication. For your diabetes, you get insulin or Metformin. For your depression, you get an antidepressant. And it’s like each of these are very siloed, and yet when you look at the actual physiology and the biology, so many of the same pathways are linked in all of them. And if we just treat it at that level, you could potentially really mitigate a lot of this morbidity by focusing on those core root cause pathways. The problem is there’s not a drug that can fix metabolism. You know this is something that Robert Lustig, an amazing author, Dr. Robert Lustig, UCSF professor, has written several books about metabolism, metabolic called Fat Chance. He says these are conditions that are suitable, but not drugable. And so, we have to be focusing on food.
Dr. Casey Means (12:39):
And so, what I’m really passionate about is helping people figure out how to do that. Like actually have the tools to understand how food is affecting their bodies so they can make better choices because at this point you can’t trust labels. You can’t trust food marketing. We’re eating franken-food that’s like not real food. It’s the vast majority of American calories are from ultra-processed foods that come from factories, not the earth. And so, the molecular information that’s going into our body through food is not the information that is in real food. It’s very, very different. And so, we’re facing different challenges now than we ever had throughout human history, where being healthy is like a monumental uphill battle. And so, having tools like continuous glucose monitoring or other metabolic monitoring tools can really give us a handhold in this modern world and help us kind of do better.
Dr. Casey Means (13:29):
And you know, 49% of Americans try and lose weight each year, or try and go on a diet, so it’s not like people aren’t trying. Like the will to do better is there, and the effort and people stepping back and saying, I want to improve my life and my health, and yet, we’re not doing well. We’re getting heavier as a country. Our life expectancy is going down. We’re getting sicker. Chronic disease rates are going up. And so, there’s effort and there’s intention, but we’re not seeing the results. And I think one of the disconnects there is just the lack of information about our own bodies, the lack of awareness and biofeedback loop between what we’re doing and what’s actually happening, and be able to make then smart choices. So, that’s really the epicenter of where Levels lives.
Dr. Casey Means (14:10):
And so, that was kind of the systems level, the issues that I saw that made me want to step back from the surgical world and do this. And then my experience in surgery was the second piece of that, which is that yeah, I was just basically seeing so many patients who are dealing with inflammatory disorders. ENT is a lot of inflammatory conditions. It’s like sinusitis, thyroiditis, laryngitis, all these itis’s are disorders of inflammation. And we know pretty well that one of the big causes of inflammation, drivers of inflammation in the body is sugar and we’re eating like 150 pounds of sugar per year. The average American adult, when 100, 200 years ago, we were probably eating less than one pound of sugar, so we’re eating like 152 pounds of sugar.
Dr. Casey Means (14:51):
And I’m like okay, so I’m treating inflammatory disorders. I know inflammation is triggered by sugar. We’re eating 150 pounds of sugar per year, per person, maybe we should think about trying to help people eat better and it would have an impact on some of this chronic inflammation that I’m operating on, and prescribing steroids for, I’m prescribing antibiotics for. And it’s certainly feels very hollow when you’re spending 80 to 100 hours per week in the hospital, but realizing that nothing of what you’re doing is actually helping people be healthier. It’s reacting to their disease with essentially a lot of things that kind of make people feel better in the short term, but don’t actually change the triggers that may be leading to their illness.
Dr. Casey Means (15:32):
And so, those things all together just was a total wake-up call five years in and I was like, there’s enough people punching holes and sinuses and sucking the puss out and helping people. Like this is not where I meant to be. I meant to be helping shift the system such that we’re addressing these things ideally decades earlier, and ideally keeping the vast majority of people out of the operating room. And that’s the side of the game that I wanted to be on and really devote my clinical energy to.
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That’s just phenomenal and it’s crazy to think that 49% of people tried to do the diet thing and what I see in my practice nutritionally, is that they’re often doing the wrong diet thing. You know, they go on the internet and they’re like how do I lose 10 pounds in a week? And they’re like okay, boop, boop, boop, I’m going to do this. And it’s either completely unattainable because it doesn’t fit their lifestyle, completely unattainable because it doesn’t fit their metabolism where they’re at. You know if you’re addicted to sugar and somebody says you can’t have sugar for the next six weeks, it’s going to be very challenging without proper support. And so, I think that’s why having the data to understand how your body’s reacting to things and to have that constant feedback like you were saying with a continuous glucose monitor, I’ve realized very quickly where my hangups were and what I needed to work on and I had no idea.
And this is a quote-unquote, pretty healthy person with big air quotes. But you know, some of my clients who wear a continuous glucose monitor, it’s just so they can see in real-time what the decisions they’re making are doing to their body within moments. Within the next two hours, you start to feel tired, check your phone, guaranteed you’re going down a sugar drop, and wow, what impacts me like that. And you start to what your CGM is telling you in your hand, you know on your phone, to your symptoms, and how you’re feeling, and starts to really put that memory into play, and you start to make better choices and personalized choices. Would you agree?
Dr. Casey Means (19:03):
Absolutely. We have literally never had that closed-loop biofeedback with nutrition before. Nutrition has just been this black box. We eat around a metric ton of food per year, and several pounds of food per day. This is a massive amount of stuff just going through our body, becoming our body, and serving as the information for our body about what to do, genetically chemically, all these things. It’s so freaking cool. And yet, we basically have no information or immediate feedback on what it’s actually doing to our body. We may be able to tune in to how we’re feeling after a meal, which is great when people can do that, although it’s hard. It’s hard in our modern world to tune in to how our bodies are feeling because we are eating a lot of that just makes us feel crummy. Crummy kind of becomes our baseline.
Dr. Casey Means (19:56):
And I think there’s a lot of people out there who don’t even really know what it feels like to feel like you’re thriving or you’re really on fire because our bodies are filled with some of this stuff that doesn’t make us feel that way. And so, to be able to take this loop of I made a choice, this is how I feel, and this is the objective data I got about it. That trifecta to me is like the heart of body awareness and behavior change, but the objective piece is key because sometimes it’s really easy to miss attribute actions or results to other things. So, an example of this is like mid-morning. Let’s say you have had breakfast, it’s around 11:00 AM now, and you feel super lethargic, and you kind of are tired, maybe a little bit anxious, want to take a nap, want another cup of coffee, a million things might come to mind.
Dr. Casey Means (20:40):
I’m stressed because of work, my coffee was too small, I didn’t get enough sleep, maybe it was the food I ate, maybe I’m just a tired person. But when you can see on your continuous glucose monitor, oh no, actually at 8:00 AM, I had oatmeal and my glucose spiked to 180 milligrams per deciliter, which is really high, and then I came crashing down, and now I’m waffling in reactive hypoglycemia, and now I’m tired. All of a sudden, the misattribution is gone. You’re like no, this was the oatmeal. That didn’t work for me and I’m not saying that doesn’t work for everyone, just in this example, and I need to fix that. And so, that might mean switching over to eggs and avocado and greens for breakfast, which are likely to cause virtually no glucose spike or it could mean doctoring up your oatmeal so it has less of a glucose impact, like switching from instant oats to steel-cut oats or grouts, adding fat, fiber, and protein, almond butter, chia seeds, flax seeds, whatever, and modulating it so that you don’t have that roller coaster.
Dr. Casey Means (21:39):
So, that closed-loop biofeedback, it’s the first time we’ve ever had that in nutrition. And I think it’s going to transform our relationship with food so that we really think of food as something we have a little bit more of a relationship with and have more control over in a positive way to serve our needs, as opposed to just guessing. And I think it’s going to have a monumental impact on holding a mirror up to the food industry and saying, I get that your claims say this, but this is what it’s actually doing to my body. And when that happens at scale, these companies are going to have to do better. Right now you can walk into the grocery store and pick up a bag of skittles and it’ll probably say something like this is a low-fat food, so it’s health washing to the nth degree. But when you actually have a mirror to that and transparency because of your own data, marketing goes out the window and we just start focusing on well, what’s actually working for us and my body.
Marketing really goes out the window and even just beyond marketing, I know that everyone markets themselves and they’re like my diet is the best diet, and if you follow this diet, you’re going to have these results. And at times, you need certain diets for certain times. You know, myself following the ketogenetic diet for seven whole years and healing from a lot from that, getting my period back after eight years of amenorrhea, and I mean the list goes No more ADD. I mean just so many things and I got to the point wearing the continuous glucose monitor, I actually had this experience two days ago and today, where now that I’m not really eating a ketogenic diet. I stopped about six months ago. I’m fine.
I used keto to attain all my goals and I got to the point where I don’t need to be eating this way anymore. My body needs something else now and two days ago I had a big bowl of low-carb oats. It had almond flour, sunflower seeds, flax, a bunch of coconut oil, and banana, and Medjool dates. I felt so good that day. That morning I was on fire. My glucose was steady and you’re thinking like banana in there. I put some maple syrup in there too.
Dr. Casey Means (23:42):
Dates maybe. Yeah, right.
And you’re thinking, Leanne, you’re totally going to crash. No, I was great. This morning I was like I’m going to do a savory thing. I’m going to make two eggs, some meatballs, and some kale, and a little bit of chickpeas, like just the crunchy ones, and chickpeas are fine for me, and that was a pretty low-carb meal. I crashed. I was so tired. I was so tired and so it’s interesting, just the reactions that different bodies can have at different times, whereas, my husband is completely different. He thrives on the eggs with the meats and the grains, but right now where I’m at, I’m not thriving on that. And had I just followed the well, keto worked for me, it’s been working for me, all is good, I never would’ve adjusted. At this point in my life where I’m at right now, it works much better for me to have that porridge with the banana, and the Medjool dates, and the things. Like it’s just fascinating.
Dr. Casey Means (24:36):
It’s so fascinating. And are you wearing a CGM currently? No.
I’m not. CGMs for a lot of people can be quite costly if you’re wearing them all the time. And I started noticing a lot of my clients and stuff like that, they would do these bouts of wear it for 28 days, then go off of it for two months until they could afford it again, so I wanted to try to get to that space so I could learn quickly, and then write down all the things that I had learned. Like this works better, this is how I know that this is working. You know if I start to get a little bit hungry, that means that my glucose is dipping down a little bit and it’s a good time to eat before it totally crashes and then I just eat whatever. Like all those little lessons so I wear it for 28 days, and I take a little break for one or two months, and then I wear it again and see what lessons I can learn.
So, I wasn’t wearing CGM during that, but I tested that multiple times. The first time I did, I was like let’s just see how much this is going to totally screw things up and it didn’t. And I was like okay, well let’s try it again, just hormones. I’ll try it again in two weeks and it didn’t. And so, I think that’s another interesting point. Just the glucose and our resistance to those fluctuations, depending on where we’re at in our cycle.
Dr. Casey Means (25:48):
Oh, absolutely. Absolutely. And I think research needs to pan this out and figure this out, but I do think there’s also something to be said for that your body can shift a little bit in its responses to carbohydrates over time and I think it probably has a lot to do with microbiome because as you know, I’m primarily plant-based, so I am eating very little animal products, and a lot of beans, and lentils, and nuts, and seeds, and greens, and things like that. And I know a lot of people who are on a more animal protein-based diet and they eat beans and lentils, and they really spike. And I can eat them and stay completely flat. And I’m like there must be something microbiomey here going on, but then as people I know have actually incorporated a lot more fiber into their diet, we’re really understanding the relationship between fiber and metabolic health, and how important it is.
Dr. Casey Means (26:42):
There’s a shift that sometimes happens and this is just again, anecdotally, just looking at our sort of levels data, where people then start responding better to the beans and the lentils. So, I also wonder if there’s sort of this transitional period where your body basically is processing carbohydrates differently. And this kind of is rooted in a paper that came out about five years ago that’s really a landmark paper out of the Journal Cell, which was called Personalized Nutrition by Prediction of Glycemic Responses. And they put continuous glucose monitors on around 800 healthy non-diabetic individuals, and they looked at what happened to their glucose when they give them standardized meals. And what you’d expect from the concept of the glycemic index, or even from the perspective of a ketogenic diet, you’d think oh, well, if they’re all eating the same food, it’s going to have the same impact on all of their glucose levels.
Dr. Casey Means (27:33):
There’s this idea that there’s some inherent property to food in terms of how it actually impacts your glucose levels. What they found was the opposite, which is that with a standardized meal across 800 people, people had wildly different glucose responses in terms of what actually made it from the food into their bloodstream, and how that response happened from completely flat, to huge spikes, and then all across the spectrum. So, what this say’s to us is that there’s something happening between the mouth and the bloodstream that’s basically changed in the way we’re processing food. And they identified several factors that were related to that. Microbiome was a big one, body composition and anthropomorphic features, which kind of can hint at insulin sensitivity. That was also related. Like how sleep and physical activity. There were lots of different variables. I think they ended up looking at like 137 variables that may be related to sort of how their response is different between people.
Dr. Casey Means (28:26):
But it just goes to show that what works for one person, might work differently for another person, but even amongst the same person, at one-time point, it may look different at a different time point. And so, that’s really, really fascinating to me and we were talking about this before the episode started, I’m someone who you’d look at my diet and someone would be like, oh my God, that’s the opposite of ketogenic. Like, that’s literally everything you can’t have, like beans, lentils. I don’t eat a lot of grains and things like that, but you know fruit and yet my glucose stays pretty much flat all the time. And usually, my ketones are up there, like around 1.2 to 1.7. And so, I’m technically on a ketogenic diet, right, because I have ketones and I’m in ketogenesis, but it’s not the label of keto or whatnot.
Dr. Casey Means (29:17):
And that’s because for whatever reason, with my physiology, the way those carbohydrates are interacting with my body is resulting in not a lot of glucose spikes in my bloodstream and my body is still looking to burn fat for fuel. And so, I just think there’s like the future of the nutrition landscape, and how we talk about diets and dietary philosophies is going to look very different in the context of personal data. And my hope is that it kind of liberates people from the more restrictive, I’ve got to do it because this is what the pamphlet says, to more like oh, there’s a lot of different roads to getting to the goal I want.
Dr. Casey Means (29:56):
And for a lot of us, I think the goal is, I mean obviously to feel good, to be a healthy weight, but also metabolic flexibility. Like the kind of this crowning jewel of metabolism, which is this idea that we can burn fat efficiently. We can burn carbs efficiently and our body can kind of bounce back and forth, which we know is associated with longevity and is a really good state to be in. And to know that there’s more than one way to kind of pass go on that and that it’s likely very individual, and changes over time, I think is really fun, and empowering, and is going to hopefully liberate people from feeling restricted or confined by a specific dietary philosophy.
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And I’m glad you mentioned that too. I find a lot of people will find something that works for them and they’ll hold onto it for a long time and things will start to not work anymore, and they’ll be like no, no, no, but it worked two years ago. I just need to get back to what I was doing and it’ll be okay. And I think what a lot of people don’t realize is that there’s a time for certain things and as your body shifts, changes, evolves, I mean especially if you’re a woman, and your hormones at different times, and life phases, how much stress you have, how hydrated you are, where you’re living, all of those things impact the type of diet that you respond best to, what nutrients you need, your gut permeability can cause issues with your glucose regulation.
I mean there are so many possibilities and I guess that leads to my next quite bigger question, which I’ll probably break down a little bit more, but the surprising foods that spike your blood sugar. Like for example, people should know this, but certain keto bars. You know I know that when I first got my CGM, I was like let’s see what I’m reacting to and I was blown away at how many bars were not actually that great or how many I needed to pair with nut butters and things in order for them to be properly so I wasn’t like up, down, up, down. What are some of the surprising foods that you’ve noticed in the Levels data and just yourself personally that’s like what?
Dr. Casey Means (34:24):
Well, some of them probably won’t be super surprising to this audience because people are quite familiar with keto, but I think that they’re surprising in the sense that we consider them healthy foods, but they may have this bit of, at least in my body, or you know collateral. Like this collateral, I don’t want to say damage, but impact. And the way I think about food is you want to maximize. I mean we only have a certain number of calories per day that we’re going to eat, whether that’s between like two or 5,000 or whatever, depending on your body, and in each bite, we’re putting in the information of what’s going to build our bodies, but also give the information to tell our bodies how to function. So, I think of food as this very precious internet action. It’s like depositing into the bank of yourself like this information that’s critical.
Dr. Casey Means (35:06):
And so, you want to get every nutrient, every possible exciting, fun building block, and molecular information to tell your body what to do possible within that set amount of calories that you have per day, with as little damaging stuff as possible. So, for me, that looks like just the most nutrient-dense amount of stuff I can get, and ideally in terms of the stuff that can be harmful, like ultra-processed sugars and grains, pesticides, chemicals, any of that stuff because it’s like I want the balance sheet to also be more positive and not negative. And so, that’s kind of how I think about some of these foods that in me were surprising. So, some of the big ones personally, were sweet potatoes, potatoes, all grains essentially, certain fruits like grapes, massive and corn.
Dr. Casey Means (35:51):
So, if you just look at myplate.gov or whatever, basically, those are all that you want to fill your plate with, but in me, they cause gigantic glucose spikes. Like oatmeal is another one certainly, like up to 170, 180, so 80 point jumps from my baseline and then a crash afterward, so I don’t feel good. You know it’s causing a big insulin release in my body, so even though there’s positive nutrients there, for me, that collateral impact is making that food less of a great thing on the balance sheet. And it’s interesting, it’s not like I have to eliminate these forever, but I can be at least aware that if I’m going to eat sweet potatoes, I better not load my plate with a bunch of other carbohydrates and I should probably add some like tahini and chia seeds to get some fat and fiber on that as well. So, it’s just more of an awareness.
Dr. Casey Means (36:37):
And also in the grain situation, for instance, if farro, and quinoa, and rice, if they’re all spiking my glucose, well, the beautiful thing is there’s a million alternatives to these and I’ve become… I love cauliflower rice. I love broccoli rice. I like RightRice, which is made of lentils. These don’t spike my glucose and have a bunch of nutrients as well and fiber. And so, if you can think about swaps or alternatives to continue to enjoy the food that you love, but not have that side stuff, that’s ideal. But if you look at our levels data set, so you know we’ve had about 13,000 people go through the program and you can see basically in the data what are our top 50 foods that cause people to spike the highest. And some of the really surprising ones we saw in the dataset, one was actually açaí bowls, which was interesting because a lot of people logged açaí bowls and açaí itself doesn’t have any sugar.
Dr. Casey Means (37:33):
It’s a not sweet substance, but you think about the way these are prepared. They’re often blended with lots of tropical fruit and there’s honey on top, and banana, and mango, and this and that, and usually not a lot of greens, and not a lot of fat, and it’s not a lot of fiber. And so, it’s just this sort of juice blended sugar bomb. And so, tons of great nutrients, phytonutrients, all that stuff, but you don’t want that huge glucose spike. So, there’s so many ways to tweak that. Make it more of a green smoothie, add lots of greens, use lower glycemic fruits like berries. Skip any sweetened nut milks in there. Skip the honey and add more things like coconut, or chia seeds, or flax, or hemp, or whatever. Totally transform it. I bet you could get it down to a really low spike, but that was actually one of the top 40 spikers in our entire data set, which is kind of interesting.
Dr. Casey Means (38:26):
This one, sushi very commonly logged as one of our top 40 spikers. Not surprising white rice, but some people do assume oh, it’s white rice that has been cooled, generally, and so that will increase as the resistant starch concentration maybe make it better, but that’s not what we see. We see huge spikes with sushi. So, I have become a big lover of cauliflower rice sushi, and it’s actually really good, and so easy to make, and it causes zero glucose spike. I’ve posted this on my Instagram several times. It’s like it takes literally five minutes to make a ton of this cauliflower rice sushi, so that’s an alternative. Also maybe lean more towards sushini where you’re just eating a beautiful piece of raw fish or preload your sushi meal with roughage, like a big salad with some vinegar, and fat, and fiber, and protein before eating the sushi.
Dr. Casey Means (39:17):
We know that if you sequence your carbs last in the meal, you can often have a much lower response. So, there’s lots of ways to kind of tweak that. A couple of others, oatmeal was one of our really big ones that’s surprising to a lot of people, probably not surprising to you or I, but in its standard forum that it’s eaten, which is often instant oatmeal with fruit on top, maybe a little brown sugar, just through the roof. That was one of our biggest. Grapes was the fruit that had the highest spike of any. I think that one’s kind of interesting because grapes compared to berries, they have about twice the sugar per gram, essentially. And grapes are interesting because you often don’t eat them with anything else. Like you just grab grapes and pop them in, whereas, I never do that with blueberries. I’m always eating blueberries with a high-fat yogurt with nuts and stuff, so you’re getting that built-in buffer.
Dr. Casey Means (40:09):
I rarely ever eat an apple alone. I usually eat it with almond butter or something like that, but grapes you just pop in and they have very little fiber. And so, it’s one where I would not recommend eating them all by themselves or in a large quantity. Eat them with the charcuterie board, right, with nuts, and cheese, and other stuff. Cut them and put them in your yogurt or whatever, but by themselves, it’s basically just like a rocket ship for your glucose. So, those were a few of our big spikes. And then there were the obvious ones. I mean those were some of the surprising ones. The obvious ones were logged words like Chick-fil-A, McDonald’s, donut, pizza, pancakes. These were all in there as well, but some of the more surprising ones were some of these kind of healthier foods.
Dr. Casey Means (40:51):
And we saw pho, and pha, and ramen in there as well, which is not super surprising because it’s either rice noodles or wheat noodles, but the beautiful thing about those is there’s so many alternatives now that you can do with noodles like konjac root noodles, which are made out of a high fiber root vegetable, the konjac root. You can do zucchini noodles. You can do tofu noodles. There’s so many ways to eat that stuff without having the gigantic glucose spike. So yeah, I’m all about the keep eating what you love, but tweak it to make it a lot better and just being aware as you’re going into a meal what’s going to happen and how to modulate the rest of your meal to make it work better for you.
I really hope you’re enjoying today’s episode. I’d love to see where you’re listening from. You can snap a pic and tag me at Leanne Vogel or leave a review for the show on your favorite podcast player. It helps me out tremendously. Okay, back to the good stuff.
Yeah, completely. I think the combinations was big for me. Like oh, I can’t have this, but if I add almond butter to it, what would happen, or I did the chia seed thing too. I’d put whatever. Like if I was eating blackberries, I just can’t eat blackberries. I just can’t. I’ve tried so many ways to combine them and it will still spike whatever I have with them, but in the case of a sweeter apple, like a pink lady apple, if I put almond butter on there and chia seeds, it’s perfect, but if I just had it by itself, it’s not perfect. And so, those combinations I think a lot of people don’t take the time and I didn’t. I didn’t think having an apple, I understand blah, blah, blah, you should have some fat with it, but I didn’t actually understand how much it could spike and how balanced my glucose could be if I just combined it with a little bit of protein or a little bit of fat, and it makes a big difference.
Dr. Casey Means (42:47):
It definitely does. Yeah.
It’s too cool. I think other ones that I experienced, sweet potatoes too. Many of… I haven’t seen CGM data from any of my clients when we’re doing carbs up and things where they can handle sweet potatoes, but I can handle white potatoes just fine. Like completely fine.
Dr. Casey Means (43:03):
Oh, that’s fascinating.
It’s so strange.
Dr. Casey Means (43:06):
I’ve seen this. There’s definitely this handful of people who like white rice, brown rice, white potatoes, like very little response. So yeah, fascinating.
Isn’t it, whereas, blackberries, I mean I would just… If I was a little bit snacky, I would have some coconut butter and blackberries. I do not do that anymore. It’s like it doesn’t matter what I combine. Cassava also, that’s a major thing for paleo people.
Dr. Casey Means (43:29):
They make pancakes and stuff with it. There’s no way that cassava works and all the key dose sweeteners, even Stevia was an issue for me. And so, that’s really I don’t know if it’s an allergic response with some of the items too. I’ve started to wonder if I’m eating this and it really shouldn’t spike my glucose, I wonder if this is an allergy. It’d be fun to kind of play around with that and see what comes about there. And you said that you don’t eat meat, that you do a lot of lentils and things like that. Any advice for people listening that want to follow a low-carb diet, but just all the animal products they just can’t get down with.
Dr. Casey Means (44:07):
Yeah, absolutely. So, and I will say I eat a little bit of animal protein, mostly it’s in the form of sardines, basically, and salmon. I’ll eat a little bit of really high omega-3 fish now and then, and that’s a difference for me from a few years ago. I was like 100 percent whole foods plant-based for several years and it was similar to your experience, actually, where I was using that diet as a way to heal myself from some health issues that I was dealing with and it did it. Like it was magical. In a couple of months of a totally whole food plant-based diet, I’d reversed the couple of things that I was dealing with. And now a few years later, I’m training differently. Life is just different.
Dr. Casey Means (44:50):
My body seems to respond really well to some high omega-3 fish and every now and then like a few ounces of some pasture-raised beef, and it’s still I would say I’m 97% plant-based, but just a little bit of that sort of adjusting, and modulating, and sort of is a nice process to kind of go through and loosen up a little bit on some of the rigidity that we can have when we’ve really been dedicated to a diet that’s had huge benefits in our lives. So, some takeaways for people who want to do essentially low-carb, but don’t really want to eat a lot of animal products. The first thing I would say in terms of a framing difference is one thing is maybe not focusing as much on low-carb and focusing on low glucose spiking because those are two different things.
Dr. Casey Means (45:37):
Like two people can eat the exact same amount of carbohydrates and have different amounts of glucose absorbed into their body, so for one person it may look like higher carb actually can achieve that. And what we really want to focus on is the bottom line, which is what’s happening in our bodies in terms of the glucose spike. And so, that’s a framing shift I would just start with. The second thing is just really focusing on fiber. And if you are looking at carbs, like net carbs because it’s just amazing. An entire can of black beans, there’s nine grams of fiber per serving, and there’s about 3.5 servings per can. So, you’re looking at like over 30 grams of fiber, which are essentially not going to be digested by the body.
Dr. Casey Means (46:21):
And so again, some people they still spike on beans, but I think that just really emphasizing fiber in the diet can be a great way to try and kind of be plant-based and still keep the glucose. If you’re on a plant-based diet that has very little fiber and you’re kind of eating more of the process plant-based stuff that’s deplete of fiber, you’re going to get big glucose spikes, but the more you can incorporate fiber at every meal, I think the better. And this kind of goes that saying, but avoid all of the processed grains and sugar. That should not be a part of a plant-based diet, so that means refined white flour, whole wheat flour. Refined sugar is basically packaged in processed foods. Stick with foods that are as close to the earth and unrefined as possible because they’re going to have less of a negative metabolic impact.
Dr. Casey Means (47:08):
So, and then I would say if you do have a CGM, experiment with some of your favorite plant-based foods and learn during that 28 days that you have it on. You may learn that certain grains are fine for you and others cause really large glucose spikes, so you can just take that information and run with it, but if you don’t have a CGM on, I would say just sticking with some of the principles. Like if you’re going to eat grains at your meal, don’t load up on a bunch of other carbs during that meal, like also have sweet potatoes, and also have cassava, or a cassava tortilla or something. That’s going to be a lot.
Dr. Casey Means (47:40):
So, just be very thoughtful about where you’re doing your carbs and look for the swaps. Like I said, cauliflower rice and broccoli rice is in every frozen section in pretty much at every grocery store I’ve been into. I always have like five or 10 of those in my freezer or you know they’re $3.99 and anytime a recipe calls for rice, I just use cauliflower or broccoli rice and it’s so simple. It’s really cheap and it’s not going to spike virtually anyone’s glucose I would assume. And yeah, so those are some of the recommendations I’d make to start with.
I love that, Casey. Oh my gosh. I could pick your brain forever and have a conversation with you, but sadly can’t. Where can people find more from you? I’m going to include a link to Levels in the show notes for people that want to check that out. That’s the CGM that I’ve been wearing for I think over a year now off and on. Any other things that you want to share with us? Your Instagram, which you mentioned before.
Dr. Casey Means (48:37):
Yeah, so definitely check out levelshealth.com. Sign up for the newsletter. There’s great information there. I really recommend levelshealth.com/blog in particular. There’s a lot of… I mean it’s just incredible articles about metabolic health written by the top metabolic health thinkers in the country, but there’s a lot of practical advice in there too, so look up the food articles if for people who are trying to think through actual tactical foods. We’ve got a great article, similar to what we talked about in the podcast, that’s 10 surprising glucose spiking foods and why. A lot of swap articles, so if you like pasta, here are these alternatives that are nutrient-rich and are less likely to spike carbs, similar for bread, lunch, dinner, holidays, desserts, breakfast, and these are just very deeply curated by our team and based in data.
Dr. Casey Means (49:25):
We have a, Foods We Love, section of the blog, which are foods that have deep research around them about how they support metabolic health, so things like turmeric, or flax. It’s just a real amazing resource. And then my Instagram is Dr. Casey’s Kitchen, Dr Casey’s Kitchen. And the Levels, Instagram and Twitter. So at Levels. So, our website is levelshealth.com. Our Instagram and Twitter at Levels. There it’s fun to follow because we’re reposting a lot of our beta members’ experiments that they’re doing, and what they’re learning, and what they’re learning about their diet by using CGM. And so, it can spark a lot of interesting ideas even if you don’t have the CGM, you can learn from other people. So, those are the resources I’d recommend. Yeah and would be thrilled to connect with anyone on those platforms.
Amazing. Well, thank you again for coming on the show. You’re welcome back anytime and it was so great to catch up with you.
Dr. Casey Means (50:15):
Great to talk with you as well. Thank you so much for having me on.
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