If you want to pull a weed out of the garden, you can’t just pull off the leaves. To truly eliminate the problem and stop it from spreading, you have to pull it out by the roots. The same is true of our health. Our modern medical system often treats symptoms, but not the root cause. Dr. Casey Means is the founder of Levels, a company that’s dedicated to helping individuals find their true healthy center through a technology called continuous glucose monitoring. Dr. Yami hosted Dr. Means on Veggie Doctor Radio to discuss the impact of glucose levels on the body, and simple ways begin optimizing health and performance for the better.
15:10 – We’re exposing our poor bodies to things we aren’t supposed to eat
Inflammation and disease is caused when the body feels it’s under threat. Diets containing processed and synthetic foods are putting the body on alert and causing that inflammation.
“What is inflammation? Inflammation is the body’s immune system saying there’s a threat. And I need to just rev up and fight this threat. And that can be any threat. Cause you know, this is a body that’s all connected through a blood system. So the threat can be anywhere and that immune activation can affect all parts of the body. And so I really started digging deep about what are the root causes of inflammation? Why are our bodies just completely on high alert all the time? And that led me to PubMed where I was reading a lot and realizing that these threats to our body are largely related to the fact that we’re exposing our bodies, our poor bodies, to these food substances and additives and environmental toxins and substances that we were never meant to encounter.”
20:11 – Functional medicine digs disease out by the roots
Functional medicine focuses on the causes of disease, the root problems in lifestyle, diet, stress, sleep. This is unlike traditional medicine, which treats symptoms of disease with drugs and surgeries, fixing the problem but not the cause.
“This is an approach to health care that addresses the root causes of disease and symptoms and aims to reverse the conditions that lead to them. So the premise is that symptoms don’t arise out of thin air. They arise out of cellular dysfunction. They’re not a mystery, there’s something going wrong in the machinery of our body. And so instead of just identifying a collection of symptoms, having pattern recognition, naming it, and then slapping the drug or surgery on it to ‘fix it’, functional medicine takes this deep root cause approach and thinks about what is actually going wrong in the body, and works to correct that. So like I mentioned before, often what is going wrong is that cellular machinery is sort of gummed up because of external stressors like diet toxins, chronic stress, sleep deprivation, lack of physical activity, all of that.”
24:49 – The body is an energy producing machine
The body turns food into energy through a process called metabolism. However, this system can become damaged with the wrong foods and other stresses like lack of sleep or movement. This leads to damage on a cellular level and metabolic dysfunction.
“So at the highest level, metabolism refers to how we process energy in the body. So whether it’s processing carbohydrates, fats, or proteins, our bodies are basically supposed to be able to digest what we eat. Process it, utilize it, store it, excrete it as waste, and then be done. But now with this unbelievable increase in the amount of food we have access to, coupled with decreases in physical activity, decreases in sleep quality and amount, over time we’re just overloading our systems, our energy processing systems. Particularly the poor mitochondria, which are the cellular organelles that convert fat and glucose to energy. They have just such a massive abundance of these substrates and they just are not working properly. So what happens is we get inefficiency in the metabolic system that results in excess circulating glucose.”
26:59 – Only 12% of Americans are healthy
There is a metabolic crisis in the US, with 88% of Americans showing signs of metabolic dysfunction. This dysfunction is the basis for a vast number of diseases.
“A UNC study, last year, 2019 I believe, showed that only 12% of Americans are metabolically healthy. And what they defined as metabolic healthy was having optimum levels of five factors. So it was blood glucose, a fasting blood glucose under a hundred, so normal essentially normal healthy triglyceride level, HDL level, blood pressure and waist circumference, without the need for medications. And if you met all those criteria, you were part of 12% of the population. And so 88% of people don’t meet that criteria. And this is paralleling our increased rates of all these chronic diseases that I mentioned. And so that’s kind of the broad overview of metabolic health. I would say the two diseases we think most closely related to metabolic disease or diabetes and obesity. And just to kind of give the broad overview of the impact of those diseases right now, 74% of the country is overweight or obese. We have about 38 million Americans with type two diabetes and about 90 million more Americans with pre-diabetes. And so about a total of 120 million people with some sort of clinical metabolic dysfunction, of the people with pre-diabetes those 90 million, 90% do not know it and most will go on to develop type two diabetes. And so we’re dealing with huge, huge, huge numbers here.”
30:46 – CGMs are the secret weapon for improving health
Continuous glucose monitors (CGMs) were designed for diabetics to measure blood glucose. The system shows how blood sugar levels respond to diet, exercise, and other markers, to help make healthier choices. Levels is bringing this technology to anyone who wants to understand and improve their health.
“CGMs is a technology that’s basically a wearable sensor. It’s a little teeny device that you wear on your arm with just a tiny, implanted little filament under the skin that is continuously sampling glucose 24 hours a day, and sending that data stream to your smartphone. So this is a technology that is FDA approved for type one and type two diabetics to help them manage their blood sugars. As part of the treatment plan for many it’s the replacement to finger stick blood glucose testing, which is where you take a small pen lancet, prick your finger and use a glucose monitor, see what the glucose is in your blood. This is painful, it’s costly, and wearing a sensor gives you a huge amount more data and gives you much more of this closed loop feedback between individual dietary and lifestyle choices and how the glucose changes. And so in closing that feedback loop, you can start to make better choices and you can start to generate better intuition about what’s actually happening between actions and reactions.”
32:33 – Removing the veil of mystery
Blood glucose is linked to many more conditions than people realize. Blood sugar affects everything from acne to infertility. Using a CGM, it’s possible to link symptoms with actions and make simple changes with life-changing results.
“One issue is that there’s just not a lot of information or education out there about all the different symptoms that actually are related to blood sugar that we don’t even realize. So for instance, acne is significantly tied to glycemic variability and poor glucose control. And there’s a number of studies, randomized controlled studies, looking at people going on a low-glycemic diet and improving their acne over 12 weeks…And there’s a number of other examples like that, like anxiety. A big glucose spike and a crash after a meal can lead to anxiety through postprandial hypoglycemia. And so by seeing with CGM, maybe some of these reactions you’re having, and then knowing that there’s a link to some of these health conditions, it can start taking out some of that mystery in life of ‘why is all this stuff happening to me?’ And actually giving some more concrete evidence of maybe one biologic link that might be leading to these problems and pain points in life that is super easily actionable. Something that you can change and affect in minutes. You can lower your glucose with five minutes on the stationary bike. You can lower your glucose with your next meal.”
37:00 – Health is a spectrum where there’s always room for improvement
Conditions like diabetes don’t just happen overnight. Years of choices lead to disease. Better choices, like managing glucose levels, are shown to turn this around and lead to improved health.
“Health is a spectrum. There’s not one day you wake up and your fasting glucose is 101mg/dl and all of a sudden you’re pre-diabetic. And you were fine the day before, and you’re not fine today. It’s more likely than it has been years to decades of marching along the spectrum of insulin resistance through thousands and thousands of choices that ultimately led to that day when you happen to be up at 101. And you go to the doctor and they say your prediabetes and they give you Metformin and now you’re in this category. That’s not, on a biological perspective, how it works. We’re not a light switch that turns on and off.”
49:20 – The secret to finding the perfect diet
There are so many so-called healthy diets. However, Levels has found that actually it comes down to each individual and what works for their body. For some people on restrictive diets, they may be able to tolerate more foods than they thought possible.
“So I think there are so many dietary philosophies out there right now. There’s keto, there’s, plant-based, there’s caveman, you know, there’s paleo. And it almost feels like warfare between these different nutritional factions. And I think people are just hungry to know how is food affecting me? What is happening in my body? Kind of cut through a lot of the rhetoric. And I think this tool can really serve as a biofeedback tool for those people to help them pretty rapidly shape a diet that’s going to have the least metabolic impact for them. So for instance, you can put it on, go through this month program with Levels, which is going through two sensors using the software. We call this a metabolic awareness program for one month. And by the end of it, they may have identified a number of foods that just really cause huge glycaemic spikes for them. And they had no idea. And they can finally understand how their symptoms, their day to day sort of subjective reality of life, was related to some of these glycaemic excursions and can kind of tailor their diet. On the flip side – so that’s sort of more the limiting view of this can help you eliminate things from your diet. But we’ve also seen the opposite, which is that people on strict diets have actually been able to liberalize their diet by figuring out things that work really well for them.”
51:30 – Forget counting calories, just keep blood sugar level
High blood glucose triggers the release of insulin. This is the hormone which encourages fat storage and hinders use of fat for energy.
“So moving past this idea of calories in calories out, and really thinking about the biochemical aspect of weight loss. A lot of people have read these books and are interested in learning more about glucose and how to manage it so that they can lose weight. And briefly touching on the concept is that insulin, which is a hormone released when we have high blood glucose, is actually an anabolic hormone. It’s a hormone that helps us build things in the body. It’s what helps us store fat and actually blocks our mitochondria from burning fat. So if insulin is high, it is very difficult to lose weight. So by using continuous glucose monitoring and Levels software to understand how much your food is impacting your glucose levels, you can theoretically by proxy understand how your insulin levels are doing. And, get into more of that low insulin, fat oxidation, fat burning state. So that’s been really interesting ”
54:04 – The key to optimizing physical and mental performance
Glucose monitoring can show how your body is using fuel sources for energy. This can help to optimize fuel usage for exercise, particularly by athletes, as well as the mental side of performance.
“Energy for workouts is basically just your body figuring out whether to use glucose or fat and how efficiently, in the moment. And CGM can be a really interesting biofeedback tool for optimizing substrate utilization during workouts and seeing what your body needs before you kind of hit the wall or bonk. There’s a lot more to say there, but it’s a really interesting topic. Lots of low carb athletes are emerging who are trying to do more fat oxidation during workouts for energy. And then there’s sort of the carb loading glycogen camp who are more focused on using carbs for energy during workouts. And CGM can really help inform that conversation. And then the last group I would say is people who really just want to be the optimizers, the biohackers, the people who want their optimal mental performance, get mood on point, optimize their sleep, and just want to be operating at the highest level by keeping glucose really stable throughout the day. So those are some of the people who have found value in it.”
56:54 – There is no one size fits all
Despite what traditional healthcare approaches might suggest, we are now seeing that everyone has different responses. A CGM provides that feedback from the body to guide individual choices.
“I think a lot of times the healthcare system and dietary philosophies try to make us feel a little bit like there’s a one size fits all approach that’s going to work. And we kind of know that’s not true. And so having tools to figure that out for yourself, I think we’re in an exciting time where there’s more of that. And I think that tools are great. Digital health is great…The body can sometimes seem like such a black box. You put stuff in and then maybe down the road, your weight goes up or goes down. Maybe 10 years from now, you get diabetes. And it’s like, what was the link? And what were the variables that led to that? And being able to, in minutes, understand how different variables are affecting that overall output, which is the glucose data stream. To me, it feels like years of mystery just kind of figured out. It’s not that simple. It does take time. I’ve been wearing one now for eight months and I’m still learning things. But I do think that the kind of maximum rewards, in terms of building intuition and learning, can happen in about a month. So I love that more people are using this almost as a mindfulness tool, you know, like understanding that feedback loop.”
1:00:34 – It’s about more than just what you eat
Food is obviously going to impact blood sugar. However the glucose response is also triggered by lifestyle choices like exercise, sleep, and stress.
“One night of sleep deprivation can increase your fasting glucose. One high intensity interval training workout can change your glucose for a week. One meal can shoot your glucose up to 200 and you can be sort of dysregulated for days, just from that one crazy excursion. And a really stressful phone call can shoot your glucose up 40 points, because cortisol is released and your body thinks you’re stressed and it tells your liver to dump out all its stored glycogen as glucose. That’s because it thinks you’re about to go fight a lion. And so it’s just, those things have such quick effects. Quickly seeing that closed loop feedback is I think really cool for people to build that intuition.”
1:03:58 – Simple adjustments can regulate glucose without changing your whole life
There are easy ways to alter habits to better regulate blood glucose, without giving up foods. This includes food pairings, activities like yoga, breathing, and high intensity will all impact glucose and insulin responses.
“We know based on research literature that a number of things can modulate a glycemic spike. So adding fat can modulate a carb load. In terms of glycaemic spike, adding protein can modulate a glycaemic spike from a carb load. Drinking, using some sort of vinegar like apple cider vinegar, including vinegar in a salad dressing with food can actually kind of improve insulin sensitivity. We know that cinnamon is an insulin sensitizer. We know that a really good night’s sleep, and especially this window between seven and eight hours, is best for metabolic health. We also know that yoga, deep diaphragmatic breathing, which lowers cortisol, and high intensity interval training all are positive for metabolic health. So let’s say you want to eat some beans or you want to eat something else that’s a little bit more carb heavy. Look into your toolbox of all those things I just mentioned these evidence-based tools for modulating glycemic response and pair some of that together to create the context, to kind of have the best response to that food.”
1:15:44 – Everyone has the power to improve their health
Dr. Means believes that lifestyle changes can improve health, reduce disease, and ease suffering.
“I wish that more people knew that we all have the power to improve our health and reverse disease and that nothing in health is static. I think if we can dial in food, sleep, exercise, and stress, just those four things, we can mitigate an immense amount of suffering on this planet and improve joy, our ability to fulfill our potential, and show up for our loved ones. So I would say on a practical level for people who are like, okay, well, that’s great. I’ve been trying to work on my food, sleep, exercise and stress, not getting me far. Which I think a lot of us do with that. What I would say is if you’re dealing with something and you just feel like the current medical system isn’t approaching it in a way that you feel like it’s necessarily getting at the root of it, take your symptom or condition or whatever diagnosis and put it into Google. And just put after it disease reversal or functional medicine or lifestyle medicine or plant-based diet. So ‘hypertension plant-based diet’, ‘depression functional medicine’, and start seeing what comes up there. It’s going to look a lot different than what’s on Healthline or WebMD. And you know, I think that’s just one start in terms of moving down a different thought process. I know I’ve had lots of patients in my functional medicine practice who have come to me after years and years of trying medications and procedures and this and that, where it was one book or one article that opened their mind to sort of thinking a different way.”
Dr. Yami Cazorla-Lancaster [00:00] You are listening to Veggie Doctor Radio. And this is episode number 105. Hey, I’m your host, Dr. Yami. I’m a board certified pediatrician, certified health and wellness coach, author, and speaker. I’m also a passionate promoter of the power of diet and lifestyle in preventing and reversing chronic disease and bringing joy and longevity into our lives. This podcast is focused on plant-based nutrition, habit formation, motivation, and mindset, so that you can have the tools to live the best life possible. Are you ready to get started? Let’s do this.
Casey Means [01:04] Because metabolism is just fundamentally how we process and utilize and get rid of sort of energy in the body, which every cell needs energy to survive, metabolic dysfunction is tied in with such a huge plethora of different problems and is really a common denominator in so much of what we’re seeing in this country.
Dr. Yami Cazorla-Lancaster [01:24] Hello, hello, veggie lovers. Happy Sunday. I hope that you are having a very fantastic day today. I have super interesting episode for you from one of my new friends, Dr. Casey Means. You guys know everybody that comes on my podcast becomes my instant friend because all of my guests are awesome, but Dr. Casey Means is really awesome. She’s super smart. She knows about metabolism and she is the chief medical officer of a metabolic health company called levels. So it’s super cool. We’re going to get a little bit geeky and sciencey in this episode, but hopefully we’re able to break it down in a way that you can understand because you know, I made sure that we went back and we clarified everything we were saying so that you understand what role continuous glucose monitoring may have in your life. So this technology has been around for a little bit, you know, it’s newer technology, but we’ve known about it for a little bit, especially with our diabetics, especially with the type one diabetics. And when they first started coming out with devices that other people could use, I was like, “Eh, I don’t think I’d ever need to use that. I mean, I eat a healthy diet. I hardly ever eat any processed foods, mainly whole foods. I’m very active. I feel great.” But after talking with Casey, I am very intrigued. Now I’m super curious. Now I can’t wait to get my hands on one of these devices so that I can get some insight into how different foods may cause variations and spikes in my blood sugar levels so that I can optimize and I can feel good and live longer, healthier. So we’re going to talk all about that. We’re also going to talk a little bit about racial disparities, racial inequities. We’re going to touch on it because right now we’re in the midst of a lot of racial tension in our country as we’re recording this episode. So we’re going to touch on that, but I definitely want to bring this topic up again in the podcast and have somebody come and talk about it in depth. Brooklyn Borough president, Eric Adams definitely touched on it, but we just had to do a really short interview because he is a very busy man. So I definitely want to continue this topic. So if you like that topic, don’t worry. We’ll continue the conversation. We just barely scratched the surface on some of the complexities in our healthcare system, the different ethnic groups, different races, and what they’re faced with when it comes to chronic disease conditions, access to food, access to healthcare, it is a very big topic. So we’re going to talk a little bit about that, but mostly we’re going to talk about metabolism, continuous glucose monitoring, how it can be applicable to the regular person out in society that does not have diabetes and all about different ways that you can utilize this technology. And we’re going to touch a little bit on how different foods and food pairings can affect your sugar levels, your glucose levels. It’s a great episode. Dr. Casey Means is fabulous and she explains things so well, so I know you are going to love it, but before I talk more about her, I want to remind you to join my newsletter mailing list so that you can be the first to hear about episodes, events, challenges, prizes, cool stuff. All right, it’s cool. Okay. Join my newsletter. You can do it two ways. You can text the word fiber F-I-B-E-R 2-6-6-8-6-6. Or you can go to dryummy.com/signup. In addition, thank you for reading my book, A Parent’s Guide to Intuitive Eating, How to Raise Kids Who Love to Eat Healthy. And I want to read a five star Amazon review by Zach Turner titled, “What A Relief.” What a relief to learn that it’s actually healthier to forego the dinnertime food negotiations that we feel compelled to do in the interest of eating more vegetables. Instead as a parent, just offer good options and structure and trust our children’s internal guidance. The philosophy is surprisingly simple, and laid out clearly while being realistic about how challenging parenting actually is. We’ve been practicing this philosophy with our toddler with great results. This book is well-organized and easy to read, and it’s refreshing that the author is open about her own path to intuitive eating for herself, and as a parent. It has just enough recipes to spark some ideas.” Thank you so much, Zach Turner. I appreciate that review. And I’m so glad that the book has helped you and your family find some joy and ease at the dinner table. Remember that the information on this podcast is for informational and educational purposes only. It is not meant to replace careful evaluation and treatment. If you have concerns about you or your child’s eating nutrition or growth, consult a health professional. Well, let’s talk about Dr. Casey Means. Casey Means, MD, is a Stanford trained physician, chief medical officer of metabolic health company Levels and associate editor of the International Journal of Disease Reversal and Prevention. Her entrepreneurial work focuses on digital health products to inspire healthy behavior change, reverse chronic disease and modernize health care by empowering patients with access to their personal data. Dr. Means has been featured in Forbes, Entrepreneur Magazine, Business Insider, Endocrine Today, Startup Beat, Healthy Human Revolution, Well Plus Good and more. And her writing has been recently published in thehill.com in metabolism with articles about the strong relationship between chronic lifestyle related diseases and COVID-19 mortality and innovative healthcare and policy solutions to ameliorate this. She is an award winning biomedical researcher with past research positions at the National Institutes, Stanford School of Medicine and NYU. Her clinical work focuses on functional and lifestyle medicine with an emphasis on whole foods, plant-based diet, mind-body connection, and physical activity as foundations of metabolic and overall health. Like I said, you’re going to love Dr. Casey Means, and I am super lucky because she lives in the Pacific Northwest. And once this social distancing phase is over, I’m going to go hang out with her and hopefully we’ll get to share some delicious plant-based food together. So you’ve been very, very patient. Thank you for sitting through all of my introduction. I really appreciate it. And now let us move on to this amazing interview. I hope that you have a very plantastic day.
Dr. Yami Cazorla-Lancaster [08:57] Dr. Casey Means, thank you so much for joining me today on Veggie Doctor Radio.
Casey Means [09:03] I am so happy to be here, Dr. Yummy, thank you so much for having me.
Dr. Yami Cazorla-Lancaster [09:08] So to all the listeners, Dr. Means, Casey and I, we had to spend about 15 minutes talking before I hit the record button today because we are just in very emotionally heavy, very strange times. You know, we’re still, some of us, socially distancing because of the coronavirus. And now we have racial tensions in our countries that are coming to the forefront, which is important. It’s important to have these conversations, but it just brings up so much emotion. It brings up so many ideas and it makes us confront some of the places within ourselves that are so uncomfortable and that we’d rather not talk about, but it’s time to talk about these things, though. What do you think Casey?
Casey Means [10:02] Absolutely. You know, we’re recording this on a Tuesday after a weekend of just seeing horrifying things in the news relating to racial tensions in our country and racial injustices. And, you know, before the call, we were talking a little bit about how this intersects with the food system and with healthcare. And I think that’s an area that is just not talked about enough. And I think that there’s a lot of hope in that arena if we can kind of, you know, orient a little bit around that. And I think, you know, especially with my practice being focused on metabolic health, I have been just absolutely astounded and horrified to see just such racial disparities in terms of metabolic health outcomes between different minority groups in our country. And so, you know, I think if there’s a way that we can bring a little bit more awareness to this and how there is really, you know, I would say systemic racism built into our food system and our food policy system. And it’s just really impacting this whole thing in a way that I think is almost invisible. And you know, the way that, you know, targeted marketing of processed foods to various minority groups, poor access to healthcare, food deserts. There are so many aspects of this that need to be improved to give everyone the best start for a healthy and happy life. And the numbers really speak for themselves in terms of how far we are away from where we need to be in terms of the metabolic health crisis and you know, and health care access and sort of racial inequities. So, yeah.
Dr. Yami Cazorla-Lancaster [11:50] So much to impact. So we’ll take that step by step, but I want to take a few steps back and talk about you. How did you become interested in nutrition and how did you land where you are today with the kind of practice that you run?
Casey Means [12:05] Yeah, well, I would say my interest in nutrition started really in college. I was at Stanford in the 2000s when it was sort of the height of the human genome project, 23andMe was getting started in Silicon Valley. And my big focus intellectually was personalized genetics. And within personalized genetics, I really became fixated on this field of nutrigenomics. So nutrigenomics is the intersection between food compounds and genetic expression. And this idea that the food compounds that we put into our body have the ability to up-regulate or down-regulate gene expression. And so this concept just floored me. You know, we are a genetic blueprint, nothing about our health is fixed. And by the choices that we make in terms of our diet and also our lifestyle, we are able to change the expression of this blueprint and can move the needle towards expressing our best health or expressing poor health. And so that was really fascinating to me, sort of the biochemical level. Later I went on, after medic, so that was undergrad where I focused on personalized genetics. I worked at 23andMe when it was early on, 2008, 2009, as a college student and then went to medical school, and then pursued a residency in surgery. So I was doing otolaryngology, head and neck surgery, colloquially known as ear, nose, and throat. And EENT was very interesting because while it’s a surgical subspecialty, it became super clear to me that a lot of these pretty much, most of the conditions we’re treating in that field are inflammatory diseases. So sinusitis is an inflammation of the nasal tissues, which causes, you know, the sinus outlets to be blocked. And then you build up pus and you get sinusitis. You know, ear infections that we see in kids and adult is the result of chronic eustachian tube dysfunction. Eustachian tube is the tube that equalizes the pressure between the ear and the nose. And when that tissue inside of it is inflamed, you get a backlog of bacteria and whatnot, and you can get an ear infection, otitis media. You know, vocal cord granulomas, which I was seeing. Those are inflammatory masses on the vocal cord. Hashimoto’s thyroiditis is inflammation of the thyroid. It’s all inflammation and. You know, we’re slinging out anti-inflammatory medications left and right. I was writing dozens of prescriptions a week for Flonase fluticasone, which is a nasal anti-inflammatory, for prednisone, which is oral anti-inflammatory for you know, inhaled corticosteroids for reactive airway disease. And after a little while, and when these medications don’t work, of course, you know, or you, you basically then are left with surgery as an option. So then it’s just like busting a hole in the eardrum to let the pus out, or busting a hole in the sinuses to let the pus out, or plucking out the granuloma from the vocal cord. And none of that actually addresses why there’s so much underlying inflammation. So the next step in that journey for me was saying, “Why do we have so much inflammation? What is inflammation?” Inflammation is the body’s immune system saying, “Oh, there’s a threat. And I need to just rev up and fight this threat.” And that can be any threat because you know, this is a body that’s all connected through a blood system. So the threat can kind of be anywhere and that immune activation can affect all parts of the body. And so really started digging deep about what are the root causes of inflammation? Why are our bodies just completely on high alert all the time? And that led me to PubMed where, you know, I was reading a lot and realizing that these threats to our body are the fact that we’re, I think are largely related to the fact that we’re exposing our bodies, our poor bodies to these food substances, and additives and environmental toxins and substances that we were never meant to encounter, not in the quantities or the process forms or the synthetic forms that we are now. And we are just creating this mountain of environmental and food stress on ourselves and our bodies and our genes that the body’s just kind of have no idea what to do with, I mean, the inflammatory system just revs up. So some of those that I think are big drivers are processed sugars, refined vegetable oils, huge quantities of animal protein, you know, and processed animal products, massive amounts of gluten and genetically modified foods and pesticides. You know, these are unnatural, especially in the quantities that we’re eating them in and put our bodies on high alert. So, you know, as an EENT, I was kind of disheartened, like, “Why are we not talking about this at all?” It’s just symptoms prescription or surgery, symptoms, prescription or surgery, and everyone comes back, same chronic sinusitis, you know, chronic ear infections. And I really began to believe that I feel like it’s because we’re not addressing this root cause, and talking about the source of this. And so that really solidified my desire to make medical nutrition and evidence-based medical nutrition, a huge part of my practice. And I really kind of shifted gears. I gave up surgery. I decided I wanted my life’s work to be, to keep people out of the operating room. There were a lot of surgeons out there, but there’s not a lot of doctors thinking about how to use food as medicine. I think it’s growing like you and others and in our plant based network. And I’m really excited about that. And I really wanted to be a bridge between those two worlds. And, you know, anyone who thinks, you know, nutritious kind of fluffy or whatnot, like I would say it’s the opposite, you know, chemically, there’s so much evidence to support its importance in, you know, the chronic diseases that are plaguing our country and our population, you look at something like obesity and diabetes, which are just, you know, ravaging our country. You know, you got upregulation of interleukin six and TNF alpha two inflammatory cytokines, that’s well-established. Those are the exact same cytokines that are upper grade and sinusitis, you know, and we know that healthy plant-based diets and avoidance of pro-oxidant foods and high and refined carbohydrates can actually decrease IL-6 and TNF alpha. So it’s all linked on the deepest biochemical level. And that’s sort of, my mission is to help people understand that and help my patients with that. So that’s kind of where I’m at now and why nutrition is such a big part of my practice.
Dr. Yami Cazorla-Lancaster [18:36] Wow. That is so inspirational. And, you know, it’s, I just have to commend you because you had guaranteed work for life. You know what I’m saying? Like, you know, you know this right? You could stay at EENT. And like you’re saying, it’s like people just keep coming back and coming back. And I know as a pediatrician too, I’m thankful because I have a very healthy patient population because families kind of self-select to come to me because of the way I practice. So I don’t see as many of those cases in my current practice, as I did my past practice, where it was very frustrating. And then the tubes fall out and you still have the problem, you have to get the tubes back in and the sinus, recurrent sinusitis, and the thing that you didn’t touch on too is yeah, you’re using all these steroids, but the antibiotics, the recurrent antibiotics, which is killing the gut microbiome and they just get this vicious cycle and it just like, “Oh, it’s just like never ending.” So you went from having assurance, job assurance forever to now focusing more on nutrition, which can be very difficult for some people to believe, like you said, accept or be willing to make changes in their life in order to decrease the risk or even reverse this inflammation that they’re having in their body. Before we go on a little bit more to metabolism, because I definitely want to define that for the audience, can you tell us what functional medicine is?
Casey Means [20:11] Yes, absolutely. So functional medicine has a lot of overlap with lifestyle medicine, which I think probably a lot of your listeners might be familiar with. And basically this is an approach to health care that addresses the root causes of disease and symptoms and aims to reverse the conditions that lead to them. So the premise is that symptoms don’t arise out of thin air. They arise out of cellular dysfunction. They’re not a mystery, there’s something going wrong in the machinery of our body. And so instead of just identifying a collection of symptoms, having pattern recognition, naming it, and then slapping the drug or surgery on it to “fix it,” functional medicine takes this deep root cause approach and thinks about what is actually going wrong in the body, and works to correct that. So, you know, like I mentioned before, like often what is going wrong is that, you know, cellular machinery is sort of gummed up because of external stressors, like diet toxins, chronic stress, sleep deprivation, lack of physical activity, all of which translate to biochemical reality, our nervous system through our hormones, through our microbiome and can cause us dysfunction. So, it’s really, it’s a really biochemistry based approach to disease reversal, and moves away from the paradigm of reactionary, sort of sick care, to more proactive health care. And it’s just been really fun and I would say totally reinvigorated just my passion in health care because you really see some amazing transformations when you change the conditions that are leading to symptoms and move people away from this idea that symptoms or disease are a fate or a destiny and give them this knowledge that is so empowering that we totally have the power to move along the spectrum of health or disease. It’s not a one-way street. It is a two-way street and changing the conditions are the foundation of that. So.
Dr. Yami Cazorla-Lancaster [22:15] I love it. Yeah, I definitely wanted the audience to understand it because there’s not that many physicians practicing functional medicine. I think it is a growing field. So not a lot of people know what it is, but also like you said, It’s very different from the traditional medical approach, which is like, “Okay, what drug or surgery can I do to treat this?” Instead of how can we stop it from happening in the first place? How can we go all the way to the root cause to stop the actual process instead of just putting a Band-Aid on it all the time.
Casey Means [22:50] Yeah, definitely. And I would say there’s, you know, while there is a big impetus, I think, in the field to use dietary and lifestyle factors to change conditions that help optimize cellular function there’s definitely still a recognition of the huge role and benefits of medication and the procedures for certain health conditions that’s just becomes one tool in our toolbox. Whereas all these other evidence-based tools, which often can kind of get neglected in the fast paced, hurrying environment of our healthcare system these days, and the stressors that doctors are under and just the way that medical education is shaped that we kind of forget to use. And so it’s fun to just kind of expand that, that set of options. And yeah, and I would say for those listening who are interested in that and approach, there are some great authors out there to kind of get started. I would say Mark Hyman, who’s an MD, who’s the head of the Cleveland Clinic for Functional Medicine. And he has written some wonderful books about functional medicine. Sarah Gottfried who’s an OB GYN functional medicine, Terry Walhs, who is an MD who kind of used a functional medicine approach to reverse her multiple sclerosis, and Dale Bredesen who wrote The End of Alzheimer’s. And he’s a neurologist who talks about Systems Biology, functional medicine approach to reversing neurodegenerative disease. So those are some people who I would kind of just maybe Google and if you wanted to start reading some books about functional medicine.
Dr. Yami Cazorla-Lancaster [24:26] Awesome. Great. All right, so let’s get into the meat of this. Can I say that?
Casey Means [24:34] The tofu steak of the.
Dr. Yami Cazorla-Lancaster [24:36] Into steak can. Just joking. Okay.
Casey Means [24:39] Exactly.
Host [24:39] Let’s talk about metabolic health. Can we define what this means? What does it mean to be metabolically healthy?
Casey Means [24:49] Yes. So at the highest level metabolism refers to how we process energy in the body. So whether it’s processing carbohydrates, fats, or proteins, our bodies are basically supposed to be able to digest what we eat, process it, utilize it, store it, excrete it as waste, and then be done. But now with this unbelievable increase in the amount of food, we have access to food substances, coupled with decreases in physical activity, decreases in sleep quality and amount over time, we’re kind of just overloading our systems, our energy processing systems, particularly the poor mitochondria, which are the cellular organelles that convert fat and glucose to energy. They have just such a massive abundance of these substrates and they just are not working properly. So what happens is we get inefficiency in the metabolic system that results in excess circulating glucose, excess circulating lipids, which can, you know, the excess glucose can be turned to fat as triglycerides stored and is constantly telling our body to pump out insulin, which is the hormone from the pancreas that helps cells take up glucose. And then we start getting numb to all this insulin building insulin resistance, and then it’s harder to get glucose into the cells. And then we’re just set up for metabolic dysfunction. And because metabolism is just fundamentally how we process and utilize and get rid of sort of energy in the body, which every cell needs energy to survive, metabolic dysfunction is tied in with such a huge plethora of different problems and is really a common denominator and so much of what we’re seeing in this country. So it’s tied in with diabetes. It’s tied in with cancer. It’s tied in with heart disease, high cholesterol, stroke, dementia, and Alzheimer’s, obesity, infertility, erectile dysfunction, depression, anxiety, all of these things touch glycemic dysregulation and metabolic dysfunction because metabolome is so fundamental to how cells run. And so when you feel like getting into the specifics of kind of how we track this. So first I’ll mention a UNC study last year, 2019 I believe, which showed that only 12% of Americans are metabolically healthy, and what they defined as metabolic healthy-healthy was having optimum levels of five factors. So it was blood glucose, under a fasting blood glucose under a hundred, so normal essentially. A healthy triglyceride level, HDL level, blood pressure and waist circumference without the need for medications. And if you met all those criteria, you were part of 12% of the population. And so 88% of people don’t meet that criteria. And this is, you know, paralleling our increased rates of all these chronic diseases, kind of that I mentioned. And so, yeah, so that’s kind of the broad overview of metabolic health. I would say the two diseases we think most closely related to metabolic disease are diabetes and obesity, and just to kind of give the broad overview of the impact of those diseases right now, you know, 74% of the country is overweight or obese. We have about 38 million Americans with type two diabetes, and about 90 million more Americans with pre-diabetes. And so about a total of like 120 million people with some sort of clinical metabolic dysfunction. Of the people with pre-diabetes those 90 million, 90% do not know it and most will go on to develop type two diabetes. And so it’s really, we’re dealing with huge, huge, huge numbers here. And, you know, it’s not a huge surprise. Over a hundred years ago, we were consuming about two pounds of added sugar per year, and now we’re consuming 152. So it’s like, how, how are we possibly, are our mitochondria supposed to deal with that? Our pancreas, our insulin receptors. And yeah, so that’s really what my intellectual and entrepreneurial and clinical practice focuses on.
Dr. Yami Cazorla-Lancaster [29:00] Yeah. I mean, that’s just, it’s just amazing because our metabolic system is so important and it uses a lot of energy to do all the processes it needs to do. And it’s so vital to everything in our bodies, but we don’t think about it because I think one of the good things is that the human body is so resilient. We can do so many things. We can eat all day if we want to, and all night and we don’t notice any problems, which is the harmful part, is that a lot of these things, we don’t start getting symptoms until it can be too late, sometimes, especially with heart disease, heart attacks. Sometimes the first symptom is the heart attack and, you know, people can be walking around with high blood sugars and, you know, maybe if they really were paying attention, they would start noticing that there’s some things off. But because we get so used to feeling a certain way, you may not notice it. And you know, when you, when you first started talking about what the definition of metabolic health is, you talked about excess calories, and then you talk about how much sugar we’re eating compared to, you know, a hundred years ago, we’re eating, in general, more of everything. We’re over-consuming everything. It’s not just sugar. It’s not just fat. It’s like every single thing we’re eating. We used to eat about three times a day. Now we eat seven times a day on average. So it’s like, we’re just eating a lot. So this is a really critical, important topic to be talking about. Well, your company focuses on continuous glucose monitoring. Let’s talk about what that is.
Casey Means [30:46] Yeah. So continuous glucose monitoring is a technology, CGMs is a technology that’s basically a wearable sensor. It’s a little teeny device that you wear on your arm with just a tiny implanted little filament under the skin that is continuously sampling glucose 24 hours a day, and sending that data stream to your smartphone. So this is a technology that is FDA approved for type one and type two diabetics to help them manage their blood sugars, that is part of the treatment paradigm for many as the replacement to finger stick blood glucose testing, which is where you take, you know, a small pen lancet, prick your finger and use a glucose monitors, see what the glucose is in your blood. This is, you know, painful, it’s costly and wearing a sensor gives you, you know, huge amount, more data and gives you much more of, sort of this closed loop feedback between individual dietary and lifestyle choices and how the glucose changes. And so in closing that feedback loop, you can start to make better and you can start to generate better intuition about what’s actually happening between actions and reactions. And I think, you know, it’s interesting when you were talking just previously saying, you know, people, metabolic health is so odd because it’s so important, but we don’t really understand maybe until it’s too late, you know, like the impact of this on our overall health. And I think something that’s helpful about CGM technology is that it does sort of build some more of that awareness. So for instance, well, I personally think that one issue is that there’s just not a lot of information or education out there about all the different symptoms that actually are related to blood sugar that we don’t even realize. So for instance, acne is significantly tied to glycemic variability and poor glucose control. And there’s a number of studies, randomized controlled studies, looking at people going on a low-glycemic diet and improving their acne over 12 weeks. Same with something like infertility, which you might not associate with glucose dysregulation. PCOS, polycystic ovarian syndrome, which is the leading cause of infertility in our country of which rates are rising, is considered a metabolic disease. It is associated with really high rates of type two diabetes. You know, almost half of people with PCOS will develop type two diabetes by the time they’re 40. And the thought is that the high insulin in the body from hyperglycemia, it’s affecting the ovaries, causing the ovaries to produce more testosterone, and that’s having an impact on fertility and menstrual regularity. And so, and there’s a number of other examples like that, like anxiety, a big glucose spike and a crash after a meal can lead to anxiety, through postprandial hypoglycemia. And so by seeing with CGM, maybe some of these like reactions you’re having, and like then knowing that there’s a link to some of these health conditions, it can start building, taking out some of that mystery in life of like, “Why is all this stuff happening to me?” You know? And actually giving some more concrete evidence of maybe one biologic link that might be leading to these problems and pain points in life. That is super easily actionable. Something that you can change and effect in minutes, you know, you can lower your glucose with five minutes on the stationary bike. You can lower your glucose with your next meal. And so anyways, this is all to say kind of jumping the gun that, while this is a technology for, that is FDA approved for type one and two diabetes management, there’s actually potentially a role for really anyone who’s trying to gain more clarity, granularity into how their diets and their lifestyle choices are affecting their overall health, their mood, their performance, and their risk for future disease. So.
Dr. Yami Cazorla-Lancaster [34:50] So fascinating. It’s so interesting. And yeah, and you know, this is still newer technology, even for people that have diabetes. I mean, this is not something that’s been out for a huge long time, and it has changed lives for people with diabetes, because it gives them more information. But let’s take a step back and explain a little bit more, because for people that have diabetes, especially for type one diabetes, they don’t make any insulin at all. So if they don’t use external insulin that they give themselves and they eat, their blood sugar is just going to keep rising and rising and rising. So it’s really important for them to monitor their sugars so that they can give themselves an adequate and appropriate amount of insulin. So that makes sense, type two diabetics, you know, it’s a little bit different because they have developed insulin resistance. So they actually may make a lot of insulin, but their cells are not responding to it. Again, they need to check their blood sugars. They may need to give themselves extra insulin because they’re insulin resistant. But what about just the average person in society? So they don’t have, you know, they make insulin, maybe they don’t have insulin resistance. So why would they care what their individual blood sugars are? What, like, if they’re fasting, blood sugar in the morning is normal. They have a normal hemoglobin A1C, how much do these individual variations in between those measures matter?
Casey Means [36:21] That is such a great question. So first, I would say that these markers like fasting glucose and hemoglobin A1C or what I would consider static glucose markers. So they are single snapshot points in time and don’t give a full picture of the hugely dynamic process of glucose that is going on in the human body and the constant fluctuations in metabolism that happened 24 hours a day. And so these metrics kind of artificially create this idea that there is a threshold in the body that is problematic. And if you don’t meet that threshold, that you’re totally fine, which from a biologic perspective, isn’t totally true. Like we know that health is a spectrum. There’s not like one day you wake up and your fasting glucose is 101 milligrams per deciliter, and all of a sudden you’re pre-diabetic, and you were fine the day before, and you’re not fine today. It’s more likely that it has been years to decades of marching along the spectrum of insulin resistance through thousands and thousands of choices that ultimately led to that day when you know, you happen to be up at 101 and you go to the doctor and they say you’re pre diabetes and they give you Metformin and, you know, now you’re in this category. That’s, you know, not, on a biologic perspective, how it works. It’s not, we’re not a light switch that turns on and off. The same is true for a hemoglobin A1C of 6.5 or above, which would be the criteria for diabetes. You know, for those who don’t know, hemoglobin A1C is a sort of a three month average of blood glucose and it talks, it refers to the percentage of red blood cells that are glycated that have sugar attached to the hemoglobin. And so 6.5% would be considered meeting a threshold for diabetes. So I think even that diagnostic criteria, it almost sets this psychological framework that is unhelpful. That like, “We’re fine. We’re fine. We’re fine. Now we’re not fine,” because within this whole spectrum, even when you meet clinical threshold, diagnostic for diagnostic criteria, you’re still able to move backwards on that spectrum. And especially in the early stages, it’s easier. So, that’s one piece I would say. And I think that, even in the non diabetic glucose ranges. So even when you haven’t met that threshold for pre-diabetes, there is still evidence that as you move up along that spectrum towards a hundred, which is the threshold for pre diabetes for fasting glucose, you’re still more at risk as you move up in that category. So there was a really interesting New England Journal of Medicine study from a few years ago that looked at healthy men and showed that as people’s fasting glucose moves from 70 milligrams per deciliter to a hundred milligrams per deciliter, if you broke that group from 70 to a hundred into quartile from 70 to a hundred, they increased their risk of developing diabetes by 3.5 X on the odd ratio. So if you were up closer to a hundred in that higher quartile, you were much more likely developed diabetes than if you were in the low seventies. So even within that spectrum, you’re kind of constantly marching up your risk. And the same is true of other conditions like stroke. There’s a really interesting study, I think it was in the journal circulation, that showed that even within non-diabetic fasting glucose ranges, as you increase within that range, you increase your risk for hemorrhagic stroke, thromboembolic stroke, ischemic stroke, and all cause mortality. So it’s not like we’re just safe because we’re not meeting that threshold. We can always optimize and get into the healthiest levels. And based on the research, my review of the literature of looking at a number of studies and increased risk of various diseases of people in the normal fasting glucose range, it looks like really between 72 and 85 would be like the healthiest fasting glucose ranges. And yet right now we tell anyone under a hundred that they’re “fine.” The third piece that I think is probably maybe the most important piece is the concept of more dynamic markers of glycemic trends and their impact on health. And so that’s like concept that, it’s called the glycemic variability. So this is referring to really more the dynamic trends in glucose throughout a day. So unlike the one point measurement of fasting glucose, or one point of post-meal glucose or an average metric of glucose, like hemoglobin A1C, this is looking at the swings in glucose throughout the day, how high they go, how low they go, glycemic excursions. And what’s interesting is that a lot of recent research has showed that glycemic variability can actually be potentially more harmful to health than sustained high glucose levels alone. It’s not that excessive peaks and dips in glucose can lead to a variety of tissue damaging sort of metabolic byproducts like free radicals, endothelial dysfunction, which is damage to blood vessels, damage to nerves, it can trigger inflammation and can also activate the stress hormone cascades. So like the sympathetic nervous system. So we already know that glycemic variability, these swings increased in people as they move along the continuum from normal glucose regulation towards diabetes. And as someone becomes more insulin resistant, they also tend to show more variability in their glucose levels throughout the day. But we also know that just a normal person without an elevated fasting glucose or an elevated A1C can have quite a bit of glycemic variation just from what they’re eating, how they’re living, how they’re moving, how they’re sleeping, these are all things that affect our glucose throughout the day. So anything we can do to basically keep that glucose line stable and in sort of the low normal range is going to be good for our fundamental health and reduce, you know, our propensity to generate free radicals, inflammation, endothelial dysfunction, stress hormones, et cetera. And in using that data stream to basically modulate our dietary choices, inform our, what we choose to eat, how we choose to pair foods, how we choose to, you know, manage our stress and exercise and how much sleep we get, all of which are factors that impact glucose control, we can make that line narrower and more stable and in doing so, reduce our risk for chronic disease or reduce our risks for all these various symptoms that I sort of alluded to, and also just increase our mental performance, our mood, our athletic performance. These are all things that are associated with glucose stability in the research literature.
Dr. Yami Cazorla-Lancaster [43:10] Wow. That’s incredible. I did not know that. What would be a good range? Because obviously we have to eat, right? So our glucose is going to rise when we eat, which is a good thing because we want to take sugar into our blood vessels so that we can have sugar to uptake into ourselves. So is there a range that would be ideal to stay within?
Casey Means [43:35] So, if you- So there have been a number of studies that have been done looking at continuous glucose monitoring profiles in healthy non-diabetic individuals. There’s about five or six that have been done. And I actually recently reviewed those in an article I wrote on the Level’s Health blog called sort of, I think it’s called The Ultimate Guide to Healthy Glucose Levels. And what you found in those studies, which were again done in, they were not interventions. They were just observational studies, slapping a CGM on a healthy non-diabetic person. And what they found is that average 24 hour glucose is typically around a hundred to 105 that, milligrams per deciliter, that post, that within a 24 hour period, people should spend about 90% the time between 70 and 120 milligrams per deciliter, and should pretty much never go above 140 milligrams per deciliter. Right now, one of our diagnostic tests for diabetes is an oral glucose tolerance test where you pound, you know, this 50 or 75 gram glucose drink, glucola, and then look at blood glucose at one hour or two hours. And if you don’t go, if at two hours, you’re not above 140, you’re considered, you know, non-diabetic. And what’s interesting is that, I think based on some of these studies with CGMs and how many people, I would actually say that that’s probably too lenient, because we should really never be going above 140 and should certainly be coming down to normal by two hours. And so yeah, so meaning 90% of the time between 70 and 120 average 24 hour glucose, less than about 105, and pretty much going up and going down after a meal within two hours with a peak around 45 minutes to an hour. So that’s just what you see out there. And I would argue that that’s great, but there’s probably actually room for even improvement within those ranges. And what that stems from, from my perspective, is that when you look at some of this other literature looking at, like I was mentioning the New England Journal of Medicine paper, the circulation paper that actually probably for optimal health, you’re looking at even tighter ranges, especially for fasting glucose. And so there may be, but the bottom line is there just has not been a lot of studies in non-diabetics about what is the healthiest glucose levels. And that’s something that’s kind of an exciting and promising thing that we might learn from more healthy people wearing these devices and kind of seeing what the trends are. So.
Dr. Yami Cazorla-Lancaster [46:19] Yeah, that’s super exciting. So tell me who would benefit from this kind of technology? Who would be the type of person? I mean, I’m imagining people, especially that have high risk factors within their family, they already know that there’s people in their family that have certain metabolic conditions, heart disease, diabetes, those kinds of things, but who else might be somebody that’s a good candidate for wearing a continuous glucose monitor?
Dr. Yami Cazorla-Lancaster [46:48] Hmm, great question. I think, yeah, you nailed it on all of those, like people who have risk factors or sort of unexplained symptoms that they may have an inkling that it’s related to blood sugar from something they’ve read online, and they just kind of want more information, but I would say kind of specifically segmenting people who might benefit from this, I’ll really speak to the people who have organically sort of sought out our product at Levels, which, just a brief sort of overview of what that is, is we’re a digital health company that is allowing people who are not diabetic, so healthy individual’s access, facilitating access to continuous glucose monitoring technology, and then overlaying software on top of the glucose data stream that helps people parse out exactly what’s happening with that data. It helps you make data-driven decisions about what to eat and about all the different factors that are affecting their glycemic control. And so we have a telemedicine network that we’ve partnered with that evaluates people for prescriptions for continuous glucose monitors. Currently it’s- Many doctors are not really familiar with this technology, especially for the use case, as a biofeedback tool for non-diabetic individuals. And so, they may not understand this benefit or utility and write a prescription for this. So we’ve partnered with a telemedicine network who can evaluate patients for this, and if deemed safe and appropriate, these prescriptions are fulfilled by a partner pharmacy that we have, the devices are shipped to patients, a month’s worth of sensors, which is two sensors because they each last on the arm for 14 days and then access to the Levels software, which helps parse out the data, so you can make these data informed decisions. So we are a pre-launch company. We have not yet done a full launch. And we’re working with a small group of individuals. We’ve had about 4,000 people, sorry, 400 people go through our program thus far, giving us feedback on the software and the process to really optimize it and make it most useful. And we’ve learned so much from this population about who, you know, who can benefit and, and how it can be most useful. And within that group, what we’ve really seen is that one big contingent is people who aren’t just hungry for objective information about their health, especially in regards to how to shape a personalized diet. So I think there are so many dietary philosophies out there right now. There’s keto, there’s plant-based, there’s caveman, you know, there’s paleo and it almost feels like warfare between these different nutritional factions. And I think people are just hungry to know, like, how is food affecting me? Like what is happening in my body? Kind of cut through a lot of the rhetoric. And I think this tool can really serve as a biofeedback tool for those people to help them pretty rapidly shape a diet that’s going to have a least metabolic impact for them. So. For instance, you can, you know, you put it on, go through this month, program with Levels, which is, you know, going through two sensors using the software. We call this a metabolic awareness program for one month. And by the end of it, they may have identified a number of foods that just really cause huge glycemic spikes for them. And they had no idea and they can finally understand how their symptoms, their day to day sort of subjective reality of life was related to some of these glycemic excursions and can kind of tailor their diet. On the flip side, so that’s sort of more the limiting view of like, “Oh, this can help you eliminate things from your diet,” but we’ve also seen the opposite, which is that people on strict diets have actually been able to liberalize their diet by figuring out things that work really well for them. So we had this wonderful woman who went through the program, who was a keto, you know, influencer on Instagram. And she used the product and she realized that there are actually a number of plant-based foods, like things like carrots and others that did not cost glycemic excursions for her, even though they’re typically no-nos on the keto diet, also beans. And so she was actually able to finally liberalize her keto diet by knowing that these were not going to bond her out of ketosis, even though the blanket keto diet says you should avoid these. So, the first big group is people hungry for objective information about health who want to personalize their diet. The second group I would say is people who are wanting to lose weight and feel like they’re stuck. So, we’ve found a number of these people have come to us. And, you know, I think Jason Fung wrote the book, The Obesity Code and The Diabetes Code and talks a lot about more the endocrine hormonal theory of weight loss. So moving past this idea of calories in calories out, and really thinking about the biochemical aspect of weight loss that a lot of people have read these books and are interested in learning more about glucose and how to manage it so that they can lose weight and sort of briefly touching on that, the concept is that insulin, which is a hormone released and we have high blood glucose, is actually a anabolic hormone. It’s a hormone that helps us build things in the body. It’s what helps us store fat and actually blocks our mitochondria from burning fat. So if insulin is high, it is very difficult to lose weight. So by using continuous glucose monitoring and Levels software, to kind of understand how much your food is impacting your glucose levels, you can theoretically sort of by proxy, understand how your insulin levels are doing and get into more of that low insulin, fat oxidation, fat burning state. So that’s been really interesting. And I think a key point to kind of mention there is that some people might say, “Well, why don’t you just follow a low-glycemic diet? Like just go online, print out a chart, and then use that.” But recent research has suggested that these glycemic index charts actually aren’t super valid for individuals. They’re sort of valid on the population scale, but each person, when they take a bite of food is actually going to process that food completely differently in terms of how it translates into glucose in their bloodstream, things like their microbiome, the sleep they got the night before, their exercise, their body type, their hormonal , their genetics. All of those things actually change the way we convert in food intake to glucose in the bloodstream. So, you know, I could eat a banana and maybe only go up five points on my glucose. Someone else could eat a banana and go up 50 points. And we’ve definitely seen this across our user population and this amazing paper done out of the Westminster Institute in Israel that was published in cell in 2015, which was called Personalized Nutrition by Prediction of Glycaemic Responses really showed how variable glucose responses are. So it really is a very personal thing. And you might be eating something that is, you think is not going to spike your glucose and insulin and be forting weight loss, but actually totally is. And so, that’s been an interesting population. I’ll just briefly mention the two others that we were seeing a lot, which is, people who are trying to optimize their athletic performance. So, you know, energy for workouts is basically just like your body figuring out whether to use glucose or fat and how efficiently, in the moment. And CGM can be a really interesting biofeedback tool for optimizing substrate utilization during workouts and seeing what your body needs before you kind of hit the wall bonk. There’s a lot more to say there, but it’s a really interesting topic. Lot of low carb athletes emerging who are trying to do more fat oxidation during workouts for energy. And then there’s sort of the carb loading glycogen camp who are more focused on using carbs for energy during workouts and CGM can really help inform that conversation. And then the last group I would say is people who really just want to, the optimizers, the biohackers, the people who want their optimal mental performance mood on point, you know, optimize their sleep and just kind of want to be operating at the highest level by keeping glucose really stable throughout the day. So, yeah, so those are some of the people who have found value in, and I think there’s a lot of other use cases that we’re just learning day by day.
Dr. Yami Cazorla-Lancaster [55:15] Wow. That’s amazing. And I’m definitely in that last group, because for me, how I make choices in my diet and my lifestyle has to do with my wellbeing and I want to feel good, and whatever information I can get to feel even better is I want it. So I’m totally excited about this technology and getting my hands on this eventually. But I wanted to make another point too, because you know, we do have these kinds of diet war sometimes even within the plant-based community, we have these diet wars of like, “This is better. No, this is better.” And I feel like this is going to help give objective data. And I think what we’re going to find is that everybody was right, you know? Because what you’re saying is that there could be one person that reacts this way to just eating fruits, but there’s another person that eats just fruits and they have very high spikes, which can actually maybe even lead to weight gain for them. So that’s, I mean, it’s super interesting how the human body, we know things in general, we have some good information. We have some good data on some generalizations, but I’m just really curious about these individual differences and how different bodies can be when they process foods.
Casey Means [56:34] Absolutely. It’s such a good point. And it’s really a beautiful point because it gets back to the individual, you know, and that we are all these unique, complex organisms that are interacting in super interesting ways with our environment. And there is no one size fits all. And, you know, I think a lot of times the healthcare system and dietary philosophies, they try to make us feel a little bit like there’s a one size fits all approach that’s going to work and we kind of know that’s not true. And so having tools to kind of figure that out for yourself I think is, we’re in an exciting time where there’s more of that. And I think that tools are great. Digital health is great. I also just like shout out for your book, Intuitive Eating- A Parent’s Guide to Intuitive Eating. I think that’s another piece to this as well, which is really actually like focusing on body awareness and you know, more of those subtle signals of, you know, satiety and hunger and this and that, that are also so important. Like really just being in tune with ourselves and how we’re feeling. And I think the two of those combined, like how to use tools to almost solidify your intuition and to help you trust your body more, is an exciting era. So, but I agree. I agree completely with that.
Dr. Yami Cazorla-Lancaster [57:57] Yeah. That’s what I was going to ask you, actually, because I wrote this down, I put biofeedback, I circled it and put stars next to it because I can imagine that, especially if you’re wearing this for a couple of months, you’re going to start to get more in tune with like, “Oh, okay. My blood sugar is dropping. This is what hunger actually feels like for me,” because, you know, some people say, “I feel this way when I’m hungry.” Other people say, “I feel this way when I’m hungry.” And some people are like, “I have no clue how I feel when I’m hungry. I don’t know.” You know? And so have you seen from your initial cohorts of your first group that’s gone through, have they given you that feedback that it’s helped them become more in tune with the different sensations in their body and what it means?
Casey Means [58:46] Absolutely. I think two words that we hear a lot in our extensive debrief and midpoint calls during the program is intuition and control. And so from the intuition piece, I think it is that closed loop feedback between action and reaction. The body can sometimes seem like such a black box. You know, you’re just, you put stuff in and then maybe down the road, your weight goes up or goes down maybe 10 years from now, you get diabetes. And it’s like, “What was the link?” You know? And what were the variables that led to that? And being able to, in minutes, understand how different variables are affecting that overall output, which is the, you know, the glucose data stream. It’s like, to me, it feels like years of mystery, just kind of like figured out. It’s not, it didn’t, and you know, it’s not that simple. It does take time. I’ve been wearing one now for, you know, eight months and I’m still learning things. But I do think that the kind of maximum rewards of building intuition and learning, can happen in about a month. And so I love that just more people using this almost as like a mindfulness tool, you know, like understanding that feedback loop. And because we know very, very well-established that variety of factors go into glycemic regulation, which include food, food combinations, and pairings, sleep, exercise, stress management, environmental toxins, all those things have an impact on, I would say environmental toxins being the least direct cause and effect, but that is known, you know, persistent organic pollutions can be mitochondrial disruptors, but I’ll kind of take that one out for now, but really like sleep, one night of sleep deprivation can increase your fasting glucose. One high intensity interval training workout can change your glucose for a week. You know, one meal can shoot your glucose up to 200 and you can be sort of dysregulated for days, you know, just from that one crazy excursion, and a really stressful phone call can shoot your glucose up 40 points, you know, because cortisol is released and your body thinks you’re stressed and it tells your liver to dump out all its stored glycogen as glucose that, because it thinks you’re about to go, you know, fight a lion. And so it’s just, those things have such quick effects that quickly seeing that, that closed loop feedback, is I think really cool for people to build that intuition. The second thing would be control. So people understanding their autonomy and their agency in what sometimes can feel like. Insurmountable, you know, choices and mixed messages. So we have access to so many choices. I may have access to so much information and sometimes I think it can feel so burdensome to know what the right option is, and that can create a lot of stress for people, especially around food and exercise. And so by just having a little bit of an answer, a little bit of clarity, I think it can relieve a lot of stress. And I think it creates a lot of freedom. You know, I’m disheartened by food marketing and by food claims and sort of, we have a very unregulated system in terms of how we label food and this and that. And to give people some of this power in their own hands, so from the bottom up, to be facing this food culture in this healthcare culture with just a little bit more power, to me, feels really exciting.
Dr. Yami Cazorla-Lancaster [01:02:23] Yeah, definitely so exciting and definitely so empowering to be able to say, you know, “This is how my body reacts. This is what’s best for me.” But you did mention food pairing. So can we talk a little bit about food itself? Are there any generalities that we can make? I mean, can we say that greens are good for everybody? Is it safe for people to eat beans? I really want you to say that it is because, you know, I’m being a pusher. So what can we draw from this in generalities? Is there anything?
Casey Means [01:02:56]Yeah, I think that’s a great question. You know, there’s that part of me who’s like the personalized medicine obsessed person, who’s like, we can’t draw any generalities, but which is kind of true. But I do think that the way I look at it is building sort of the right context for four different choices. So I am also a bean pusher. I love fiber more than anything. I preach fiber from the rooftop. I try and get most of my patients to try and eat 50 or more grams of fiber per day. You know, I eat beans every single day, multiple times a day. So I’m with you on that. But the truth is that some people based on their various biological hue may spike really high with beans. I don’t spike at this point at all with beans. I think my microbiome is like, “This is our food. We love it. We’re going to process it perfectly.” But what’s beautiful about a tool like this is that you can shape the context of the foods you’re eating that might be spiked, to make them work for you. So just as an example, if, we know based on research literature, that a number of things can modulate a glycemic spike. So adding fat can modulate a carb load in terms of glycemic spike. Adding protein can modulate a glycemic spike from a carb load. Drinking, using some sort of vinegar like Apple cider vinegar, including vinegar in a salad dressing with food can actually kind of improve insulin sensitivity. We know that cinnamon is an insulin sensitizer. We know that a really good night’s sleep, and especially this window between seven and eight hours is best for metabolic health. We also know that yoga, deep diaphragmatic breathing, which lowers cortisol and high intensity interval training all are positive for metabolic health. So let’s say you want to eat some beans or you want to eat something else that’s kind of a little bit more carb heavy. Look into your toolbox of all those things I just mentioned, these evidence-based tools for modulating glycemic response, and pair some of that together to create the context, to kind of have the best response to that food. So maybe that means adding two or three tablespoons of tahini to your beans, which is, would probably be like, you know, 30 grams of fat, the beans already have protein, which is great, but you could add some more protein by sprinkling some chia seeds or some flax seeds on top, which also has some fat. You could make a salad dressing with an ounce of Apple cider vinegar and make a dressing for the beans. You could do a high-intensity workout in the morning that you’re going to have a big bean load. So these are just examples of how to create context to make foods work for you. Nothing I think within the whole foods plant-based world needs to be off limits. We know that plants are beautiful for cellular biology and health. And if. It’s really just being smart about, you know, how you eat them. And sometimes eating whole foods, plant-based food totally in isolation on a bad day when you’re stressed and sleep deprived is not a good option. Like pounding a couple of mangoes when you’re not in a good context for that might not be the best thing. So it’s just thinking that bigger picture about it. If that makes sense.
Dr. Yami Cazorla-Lancaster [01:06:02] Oh yeah. Wow, that’s- And I love the way you put it, because it does make you think of all of these other factors when it comes to the complexity of our bodies and our metabolism, you know, it’s not just what we put in there, but what else we’re doing. And the other thought I had too, was just hormones. I’m imagining that for women around the time of their periods, they may have a little bit slightly different reactions to food. Is that true?
Casey Means [01:06:29]It’s totally true. Yeah. And this is starting to be studied more, but there do seem to be big differences in the luteal and the follicular phase of the menstrual cycle in terms of glycemic function. I’m sorry, glycemic trends. It does seem like estrogen has a positive metabolic effect and progesterone has a little bit more of a negative metabolic effect. And, you know, so there are certainly going to be fluctuations. To be perfectly honest, there was a nature paper about this actually, basically showing what I just said recently, but truly putting continuous glucose monitors on a large population of women and following them throughout their cycle and measuring hormone levels, that still needs to be done in a really high fidelity way. And I would be fascinated, but we do know that estrogen and progesterone have big metabolic effects. So.
Dr. Yami Cazorla-Lancaster [01:07:24] Yeah, I mean, we know this intuitively right, as women? We know this, I mean, but it’s fun whenever we can get science to show what’s actually happening in our bodies. And then we can take that information and apply it in a way that’s actually more health promoting for us. And that even makes me, helps us feel better. Like, “Is there a way that I can use food to manipulate my metabolism so that I don’t feel quite as anxious a day or two before my period starts?” You know? I would love to have information like that. That would be great.
Casey Means [01:08:00]I agree. A big shout out to, there’s a great podcast that touches on this, Alisa Vitti who wrote, I think, In the Flow is what it’s called. She talked with Dhru Purohit on the Broken Brain podcast and talks quite a bit about metabolic function, and basically how to use, yeah use our cycle as a way to tap into our super powers, you know, and how to like, understand where we’re going to be, have different strengths at different points in the hormonal cycle and brings in a little bit about how metabolic function fits into that, you know. We probably should not be working out the same way every day of the month, which is a bummer because I know you and I are both big Peloton lovers, but you know, I found that really, really interesting. So yeah, so that’s a great, it’s a great podcast for kind of a primer on that.
Dr. Yami Cazorla-Lancaster [01:08:54] Cool. Very good. I’ll find that and I’ll make sure it gets linked in the show notes. Okay. Really quickly, even though I know we got really into this, but can you just touch about, a little bit about racial inequities and racial disparities when it comes to metabolic health and maybe a couple of things that we need to think about in this area?
Casey Means [01:09:19]Yes. And thank you for bringing us back to this. So the health disparities in metabolic disease are horrendous in our country and we need to do so much better. Especially I think at the end of this conversation, I mean, we talked a lot about root causes of these things. And so, you know, just saying that, “Oh, this is, you know, this is something inherent to maybe this population.” Like that is not enough, that this is very much I think systemic in our food system and our public policy system. And so just to give some numbers, so, and you’re going to find different numbers from different resources, but looking at some sort of recently published data of age adjusted prevalence of diagnosed diabetes by race and ethnicity for people above age 20, you’ve got basically Caucasians with seven to 8% of the population with type two diabetes. Asian-Americans 8%. Hispanic Americans, 11%. African-Americans 12.6% and native Americans, 33% of the population with type two diabetes. And this is not accounting for pre-diabetes of which that’s going to be significantly, significantly more. And so that’s just, you know, I mean, 33% of people above the age of 20 in the native American community having type two diabetes is just, we need to do better. And I think some of the things to think about, first of all, I will just say anyone listening to this who has not listened to the episode with Eric Adams, Borough president of New York, he talks a lot about this in that episode, in the episode with you that came out, I think on May 31st.
Dr. Yami Cazorla-Lancaster [01:11:03] Episode 101.
Casey Means [01:11:05]Episode 101. It really, I think, painted the full landscape and I will not be able to do it justice, you know, super quickly, but that one, I think, beautifully painted the policy, the community, the agricultural system, the environmental implications, all of how this is related. And so I think that was, I would put a plug in for that, but I think we need to be thinking about, just a few things. You know, one, our targeted marketing of processed foods to different ethnic groups. We, some companies are spending huge amounts of money to basically get this marketing in front of specific minority groups, which I think is wrong. Access to healthcare, and then implicit bias within the healthcare system is a huge problem. Food access in certain communities is just abysmal. There are people in our country who have to drive 45 minutes to get a piece of fresh food and, you know, that’s crazy. So those are some of the things. And I think school lunches as well. So within the public school system, which is where many families, you know, children are getting a huge portion of their nutrition is through schools. And school lunches could not really be farther from metabolically healthy diet. And so, we really need to be thinking about this as we choose where to spend our dollars and our votes in terms of electing people who are going to be thinking about this and setting people up for success and building a system that helps set people up for metabolic health and overall success.
Dr. Yami Cazorla-Lancaster [01:12:37] Absolutely.
Casey Means [01:12:38]So yeah.
Dr. Yami Cazorla-Lancaster [01:12:38] And you know, I think sometimes when we look at statistics, especially when we’re breaking it down by race or ethnic group, we may just assume that it’s all genetics and, you know, there is the thrifty gene hypothesis and there are some, there’s definitely some theories that there is some genetic differences that can account for that, but it’s way more complicated. It’s very multifactorial and there are things in place in our society that’s going to naturally lead for these groups of people to have a larger burden of chronic disease. So really paying attention to that, really being open-minded and looking at that and thinking of ways that we can address this as a society. And, you know, so I love thinking about things like the blue zones and looking at ways that we can help everybody live in a society that nudges them towards healthful living, not just for nutrition, but for connection and for, you know, exercise and physical activity and those kinds of things. Obviously we’re not there yet, but how can we get there step-by-step so that we can all live longer, healthier lives? So thank you so much for addressing that.
Casey Means [01:13:59] Yes. Thank you.
Dr. Yami Cazorla-Lancaster [01:14:02] What do you wish more people knew?
Casey Means [01:14:04]Hmm, I wish that more people knew that we all have the power to improve our health and reverse disease and that nothing in health is static. I think if we can dial in food, sleep, exercise, and stress, just those four things, we can mitigate an immense amount of suffering on this planet and improve joy, our ability to fulfill our potential, and show up for our loved ones. So I would kind of just say on a practical level for people are like, “Okay, well, that’s great. I’ve been trying to work on my food, sleep, exercise and stress. Not getting me far,” which I think a lot of us deal with that. What I would say is if you’re dealing with something and you just feel like your current, the current medical system isn’t approaching it in a way that you feel like it’s necessarily getting at the root of it, take your symptom or condition or whatever diagnosis and put it into Google and just put after it, Disease reversal, or functional medicine or lifestyle medicine or plant-based diet. So, you know, hypertension, plant-based diet. Depression, functional medicine. And start seeing what comes up there. It’s going to look a lot different than what’s on Healthline or webMD. And you know, I think that’s just one start in terms of moving down a different thought process. I know I’ve had lots of patients in my functional medicine practice who have come to me after years and years of trying medications and procedures and is not, who it was one book or one article that opened their mind to sort of thinking a different way. So that’s one sort of practical idea. And I would say, you know, I wish more people knew about some of these fabulous leaders leading the charge in this way of thinking. You know, Michael Greger, How Not to Die. Neil Barnard, The Cheese Trap, Jeffrey Bland, The Disease Delusion, Dale Bredesen, The End of Alzheimers. You know, these are some authors, you know, I guess if there’s one thing I would say it’s like reading Michael Greger’s How Not To Die and just like start thinking that mindset disease is mutable. Health is a spectrum. We have power and agency, and there’s lots of people here to help in the healthcare community. And we’re happy to, we’re happy to do that.
Dr. Yami Cazorla-Lancaster [01:16:34] Love it. That was music to my ears. That was beautiful. Casey, what personal habit are you most proud of? How did you develop it and how do you maintain it?
Casey Means [01:16:34]Ooh, great question. I think. I would say that I am honestly right now in terms of habits, I’m most proud of my whole foods plant-based lifestyle. Growing up, I was very overweight. I struggled for years, you know, sort of not knowing what was the best diet to eat. There was some yo-yo dieting. And I feel like going whole foods, plant-based, has transformed my personal life mentally, definitely mentally, definitely physically, and has also done so for my intellectual pursuits and my professional practice. So now after going whole foods, plant-based I see food as a gift. I see food as a tool. I see food as the primary connection with which I relate to the earth and the greater cosmos. It’s the way that the bounty of the earth is coming into me and my body and helping basically turn the, pull the levers and turn the knobs that let me express the best version of myself. So the relationship has just become empowering and positive and rich with food. And I would say it all started with that kind of focus on nutrigenomics back when I was in college, understanding how food, which is the earth, is co-creating me with my genetic blueprint, and I just, yeah that’s just, going fully whole foods plant-based has taken that to the nth degree. And I think of food as almost a, not to get too philosophical here, but I think of eating is almost like a mystical experience of connecting with community, connecting with earth and you know, realizing that our potential. I think adding more recently in my life CGM to this equation has just amped it up a little bit more. It’s taken my whole food plant-based diet and made it even safer for me, I think, in terms of helping me eliminate things that were causing a lot of variability in my day and just kind of eliminate them and learn how to pair things properly so that I’m more, just from a glucose perspective, stable and then from a performance and mental perspective, more stable. And so, but root thing would be whole foods, plant-based. It’s just, yeah, it’s transformational.
Dr. Yami Cazorla-Lancaster [01:18:47] Oh, that’s so beautiful. I love it. So, I mean, I love how you’re able to go both directions. Like you’re obviously like such a brilliant person, so smart. You can like spew out. I’m not good at spewing out, like, you know, different journal articles and stuff like that. And there are good- You can do all that, but at the same time, you can bring it down to like the spiritual and the philosophical and combine those two things. I just, I love that. I find that so beautiful. So thank you for sharing that with us.
Casey Means [01:19:19]Thank you.
Dr. Yami Cazorla-Lancaster [01:19:20] Well, Dr. Means how can listeners connect with you and learn more about your company, Levels, and what services do you provide?
Casey Means [01:19:28]Yes, absolutely. Listeners can connect with me personally on Instagram and Twitter, which is @drcaseyskitchen. And you can follow Levels on Twitter and Instagram @unlocklevels, all one word. You can find Levels at www.levelshealth.com. And I would, if any of this, you know, interested people listening, and then they want to learn more, I would check out the levelshealth.com blog, which is just a backslash blog after the URL, which is a lot of articles I’ve written and that other metabolically health obsessed doctors and PhDs have written about this topic, and really goes into more detail into a lot of the things we talked about during this conversation. So yeah, we’d love to hear from anyone interested in Levels and tell you more. And in terms of our offering, so right now, like I mentioned, we’re pre-launch, we’re in a closed beta program. Basically just refining our product with a small number of people each month. And we should be taking pre-orders likely later this summer, with a full launch later at the end of this year, early next year, when we can get this technology available to everyone. So we’re really excited about that, but for now, you know, sign up, put your email on our waitlist and our email list and we will get in touch and we’ll keep you in the loop. So.
Dr. Yami Cazorla-Lancaster [01:20:57] Awesome. And then how about your practice? Are you taking patients or are you closed right now?
Casey Means [01:21:02]I’m currently not. I am still running my practice, still working with existing patients, but not taking really many new patients. So really, really limiting my clinical practice right now. But certainly, can go to my website, which is www.caseymeansmd.com and shoot me an email and as things open up, I’ll be happy to reach out to people. So.
Dr. Yami Cazorla-Lancaster [01:21:28] Great. Well, this has been amazing and I know we probably could have talked for a whole another hour, because there’s just so much to talk about, but before you leave, can you please leave my listeners with a call to action for the week? What one thing can they do to improve their lives?
Casey Means [01:21:49]I got to go with, “Eat more fiber.”
Dr. Yami Cazorla-Lancaster [01:21:53] Yes!
Casey Means [01:21:54]There’s just too much research, you know, I just, it’s like, and I just think it’s, I’m like, “This is a public health crisis. Let me talk about other macronutrients, but it’s like, if we just all eat more fiber, I think there’d be a lot of good in the world. And our beautiful little microbiomes would be so happy. So in terms of practical things, I’d say I recommend 50 or more grams of fiber a day. Sometimes you have to ease up. You have to ease into that because a lot of big fiber load all at once can cause gas and your microbiome does need to adjust. But I’d shoot for trying to get 50 or more grams per day. It’s amazing for metabolic health. It lowers glycemic responses. Higher fiber diets are associated with lower rates of diabetes and obesity. And some of my favorites in terms of high fiber rich foods include every type of beans with black beans and pinto beans, being some of the highest fiber content, like nine grams per serving. I can have 3.5 servings, so you’d have a sprinkle of some beans on your salad and the side of your, you know, dinner and maybe a little bit on a veggie scramble for breakfast, and you’re easily at like 30 grams right there just with beans. And then other easy low-hanging fruit would be ground flax seeds, chia seeds, you know, two tablespoons of chia seeds have like 10 grams of fiber, any type of legumes, like lentils, mung beans, and then nuts and other seeds have great fiber. So it’s really not hard as long as you’re consciously thinking about adding it to each meal. So fiber, fiber, fiber.
Dr. Yami Cazorla-Lancaster [01:23:24] I love it. I love how we got so scientific. We’re talking about this technology and optimizing and all this stuff. And when it comes down to it, she says, “Eat more fiber.” Listeners, I hope you see that there’s a pattern in almost every single podcast episode when it comes down to it. “Just get more fiber in your life. That is a good start.” And then, you know, when you got all the fiber and you need to optimize, then let’s get those continuous glucose monitors going. Well, Dr. Casey Means, this has been absolutely such a pleasure. Thank you so much for coming on Veggie Doctor Radio today. And I can’t wait to see what happens with your company and all of this data and all the information that we get from this, but I really appreciate everything that you do for the world and for your patients. So thank you so much.
Casey Means [01:24:18]Thank you so much. This was an absolute pleasure. I just, so I could, I feel like we could talk all day and I am so grateful for the work you’re doing with the pediatric community, what you’re spreading on social media and through your podcasts and through your writing. And I just look forward to seeing everything you put out there. So thank you for this opportunity. And I look forward to talking soon.
Dr. Yami Cazorla-Lancaster [01:24:39] Thank you. And I hope that you have a very plantastic day. I hope that you enjoyed today’s episode. Thank you for tuning in. And I look forward to having you back again next week. A very special thank you to the band Rocket Surgeons for permission to use their Broccoli Song. To find out more about the rocket surgeons, please visit their website at rocketsurgeonsband.com or Facebook @rocketsurgeonsmusic. Please subscribe so that you never miss an episode. Also, all of my social media links can be found in the podcast description. Send me a message and let me know what you think of today’s podcast. Sharing is caring. Please share, rate and review my podcasts and drop me a line if you have ideas for future episodes. Thank you once again and have a plantastic day!