Dr. Casey Means stepped away from a career as a surgeon to focus on more foundational health research, focusing on what is causing chronic inflammatory conditions and what can be done to prevent them. Flash forward to now, Dr. Means is the co-founder and Chief Medical Officer of Levels Health, a metabolic health company that uses continuous glucose monitoring and integrated software to help people make better choices on a daily basis toward improved health. On this episode of Get the Stuck Out, host Austin Perlmutter MD talks to Dr. Means about her background in medicine, the glucose control epidemic, and how wearable technologies could someday soon be the key to treating chronic conditions.
3:03 – Our genetics are a blueprint, but our health isn’t predetermined
Dr. Means trained at Stanford Medical School, where she came to understand that when it comes to our health, we’re more empowered than we’re sometimes led to believe.
“The foundation of what I came to healthcare with was that we are these unique biochemical blueprints, but that really the difference between health and disease is how those blueprints are expressed. You know, this blueprint is not our fate, it’s not deterministic. It’s just a part of the puzzle. And you hear about this concept of like nature versus nurture, with nature being the genetics and nurture really being what happens after you’re born. But there’s really so much to that nurture part, so much the outcomes that we see in our health and our lives is how our environmental exposures affect our genome to express disease and those environmental exposures can be so many things. It can be what we eat. It can be the amount of stress in our lives or traumatic experiences. It can be how much or how little sleep we’re getting. How much or how little exercise we’re getting. What toxins we’re exposed to in our food, water, and air. All of these things can translate to molecular information in our body that changes the expression of that blueprint.”
19:26 – The medical profession doesn’t make room for healthy behaviors
While Dr. Means was a surgeon, she began suffering from lots of health problems from the stressful lifestyle. She realized that the medical system doesn’t promote a healthy lifestyle for doctors.
“I certainly was dealing with some brain fog. Like I was having trouble sometimes remembering what I’d learned the day before in grand rounds or something. And that was absolutely shocking to me. Because I had prided myself my whole life on my fact recall, that’s how you get through medical school. And so I was seeing me change and, you know, stepping back and reading The UltraMind Solution is all about the root causes of brain fog, depression, anxiety, all the different, you know, root causes that can lead to these symptoms. Any symptom in the body is a sign that there’s underlying dysfunction in yourselves. That’s really a foundational principle of functional medicine. And you have to then dig for what is that underlying dysfunction. So I’m looking at myself and saying, okay, I’m having some dysfunction in a number of different systems, what is going on? And you know that process of just, I would say, moving out of a state of like, what’s happening, this is so bad victimization to like, let’s understand this and figure out what’s going on. And that kind of led me to I think also having a really critical appraisal of the system, and the system of how we’re training doctors and of what conditions we’re putting people under who are supposed to be healers, and how much I think that that whole environment is setting us up for future problems. Because we’re not even approaching our own lives in a way that is generating health.”
28:23 – Increased sugar consumption has led to an epidemic
Our bodies need glucose for energy, but easy access to refined carbohydrates and refined sugars has led to high blood glucose levels and insulin resistance in adults. The result is chronic diseases.
“When the sugar is in the bloodstream higher than it’s supposed to be, three main problems can happen. One, it can drive chronic inflammation. Two, it can drive glycation, which is where sugar sticks to proteins and fats and other structures in the body and changes their structure, creates an advanced glycation end product, and that can cause dysfunction. And the third thing is it can generate oxidative stress. So reactive molecules in the body that can be damaging. You’ve got an insulin resistant problem. You’ve got glucose in the blood elevated, which is a problem. And then the third, the kicker is that when insulin is high, it’s a signal to the body, like we have plenty of glucose for energy. We don’t need to use fat right now. So it actually blocks fat burning for energy. And you get into this place where your body kind of forgets how to burn fat and because the insulin is just this break on it. And, you know, that’s of course associated with everything we’re seeing with 72% of the country being overweight or obese. 128 million Americans with pre-diabetes or diabetes.”
29:28 – Not burning fat leads to constant cravings
When our bodies reach a stage of no longer consistently burning fat, we tend to crave more carbohydrates for energy.
“If you can’t efficiently burn fat, then you can imagine anytime in your body when you’re not consuming enough glucose and you’re not really able to burn fat because your insulin is chronically high these days, that means that you’re not able to flip into fat burning when you have low glucose. And so that shows up in a lot of ways. It shows up with our chronic cravings for carbohydrates foods. We want that glucose because we’re not flexible enough to balance between glucose and fat burning for energy, and that’s called metabolic inflexibility. And that’s a big problem. So the more we can keep our glucose stable, keep our insulin down, the more our cells are going to be responsive to insulin or insulin sensitive.”
40:23 – Instant feedback lets you make instant changes
Sometimes we don’t know which thing in our life is making us feel bad. Is it our sleep, stress, or food? With a CGM, you can get a clearer insight into what is happening in your body.
“What I love about continuous glucose monitoring is that you can do this process where you have this sort of trifecta of behavior change, where you do something and then you have a subjective experience sometime later, you know, the next two hours or so. And that might be a little bit of lethargy or a little bit anxiety or something. And then you can scan the sensor on your arm and sort of see what happened. Was it the glucose? Was it the food I ate? The CEO of my company, he had this experience with oatmeal. He had oatmeal in the morning every day for like five years. He’d always kind of like late morning feel tired, kind of want to take a nap. And then the first time he scanned a sensor after eating oatmeal, he saw that he went up to 210 glucose, which is like very, very, very high. And he crashed to like the 55, which is too low and then came back up to like the eighties or nineties sort of. And once he saw that, he’s like, oh, it’s not the sleep. It’s not the coffee. It’s not the stressful work stuff. It’s the oatmeal.”
48:50 – Work your metabolic fitness like a muscle
Metabolic health isn’t fixed. It takes consistent, daily work just like physical fitness.
“So there’s all sorts of things that can keep us in sort of the best optimal category of metabolic health, really in that healthiest part of the nondiabetic range. And that is foundationally keeping our glucose spikes down every day. And I really like to think about it as working our metabolic fitness. You know, we think about building muscle as fitness, and we think about fitness as you do these reps over and over and over again and then over time you become fit. And the exact same thing is true about metabolic health and metabolic fitness. We have to put in the reps every single day to get to the state of optimal metabolic fitness. And those reps happen to look like keeping our glucose spikes low and not having these spikes and valleys, but much more sort of like gentle, rolling hills. Keeping our insulin under control and letting ourselves perk up to that insulin signal and be insulin sensitive. That’s the reps we have to do.”
Blood glucose management has to be personalized
Different foods impact people differently, as does amount of sleep, exercise or stress. The important thing is to track your own data and make necessary changes.
“So we’ve got food, stress management, exercise, and sleep all as levers we can pull to improve our metabolic fitness. It’s not just about deprivation. It’s about creating these nice contexts for keeping that glucose low and stable. And for each of us, it’s going to be different amounts of those levers and we have to really experiment and figure out ultimately for our own bodies, what do we have to do? And in what levels? What choices do we have to make to keep that glucose as stable as possible? But it’s kind of a fun experimentation process to sort of figure that out. What foods work for me, what amount of sleep works for me, and then to see the data it’s just so reinforcing. So that’s kind of what I would say about the continuum and ultimately I just want to really reinforce the message that it is not a one-way street. Like even if you’re in the pre-diabetic range, and even if you’re in the diabetic range, that is not the destiny. People have been able to reverse their diabetes, come back down to pre-diabetic or normal levels with just lifestyle and dietary interventions.”
58:04 – Glucose control needs to viewed as a public health crisis
Dr. Means believes that high glucose conditions constitute a severe health epidemic – and will be recognized as such in the near future.
“My prediction with metabolic health is that in five years, we are going to be talking about poor glucose control in the same way we’re talking about the opioid epidemic. It is shocking to me that we’re not talking more, that glucose is not on the tip of our tongues every single day, you know? And it’s not, certainly controlling glucose is not the panacea for health, but it is absolutely underlying so many conditions and exacerbating so many of the conditions that people are dealing with these days. And I think over the next five years, we’re going to see really an explosion of understanding about that. I think, especially as we move towards, you know, more of a value-based care system, or we’re really focusing more on outcomes over cost, we’re going to be looking for some of the more underlying like low-hanging fruit that we can intervene upon for many, many different diseases. And certainly metabolic health inflammation, these are going to be some of them.”
1:00:07 – Wearables are the future of effective healthcare
Wearables that track biomarkers throughout the day will be crucial in the prevention of many conditions that are caused by lifestyle choices.
“How people engage with the data and use it as a behavior change tool and tapping into these rewards circuitry pathways that we have in our brain, that is going to be also a key piece of, I think, where we’re moving in healthcare. And I think the more and more we realize at large that the vast majority of the conditions and the morbidity we’re seeing in the country, but also what’s contributing to our $3.4 trillion of healthcare costs, is conditions that are rooted in dietary and lifestyle choices. And until we address behavior change at scale in healthcare, we are not going to make a big dent in those conditions. We are not going to make a dent in those conditions by just giving medications and surgery. We are going to have to approach the behavioral aspects of those diseases. And I don’t think that’s going to happen in the doctor’s office. I really don’t. Doctors are not, we’re not trained to be agents of behavior change really. I mean, that’s not our core skill set. And I think we were going to need to outsource a lot of that to technology that does it more efficiently, analyzes the data better than a human brain can, and can be with a patient 24 hours a day.”
Dr. Austin Perlmutter: [00:16] Okay. Well. Hey, everybody, this is The Get The STUCK Out podcast. I’m Dr. Austin Perlmutter. And today, I’m so excited to have the pleasure of hosting a friend of mine, an accomplished physician and an all-around impressive person. This is Dr. Casey Means. Let me give you a taste of her background, because I think you will be as impressed as I am. She did her MD training at Stanford. She is currently the chief medical officer and co-founder of an amazing company that we’re going to talk about, called Levels, and she’s also the associate editor of the International Journal of Disease Reversal and Prevention, kind of important stuff. Her mission is to maximize human potential, to reverse the epidemic of preventable chronic disease by empowering individuals with tech enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. She’s had her perspectives featured in a number of different sources, everything from Forbes to the medical journal Metabolism and she’s done research with NYU, with Stanford and the NIH. You may have already heard of her and her perspectives because she’s been doing lots of podcasts where she’s talking about metabolic health, such a critical aspect of our health. And there are so many other things that I could talk about and so many things that make me excited about this conversation but, especially as it relates to this idea of talking about stuckness- how to get unstuck, she has gone outside the box in her medical journey and her approach to applying medical science for better health. So, Casey, I’m absolutely thrilled to welcome you to The Get The STUCK Out podcast.
Casey Means: [01:57] Thank you so much for having me, Austin. I’m so happy to be here.
Dr. Austin Perlmutter: [02:02] Well, like I said, there are so many things that I’d like to talk to you about, but I’d love to start with a little bit of background. Would you be able to tell us about your path in medicine that’s brought you to this very moment?
Casey Means: [02:13] Sure, absolutely. So you know, it really starts kind of way, way back, I think in undergrad, I was at Stanford. And I was really fortunate to be there during this like personalized genomic revolution. So it was mid 2000’s and the human genome project had just wrapped up and direct to consumer genetics companies like 23andMe were coming online. And so there was this really amazing energy in the biomedical sciences in Silicon Valley that was really focused on people understanding their bodies in a whole new way, really understanding their genetic blueprint and how this related to health outcomes. This is something we could never do before. And so that’s what I studied and that’s what I researched. And I worked at 23andMe and I, you know, majored in personalized genetics. And so the foundation of what I came to healthcare with was that we are these unique biochemical blueprints, but that really the difference between health and diseases, how those blueprints are expressed, you know. This blueprint is not our fate, it’s not deterministic. It’s just a part of the puzzle. And you hear about this concept of like nature versus nurture, with nature being the genetics and nurture really being what happens after you’re born. But there’s really so much to that, that nurture part, you know. So much of the outcomes that we see in our health and our lives is how our environmental exposures affect our genome to express disease and those environmental exposures can be so many things. It can be what we eat. It can be the amount of stress in our lives or traumatic experiences. It can be how much or how little sleep we’re getting, how much or how little exercise we’re getting, what toxins were exposed to in our food, water, and air. All of these things can translate to molecular information in our body that changes the expression of that blueprint. So that was actually a really empowering mindset for me coming into medicine, because it really tells you that there’s so much that you can do. Those are all, you know, those exposures, those environmental factors are ultimately come down to choices. And so that’s really empowering because you know, it’s nothing is, you know, fully faded or deterministic. And so, that was what I studied in undergrad. Then I went to medical school. I was also at Stanford and ultimately, I went into your nose and throat, head and neck surgery for my residency training. And I came up to Oregon for that, where I met you. And, you know, that was a really interesting phase. So I was in that world of head and neck surgery for about four and a half years and something that really struck me after about, you know, this amount of time of practice was so many of the conditions I was treating in ENT were fundamentally chronic inflammatory in nature, just over and over again, it was the same pattern. It was like sinusitis, thyroiditis, you know, all these itises or like the chronic inflammation, you know, chronic ear disease and ear infections is inflammation of, you know, the middle ear tissue. You’ve got like vocal cord granulomas, which are inflammatory masses of the vocal chords. You’ve got cancer, which of course has a huge relationship with the immune system. It was just overwhelming. And I just found myself reaching for that prescription pads so often, to give steroids. Either nasal steroids like Flonase, or oral steroids like Medrol dose packs, or intravenous steroids. It was so much like quelling the immune system. And it really got me stepping back and thinking like, Why is everyone so chronically inflamed? Like, why is it that people, we give them a pack of steroids and they come back six months later with the exact same condition, you know. Then ultimately when these things fail over time, we reach for the scalpel and we take them to the operating room. And it just seems, you know, somewhat strange to me that we would do a surgical, like anatomic intervention for what is fundamentally, physiology based in the immune system. Like you can’t operate on the immune system. And so it seems like a strange path. And so, you know, it really got me thinking about that a lot. And you know, fundamentally, a lot of our chronic inflammation, as we know again, comes back to our exposures. So the same types of things, like what we eat, you know, how much we stress, how little or how much sleep we get, how much movement we’re getting, exposures in the environment. These things all can trigger our body to think that there’s a threat when, and get our immune system revved up. And when that happens, we can see it in all sorts of tissues. It can really show up anywhere. And we’re seeing in modern medicine now, and especially through like systems and network biology that are really core pathway amongst a lot of chronic diseases, not just ENT but also diabetes, obesity, Alzheimer’s, you know, a lot of these all have this underlying thing of chronic inflammation. So that was kind of a journey for me. And, you know, ultimately really became fixated on how do I help my patients with that part of the puzzle? You know, what if I could help them more upfront, understand their health and their, you know, how their choices are affecting their underlying physiology. And maybe we could keep some people out of the operating room if we got on top of that. And maybe there would be amazing other effects because we know there’s so much rooted in these core physiologic pathways. So that was really a journey and, you know, during this time I was reading, as I was walking to the hospital, when I was on call, I had my ear buds in, and I was listening to tons and tons and tons of audio books of people who were thinking this way in medicine. And I was, you know, listening to people like your dad, you know, and Grain Brain, and I was listening to Sara Gottfried- The Hormone Cure, and Mark, Gottfried- Ultra Mind Solution, and The Blood Sugar Solution. And I was listening to Joel Fuhrman-Eat to Live, who talks about food and inflammation. And I was listening to Michael Greger-How Not to Die and, you know, Joel Furman, The Obesity Code, The Diabetes Code. And I was listening to all these books and it was just such a different perspective from what I was actually doing in my day-to-day life in medicine, which was just like seeing 30 patients a day, you know, sometimes seeing patients with chronic diseases for literally three minutes, you know, as we were rounding and taking it to the operating room and cutting things out, but not really doing anything that was talked about in these amazing books, which were really all in the functional medicine, longevity medicine space, really thinking about the root cause of illness. So, you know, ultimately long story short, I moved away from the operating room, I transitioned into really functional medicine, high touch longevity medicine, opened up my own private practice where I was able to spend like two hours with each patient and dive into all aspects of their diet and lifestyle, really get to the root cause of chronic health issues. And, you know, that was beautiful because people were getting better, like really the really fast, and symptoms were kind of melting away when people got on top of, you know, these fundamental aspects of their health- their diet, their exercise, their stress, all of these things. People were just getting better in so many different ways, and it was so beautiful. But the reality is, it takes time to do that as a physician. And you have to dig into all those aspects, really understand the barriers for patients and the people who got better are the people who made real changes in their life, who made behavior change. And so, it became so clear to me that behavior change and getting unstuck, you know, from patterns we’ve been in for maybe decades is the linchpin of changing the conditions in your body that ultimately lead to health. And so basically, it became sort of a behavior change evangelist, like how do we help people and support people make the right decisions. And that’s sort of led to where I’m at now, which is, you know, starting a company that ultimately takes a tool that people, a wearable that people can put on their arm and give them data about how their diet and lifestyles are affecting them in real time and how it’s affecting their metabolism and coach them essentially all day, every day on these sort of micro decisions we’re making, to ultimately move people to make better sustainable, personalized lifestyle decisions by having their own, you know, data stream about glucose and about their metabolism, which is a really core, fundamental substrate to health. And what’s also interesting about glucose is that when glucose is high in the body chronically, this drives chronic inflammation. So it really is just a key factor in that whole pathway we’ve been talking about. So that’s kind of the 15year journey, but yeah.
Dr. Austin Perlmutter: [10:49] Well, there are so many things in that that I’d like to talk about more. And I think as it gets to this central conversation about “How do you get unstuck? ”there are a couple of pieces I’d like to highlight. One is what you mentioned early on, which is that your genes are not your destiny. That it’s the way they’re expressed. It’s the way that you make choices that affects their expression. And I think, unfortunately, that’s just not the way that this information is conveyed, that there’s a sense that your life is kind of predetermined based on your DNA. So I just love the idea that you presented, which is you got lucky, you were exposed early on to this concept, that it’s the way your genes are expressed, not the genes themselves that is so fundamental in enabling us to take control over our health. Another thing that really hit for me was when you were talking about this almost building conflict, I guess this awareness and building conflict, during your medical training, where you were doing one thing, but listening to something else, and those were more or less different ways of approaching this medical model. One being, getting to the root cause talking about food, talking about metabolism, the other one being these interventions, like providing steroids, or even in some cases doing surgery where you’re looking at 2 miles down the road, after these diseases have gone on unchecked for years and after inflammation has taken its toll. And I’m just wondering, do you feel like you’re just the type of person who, throughout your life, you’ve always been open to new ideas or was there something that triggered a search for more and the exposure to these other perspectives?
Casey Means: [12:27] That’s a great question. You know, I do think a lot of it comes down to good fortune of what you’re exposed to and what seeds are planted early. But I do think that we do have some control over that, because the more that we are seeking out new ideas and the more that we put ourselves in the framework of being open to other ideologies and other thought, I think the more we have the chance of being able to have seeds planted that could ultimately be really fruitful and take us towards, you know, a fulfilling path. But, you know, I do think I, some things that I reflect on now, because there have been some big changes in my life, you know, I think about support systems too. You know, I did have a family that was incredibly supportive of thinking outside the box, and my parents have always done that, and I think that that’s been really helpful. So that’s another thing I would say, that’s, you know, that was good fortune, but I think we can create those conditions for ourselves in our lives, at any stage. And that means surrounding yourself by people who are willing to think differently and not necessarily be hyper dogmatic and aren’t going to, you know, look at a new idea and demonize it necessarily. And, you know, at this point I think, and then it becomes I think a sort of a wonderful cycle where you see, Okay, this is how things unfolded. I really believed this and was entrenched in this. I got exposed to something else. You know, I felt attention in myself and my body between what I was doing and what I was learning. I listened to that and I sort of moved forward with that. And then, you know, five years later, you’re doing something very different in your life that ultimately feels more right, you know, inside your body and in your nervous system, more aligned. And when that happens a few times, I think you really have to step back and start trusting that process, that this is actually a really positive process. And I think that generates some openness then that is even more entrenched of like, I am going to look for opportunities in this world to learn and to grow. And that process is ultimately going to get me to a better place. But it can be scary, of course, each time you start feeling that discomfort or that tension between what is and what you think there could be. But I think it’s a lot of having faith in that process that it ultimately, you know, may lead to much more alignment in your life.
Dr. Austin Perlmutter: [14:50] Yeah. I love what you said about exploring that tension and almost stepping into that tension, being aware of what it’s telling you, because I think, you know, you need to have that conflict to give you the idea that there’s something else that maybe is a better option. It doesn’t always mean that there is a better option, but it’s something telling you, internally telling you there’s more to this picture than meets the eye. And I love what you’re talking about when you relate this idea of becoming comfortable with the discomfort, that it is the discomfort that you want, because that is what signals growth and change and having a network of people, ideally, who are also in that space. Not necessarily exactly in the medical space, but who are promoting the idea of change. One of the things that concerns me about the medical system right now is that I feel it provides a complete set of beliefs for how you’re supposed to do your life. It’s all about medicine. Here’s how medicine is practiced. Here’s how you’re supposed to, I think, go through your twenties and thirties and so on and so forth. And you start exploring concepts outside of that, it becomes concerning, I would say, for certain people which is, What are you doing? This is what your life is supposed to look like. And, you know, I think the fact that early on, you were willing to look at perspectives outside of the traditional medical model, it’s so important because otherwise I just see that the rates of burnout in traditional medical practice are, depending on the year hovering at around 50%. And part of that is just, it’s not set up to optimize for the providers’ mental health and the opportunity to experiment with different ideas in practice is something that really drew me to functional medicine, to integrative medicine. It’s saying, let’s look at it at all. Let’s look at all the different possibilities here for what it might look like to work with a patient and to look after yourself. So again, I love what you’re talking about, about being open to possibilities and having a team, hopefully available that can support you with that. I guess I would ask if somebody is listening and they’re a little bit disenfranchised with the way that medicine is typically practiced, do you have a go-to recommendation for either a book or some other source where they can get inspiration or a sense as to what could be?
Casey Means: [17:20] Yeah, that’s a great question. I think the book that was sort of the beginning of my journey, I think, was Mark Hyman’s The Ultra Mind Solution. And the reason for that, and so I would probably recommend that to anyone who is sort of feeling that burnout, because it does, it was relevant both to me personally, but also to what I was seeing in patients. So, this sort of brings me back to kind of the steps of awareness of this journey. And one of them is really, you know, stepping back and giving space for like self-reflection and to really understand what’s going on inside of you. Because a lot of this tension that we’re talking about, wasn’t just necessarily intellectual. It was also physical. You know, inside my body, I wasn’t doing great. You know, I was in residency and things were very, very stressful and the lifestyle was very, very challenging. I, you know, was on call for sometimes 30 hours at a time. I was eating cafeteria food. I wasn’t exposed to natural light.
Dr. Austin Perlmutter: [21:32] Yeah. I think there’s a lot to take away from that. And the point you made about kind of interpreting your physical health issues or your mental health issues and not just the intellectual understanding of I am or I’m not in a good place is so important. I think that as it relates to understanding our health, it’s the tendency, especially in medicine, to downplay physical issues and to downplay mental health issues as weakness. And it’s, if you’re a good doctor, you get through it. You soldier on. You give yourself three hours of sleep. You wake up the next day. Depression, anxiety is a reflection of an internal weakness, so you definitely don’t tell anybody about it. And it’s not a problem with the system, it’s a problem with you. I think that, you know, in all levels of training. I mean I’m actually quite thankful for the program at OHSU in being far more open to helping people get mental health. But in general, I believe that the medical system does not prioritize mental health for physicians or for other providers. And it really sets us up for kind of a lifetime of blaming ourselves when things are not going well. So, you had mentioned the piece of this, which I really like, which is asking what’s going on inside of the body and how is that then kind of being converted into our mental health and our general wellness. And obviously you do a lot of work now with glucose as a central molecule in helping us to understand how information from the kind of through our body is converted into various health outcomes, one of which I would say, is mental health, because you think about how inflammation, as you described, is at the root of so many diseases and seems to be the case, especially in depression, that inflammation plays a major role. So you can think through how there’s this amazing cycle, where it’s the choices you make as a reflection of your physiology and your brain set up are going to determine your levels of glucose and your insulin sensitivity, that is going to also determine how your fat cells get situated, that’s going to then, down the line, influence levels of inflammation, which influence your heart disease, your diabetes, but also your brain health, and then the way you make choices. So what I love is that, I think you and a handful of other people are really looking at the influence of this molecule glucose, which sounds so trivial, right? Oh, it’s just sugar, but on so many systems in the body. And finally, we’re starting to get this real-time feedback, being able to connect the way that we feel, both physically and mentally, with our levels of circulating glucose, which is really not something that you were able to do until very recently. I remember even about a year ago, I was doing the whole ketone checking all the time. And so, I would stab my finger with a Lancet to see what my blood sugar was and to check my ketone levels. As interesting as that was, it, wasn’t a pleasant experience. And I could only get myself, stab my finger, a few times of the day. So I’d love to, I guess get your general basics for the listening audience, as to what Levels is, what is the importance of CGM and how that might relate to being able to help people get their health unstuck?
Casey Means: [24:54] Absolutely. Yeah. So first, I think I’ll start with sort of why glucose matters and all of this. So, you know, glucose is one of these primary metabolic substrates in our body. For our cells to function, we have trillions of cells and when those are working properly, we have good health. And when they’re not working properly, we have symptoms and disease. And how does a cell work properly? Well, it needs energy. And how does a cell get energy? By breaking down substrates. And the two primary ones are glucose and fat. And glucose is really one of the, really the primary one. And so, when we consume carbohydrates, glucose comes into the bloodstream, you know, when carbohydrate have been ingested, glucose comes into the bloodstream and we have to get it inside our cells to be able to convert it to usable forms of energy so our cells can function. And for that to happen, you know, we have to release insulin, a hormone from the pancreas, which then comes and binds to the cell and actually opens up the channel for the glucose to come in. This is by and large, the process that happens. And then that glucose is converted by the mitochondria to usable energy. And so when that process is working well, we are able to form that ATP and that’s like currency for our cells to function. And so, some interesting things happen though when glucose isn’t, when we don’t have the right amount of glucose in our body. And by and large, we’re dealing with too much glucose in our body right now because of what we’re exposed to in our current food environment. You know, we’re exposed to just an astronomical amount of refined grains and sugars and carbohydrates, all of which turn into glucose in the body. And we’re seeing, you know, we just have access to more of this than we’ve ever had in human history. And, you know, the average American is eating about, you know, 150 pounds of sugar per year versus just like, 2 or 3 pounds, 150 years ago. So.
Dr. Austin Perlmutter: [31:29] Yeah. A ton of critical information, I think. And I really appreciate the way that you broke that down. I think that as it relates to sugar, the way that I learned about it in my medical training is, in diabetes, which is the prototypical disease of sugar issues, the problem is a lack of insulin. And so, you basically give enough insulin to bring the blood sugar levels down and you don’t really ask what’s going on in the body that caused this to happen in the first place. It’s just, Oh, I don’t know. At some point you developed diabetes, your blood sugar levels are high and we need to drive them down. And what you so eloquently described is that, it’s really kind of this glucose issue with an insulin insensitivity at the same time. And without understanding those two things, it’s hard to get the bigger picture of what’s going wrong, as well as what we can do to improve our situation. And this idea that it’s not the fact that, you know, your glucose levels are high throughout the body, but that the cells can’t get that glucose. So you have, relatively speaking, cells that are energy depleted and all of this extra energy floating around in your blood stream where it creates all of these problems, like you said, inflammation, oxidative stress, and these advanced glycation end products or AGEs. This is, it’s a totally different picture because then what you’re talking about is, How do you ensure that your glucose isn’t going too high in the first place? How do you deplete your glucose to normal levels while working on your insulin sensitivity? As opposed to the strategy that is so commonly used in the medical sphere which is, you wait until your glucose is really high, and then you blast the person with exogenous insulin in an attempt to try to force that blood sugar or that glucose into the cells. It’s just, it doesn’t make sense mechanistically as any sort of a solution to this problem. The other thing that you said, which I think is really a key takeaway, as we’re talking about methods of getting unstuck, one of the things that I like to focus on is flexibility, because we know that conditions of rigidity, whether that’s psychological rigidity or physiological rigidity are associated with worse outcomes. So depression, for example, or anxiety, these are conditions where our thinking is more rigid, where we get stuck in the case of depression, in negativity, we focus on the chances of things going wrong, and we’re not looking at all the positives in our lives, obviously not optimal. Same thing in the body. When you think about metabolic flexibility, the ability to use multiple fuel sources and to help smooth out these spikes, one of the things that got me really interested in cutting back on my refined carbohydrates and doing intermittent fasting was learning about how Leptin and Ghrelin levels change when you change your simple carbohydrate intake and that it’s not so much that your body is desperately in need of fuel, as much as it is that you have these Ghrelin spikes that are telling you You’re hungry now, and you have to eat. And that when you space out your meals a little bit more and you stop eating so many refined carbohydrates, those Ghrelin spikes flatten out a bit. So you’re not really, where I was through much of my medical training, waking up in the morning and feeling this intense gnawing in my belly, which is I have to eat something. And then you wind up in that early morning conference and somebody brought bagels and there’s no way around it. You say, Oh. Well, my body says I’m hungry. I need to be focused. I need to eat that something. But when you switch from a largely refined carbohydrate-based lifestyle which, let’s face it, that’s the diet for most Americans, to something that’s a little bit more metabolically stable, where you’re burning some fats in addition to carbohydrates, you just don’t feel that intense desire anymore. And so what I love about the CGM and about this Levels program is it enables you to correlate the feelings of intense hunger with your blood sugar levels. And you can see, sometimes, that your blood sugar levels drop as a result almost afterwards of eating a high carbohydrate meal. You’ll see they go way up and then they kind of plummet. And then you can say, Oh, well now I’m starting to feel a little off. Now I’m starting to feel a little bit hungry. And you know, the way that a lot of people approach this is they say My blood sugar is getting low. So now I need that snack. Now I need that bag of chips or candy bar. You know, certain candy companies have made their slogans around those cravings and it’s literally chasing a problem with another problem. You’re making things worse because you’re constantly infusing more glucose into the system, where what you need is to be able to run on cleaner fuels. So again, I think there’s so much to pull out of this concept of blood sugar and insulin, and it’s an absolutely central molecular mechanism for getting your health unstuck and forgetting your brain unstuck, because I just want to drive this home. Casey, you already mentioned this, but when you think about your brain and the fact that your brain needs a lot of glucose to run, but it can also, to some extent, run on ketones, that if it’s not able to get that fuel, then it’s not able to work well. And if your heart wasn’t able to get the fuel, then it wouldn’t pump that well. And you would kind of know that, right? But when your brain doesn’t get the necessary fuel, it’s not always as easy to pin down how that’s experienced. And so we know that in the long run, this insulin resistance in the brain has been associated with Alzheimer’s disease, is worsen cognition, dementia. But what Casey was referring to here is the short-term implications of your brain not having enough fuel or not being able to pick up that glucose and not having access to fat for fuel. And that can manifest, as we said, depression, cognitive issues. So this is really not a, you know, 30 years down the line where we’re worried, we’re talking about, if you want to optimize your brain function today, you need to be aware of this. You need to be aware of these cycles of blood sugar, and honestly, you need to get off of the standard American diet. Because if you don’t, you are going to be at the mercy of these glucose spikes and over time, probably are going to wind up with insulin resistance that is going to damage your mood, is going to damage your thinking, and overall decrease your quality of life. So that was tending towards a rant there, but I just think it’s so important for people to understand this, that the model we have of blood sugar going up and then chasing it with either more blood sugar when it dips and you feel uncomfortable or chasing it with insulin in an attempt to fix the problem, both of those are actually making things worse.
Casey Means: [38:12] I love everything you just said. And I think it’s so important. It cannot be said enough. And so, you know, thank you. And I think something though important is that, you know, then you’ve talked about this in some of your past podcast, which is that we can know the information and know how bad it is, but to actually change and not reach for those candy bars and the potato chips and all these things, like that process is so hard. And that’s really what is exciting to me about, you know, CGM technology and also just more broadly, like the bio wearable, biofeedback movement, because I think there is something, you talked about how you can have a glucose spike and you were, I think you were referring to sort of reactive hypoglycemia cycle where basically people will have a big glucose spike and then you release all this insulin and you can overcompensate and crash. And actually, your glucose can be like so much of it gets soaked up by all that insulin that they dip below your baseline. And that reactive hypoglycemia is associated with anxiety. It’s associated with lethargy. It really is that post-meal slump that a lot of us feel. And I think, you know, we can consciously sort of know that that’s a thing, and you know, maybe sometimes throughout the day we feel a little bit tired or we feel a little bit anxious or we feel a little bit foggy in our brain. But without actually knowing what the causative reason for that was, and being really confident in that, it’s really hard to move forward and make different choices because you can miss attribute that to so many different things like, Oh, I had a ton of coffee and I crashed, or like I didn’t get much sleep last night or I’m having some struggles at work and so I’m feeling a little off. And so it really makes it difficult to move forward. And so, you know, I’m a firm believer that the more we can, you know, create one-to-one relationships between things we’re doing and the outcomes we’re having and the more we can close the loop between an action and reaction, that that is going to be foundational for people to actually make movement, you know, above and beyond just knowing that, you know, refined carbs are bad and I shouldn’t eat them. And so, what I love about continuous glucose monitoring is that you can do this process where you have this sort of trifecta of behavior change, where you do something and then you have a subjective experience sometime later, you know, the next two hours or so. And that might be a little bit of lethargy or a little bit anxiety or something. And then you can scan the sensor on your arm and sort of see what happened. Was it the glucose? Was it the food I ate? And, you know, the CEO of my company, you know, he had this experience with oatmeal. He had oatmeal in the morning every day for like five years. He’d always kind of like late morning, feel tired, kind of want to take a nap. And then the first time he scanned a sensor after eating oatmeal, he saw that he went up to 210 glucose, which is like very, very, very high and then crashed down.
Dr. Austin Perlmutter: [42:27] Yeah. I think that it’s absolutely key. You know, there are so many variables that go into everything. And one of the challenges that I had when I was in my internal medicine clinic here in Portland is that, a person comes in and they have high blood pressure and, you know, there’s the possibility of talking through all the potential contributors. Is it the stress you’re going through because of your divorce? Is it the fact that you’re not eating healthy? Is it the fact that you haven’t exercised in two years? Is the fact that you’re being exposed to smoke from the wildfires? And it’s really hard to know. So eventually, you wind up just saying, Hey, you should do all of those things. You should start exercising, eating healthier. Don’t go outside. Also, let me put you on an ACE inhibitor because let’s be honest, those things aren’t going to work. So what you’re describing here is closing that feedback loop and getting an explicit answer as to what might be causing it, because it’s not just that you can say, I feel crummy and my blood sugar is low, is that you can do something about it. And you can say, Tomorrow, I change that morning meal, instead of eating oatmeal, I decided actually to fast, or maybe you decided to eat some eggs or maybe you decided to eat some vegetables. And what you found is that not only was your blood sugar better, but you felt a whole lot better. And so now, all of a sudden, you actually have a functional solution, which I think the more of those you can accumulate, the more you personalize your health and the more you get interested in personalizing your health, I found so often that the reason people are engaged with their health is because they found something that they could do that dramatically improved their quality of life. And it was, Oh, I changed my diet because I was having GI issues or I was able to go off my blood pressure meds because I started meditation. These are the things that you need in order to get you interested in continuing that cycle. The other thing I wanted to mention, which I think is really key in the modern world, is that we understand enough about the way that behavior is kind of embedded in the brain, why we do certain things and not other things. And a lot of that relies on dopamine, but a lot of that relies on how you create habits and how you create those habit loops. And it’s just so important to tether and action with the reward so that your brain knows this was a result of this thing that I did. And I think so often as it relates to nutrition type interventions, you just don’t know right away. So you change your diet and, you know, you’re trying to cut back let’s say, on calories or trying to eat less fat or trying to eat less carbohydrates. And you start that, you go really hard for a week and you do all the right things. And then you don’t really experience any weight loss. You get on the scale. You’re maybe a pound down, maybe you’re not, or you don’t really experience any increase in your energy levels. And so your brain says, This wasn’t worth it. It’s not worth this challenge. And it doesn’t embed that into a new behavior pattern. But what you’re talking about here with this blood sugar is getting that information and embedding it in your brain with the rewarding information right away. It’s eating the meal and then seeing, depending on, I guess the type of meal and depending on your individual patterns of metabolism, 40 minutes, an hour, maybe a little bit more, you’re able to see what happens with that spike or not. And for me at least, I’ve been more on the Levels monitor for a couple of weeks. It is phenomenal to see that connection. You can see, in real time, what that food is doing to your body. And I think that, you know, for so many of us in the food is medicine space, having that connection changes the game because it’s no longer having to explain to somebody, which of course I love to do, but the biochemical process which is, the reason you should care about eating less carbohydrates is because of the advanced glycation end products. And let me give you examples of this and let me tell you about what it does to your eyes. It’s just so different when that person can say, I did this thing and here’s the outcome. And then be able to talk about that in a way with their friends, which is, Look, I know that you say that it’s okay to eat a bag of potato chips, but for me, it’s not. Here’s why. And I just think there are so few opportunities right now, in the health space, to make this information available, that it’s something we all need to be aware of, especially as it relates to I think early on, before people get diabetes. So I know I just said a lot but I would love it if you could talk about maybe the continuum between insulin resistance, pre-diabetes, diabetes and where maybe you see this type of device and this type of I guess a formula for interpreting that information going in that continuum.
Casey Means: [47:19] Yes, absolutely. So I love, first of all, that you called it a continuum from non-diabetes to prediabetes, to diabetes, because I think it’s really important to look at health in that way, as a spectrum and a continuum. We tend to actually really focus on lumping things into boxes. And we think that like, you know, if I’m non-diabetic I’m in this perfect box, if I’m pre-diabetic I’m in this box and if I’m diabetic in this box and we kind of jumped from one to the other and it’s like a light switch, like one day I was pre-diabetic and the next day I was diabetic, and that’s not the way health works. Health is a process and a continuum. And every single day we are moving back and forth on this continuum of metabolic health. And so I think it’s really important to frame it in that way. You know, you don’t walk into the doctor one day and have diabetes, and then the day, you know, before you were fine, this is something that’s probably been developing for years, if not decades. And these days, from childhood, you know, and of this process of our cells just becoming more and more insulin resistant and our glucose over time, slowly rising and, you know, leading to the problem. The beauty is that this process is not a one-way street in, by any stretch of the imagination. This is a two-way street. Every day, we can sort of move in the right direction or the wrong direction on this metabolic health spectrum. And the differentiating factor of that is really of what we’re choosing to do that day. So there’s all sorts of things that can keep us in sort of the best optimal category of metabolic health, really in that healthiest part of the non-diabetic range. And that is foundationally, keeping our glucose spikes down every day. And I really like to think about it as like working our metabolic fitness. You know, we think about building muscle as fitness, and we think about fitness as you do these reps over and over and over again. And then over time, you become fit. And the exact same thing is true about metabolic health and metabolic fitness. We have to put in the reps every single day to get to the state of optimal metabolic fitness. And those reps happen to look like keeping our glucose spikes low, and not having these spikes and valleys, but much more sort of like gentle, rolling hills, keeping our insulin under control and letting our cells perk up to that insulin signal and be insulin sensitive. That’s the reps we have to do. And so I really like to orient people around like, this is very hopeful. This is a two-way street and we have total power over this. And the coolest part about metabolic fitness is that it actually isn’t just about limiting foods that you love. That’s not the linchpin of this. It’s actually about really building a healthy, metabolic context in the body. And there’s so many levers that we can pull to build the healthiest metabolic context. So one of them, of course, is food and, you know, avoiding the refined sugars and grains is great, but also testing out other foods and understanding how they affect you. You know, for me like grapes, corn, sweet potatoes, these like really spike my glucose and for another person that might not be the case. And each person is going to respond to carbohydrates differently in terms of how their glucose spikes. And one of the big differentiators between people is their microbiome composition. You know, you and I could both eat a banana, but because of the differences in our microbiome composition and other factors, we could actually have a different glucose response. So knowing that personalized element I think is very helpful. So food’s a big lever. Exercise is another big lever, you know. We might want to eat, you know, like yesterday I had Indian food that had some rice and my glucose was going up, but you know, exercise is a way to bring glucose down and to improve insulin sensitivity, both acutely, you know taking a walk after a meal, you can absolutely blunt a glucose spike, but over the long-term, exercising long-term you could just generally improve your insulin sensitivity. A third lever we can pull is stress management. When we’re stressed, it signals Cortisol and other catecholamine hormones in the blood to rise and this actually tells our liver to dump glucose into the bloodstream. The purpose of this is because when our bodies are under stress, our bodies think that we’re going to need to like gear up for battle or something like that and we need more glucose, so our liver actually puts the glucose in the bloodstream when we’re stressed to help us. But of course, our stressors, these days are not physical. They are like totally psychological by and large, you know, a text message or honking or, you know, an email or a stressful conversation. We don’t actually need that extra glucose. So it’s fairly maladaptive now, this response, you know, to stress. And so the more we can keep our stress controlled and practice our mind body practices, the more we can improve our metabolic fitness. And then the fourth one, the big one is sleep. When we don’t get sleep it causes massive hormonal cascades that are all not good for metabolic health. It makes us more insulin resistant. It screws up our circadian rhythms and that changes our melatonin secretion, which affects our insulin production. It affects Ghrelin and Leptin. It affects Cortisol. So when we don’t sleep, we are just absolutely setting ourself up for poor metabolic outcomes. So, you know, we’ve got food, stress management, exercise, and sleep, all as levers we can pull to improve our metabolic fitness. So it’s not just about deprivation. It’s about creating these nice contexts for keeping that glucose low and stable. And for each of us, it’s going to be different amounts of those levers. And we have to really experiment and figure out ultimately, for our own bodies, what do we have to do and in what levels, what choices do we have to make to keep that glucose as stable as possible. But it’s just, you know, it’s kind of a fun experimentation process to sort of figure that out. What foods work for me, what amount of sleep works for me, and then to see the data. It’s just so, so, so, so reinforcing. So that’s kind of what I would say about the, you know, continuum. And you know, ultimately I just want to really reinforce the message that there, it is not a one-way street. Like even if you’re in the pre-diabetic range and even if you’re in the diabetic range, that is not the destiny, people have been able to reverse their diabetes, come back down to pre-diabetic or normal levels with just lifestyle and dietary interventions. And so, our physiology is amazing, but we have to do those reps of keeping the glucose stable and the conditions good in the body to be able to move in that direction.
Dr. Austin Perlmutter: [53:49] Yeah. I think that’s a fantastic explanation of all the things that a person can do right now to improve their metabolism. That it isn’t just about turning down that piece of cake. There’s so much more that you can do. And if you ate that piece of cake, Okay, You’re not done yet, you know, you’re still in the game. Go for a walk afterwards. These are things that you can do after the fact so you can still enjoy the birthday and everyone won’t stare at you because you’re the one person saying, No, I’m not going to eat your homemade cake. We’ve all been there. The two way street thing too, is critical to understand, because the way that I think probably you were trained as well, is that things are more or less, okay until you meet criteria for a disease. We just don’t have to worry about so much, your pre this, that, or the other. Maybe you mentioned, Hey, you should probably eat a little bit more healthy food or exercise, but for the most part, that’s fine. Then all of a sudden, you walk into the clinic, it’s a Thursday in July and you’ve finally met your A1C criteria for diabetes, or you finally met the blood pressure recording criteria for hypertension and now all of a sudden, it’s a big deal. And really at that point, there’s only one direction, which is trying to slow the rate of decline. It’s saying, You’re probably going to be diabetic for the rest of your life, but maybe we can help to keep it in check. There’s really not a lot of conversation about, Hey, you know, you can completely reverse this condition. You can make a few changes now and never need medications. It’s, Look, here’s the situation, you’re probably going to need to go on insulin. We’ll put you on Metformin for the moment. Try to exercise a little bit more, but here’s what the trajectory looks like. So what you’re talking about here, as it relates to glucose and insulin, is that we’re always able to do something. And even people who have what we would call a diagnosis of diabetes, which, let’s be honest, I mean, the difference between an A1C of 6.5 and 5.9, like it seems like a huge deal, but it’s part of the continuum. And for anyone who’s not sure of what I’m talking about here, I’m talking about hemoglobin A1C, which is a marker of glycated or basically blood sugar bound to hemoglobin molecules, and it tells you about your blood sugar, average blood sugar over a couple of months. But again, these are just one measurement. And the A1C gives you an estimate of what it is. It’s very different from knowing moment to moment what your blood sugar is doing, because it’s so much more data. So I love this idea of a two directional street, and I love the idea of thinking that there are so many things that we can do each day to modulate our blood sugar. Because I think that this conversation is really a microcosm for what we’re starting to understand about health which is, it isn’t about one variable. It’s about the sum total of what you’re doing in the course of your day. And if you fall off the wagon in one thing, there’s something else that you can do. I found so many people will make a poor dietary decision or they’ll skip exercise, and that takes them out of it for the day. It’s, Oh, well, I missed my workout. So now I might as well sit on the couch and binge watch TV. But it really isn’t like that. So I would just encourage people to feel empowered that there are so many different things that they can do to get started on a journey to better health, better metabolic health is a wonderful way of doing it, but even just a little bit of mindfulness, meditation or a walk around the neighborhood, these are all steps to improve your metabolism, to improve your mental health. And there are a lot of people out there who will tell you the only way forward is blank. And it’s really not the case. So I, again, very much appreciate Casey, the way that you described this and how we have all these different levers that you can pull to improve your health. So I’d like to, I guess, kind of wrap up this conversation as it relates to blood sugar and to insulin, and to see, you know, you’re somebody who is very much involved in this space. And where do you think this technology and this information is going next? Because a lot of people may only be starting to hear about the importance of these things and the monitoring of these things, but it just seems like there’s so much runway for this to expand.
Casey Means: [57:58] Yeah. I think that’s true. And I think we’re going to see, you know, my prediction is that. Well, first of all, my prediction with metabolic health that is in five years, we are going to be talking about poor glucose control in the same way we’re talking about the opioid epidemic, you know. It is shocking to me that we’re not talking more, that the glucose is not on the tip of our tongues every single day, you know? And it’s not, it’s certainly, controlling glucose is not the panacea for health but it is absolutely underlying so many conditions and exacerbating so many of the conditions that people are dealing with these days. And I think over the next five years, we’re going to see really an explosion of understanding about that. And I think, especially as we move towards, you know, more of a value-based care system, where we’re really focusing more on outcomes over cost, we’re going to be looking for some of the more underlying, like low-hanging fruit that we can intervene upon for many, many different diseases and certainly, you know, metabolic health, inflammation, these are going to be some of them. And so my hope is that some of that, you know, financial side of healthcare is going to promote investment in some of these root cause physiologic pathways that are underlying so many seemingly disparate diseases. So that’s one thing, but I also think just like general movement towards biofeedback and bio wearables. We’re going to see even more of an explosion in that. You know, right now, we have wearables for things like heart rate. We have, we basically have wearables right now for sleep, for stress and for exercise. We’ve got heart rate variability monitors as an objective measure of stress. We’ve of course got, you know, heart rate and, you know, activity trackers that can tell us about our sleep and our movement, but we’ve never had wearables related to nutrition. That’s never been a thing. We’ve never been able to close that feedback loop. And so I think we’re going to see really an expansion in that and other wearables that are testing internal biomarkers, like really blood-based biomarkers. And I think that the beauty is that like, hardware is all very, very important, but the software side of that, so actually how people engage with the data and use it as a behavior change tool and it happening into these reward circuitry pathways that we have in our brain, that is going to be also a key piece of, I think, where we’re moving in healthcare. And I think the more and more we realize at large, that the vast majority of the conditions and the morbidity we’re seeing in the country, but also what’s contributing to our $3.4 trillion of healthcare costs is conditions that are rooted in dietary and lifestyle choices. And until we address behavior change at scale in healthcare, we are not going to make a big dent in those conditions. We are not going to make a dent in those conditions by just giving medications and surgery. We are going to have to approach the behavioral aspects of those diseases. And I don’t think that’s going to happen in the doctor’s office. I really don’t. Doctors are not, you know, we’re not trained to be agents of behavior change, really. I mean, that’s not our core skill set. And I think we were going to need to outsource a lot of that to technology that does it, you know, more efficiently, analyzes the data better than a human brain can and can be with a patient 24 hours a day. And that’s where I think tech and biofeedback and bio wearables and really intelligent software is going to potentially offload some of that burden and responsibility from doctors who right now aren’t equipped with the time or the know-how to really be that constant agent of behavior change for a patient. So I’m hoping that’s where we go and I think it’s going to be good for the healthcare bottom line, I think it’s going to be good for people. And you know, hopefully we’ll create some of the sustainable, you know, behavior changes at scale that we need to see to make, you know, better physiology at large.
Dr. Austin Perlmutter: [01:01:46] Yeah. Yeah. I agree with basically all of them. And I think this is an amazing bookend too, because where we started in this conversation was your journey of, I guess, getting unstuck and being aware of what was happening inside your body, your physiology as a signal, that it was time to make a change. And then, so you made changes in what you were doing in your life, and that led you to where you’re at now, which is helping other people become aware of what’s going on inside of their bodies, and using that as a possibility for getting unstuck, for making those types of changes. And what you’re talking about here is the idea of doing this at scale, of getting these types of bits of information and being able to provide those to people so that they can create those reward circuits in a way that’s beneficial to them. I talk a lot about how reward circuits have kind of been hijacked by unhealthy food and by social media and the like, but they can work both ways. It’s like neuroplasticity. It’s there for the taking, if we know what to do with it. And it may very well be that this glucose monitoring is our first major foray into this consumer friendly bio, I guess I should say personalized biofeedback that uses molecules inside of the body. So it’s all really exciting stuff. And for those of you who have made it to this point in the conversation, I think it’s such a powerful bit of information to know, that we now have the technology to correlate what’s happening at a molecular level, inside of our bodies in real time, with our emotions, with our cognition. And that is, it’s really impressive. It’s really exciting. So Casey, again, I so appreciate this conversation and all of your amazing insight into both your background and these pathways of metabolism that, I think for so many people, are a central way of getting their bodies and their brains to a better state. And we mentioned Levels a lot, would you let us know where we can reach you and where we can learn more about Levels?
Casey Means: [01:03:57] Yeah, absolutely. So, you can find out more about Levels at www.levelshealth.com. We are a, you know, company that is essentially providing access to continuous glucose monitoring technology through our telemedicine network, for health seeking individuals, and then pairing it with the software to help with behavior change. We’re currently in a beta program right now, so we do have a wait list. But sign up for the waitlist and you’ll get on our newsletter. And you’ll be the first to know when we’re able to bring you into the program. If you want to find out more about metabolic health and how really, you know, metabolic health is something we should all be caring about, even before, you know, a diagnosis of metabolic disease, I would really check out our blog- levelshealth.com/blog. We’ve got a ton of information and wonderful guests posts, I guess, experts about metabolic health and fitness. For me personally, you can find me on Instagram and Twitter at Dr. Casey’s kitchen. I write a lot about plant-based nutrition and how that relates to metabolic health. And you can find Levels on Instagram and Twitter @Levels, and those are really fun to follow because people are doing tons of, people in our beta program are doing tons of really exciting experiments to kind of figure out how to improve their metabolic health and it’s fun to follow along. So, you know, look forward to hearing from anyone on any of those plans.
Dr. Austin Perlmutter: [01:05:19] Yeah. And I can personally vouch for the quality of the blogs on the Levels site, many of which were written by Casey and they’re excellent. But also, if you are somebody who is interested in plant-based nutrition, Casey does a great job of talking through what our strategy is to make that fun and healthy and tasty. So, her Instagram is a great resource for that. Casey, thank you again so much. This has been a wonderful conversation. I hope you have a phenomenal day here in Portland, where it is getting really cold, but still beautiful out.
Casey Means: [01:05:48] Thank you so much, Austin. It was so wonderful to talk to you and hear your insights as well. And thank you for all the work you’re doing and your wonderful writing. It’s a real, a gift to the world. So thank you so much.
Dr. Austin Perlmutter: [01:05:58] Wonderful.